Exploring the relationship between newspaper coverage of vaccines and childhood vaccination rates in Spain

Figures & data

Table 1. Examples of tone coding

Tone type	Examples (translated into English)
Positive	“A safe vaccine for Hepatitis C” (El Mundo, 6/11/2014) “The refusal to vaccinate minors spreads measles in Disneyland” (El País, 23/01/2015)
Neutral	“The vaccine against cancer is being developed this way” (El Pais, 24/03/2017) “Serum and vaccines will come to Africa in a few weeks” (El Mundo, 22/10/2014)
Negative	“Current immunization is poorly effective in prevention” (El Mundo, 18/11/2015) “Jim Carrey criticizes the use of vaccines in Twitter” (El Pais, 02/07/2015)

Table 2. Vaccination rate, number of articles, and risk messages for Spain (2012–2017)

	Vaccination rate^a	Articles^b	Positive tone articles (weight)^c	Neutral tone articles (weight)^c	Negative tone articles (weight)^c
	Spain (%)
2012	92.1	8	1 (0.62)	2 (1.24)	5 (2.62)
2013	92.0	20	8 (4.72)	8 (4.24)	4 (2.24)
2014	92.5	22	7 (3.62)	13 (7.10)	2 (1.24)
2015	93.6	52	28 (14.00)	19 (9.86)	5 (2.38)
2016	93.9	15	6 (3.24)	8 (3.76)	1 (0.38)
2017	94.4	14	8 (3.52)	5 (2.38)	1 (0.62)
Total	93.1	131	58 (29.72)	55 (28.58)	18 (9.48)

^aFrom statistics of the Ministry of Health, Spain. Data show average vaccination rates for first dose of Poliomyelitis, DTaP (diphtheria, tetanus, and pertussis), Hib (haemophilus influenza type B), Hepatitis B, MMR (measles, mumps, and rubella), and all doses of HPV (human papillomavirus).

^bTotal number of articles reporting on vaccines from two major newspapers in Spain.

^cTotal number of articles by tone and a weight factor representing an index of the potential impact of articles based on circulation rates of newspapers.

Figure 1. Flow diagram

Table 3. Most frequent trending themes in newspaper articles included in the analysis

Coverage dates (dd/mm/yy/)	Trending themes	Theme description	Frequency of articles, n (%) N = 131
03/08/2014–18/12/2015	Development of the Ebola vaccine	Coverage about the development of the Ebola vaccine, which was intensified after the first case of Ebola infection outside Africa which took place in Madrid, in October 2014	13 (10%)
04/09/2013–09/03/2016	Chickenpox vaccine crisis	The Ministry of Health limited chickenpox vaccine storage in pharmacies due to overuse. After pressure from the pharma industry and some professional associations, the Ministry decided to unblock this vaccine.	12 (9%)
10/05/2014–05/04/2017	Meningitis vaccine crisis	Firstly, in 2014 and 2015, the coverage focused on the Ministry decision to not dispatch the meningitis vaccine to pharmacies. After some pediatric associations criticized this decision, the Ministry decided to allow the delivery of this vaccine. Secondly, in 2017, the coverage focused on a lack of provision of this vaccine in Spain and the death of some children who had not been vaccinated.	8 (6%)
03/06/2015–5/08/2017	Decrease of vaccination	This coverage focused on the alarming decrease of vaccination in some European countries. Articles recalled the positive aspects of vaccination, especially in childhood.	8 (6%)
24/04/2015–21/05/2017	Obligatoriness of vaccination	Due to the decrease in vaccination rates and laws in other countries (Italy, France) about making vaccination obligatory, the Spanish media covered these news items and included some opinion articles about the obligation to vaccinate.	7 (5%)
26/12/2012–26/08/2015	Influenza vaccine	In 2012, a stock of influenza vaccines had to be taken out of market due to unexpected side effects. In 2014, coverage focused on the low uptake of the influenza vaccine in Spain. In 2015, the media covered a research project to find a universal influenza vaccine.	7 (5%)
10/11/2012–24/10/2015	Development of the malaria vaccine	The research into a vaccine against malaria was popular in Spain due to studies conducted by Dr. Alonso, a Spanish scientist who has conducted large projects in African countries about Malaria.	7 (5%)
15/02/2013–06/07/2017	Development of cancer vaccines	Media attention was given to research developments toward different research projects about new vaccines for different types of cancer.	6 (4%)
24/02/2013–24/02/2017	Vaccine supply	In this theme, articles about vaccine supply issues were included, such as the new vaccination schedule for children and delivery issues in low-income countries.	6 (4%)
06/06/2015–30/06/2015	Diphtheria vaccine outbreak	The death of an unvaccinated child due to diphtheria brought media coverage of this event and the importance of vaccination to prevent these lethal infections.	6 (4%)
28/10/2015–24/11/2015	Whooping cough outbreak	Media attention was given to a child infected with whooping cough because there was no supply of the vaccine in pharmacies and the child’s mother could not get the vaccine. It was the first case since 1987 in Spain.	6 (4%)
04/02/2016–14/07/2017	Zika alarm	The Zika alarm, especially in South American countries, was reported by the media in relation to the development of a vaccine.	6 (4%)

Figure 2. Vaccination rate in Spain by number of articles in the two selected newspapers (2012–2017)

Note: Adapted from Meyer et al.²⁰

Figure 3. Vaccination rate by tone of articles weighted by circulation (2012–2017)

Note: Adapted from Meyer et al.²⁰

Meyer SB, Lu SK, Hoffman-Goetz L, Smale B, MacDougall H, Pearce AR. A content analysis of newspaper coverage of the seasonal flu vaccine in Ontario, Canada, October 2001 to March 2011. J Health Commun. 2016;21(10):1088–97. doi:10.1080/10810730.2016.1222038.

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