Hashtag Bumper Stickers and the New Failure of Vaccine Rhetoric

What can hashtags and the way we use them tell us about challenges in our ongoing vaccine conversation?

To say mandatory childhood vaccination is a complicated topic is to put it lightly. Children’s health is always emotionally charged, and vaccines in particular circulate in conversations that tap into deeply held and typically polarizing convictions — religion, the role of government, the ethics of industry, and the soundness of scientific institutions all come up in discussions about choices and policies regarding vaccination.

Despite continued medical research to support their claims, convincing some parents that vaccines are safe and effective remains a challenging public health issue, one with serious implications. Since the Disneyland measles outbreak was first reported in January, the vaccination debate has been renewed, and especially after several conservative politicians came out in favor of vaccine choice, the controversy has spread quickly on social media. Could these digital spaces be productive for engaging with communities and spreading information about vaccinations?

The Rhetoric/Reality Gap

Increasing the uptake of vaccinations has proved a consistent challenge for public health professionals. Heidi Lawrence and her colleagues found that doctors remain stymied in their attempts to increase vaccination rates in the face of anti-vaccination sentiment, even as studies continue to support vaccine safety and efficacy. One problem seems to be that while health care professionals are concerned and knowledgeable, they fail to take into account the ways in which vaccines are talked about with and among members of the general public.

“Those not in the medical field do not evaluate and make claims in the same way as scientists, and so materials like clinical studies that doctors find convincing don’t carry the same weight in the lived experiences of their patients.”

Lawrence and her colleagues describe this in terms of Hauser’s notion of vernacular rhetoric, or the idea that conversations regarding practices within communities differ from those in theoretical settings. Essentially, this means that those not in the medical field do not evaluate and make claims in the same way as scientists, and so materials like clinical studies and epidemiological statistics that doctors find convincing don’t carry the same weight in the lived experiences of their patients.

When health care professionals expect the general public to respond the same way they do to scientific data, the conversation will not always be productive. In the worst case, doctors and public health experts interpret subsequent patient hesitancy as a sign of ignorance or anti-science sentiment, while patients feel as though medical professionals are trying to strong arm them or being condescending. This does not lead to beneficial outcomes.

Because social media offers the ability to engage with many different communities and provides its users a digital place of personal relevance, sites like Twitter could be productive spaces for practical outreach. Or, on the other hand, digital interactions could simply devolve into the unproductive polarized conversations we see in the other types of vaccine discussions the above paper identified.

Locating the Online Conversation

To find Twitter conversations pertinent to the vaccine debate to examine, I watched Twitter’s trending hashtag list and selected three particularly active tags: the more rhetorically charged #VaccinateYourKids and #VaccinesWork, as well as the relatively ideologically neutral #Vaccines.

To pull a sample of tweets containing these tags, I used Martin Hawksey’s free TAGS tool, which accesses Twitter’s servers to download user-defined sets of tweets to a Google spreadsheet. It’s fairly simple to use, though first you need to associate it with your Twitter account and Twitter’s API, which can be a bit tricky.

Once TAGS is set up with Twitter, you can specify search terms and a period of time from which to pull tweets, or you can collect data live by pulling new tweets hourly. I set TAGS to pull no more than 5,000 Tweets containing each of the above three tags over a period of 24 hours on Sunday February 1. For this experiment, I wanted to focus on the currently unfolding debate in the wake of the measles outbreak, although I was able to find that these tags do have a prior history that dates back as far as seven years.

TAGS archives and lists tweets chronologically, and also provides an overview of the archive, including total number of tweets collected, number of tweets that appear to be retweets or contain links, and a list of users in order of the amount of tweets they contributed to the conversation. TAGS pulled nearly 5,000 tweets containing #VaccinateYourKids and/or #VaccinesWork during this time. Only about 4,000 tweets contained #Vaccines during that same time period.

#VaccinateYourKids and #VaccinesWork

#VaccinesWork and #VaccinateYourKids tweets contained mostly retweeted content during the period studied.

The first thing I noticed when sifting through the resulting data was that tweets marked with these two overtly rhetorical hashtags contain a surprising preponderance of retweeted content. TAGS identified the retweet marker (“RT”) in 4,811 #VaccinesWork tweets and 4,654 #VaccinateYourKids tweets, a staggering 97.2 and 94 percent of each corpus, respectively. The tweets also contained links at comparable rates, with 92.4 percent of #VaccinateYourKids and 95.4 percent of #VaccinesWork tweets linking to other content.

Exploring the content of individual tweets offers an explanation for these numbers. Textmining the two corpora using Voyant Tools revealed that within these two hashtagged conversations, one particular post had gone viral: a tweet from user @DocBastard that contained both hashtags and linked to an aggressive pro-vaccine message from pediatrician Mike Ginsberg.

@DocBastard’s tweet contained a brief, sarcastic message and a link to Ginsberg’s original text. The message was very emotional, but provided little evidence to support claims regarding vaccines and did not attempt to engage with those wary of vaccines.

@DocBastard is an interesting online character. He describes himself as “a regular trauma surgeon trying to save the world one idiot at a time,” and maintains a blog where he chronicles “all kinds of crazy shit” he sees and rails against “clueless asshats,” like smokers and those who don’t wear seat belts, with the sarcastic invective you might expect. His regular readers seem to love him, as do his nearly 3,000 Twitter followers. Of the tweets containing links in the two hashtag corpora, 73.8 percent of #VaccinateYourKids and 79.4 percent of #VaccinesWork tweets reference that same @DocBastard tweet.

Despite the rhetorical nature of these two tags, the vast majority of users are simply using them to recirculate this message, which on examination doesn’t actually provide any real evidence regarding how #VaccinesWork or why you should #VaccinateYourKids. Combining the two above tags with the hashtag #AntiVax (not one of the tags I studied here, but commonly used in tweets belittling those hesitant about vaccinations), along with the “*drops microphone*” message serves to mock and alienate the exact individuals the hashtags appear intended to address.

In addition, Ginsberg’s position regarding unvaccinated children does not seem likely to prove rhetorically effective in encouraging others to vaccinate, either. Lawrence and her colleagues cited a study that found the number of pediatricians with policies like Ginsberg’s continues to rise — as of 2011, one out of four pediatricians has such a policy — yet the rate at which individuals decline vaccination remains steady.

If you don’t already agree with vaccinating your children, it seems improbable that this policy, the related rant, or @DocBastard’s mic drop would convince you to get your children vaccinated. While I certainly don’t doubt @DocBastard’s sincerity and good intentions, conversations typically don’t go well if one interlocutor calls the other an “asshat.” His approach may not be the most effective if his goal is to encourage hesitant parents to vaccinate, though it clearly resonates with his already supportive followers.

“This online discourse has predictably formed in exactly the same unproductive fashion as discourses in non-digital environments, where individuals opposed to vaccinations are constructed simply as ignorant.”

This sort of discourse surrounding those hesitant about vaccines is nothing new. Lawrence and her colleagues identified a similar situation during their research: health care professionals tend to posit members of the vaccine-hesitant public as “nondeliberative at best or negligent at worst.” This online discourse, then, has predictably formed in exactly the same unproductive fashion as discourses in non-digital environments, where individuals opposed to vaccinations are constructed simply as ignorant, and are shamed rather than engaged with. Rhetorical strategies like @DocBastard’s and Ginsberg’s develop as a result of this caricature, and in practice do not prove to be productive in regards to increasing vaccine uptake.

Because the retweeted viral tweet that dominated conversation within these two hashtags contained both tags, there is likely a great deal of overlap that skewed this particular dataset. Nonetheless, it remains interesting that only about three out of every 100 tweets in these corpora provide original content. For the most part, people seem to be using these hashtags and @DocBastard’s tweet like bumper stickers — they are advertising something they already agree with rather than attempting to change minds or join an ongoing dialogue.

While the virality of @DocBastard’s tweet in particular may be accidental during this time period, the overarching ethos of the community defined by these tags seems to lend itself to a general pattern of this bumper sticker mentality. Despite the claims embodied in the tags, their use in this corpus does not appear intended to have rhetorical effect beyond personal identity work, and in fact reifies an understanding of the debate controversy that has consistently proved ineffective in convincing those dubious that #VaccinesWork. Just as you rarely get out of your car in traffic, knock on the driver’s side window of the vehicle in front of you, and attempt to follow up on a bumper sticker’s message, the content indexed by these tags may resonate with the convinced but does little to foster further engagement.


The conversation in #Vaccines was a different story. While #VaccinesWork and #VaccinateYourKids appear only to really have taken off lately in response to the recent measles outbreak, #Vaccines has been an ongoing conversation. Again unlike the two previous tags, #Vaccines seems to have started as a network for those opposed to mandatory vaccination formed by @TannersDad at the not-so-subtle suggestion of another parent of children with autism who felt that his anti-vaccination content was dominating her nonpolitical conversation.

The first #Vaccines tweet arose out of a hashtag “ownership” dispute between @TannersDad and another parent of autistic children.

@TannersDad remains active in the conversation to this day — during the period of time I studied, he was the eighth most frequent #Vaccines tweeter and received more than 200 @-replies.

Key differences also stand out in the corpus of tweets. In the cases of #VaccinateYourKids and #VaccinesWork, no one user really dominated the discussion. @DocBastard’s tweet was by far the most retweeted, but many different people were retweeting it. The top tweeter of the #VaccinesWork hashtag during this time period (@AboutPediatrics) tweeted only four times. The top tweeter of #VaccinateYourKids (@JimealeNewYork) tweeted nine times. In #Vaccines, the top tweeter (@HoneyBadger253) tweeted no fewer than 170 times, all of which were retweets of anti-vaccination materials.

@HoneyBadger253 wasn’t alone — the top five tweeters in the #Vaccines corpus tweeted at least fifty times each during a 24-hour period. These users, all of whom opposed mandatory vaccinations, served primarily as content curators, retweeting anti-vaccination content and sharing links to news articles. Of the top 10 users, five accounts only posted retweets during the period of time of time I collected tweets.

#Vaccines contained much more original tweets than the prior two corpora, according to TAGS.

However, unlike #VaccinesWork and #VaccinateYourKids, only 60.2 percent of the total overall corpus of #Vaccines tweets were marked as retweets. That’s a lot more original content. Voyant Tools confirmed that the tweets in this corpus were much more unique — despite #Vaccines containing fewer tweets overall than the above two corpora, words per tweet and the rate of unique word use was much higher. While the entire corpus of #VaccinateYourKids contained 1,738 unique words and #VaccinesWork contained 1,177, #Vaccines contained significantly more: 7,385. Two or three percent of words in #VaccinateYourKids and #VaccinesWork tweets were unique, as opposed to a nearly 11 percent unique words rate in #Vaccines tweets.

#Vaccines tweeters were also more talkative in general, with the average tweet coming in at 17.7 words in length, as opposed to around 11 or 12 in the other two datasets. Keep in mind that this word count does not contain the paragraphs of text in Ginsberg’s message, although the short average tweet length does support the idea that users are not engaging in conversation, say by adding commentary or directing the content to other users, while retweeting.

Links were also used much differently in the #Vaccines tweets. First, fewer tweets contained links at all. Recall that more than 90 percent of #VaccinesWork and #VaccinateYourKids tweets contained links, mostly to @DocBastard’s viral post. In comparison, only 70.7 percent of #Vaccines tweets contained links.

Exploring these links further, we find a much greater diversity of linked material. While more than three quarters of #VaccinateYourKids and #VaccinesWork links were to @DocBastard, the most-referenced link in the #Vaccines corpus was only present in one out of every 50 link tweets. And contrary to anti-vaccination content spread by users such as @HoneyBadger253 and @NOWinAutism, the most-linked link was to a PBS NOVA science article challenging anti-vaccination assumptions, tweeted from a PBS account.

While containing an emotional image, this PBS tweet did more work to support claims in favor of vaccination than @DocBastard’s viral tweet.

As opposed to the pathos-laden @DocBastard tweet, users sharing this tweet were countering anti-vaccination claims with scientific evidence from the article and establishing credibility through its affiliation with a generally well-respected media outlet. While the photo lends a degree of emotion to the post, the article goes beyond the visual content to summarize vaccine controversies in a timeline supported by reviewed research. While this does not address local variations in vaccine-hesitant discourse as described by Lawrence and her colleagues, the tweet does more work to logically support vaccination claims than Ginsberg’s more visceral reaction.

In short, although #Vaccines began as and does seem to remain a conversation containing predominantly anti-vaccination sentiment, during this 24-hour window, it looks more like something resembling a conversation. In fact, three times more #Vaccines tweets were @-replies than #VaccinesWork tweets, and almost 10 times more as compared to #VaccinateYourKids. #Vaccines appears to include a greater plurality of voices than the more pointed tags, and more #Vaccines tweeters seem to be using the tag and @-replies to spread news and directly engage with and possibly challenge the positions of others.

That’s not to say all of the content is always great — it isn’t. But the rhetorical use of this more neutral tag is much more nuanced. As opposed to #VaccinesWork and #VaccinateYourKids, which focused on developing and sharing self-identity as opposed to engaging with other groups, #Vaccines tweeters were interacting with one another, generating original content, and questioning dominant anti-vaccine messages within the tag with logical and ethical rhetorical appeals. Those countering anti-vaccine sentiment using #Vaccines were more likely to reach an audience of individuals with whom their message could have an impact, and were doing so in a decidedly more rhetorically sophisticated way.


So what do these data tell us? Those tweeting (or in most cases, retweeting) with #VaccinateYourKids and #VaccinesWork are generally doing so without any apparent interest in joining a real conversation. Their content isn’t unique and doesn’t generally engage other users. Despite the rhetorical nature of the tags, they aren’t being used to convince so much as to provide a digital bumper sticker to share their own identity. They want to advertise their views and express solidarity with another user who shares those same beliefs. #Vaccines tweeters, however, seem more interested in spreading content related to their side of the debate and directly engaging with others with different views.

I think we can take a couple of things from this. First, if you’re looking to research both sides of an issue on Twitter, you might do well to find a neutral hashtag. That feels kind of straightforward, but there you have it. On the other hand, if you’re a marketer or brand manager, composing a rhetorically charged, complete sentence hashtag might get you the viral retweets that you’re looking for.

“We all should think more about the rhetorical potential of social media as a public space, rather than simply as a site for establishing a particular image. Social media is a social space that affords interactions beyond static content.”

For social media to become truly social and productive, however, the key is to find a way to move beyond the anonymous upvote, thumbs-up button, and the hashtag bumper sticker. If you really want to make a rhetorical impact online, the key is to find hashtags that circulate among diverse audiences and use it to share unique content. Simply retweeting messages from others, especially content tagged with hashtags that are already formulated to alienate some audiences, may make you feel good about yourself, but it won’t in any meaningful way further the position you purport to espouse. #Vaccines could be a beneficial site to engage with anti-vaccination groups and develop a rhetorically sound approach to assuage concerns, as the case appears to have been with the NOVA science article.

Ultimately, this small project suggests that we all should think more about the rhetorical potential of social media as a public space, rather than simply as a site for establishing a particular image. What differentiates social media from previous web technologies is just that — it is a social space that affords interactions beyond static content. Those who believe, as I do, that #VaccinesWork or that you should #VaccinateYourKids would better serve their cause by participating in a conversation, rather than alienating their most important audience. Richards defines rhetoric as the study of “misunderstanding and its remedies,” and the vaccine debate remains an area where misunderstanding persists to the detriment of productive discourse, both in the examination room and online.

As the internet becomes more and more affordable, accessible, and ubiquitous, we need to foster discussions in classrooms and other public spaces about how we participate in online conversations and better ways to use digital tools. Public health remains one of many real challenges that we must take up together as a society, and we shouldn’t neglect the potential of digital media as an ever more available means of persuasion.