Thesis advisor: Penelope Ismay / This dissertation explores medical professionalization, public health, and vaccination in England, India, and Jamaica in the nineteenth century. England was the site of the most sustained anti-vaccination agitation of any British possession in the second half of the nineteenth century. Yet by the early twentieth century, the medical profession was a trusted authority and vaccination enjoyed wide public support. In India and Jamaica, we find the opposite. India and Jamaica did not have organized resistance to vaccination on the scale of England, yet vaccination and public health floundered in both areas. In England and the Empire, doctors had a trust problem. New technology and expanding health legislation sparked backlash against the medical community. How doctors responded to that backlash shaped public health and influenced medical authority into the twentieth century. By analyzing the role of trust in the process of medical professionalization in a comparative framework, my dissertation allows us to analyze how medical authority is created and functions in society. / Thesis (PhD) — Boston College, 2021. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: History.

In 1911, the Uruguayan Parliament approved a law of mandatory smallpox vaccination. It was a controversial measure that generated a strong anti-vaccination campaign, led by the naturist movement. Embracing a transcendental understanding of nature, they saw vaccines and surgeries as a threat to the natural balance between body and soul. In this dissertation, I study how Uruguayan naturists positioned themselves as a secular alternative to science that combined reason and spirituality, and I show how they had a documented impact on the local political and scientific culture. By focusing on a country with a distinct anti-clerical tradition, I bring to the fore how apparently contradictory phenomena like secularity and spirituality overlap. The spirituality imbricated in their idea of nature, I conclude, resulted in conservative political gestures, even within progressive movements. Among many other things, they embraced a language of purity and sacredness around the body, both human and animal, that led them to the opposition to vaccinations, surgeries and meat consumption, which they regarded as violent moral transgressions. The influence of naturism in the country has not yet been sufficiently considered, and my research presents a first approach to a central aspect of the intellectual life of the period. Besides being a popular movement, it influenced key political, scientific and cultural figures, who, in turn, shaped laws, scientific policies and the elite’s understanding of science and its possibilities. To demonstrate this, through a cultural studies perspective, and in dialogue with science and technology studies and medical humanities, I do close-readings of an unexplored archive of naturist and theosophist periodicals, pamphlets and books published in the first two decades of the 20th century. I also study more well-known anarchist publications and philosophical works by prestigious medical doctors, such as Mateo Legnani (1884-1964), and Carlos Santín Rossi (1884-1936), both close to naturism, focusing on how they also represent an alternative body of knowledge where scientific thought and spirituality coalesce. I conclude by studying essays by the Spanish-Paraguayan writer Rafael Barrett (1876-1910), who debated with the Uruguayan naturists and wrote illuminating pieces on the issue. To this end, I structure the dissertation in three chapters. In the first one, I discuss the political impact of naturism and argue that the movement’s opposition to the 1911 law of compulsory smallpox vaccination highlighted the Government's tendency to subordinate individual freedoms, a fundamental principle of the newly formed liberal state, to what they saw as the common good, which contradicted the Government’s modernizing discourse and agenda. Moreover, naturists formulated some well-founded systematic critiques of the political values imbricated in academic medicine. By pointing this out, I challenge the opposition between them and university trained physicians, the latter historically represented as defenders of science and reason, and the former as religious fanatics. Indeed, the public health paradigm adopted by medical authorities appealed to nature in a very similar way than naturists did. Several renowned medical doctors, some of them parliamentary representatives, without openly identifying themselves as such made direct references to naturists’ precepts in their books and in public documents, including law bills. The second chapter revolves around the vision of science developed by naturism and its political and epistemological implications; there, I argue that while naturists amplified the metaphysical elements present in the history of medicine, from vitalism to Neo-Hippocratism and romanticism, such spiritual views remained compatible with the anticlericalism that characterized the Uruguayan society. I study two iterations of the movement that represent different understandings of science and that reveal specific political and philosophical tensions present in Uruguayan society. One of them, led by Antonio Valeta (1882-1945), proposed an accessible version of science, highlighting the autonomy of the individual. He appealed to values of freedom and personal effort that were part of the liberal imaginary and came into tension with the centrality of the state and its reformist agenda. The second one was developed by Fernando Carbonell (1880-1947), a member of the Theosophical Society and other esoteric groups. His vision was informed by a sophisticated system of beliefs, composed of mystical and conceptually dense metaphysical, ethical and aesthetic teachings that led to valid epistemological criticisms to the model of laboratory science that was being embraced by the authorities. In the third and final chapter, elaborating on the fact that naturists and other groups across the political spectrum mobilized a secular spirituality inherent to the idea of nature, I posit that this led to conservative political positions, even within progressive movements and individuals that were attracted to naturist precepts. Indeed, naturism explicitly opposed actions that could be considered revolutionary in favor of a gradual evolutionism, appealing to the same principle of non-violence embraced in their vegetarianism. In turn, they elevated the philosophical and metaphysical purity of the defense of the life of all beings above the actual living conditions of people and human suffering, romanticizing poverty and illiteracy as states closer to nature. To conclude, my dissertation brings attention to the diversity of belief systems and values still at stake in the present-day scientific landscape. Current iterations of naturism, as illustrated by the anti-vaccination movement both in Uruguay and internationally, resort to claims and arguments eerily similar to those developed more than 100 years ago in Montevideo and other parts of the world. Now, as they did in the past, activists advocate for individual freedom and against the intervention of foreign substances that alter the natural balance of their bodies. Moreover, within the context of the coronavirus pandemic, scientific discussions are taking over the public sphere in an unprecedented way, echoing past dynamics where public figures denounced scientists as biased and despotic elitists who wanted to subject the people to their arbitrary regulations.

Syften med uppsatsen var att ta reda på hur folk som är en del av anti-vaccinationsrörelsen kommunicerar i sociala medier. Uppsatsen undersöker hur de kommunicerar i inlägg och kommentarer i en sluten grupp på Facebook. Med hjälp av ett kodschema så blev 97 inlägg analyserade och placerad i olika kategorier med olika variabler. Utifrån kodschemat blev flera tabeller skapade som visade den mest relevanta faktan. Utifrån den information, och med flera detaljerat beskriva exempel-inlägg, beskrivs den generella stämningen i gruppen och hur de talar med varandra. Resultatet blev att de kommunicerar med varandra på ett vänligt och stöttande sätt, bidrar med relevant information när det frågas efter, men med lite fientlighet visas mot de som kommer med motsatta åsikter. Gruppen var sluten, vilket innebär att bara individer som delar samma åsikter som dem är medverkande på plattformen, vilket också betyder att åsikter blir så gott som aldrig utmanade. / The purpose of this essay has been to figure out how people that are a part of the anti-vaccination movement communicate in social media. The essay explores how they communicate in posts and comments in a closed group on Facebook. With the help of a coding scheme, 97 posts became analysed and placed in different categories with different variables. A couple of tables were created from the code scheme that demonstrated the most relevant facts. From that information, and with several detailed descriptions of example posts, describes the general mode in the group and how they speak with each other. The result was that they communicate with each other in a nice and supporting way, contribute with relevant information when it was asked for, but with some hostility shown towards those who come with opposite views. The group was closed, which means that only individuals who share the same views as them are involved with the platform, which also means that opinions are almost never challenged.

The global rise of anti-vaccination movements has led to serious consequences for the public health such as the recent measles outbreak in the United States. The increased promotion of misleading information on vaccinations by social media influencers as well as by media outlets seems to have resulted into a more negative view on vaccinations. The popularity of these social media influencers and the good reputation and authority of the media outlets could have played a substantial role in these developments. The following experimental study will try to explore whether popularity or authority cues can have an impact on the evaluation of the credibility of these two types of sources via an online survey. Furthermore, it aims to examine whether said heuristic cues and resulting conformity effects or the source credibility in general could have an impact on the opinion of recipients on a potential autism-vaccination link. Results have shown that especially authority cues seem to have a positive impact on source credibility evaluations. Furthermore, a high general trust in the media positively influences assessments of source credibility of well-established news outlets. Popularity cues as well as authority cues seem to have a positive effect on the recipients´ opinion. However, authority cues and the resulting effects of informational conformity seem to lead to greater attitude changes. Particularly people with a high need for conformity exhibit considerable attitude changes when exposed to the well-established news outlet as a source. Also, a high perceived source credibility is positively correlated with a desired attitude change. Especially the high perceived credibility of the social media influencer resulted in significant attitude changes. The results underline the importance and positive impact that a perceived authority can have on source credibility assessments and on recipients’ opinions. This highlights the great necessity for self-proclaimed experts on social media platforms and particularly for well-established news outlets to increase their effort to thoroughly and accurately research health-related topics.

Background: Following the publication of Andrew Wakefield’s article claiming a link between Autism and the MMR vaccine in 1998, the U.K. and U.S. experienced a decline in vaccination rates. Combating the anti-vaccine messages highlighted by the media are the medical providers, who are consistently reported as an influential source of information for parental vaccine decision making. Despite efforts of the medical and public health community, some developed countries have seen a resurgence of vaccine preventable diseases. Purpose: This study seeks to examine parental vaccination concern in a private pediatric practice in metropolitan Atlanta. Methods: A questionnaire was created by the PI to assess parental vaccination concerns, including items to assess parental feelings toward the providers and nurses regarding preventative care. Data was analyzed in SPSS version 19.0. The study was approved by the IRB at Georgia State University. Results: A total of 283 participant responses were included in the sample. Overall vaccine adherence was 96.1% (272). However, a large minority of participants who were considered to have vaccine concerns were identified: 40.3% (114) of participants responded yes to at least one vaccine hesitation item. Conclusion: Vaccine adherence in a private pediatric practice remains high. However some parents continue to have vaccination concerns and may be at risk for deviating from the vaccine schedule. Using qualitative methods to obtain parental beliefs may provide a deeper understanding of parental decisions to aid in the development of public health education programs. The feasibility of collecting data at a private pediatric practice is discussed.

Measles is a potentially deadly illness that has been declared no longer endemic in the United States of America since 2000.1 However, in the past few years, imported cases of the measles have continued to cause hospitalization and deaths among those citizens who remain unvaccinated, or have waning immunity, against measles, especially children. The Measles, Mumps and Rubella (MMR) vaccine has been available since 1963 and is routinely given to children in the first two years of life.1 Endemic cases of measles are increasing each year, specifically in undervaccinated communities. In 2018-2019, there was an outbreak of measles in the Williamsburg neighborhood of Brooklyn, New York. Investigating the knowledge, attitudes and opinions on the measles virus and the MMR vaccine in the Williamsburg neighborhood may facilitate discussions that could increase the vaccination rate among its population, as well as elucidate more effective strategies for vaccination in the future. Comparing attitudes from the Williamsburg neighborhood with a population across the Hudson River, in the East Village, which has previously had higher rates of vaccination, could shed light on how to target and tailor vaccination campaigns to different populations in New York City moving forward.2–4

Though it is a centuries old practice, anti-vaccination has become a growing trend since the rise of the internet. Anti-vaccination rhetoric complicates neoliberal beliefs about public health and systems of medical knowledge-making. This study follows 100 Twitter accounts which advance anti-vaccination beliefs. Studying these accounts reveals that anti-vaccination is part of a larger moral and epistemological universe of belief. Anti-vaccination advocates on Twitter use a digital activist identity to create affective networks which draw from epistemologies of conspiracy theory and connect to current political events. Anti-vaccination advocates on Twitter are not uninformed. Rather, they ascribe to their own process of information legitimization. Anti-vaccination advocates on Twitter draw from their complex epistemologies and affective networks to build an alternative immunology which focuses on maintaining the purity of the individual body as a metaphor for protection of the state and of humanity

No description available.

L'immunité collective - parfois appelée immunité de groupe - est un concept important et complexe de la santé publique qui n'est pas toujours bien compris par le grand public. Cette incompréhension est particulièrement prononcée chez les personnes qui hésitent à se faire vacciner. Des recherches antérieures ont suggéré que la décision d'obtenir un vaccin pour soi ou son enfant est principalement motivée par les avantages et les risques individuels, plutôt que par les avantages pour la communauté. Cependant, peu de recherches ont identifié des moyens d'aider les gens à comprendre le fonctionnement de l'immunité collective. Il y a également eu relativement peu de recherches sur le rôle des émotions sur la perception du risque et sur les connaissances et les comportements relatifs à l'immunité collective. La visualisation d'informations est un mécanisme de communication puissant pour transmettre des informations et des données sur les risques, car elle permet de présenter rapidement des concepts complexes de manière claire et attrayante. La visualisation d'informations pourrait également permettre d'influencer les émotions. La première partie de ce travail visait à examiner systématiquement les interventions conçues pour communiquer au grand public ce qu'est l'immunité collective et comment elle fonctionne. Cet examen systématique a montré qu'il existe relativement peu de preuves scientifiques des effets de stratégies de communication sur l'immunité collective. Il existe un certain nombre d'interventions disponibles en ligne pour transmettre le concept d'immunité collective, mais leurs effets ont rarement été évalués et aucune étude n'a évalué les effets des interventions sur les émotions. La deuxième partie de ce travail visait à concevoir une application Web au sujet de l'immunité collective et à optimiser cette application en fonction des réponses cognitives et émotionnelles des utilisateurs. Dans notre application, les utilisateurs sont invités à construire leur communauté en créant un personnage qui les représente (leur avatar) et huit autres personnages qui représentent des personnes de leur entourage, par exemple leur famille ou leurs collègues de travail. L'application intègre ces personnages dans une visualisation animée de deux minutes montrant comment différents paramètres (par exemple, la couverture vaccinale et les contacts au sein des communautés) influencent l'immunité collective. Cette étude a montré que notre animation avec des avatars personnalisés peut aider les gens à comprendre leur rôle dans la santé de la population. Notre application s'est révélée être une méthode de communication prometteuse pour expliquer la relation entre les comportements individuels et la santé de la communauté. Elle offre une stratégie potentielle pour concevoir du matériel de communication sur des sujets complexes tels que la santé ou l'immunité collective. La troisième et dernière partie de ce travail visait à évaluer les effets de notre application Web montrant le fonctionnement de l'immunité collective sur la perception des risques, sur les émotions, sur la confiance dans les informations, sur les connaissances et sur les intentions en matière de vaccination. Dans le cadre d'un vaste essai contrôlé randomisé en ligne et factoriel, notre application a influencé tous les résultats dans le sens souhaité, en particulier chez les personnes ayant une vision du monde plus collectiviste. Cette étude est encore plus pertinente aujourd'hui, alors que les pays du monde entier mènent des campagnes de vaccination contre la COVID-19. Notre application est d'ailleurs présentement utilisée dans un outil d'aide à la décision en ligne, permettant aux gens de prendre une décision éclairée par rapport aux vaccins contre la COVID-19 pour eux-mêmes ou leurs enfants. / Community immunity--sometimes referred to as herd immunity--is an important and complex concept in public health that is not always well-understood by members of the general public. This lack of understanding is particularly pronounced among people who are vaccine hesitant. Previous research has suggested that decisions about whether or not to vaccinate oneself or one's child are primarily driven by benefits and risks to the individual, with community-level benefits being less compelling. However, little research has identified ways to help people understand how community immunity works, and there has also been relatively little research investigating the role of emotion in risk perceptions, knowledge, and behavior relevant to community immunity. Visualization is a powerful communication mechanism for communicating information and data, including information and data about risk, because it enables rapid presentation of complex concepts in understandable, compelling ways. Visualization may also influence emotions. The first part of this work was aimed to systematically review interventions designed to communicate what community immunity is and how community immunity works to members of the general public. This systematic review demonstrates that there is relatively little evidence about the effects of communicating about community immunity. There are a number of interventions available online for conveying the concept of community immunity, but very few interventions were evaluated for its effects and no studies evaluated the effects of interventions on emotions. The second part aimed to design a web application about community immunity and optimize it based on users' cognitive and emotional responses. In our application, people build their own community by creating an avatar representing themselves and 8 other avatars representing people around them, for example, their family or coworkers. The application integrates these avatars in a 2-min visualization showing how different parameters (eg, vaccine coverage, and contact within communities) influence community immunity. This study found out that applications with personalized avatars may help people understand their individual role in population health. Our application showed promise as a method of communicating the relationship between individual behaviour and community health. It offers a potential roadmap for designing health communication materials for complex topics such as community immunity. The third and last part of this work aimed to evaluate the effects of our online application showing how community immunity (herd immunity) works on risk perception, emotions, trust in information, knowledge and intentions regarding vaccination. In a large, factorial, online randomized controlled trial, our application influenced all outcomes in the desired directions, particularly among people who have more collectivist worldviews. This work is increasingly relevant as countries around the world carry out COVID-19 vaccination campaigns. Accordingly, our application is currently being used in an online decision aid to support people making evidence-informed decisions about COVID-19 vaccines for themselves or their children.

Les médecines alternatives et complémentaires (MAC) gagnent en popularité dans de la population québécoise, dont la naturopathie. En parallèle, un phénomène d’hésitation à la vaccination gagne de l’ampleur mondialement. Si cette tendance perdure, les taux de vaccination pourraient chuter et plusieurs maladies graves pourraient connaître une recrudescence. La littérature sur les MAC montre que ces praticiens de la santé et leurs usagers ont des attitudes plutôt négatives envers la vaccination. Il est dès lors impératif d’étudier les liens entre l’hésitation à la vaccination et la naturopathie québécoise. Dans le cadre de ma maîtrise, je me suis penché sur l’influence des savoirs et de la confiance sur les manières de penser les risques liés à la vaccination des naturopathes, en plus d’examiner la façon dont ceux-ci gèrent ces risques. Pour ce faire, j’ai réalisé 15 entrevues semi-dirigées auprès de naturopathes québécois. Les résultats de ma recherche montrent que l’approche naturopathique québécoise de la santé cherche à déterminer les causes des maladies dans une perspective holiste afin de stimuler la vitalité du corps. Les maladies ont ainsi pour origine les déséquilibres de ce que les naturopathes nomment le « terrain ». À travers leurs pratiques, principalement axées sur la nutrition, ils cherchent à rendre leurs clients autonomes et responsables de leur santé afin qu’ils puissent rééquilibrer eux-mêmes leurs terrains et ainsi accéder à la santé. Cette conception de la santé et des soins, jumelée à la confiance que les naturopathes ont envers leur savoir expérientiel, est centrale dans la manière dont ils pensent les risques inhérents à la vaccination et aux maladies infectieuses. Les risques que la vaccination rompe l’homéostasie du terrain sont conçus comme plus grands que ceux liés aux maladies infectieuses. C’est pourquoi les naturopathes adoptent plusieurs stratégies pour gérer ces risques, lesquelles visent le maintien de l’équilibre du terrain. / Complementary and Alternative Medicine (CAM), particularly naturopathy, has increased in popularity among the Quebec population. Simultaneously, vaccine hesitancy is gaining momentum worldwide. If this trend persists, vaccination rates could decrease and there could be a resurgence of many deadly illnesses. Scientific literature suggests that CAM practitioners and their users have generally negative attitudes towards vaccination. It is therefore of the utmost importance to study the links between vaccine hesitancy and naturopathy in Quebec. Within the scope of my Master’s, I studied the influence of knowledge and trust on naturopaths’ ways of reasoning about risks associated with vaccination and I investigated how they manage these risks. To achieve this goal, I conducted 15 semi-structured interviews with Quebec naturopaths. The results of my research suggest that Quebec naturopaths believe that health can be achieved through a study of the causes of diseases in a holistic perspective and through the stimulation of the body’s vitality. Diseases, in this perspective, come from the imbalances of what naturopaths call the “field”. Through their practice, primarily based on nutrition, they encourage their clients to autonomously take responsibility for their health so they can restore the balance of their fields themselves, and therefore, return to health. This notion of health and care, paired with the trust naturopaths have toward their experiential knowledge, play a key role in how they think about risks inherent to vaccination and infectious diseases. Concerns about the risks that vaccination might break the homeostasis of the field are far greater than those associated with the risk of infectious diseases. Therefore, to manage these risks, naturopaths adopt many strategies that target the upholding of the field’s balance.