In response to a desired degree of participation within vaccination against the Covid-19 pandemic, the Swedish government chose to implement mandatory marketing measures. This has been exemplified by vaccine mandates which caused to provoke varying reactions from affected consumers. This study was, thus, based on investigating established marketing strategies for sensitive products from a consumer perspective and measuring the perceived level of trust between the state and its citizens. The study adhered to a qualitative research method to facilitate the assessment of a phenomenon with respect to medicalization. Semi-structured interviews were designed based on three main categories of respondents: critical-, neutral-, and positive-minded individuals, in relation to opinions concerning the marketing of vaccines and government mandates. Respondents were further distributed on the basis of four age groups to investigate the relevance of the individual's age and their corresponding level of trust. Based on the following results, however, there appeared to be no established link between these two variables, i.e. age and confidence. Furthermore, it has been shown that respondents' previous attitudes were related to their degree of social capital which determined the individuals' level of trust with regard to the state and its implementation of the vaccine mandate. The respondents' previous attitudes on the subject of vaccination mainly affected the level of trust they had for their state and how well they could identify with the message behind the marketing of vaccines. Further conclusions also showed a link between the degree of consumers' relatability with regard to the marketing message and their respective consumer behavior, for example within the vaccination frequency of each individual respondent. / Som svar till ett önskat vaccinationsdeltagande mot Covid-19 pandemin valde den svenska regeringen att implementera tvingande markandsföringsåtgärder i form av exempelvis vaccin mandat som väckte varierande reaktioner från påverkade konsumenter. Denna studie utgick därmed från att utreda etablerade marknadsföringsstrategier kring känsliga produkter utifrån ett konsumentperspektiv och mäta den uppfattade förtroendenivån mellan respektive stat och medborgare. Studien förhöll sig till en kvalitativ forskningsmetod för att underlätta undersökningen av ett fenomen med avseende för medikalisering. Semistrukturerade intervjuer utformades utifrån tre huvudsakliga respondentkategorier: kritiskt, neutralt samt positivt inställda individer, i förhållande till deras antaganden för marknadsföring av vaccin och statliga mandat. Ytterligare fördelades respondenter utifrån fyra åldersgrupper för att utreda relevansen kring individens ålder och dess korresponderande förtroendenivå. Utifrån följande resultat uppkom det däremot inte någon förekommande koppling mellan dessa två variabler, det vill säga ålder och förtroende. Vidare har det påvisats att respondenternas tidigare inställningar relaterade till deras grad av socialt kapital avgjorde för individernas tillitsnivå med avseende på staten och dess implementering av vaccin mandat. Huvudsakligen påverkade respondenternas tidigare inställningar kring ämnet om vaccinering den nivå av förtroende de utgjorde för staten samt hur väl de kunde identifiera sig med den etablerade marknadsföringens budskap. Vidare slutsatser visade även på en koppling mellan graden av konsumenters relaterbarhet med avseende på marknadsföringens budskap samt deras respektive konsumentbeteende exempelvis inom de individuella respondenternas vaccinationsfrekvens.

People are increasingly turning to online communities for entertainment, information, and social support, among other uses and gratifications. Online communities include traditional online social networks (OSNs) such as Facebook but also specialized online health communities (OHCs) where people go specifically to seek social support for various health conditions. OHCs have obvious health ramifications but the use of OSNs can also influence people's mental health and health behaviors. The use of online communities has been widely studied but in the health context their exploration has been more limited. Not only are online communities being extensively used for health purposes, but there is also increasing concern that the use of online communities can itself affect health. Therefore, there is a need to better understand how such technologies influence people's health and health behaviors. The research in this dissertation centers on examining how online community use influences health and health behaviors. There are three studies in this dissertation. The first study develops a conceptual model to explain the process whereby the characteristics of a request from an OHC user for social support is answered by a wounded healer, who is a person leveraging their own experiences with health challenges to help others. The second study investigates how algorithmic fairness, accountability, and transparency of an OSN newsfeed algorithm influence the users' attitudes and beliefs about childhood vaccines and ultimately their vaccine hesitancy. The third study examines how OSN social overload, through OSN use, can lead to psychological distress and received social support. The research contributes theoretical and practical insights to the literature on the use of online communities in the health context. / Doctor of Philosophy / People use online communities to socialize and to seek out information and help. Online social networks (OSNs) such as Facebook are large communities on which people segregate into smaller groups to discuss joint interests. Some online communities cater to specific needs, such as online health communities (OHCs), which provide platforms for people to talk about the health challenges they or their loved ones are facing. Online communities do not intentionally seek controversy, but because they welcome all perspectives, they have contributed to phenomena such as vaccine hesitancy. Moreover, social overload from the use of OSNs can have both positive and negative psychological effects on users. This dissertation examines the intersection of online communities and health. The first study explains how the interaction of the characteristics of a request for social support made by an OHC user and the characteristics of the wounded healer drive the provision of social support. The model that is developed shows the paths through which the empathy of the wounded healer and the characteristics of the request lead to motivation to provide help to those in need on an OHC. In the second study, the role of characteristics of a newsfeed algorithm, specifically fairness, accountability, and transparency (FAT), in the development of childhood vaccine hesitancy is examined. The findings show that people's perceptions of the newsfeed algorithm's FAT increase their negative attitudes toward vaccination and their perceived behavioral control over vaccination. The third study examines how different uses of OSNs can influence the relationships between social overload and psychological distress and received social support. The findings show how OSN use can be tailored to decrease negative and increase positive psychological consequences without discontinuing use.

Vaccine Hesitancy is a critical public health issue that threatens global health security, increases rates of transmission of deadly diseases, and poses additional infectious risk to everyone. This dissertation uses records from the National Archives and Records Administration of the United States, National Archives of Mexico, World Health Organization, multiple Presidential Libraries, and an assortment of digital records to examine the historical roots of vaccine hesitancy. I argue that the choice to delay vaccination or outright refusal of vaccination often constitutes a form of political protest. This anti-vaccine sentiment has historically functioned as political protest that opposes American and Western presence in developing countries. Illustrative case studies of Pakistan and Mexico between 1947 and 1990 illustrate how the manner in which vaccines are distributed within the context of Cold War disease eradication campaigns can influence vaccine hesitancy. Horizontal vaccine programming in Mexico wherein vaccines were distributed using a robust, native public health infrastructure found more epidemiological success than Pakistani vaccination programs that relied on vertically-oriented, Western-led mass vaccination programming to mitigate the burden of infectious diseases including smallpox and polio. Rhetorical analysis of archival vaccine-related media in these countries also reflects the politicized nature of Cold War vaccine hesitancy. Additionally, this dissertation broadly considers the array of weaponry in the American diplomatic arsenal and compares the diplomatic utility of vertical mass vaccination campaigns with military assistance that was also provided to developing nations in the pursuit of American anti-communist goals in the midst of the Cold War. I argue that certain programmatic ambiguities in Cold War American Foreign Policy led to the production of a uniquely militarized form of American diplomacy. An examination of biosurveillance networks constructed to support the global eradication of smallpox and subsequently replicated to eradicate polio illustrate the long-standing historical intersection between public health programming and military force that underlie historical and modern vaccine hesitancy.

Vaccinmotstånd är ett fenomen som har vuxit sig större världen över i en sådan mängd att Världshälsoorganisationen har inkluderat vaccinmotstånd i listan över “ten threats to global health”. I och med Coronapandemins framfart har skepticism till vaccin återigen fått fäste när vaccin mot sjukdomen covid-19 skulle tillverkas. Enligt tidigare forskning är sociala medier en möjliggörande faktor till att skepticism till vaccin växer och är därför en viktig miljö att studera. Fenomenet vaccinmotstånd är ett utforskat område i flera länder, men kan anses vara relativt outforskat i en svensk kontext. Syftet med studien är därmed att undersöka vaccinmotstånd i en svensk kontext genom att studera de föreställningar och uppfattningar som skildras i vaccinkritiska forum i sociala medier. Metoden som ligger till grund för studiens utförande är diskursanalys, som innebär att fokus i materialet som insamlas är språket samt kommunikation. Detta möjliggör utforskandet av föreställningar och uppfattningar till vaccin. Studiens material är insamlat från de sociala medieplattformarna Facebook och Flashback, för att sedan analyseras utifrån teoretiska begrepp såsom risk, tillit och expertsystem samt individualism, som är baserat på teoretikerna Ulrich Beck, Anthony Giddens samt Zygmunt Bauman.    Resultatet visar att användarna uppvisar en bristande tillit till regeringen och myndigheter på grund av hanteringen av rådande pandemi, samt tidigare hanteringar av vaccinbiverkningar av svininfluensavaccinet. Detta inkluderade även en föreställning att forskningen kring vaccin är korrupt på grund av ekonomiska intressen från läkemedelsföretag samt myndigheter, som påverkade användarnas tillit till vaccin generellt, men även till de nya covid-vaccinen. De användare som uppvisade denna bristande tillit till myndigheter och andra experter upplevde pandemi restriktioner, kommande vaccinpass samt faktagranskningen på plattformarna som inskränkande. De upplevda inskränkningarna ovanifrån tillsammans med rädsla för eventuella vaccinbiverkningar resulterade i att användarna hellre vände sin tillit till online-miljöer och alternativa experter, istället för expertsystem som exempelvis sjukvården, som på grund av negativa erfarenheter med experter även resulterar i att tilliten riktas åt annat håll. De som upplevde vaccin som skadliga förespråkar alternativ till vaccin, där användarna kunde vända sig till plattformarna för rådgivning och stöd. Föreställningarna som yttrades skiljde sig även mellan plattformarna, där Facebook uppvisade tendenser på selektiv exponering, medan det på Flashback kunde råda diskussioner från olika ståndpunkter. / Vaccine resistance is a phenomenon that has grown larger worldwide around such an amount that the World Health Organization has included vaccine hesitancy in the list of "ten threats to global health". With the rise of the Corona Pandemic, skepticism about vaccines has once again taken hold when vaccines were to be manufactured to prevent the illness Covid-19. According to previous research, social media is an enabling factor for growing skepticism about vaccines and is therefore an important environment to study. The phenomenon of vaccine resistance is an explored area in several countries, but can be considered relatively unexplored in a Swedish context. The purpose of the study is thus to investigate vaccine resistance in a Swedish context by studying the ideas and perceptions portrayed in vaccine-critical forums on social media. The method that forms the basis for the study is discourse analysis, which means that the focus in the material collected is language and communication. This enables the exploration of notions and perceptions of vaccines. The study material is collected from the social media platforms Facebook and Flashback and then analyzed on the basis of theoretical concepts such as risk, trust and expert systems as well as individualism, which is based on the theorists Ulrich Beck, Anthony Giddens and Zygmunt Bauman.    The results show that users show a lack of trust in the government and authorities due to the management of the current pandemic, as well as previous management of vaccine side effects of the swine flu vaccine. This also included the notion that vaccine research is corrupt due to the financial interests of pharmaceutical companies and authorities, which affected users' confidence in vaccines in general, but also in the new covid vaccines. The users who showed this lack of trust in authorities and other experts experienced the pandemic restrictions, upcoming vaccine passes and fact-checking on the platforms as violating. The perceived violating restrictions from above together with fear of possible vaccine side effects resulted in users preferring to turn their trust in online environments and alternative experts, instead of expert systems such as healthcare, which due to negative experiences with experts also results in trust being directed elsewhere. . Those who perceived vaccines as harmful advocate alternatives to vaccines, where users could turn to the platforms for consultation and support. The views expressed also differed between the platforms, where Facebook showed tendencies towards selective exposure, while on Flashback there could be discussions from different points of views.

Syftet med denna studie är att undersöka antivaccin-diskurser på Facebooksidan Kavla Ner och jämföra dem med tre antivaccin-diskurser tidigare funna av Kata (2010). Tidigare forskning visar att antivaccin-grupper utnyttjar postmodernistiskt tänkande och att sociala medier är ett kraftfullt verktyg vad gäller åsiktsbildning om vaccin. Därtill kan konspirationsteorier som sprids om vaccin bidra till en ökad tro på att vaccin är farligt.Materialet som analyseras är 30 inlägg från Facebooksidan Kavla Ner och studien bygger på Faircloughs (1992) tredimensionella modell för kritisk diskursanalys. Texterna har analyserats med hjälp av analysverktygen lexikala val och modalitet. Detta görs med utgångspunkt i teorier om ideologi och diskurs, postmodernism samt kulturell hegemoni.Resultatet av analysen visar förekomsten av antivaccin-diskurser och att två av de funna diskurserna stämmer överens med de Kata (2010) funnit. Därtill gjordes nya upptäckter i form av en ny diskurs och de kategoriserande teman Kata funnit utvecklades. Resultatet visade att en stor mängd av inläggen är färgade av ett postmodernistiskt tänkande. Konspirationsteorier visade sig också vara vanligt förekommande i inläggen. Slutsatsen av studien är att de sociala praktiker som påverkar antivaccin-diskursen även skulle kunna påverka andra områden, vilket ytterligare förklarar vikten av att förstå fenomenet vaccinmotstånd. / The purpose of this bachelor thesis is to examine anti-vaccine discourses on the Kavla Ner Facebook page and to compare them to three anti-vaccine discourses previously found by Kata (2010). Research shows that anti-vaccine communities utilize postmodern ways of thought, and that social media is a powerful tool when it comes to affecting people's opinions about vaccination. Furthermore, conspiracy theories which are spread on the internet can contribute to belief that vaccines are dangerous.The material which has been analyzed consists of 30 posts from the Kavla Ner Facebook page and the method is based on Fairclough’s (1992) three-dimensional model for critical discourse analysis. The texts have been analyzed using the tools lexical choices and modality, while drawing on theories about ideology and discourse, postmodernism and cultural hegemony.The result shows the presence of anti-vaccine discourses on the Facebook page, and that two of the discourses are consistent with those found by Kata (2010). In addition, a new discourse was found and the categorizing themes by Kata were expanded. Conspiracy theories proved to be common in the posts. The results also showed that a large number of the posts are characterized by postmodernist thinking. Finally, it is concluded that the social practices which influence the anti-vaccine discourse could affect other areas, which further explains the importance of understanding the phenomenon of vaccine resistance.

研究の目的 : 多変量解析とGISを用いて、乳幼児を対象とする日本の予防接種率の地域差の実態を把握し、その要因を検討する。研究の背景 : 公衆衛生上の課題である予防接種率の地域差の特定と改善を目的として、多様な地域スケールからその要因を分析する研究が行われている。しかしながら、日本における既往研究では個人を対象とした研究が多く、接種率の地域差の検討や関連要因を用いた生態学的研究もほとんど行われてこなかった。研究手法 : 日本の1737の市区町村における7種類19回の予防接種を対象として、重回帰分析と市区町村―都道府県間の階層を用いたマルチレベル分析を行った。被説明変数には推計した2013年から2018年までの予防接種率を、説明変数には9つの個人要因と4つの環境要因を用いた。これらの変数の作成には国勢調査などの政府統計を用いた。予防接種率の分布図と予測モデルの残差プロットを用いて、地理的な関連要因を探索した。結果 : 一人当たり課税所得と乳幼児健診受診率は市区町村レベルで、世帯の児童数は都道府県レベルで全般的に有意な関連を示した。その他の変数は予防接種の種類や接種時期(回数)によって関連の有無が異なった。接種率は西日本で低く、大都市圏で高い傾向がみられた。残差は内陸部と接種率の偏差が大きい地域に多く見られた。考察 : 市区町村の所得格差と都道府県の世帯あたり児童数の差が、地域の接種率の格差に関連すると示唆された。また、人口減少と高齢化が進む小規模地域には接種率に関連する固有の因子が存在する可能性がある。結論 : 接種率の向上には、その地域の社会経済的状況や人口構造、地域の文脈、予防接種の種類、それらの要因の影響するスケールを踏まえた施策が求められる。 / Objective: Examining geographical variation and the factors of infant immunization coverage in Japan. Background: Incomplete vaccination coverage is one of the largest public health threats. Many interdisciplinary studies have investigated factors that might increase immunization rates or cause Vaccine Hesitancy. However, most studies in Japan have focused on individuals and few studies have considered regional disparities of vaccination coverage. Methods: We conducted a multiple regression analysis and a multilevel analysis (municipality-prefecture hierarchy) for 19 vaccinations in 1737 municipalities in Japan, during 2013-2018. The dependent variable was the estimated vaccination rate, and nine individual factors and four environmental factors were used as explanatory variables. Data were collected from publicly available sources. We used distribution maps of vaccination rates and residuals of the predictive models to explore geographical factors. Results: In general, per capita taxable income and infant health checkup rate showed generally significant positive associations at the municipal level, and the number of children in the household negative association at the prefectural level. Other factors showed various associations depending on the type and the timing of vaccines. Vaccination rates were likely to be lower in western Japan and higher in metropolitan areas. Residuals were found mostly in inland areas and areas with large deviations in vaccination rates. Discussion: These results suggested that vaccination rates were associated with regional differences in municipal income inequality and in the number of children per household in prefectures. Smaller villages with declining and aging populations might have unique factors. Conclusions: To increase vaccination coverage among infants, it requires to consider the effect size at various spatial scales, in addition to compositional and contextual effects as the socioeconomic status, demographic structure, the local contexts, and the type of vaccination. / 京都大学 / 修士 / 修士(文学) / Kyoto University / TFtmp

The rapid development and disitribution of COVID-19 vaccines have sparked diverse public reactions globally, often reflected through social media platförms like Twitter. This study aims to analyze the sentiment andd public discourse surrounding COVID-19 vaccines on Twitter, utilizing advanced text classification techniques to navigare the vast, unstructured nature of sicial media dfata. By implementing sentiment analysis, the research categoizes tweets into positive, negative, and neutral sentiments to gauge public opinion more effectively. In-depth analysis thorugh topic modelingtecniques helped identify seven key topicvs influencing public sentiment including aspects related to efficiacy, logisticl challenges, safety concens, and personal experiences, each varying in prominence depending on the country, as well as the specific timeline of vaccine deployment. Additionally, this study explorers geographical variations in sentiment, notig significant differences in public opinion across different countries. These variations could be tied to local cultural, social, and political contexts. Reults from this study show a polarized response towards vaccination, with significant discourse clusers showing either strong supprt for or resistance against the COVID-19 vaccination efforts. This polarization is further pronounced by the logistical challenges and trust issues related to vaccine science, particularly emphasized in tweets from couintries with lower vaccine acceptance rates. This sentiment analysis on Twitter offers valuable insights into the public's perception and acceptancce of COVID-19 vaccines, providing a useful tool for policymakers and public health officials to understand and address publiv concerns effectively. By identifying and understanding the key factors influencing vaccine sentiment, tageted communication strategies can be developed to enhance publiv engagement and vaccine uptake.

Helper T cells direct the immunological response to foreign pathogens and cancer. To become activated, helper T cells must recognize unique peptides presented on major histocompatibility complex II (pMHCII) by antigen presenting cells (APCs) with their T cell receptor (TCR). While much is known about helper T cell activation signaling cascades and the subsequent roles of helper T cell subsets, the initiation of helper T cell activation by the TCR and other co-receptors is less well understood. Specifically, the affinity of the TCR for its pMHCII can change helper T cell subset fate, proliferation, and alter the risk for activation induced cell death. High affinity TCRs are attractive targets for immunotherapies, but little is known about how helper T cells respond to high affinity TCRs. Here we describe high affinity TCR activation thresholds for both full length TCRs and chimeric antigen receptor TCRs both with and without the presence of the coreceptor CD4 and propose a mechanism whereby CD4 inhibits T cell activation via Lck sequestration and a CD4-independent method. Dysregulated helper T cells play critical roles in the development and perpetuation of systemic lupus erythematosus (SLE), a systemic autoimmune disease that causes widespread inflammation and organ damage throughout the body. Chronic inflammation in SLE affects the immune response to viruses and the risk of developing cancer. However, in SLE patients, it is unclear if viruses initiate the development of cancer directly or if the effects are non-interacting and concomitant. Here we describe the interactions between SLE, viruses, and cancer risk revealing that viruses and SLE do interact to increase the both the overall cancer risk and the risk for hematological malignancies. Due to vaccine efficacy, vaccine preventable diseases (VPDs) are no longer commonly experienced or understood by the public. Vaccines are a victim of their own success and according to the World Health Organization (WHO), vaccine hesitancy (VH) is one of the top threats to global health. VH is the refusal to accept vaccinations and the reasons for VH vary across time, place, and vaccine. Refuting VH is difficult as directly confronting false assumptions can cause individuals to become more entrenched in their position resulting in confirmation bias. Adults with VH attitudes are often motivated by concerns over personal liberty, harm, independence, and body purity. Here we describe the results of a VPD interview- and education-based intervention geared towards promoting positive vaccine attitudes for young adults and demonstrate that education focused on VPDs is more effective than vaccine safety.