This study examines the kind of imagery that Anti-vaccination movements post on Pinterest, an emergent social network specialized in image sharing and very popular among women. There is almost no data available about which type of images is most effective at reaching people, or how activists choose the images to increase public risk perception about vaccines, and to persuade the public not vaccinate themselves and/or their children. To discover which images could create an emotional connection to the issue, I carried out a qualitative analysis on Pinterest to explore the recurring characteristics of the most shared anti-vaccine pictures. I classified three main categories of images: graphs, drawings and photos, and I further split in subcategories having common characteristics (e.g., children and/or syringes). I also explored the context, composition, recurrence of stereotypes, and emotional content of these pictures, in order to identify their repeated features. Photos connect viewers to the vaccine issue, while charts and graphs help people to understand complex concepts about vaccination, thus I measured the proportion between the two categories.

1. ElenaMilani
UniversitàdegliStudidiPadova
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Images à l'appui de la communication des risques
Images for advocacy in communication of risk
16.1
résumé
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summary
motsclés
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keywords
auteur
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author
présentation
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detailed
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Vaccinations
Pictures
Pinterest
Socialmedia
Visualriskcommunication
Advocacy
This study examines the kind of imagery that Anti-vaccination movements post on Pinterest, an
emergent social network specialized in image sharing and very popular among women. There
is almost no data available about which type of images is most effective at reaching people, or how
activists choose the images to increase public risk perception about vaccines, and to persuade
the public not vaccinate themselves and/or their children. To discover which images could create
an emotional connection to the issue, I carried out a qualitative analysis on Pinterest to explore the
recurring characteristics of the most shared anti-vaccine pictures. I classified three main categories
of images: graphs, drawings and photos, and I further split in subcategories having common
characteristics (e.g., children and/or syringes). I also explored the context, composition, recurrence
of stereotypes, and emotional content of these pictures, in order to identify their repeated features.
Photos connect viewers to the vaccine issue, while charts and graphs help people to understand
complex concepts about vaccination, thus I measured the proportion between the two categories.
Vaccinationshaveeradicatedorsignificantlyreducedvaccine-preventablediseaseepidemicsindeveloped
countries. However, since preventable infectious diseases have waned, vaccines may be perceived as
unnecessary or even dangerous. Moreover, the media and the anti-vaccination movements contribute
to disseminate and sensationalise vaccine objections, thus increasing public risk perception about
vaccinations.
Anti-vaccinationargumentsareusuallydisseminatedthroughvariouschannels,typicallytelevision,the
Internet,andsocialmediaoutlets(1).EveniftheInternetandsocialmediaarenotconsideredimportant

2. Entre médiation scientifique et recherche collaborative au sein
du labex ITEM : quelle place des sciences sociales dans les territoires de montagnes ?
Between scientific mediation and collaborative research within
the labex ITEM: what role the social sciences in the mountains
of territories?
188
sources, they may still influence people’s decisions. Actually, anti-vaccination websites rely heavily on
emotional appeal to convey their message, and they contain narrative information, such as personal
descriptions of vaccine-adverse effects. Thus, they influence readers’ risk perception about vaccines
andaffecttheirvaccinationintentions(2)(3).
Narrativeinformationmaybeconveyedalsobyimages foradvocacy(4). Thesepersuasivepictures are
used in anti-vaccination campaigns, and are shared on the Internet. However, there is almost no data
available on how activists choose the images to increase public risk perception about vaccines and
to persuade people not to vaccinate themselves and/or their children. The lack of data makes it also
impossibletounderstandwhichtypeofimagesismosteffectiveatreachingpeople.
Tocontributetothegeneralunderstandingofhowanti-vaccinationimagesinfluencepeople’sattitudes
towardsvaccinations,IcarriedoutapreliminaryresearchattheUniversityofPadova.Iexplored:
1)Whichtypesofanti-vaccinespictures(e.g.;charts,images)aremainlysharedinPinterest,animage-
sharingnetworkverypopularamongwomen(80%ofitsusersarefemale)(5);
2)WhicharetherecurringfeaturesofthemostsharedimagesforadvocacyinPinterest.
I undertook my qualitative analysis in September 2014. To find out pictures about vaccinations on
Pinterest, I searched the “pinboards” on this topic. Pinboards are thematic collections of images that
users make by collecting pictures from other boards, Internet, social media, but also by uploading self-
made images. Moreover, users can follow other people or specific pinboards, and share or like their
pictures. I searched the pinboards about vaccinations using only one keyword, “vaccines”, because
poorly informed people usually use common queries to search a topic of interest on the Internet (6).
Furthermore,Pinterestsearchreturnsallthevariationsofthequery,bothinpinboardtitleordescription
andinpicturescaption.
Iidentified185pinboardsaboutvaccinations,93%ofwhichareagainstvaccines.Ifocusedmyresearch
onthefourofthemthatareclearlyanti-vaccinationandwithahighnumberofpicturesandfollowers.I
excludedvideosandelementswithoutimagesfromtheanalysis,thusIgotasampleof1,131pictures.I
didnotanalysepicturescaptionnortextualcontent.Only127imagesincludetext,mostlycatchphrases
that distrust vaccines safety and efficacy, or that relate vaccinations to Autism, or that defend the right
tonotvaccinate.
Photosconnectviewerstothevaccineissue,whilechartsandgraphshelppeopleunderstandcomplex
concepts about vaccinations, thus I classified the pictures into three main categories: charts and
infographics, drawings, and photos. From the analysis of the four pinboards I found out that 83.9%
of the pictures are photos, 10.2% are charts, and 5.9% are drawings (n=1,131). Then, I further divided
the photos into subcategories having common characteristics, and I analysed: subject, semiotic signs,
figurativeelements(7)(8)(9)(10),thepresenceoftextoverlays,andemotionalcontent(9)(11)(12).
Visual aids such as charts and simple-designed drawings are often recommended in health risk
communicationtolaypublic,becausetheyturnrisk-relatednumericaldatainmeaningfulpicturesforthe
audience(14)(15)(16)(17)(18).However,Ididnotfindmanyinmysample.Moreover,theanalysedcharts
donothaveaclearcaptionnoratextguidingthereader,andtheirdesignoftenleadstomisunderstanding
(14)(16)(17). Instead of being informative, the drawings are mainly decorative and their message is
entirelyconveyedbyapersuasivetextoverlay.

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In the photos I identified five main subjects: Syringes (30.8%), Children (19.8%), Children AND Syringes
(11.7%), Adults (14.6%, physicians and nurses are included, but not syringes), and Vaccine vials (4.2%,
syringes not included) (n=949). I did not consider the remaining subjects (18.9%) because of their low
frequency.Ifocusedmyinvestigationonthedifferentfeaturesofthefirstthreesubjects(i.e.childrenalone,
withparentsoringroup;healthyandsickkids;presenceorabsenceofaphysicianetc.).
Ithenlookedforsemioticsigns.Themainsignisthesyringe,whichisbothaniconicandanindexicalsign
of vaccinations. Moreover, in a few images syringes and/or vaccine vials include poison pictograms (7).
Due to the presence of both syringes and children, it is clear that these images are about vaccinations,
even if no explanatory text is given (7)(9). Medical gloves and/or medical coats represent the figure of
physiciansornurses.
Stereotypes are frequent in the photos, especially ethnical ones: physicians, paramedics and 92.1% of
babiesareCaucasian(n=428).Anotherrecurringstereotypeisrelatedtoparentalcare:70%ofthephotos
depictingchildrenwiththeirfamiliesshowonlythemother,whereas20%ofthemdisplaybothparents.In
theremaining10%thereisonlythefather(n=66).Whenasyringeisshown,onlythemotherisdepicted.
There are no stereotypes related to gender in the representation of kids and physicians as males and
femalesarealmostinthesameproportion(10).
Mostoftheimagesrepresentingsyringesdonotstiremotionsintheviewer.Manysubjectshaveneutral
facialexpressions,especiallyinpicturesshowingadultsbeingvaccinated,orphysicians.However,some
of these images combine subjects, semiotic signs, background colours, composition and text with the
purpose of persuading the viewer not to vaccinate (4)(8). Children often show neutral emotions when
theyaredepictedalone,whereastheyoftensmileorlaughwhentheyarerepresentedingroupsorwith
theirfamily.Cryingorscaredchildrenarerecurrentinimagesthatincludesyringesorportraythemassick.
Smilingkidscanevokefeelingssuchastenderness,whereascryingbabiescaninducecompassion,concern,
andfearintheviewer(12).Inphotosshowingthevaccinationofbabies,themothercomfortsthechildor
protectshim/herfromthevaccinationorthephysician,whereasthephysicianlooksemotionless.These
images are emotional and persuasive and evoke in the audience feelings of compassion, fear, concern,
andevenanger,thusinfluencingtheirconfidenceinvaccinationsandinthehealthcaresystem(8)(12).
The most shared anti-vaccination images on Pinterest have few recurring elements rich in emotional
contentandtheycommunicateananti-vaccinesmessagewithouttextualexplanation(11).Theseimages
arepoorlyinformativeaboutvaccinations,buttheyaresopersuasivethattheycanconveytheideathat
vaccines are unnecessary and even harmful (4). Indeed, the metonymic and analogical codes of/within
thepicturescontributetothiscapability,inducingviewerstoassumethatvaccineswouldkillchildrenor
would make them sick (7). Moreover, the persuasiveness of anti-vaccination images is mainly based on
twoelements:pathos(emotionalappeal)andethos(moralappeal).Forexample,somepersuasiveimages
induce an emotional response in the audience by showing crying and frightened babies (i.e., pathos),
whereasothersfocusontheparents'righttodecideontheirownwhethertovaccinatetheirchildren(4).
Stereotypesinfluencethepersuasivenessofanti-vaccinationsimages,too.Caucasianadultsandchildren,
as well as a mother portrayed next to suffering babies are stereotypes that belong to a specific culture;
thereforetheymayberepresentativeofthetargetaudience(10).
Actually, the communicative power of images is determined not only by their design, but also by the

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individual,social,educational,andculturalcharacteristicsoftheintendedaudience(7)(19)(20).Fromthis
pointofview,theanalysedimagesseemtoconveyeffectivelythemessageagainstvaccinations,because:
•TheirdesignmakesthemsuitedtobesharedonPinterest;
•Theydonotneedanytextormedicalknowledgeonthetopictobeunderstood;
•Theirrecurrentfigurativeelementslikelybelongtothetargetaudience’sculture(21).
Anti-vaccinationimagessharedonPinterestareemotionalandpersuasive,andtheyhavesomerecurring
figurative elements that seem suitable for conveying messages to a specific public. Because of these
features, the pictures may influence public risk perception about vaccinations (22). Moreover, the
emotionalintensityofthesepicturescanincreasetheircommunicativeefficacy(4)(11)(12),andthestrong
negativeemotionsthattheyevokemaychangetheaudience’shealthattitudesandbehaviours,asinanti-
tobaccocampaigns(23).
Myqualitativeresearchhasseverallimitations,asIdidnotanalysecontextmetadata(e.g.;descriptions,
comments, and pictures sources). A quantitative analysis is highly recommended to further investigate
both my preliminary results on the recurring features of the most shared anti-vaccination images on
Pinterest,andtheinfluenceofthesecharacteristicsonpublicriskperceptionaboutvaccinations.Further
studies may be useful to explore the impact of the anti-vaccination movements and to develop better
immunizationcampaigns.
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