Social Science & Medicine 346 (2024) 116725
A ailable online 28 Feb ua y 2024
0277-9536/© 2024 The Au ho s. Published by Else ie L d. This is an open access a icle unde he CC BY-NC license (h p://c ea i ecommons.o g/licenses/by-
nc/4.0/).
Agency in u gency and unce ain y. Vaccines and accina ion in Eu opean
media discou ses
Aleksand a Wagne
a
, Paulina Polak
a
,
*
, Tadeusz J´
oze Rudek
a
, Ma ia ´
Swią kiewicz-Mo´
sny
a
,
Alis ai Ande son
b
, Ma lies Bocks al
c
, Luigi Ga iglio
d
, Ja osla a Hasmano ´
a Ma h´
anko ´
a
e
,
Ana Pa ícia Hil´
a io
, P u Hobson-Wes
b
, Juliana Io io
, Aappo Kuusipalo
g
, Dino Nume a o
e
,
Alice Sca a da
d
, Ped o Alcˆ
an a a da Sil a
, E a Soa es Mou a
e
, Pia Vuolan o
g
a
Jagiellonian Uni e si y in K akow, Poland
b
Uni e si y o No ingham, Uni ed Kingdom
c
Uni e si y o Can e bu y, New Zealand
d
Uni e si `
a Degli S udi di To ino, I aly
e
Cha les Uni e si y in P ague, Czech Republic
Ins i u o de Ciˆ
encias Sociais da Uni e sidade de Lisboa, Po ugal
g
Tampe e Uni e si y, Finland
ARTICLE INFO
Handling edi o : Medical Sociology O ice
ABSTRACT
Al hough Co id-19 was no he i s pandemic, i was unique in he scale and in ensi y wi h which socie ies
esponded. Coun ies eac ed di e en ly o he h ea posed by he new i us. The public heal h c isis a ec ed
Eu opean socie ies in many ways. I also in luenced he way he media po ayed accines and discussed ac o s
ela ed o accine hesi ancy. Eu opeans di e ed in hei isk pe cep ions, a i udes owa ds accines and accine
up ake. In Eu opean coun ies, Co id-19- ela ed discou ses we e a he cen e o media a en ion o many
mon hs. This pape epo s on a media analysis which e ealed signi ican di e ences as well as some simila i ies
in he media deba es in di e en coun ies. The s udy ocused on se en Eu opean coun ies and conside ed wo
dimensions o compa ison: be ween he p e-Co id pe iod and he beginning o he Co id pandemic pe iod, and
be ween coun ies. The ich me hodological app oach, including linguis ics, seman ic ield analysis and
discou se analysis o mains eam news media, allowed he au ho s o explo e he se o meanings ela ed o
accina ion ha migh in luence ac o s’ agency. This app oach led he au ho s o ede ine accine hesi ancy in
e ms o cha ac e is ics o he “socie y in he si ua ion” a he han he psychological p o ile o indi iduals. We
a gue ha accine hesi ancy can be unde s ood in e ms o agency and empo ali y. This dilemma o choice ha
ans o ms he p esen in o an i e e sible pas and mus be aken in ela ion o an unce ain u u e, is pa ic-
ula ly acu e unde he p essu e o u gency and when someone’s heal h is a s ake. As such, i is linked o how
accine meaning is co-p oduced wi hin public discou ses.
* Co esponding au ho .
E-mail add esses: [email p o ec ed] (A. Wagne ), [email p o ec ed] (P. Polak), [email p o ec ed] (T.J. Rudek), ma ia.swia kiewicz-
[email p o ec ed] (M. ´
Swią kiewicz-Mo´
sny), [email p o ec ed] (A. Ande son), [email p o ec ed] (M. Bocks al), luigi.
[email p o ec ed] (L. Ga iglio), [email p o ec ed] (J. Hasmano ´
a Ma h´
anko ´
a), [email p o ec ed] (A.P. Hil´
a io), P u.Hobson-Wes @
no ingham.ac.uk (P. Hobson-Wes ), [email p o ec ed] (J. Io io), [email p o ec ed] (A. Kuusipalo), [email p o ec ed] (D. Nume a o), alice.
[email p o ec ed] (A. Sca a da), [email p o ec ed] (P. Alcˆ
an a a da Sil a), [email p o ec ed] (E. Soa es Mou a), [email p o ec ed]
(P. Vuolan o).
Con en s lis s a ailable a ScienceDi ec
Social Science & Medicine
jou nal homepage: www.else ie .com/loca e/socscimed
h ps://doi.o g/10.1016/j.socscimed.2024.116725
Recei ed 30 Oc obe 2023; Recei ed in e ised o m 19 Feb ua y 2024; Accep ed 23 Feb ua y 2024
Social Science & Medicine 346 (2024) 116725
2
1. In oduc ion
1.1. Vaccine hesi ancy
Vaccine hesi ancy is a long-las ing phenomenon. I is o en iden i ied
by policymake s as a h ea o public sa e y (E. Dub´
e e al., 2013, 2015;
Galagali e al., 2022). Li e ally, a hesi an pe son is de ined as: "slow o
begin o p oceed wi h an ac ion because o doub o unce ain y"
(Me iam-Webs e Dic iona y, n.d.). In heal hca e, howe e , a hesi an
pa ien is much mo e ac i e - e using o make a decision o choosing no
o be accina ed. The Wo ld Heal h O ganiza ion (WHO) de ines accine
hesi ancy as he delay in accep ing o e using sa e accines despi e he
a ailabili y o accina ion se ices (WHO, 2015). The “3 Cs” model,
based on com o , con idence and con enience, i s p oposed by he
WHO EURO Vaccine Communica ion Wo king G oup in 2011 (Mac-
Donald, 2015), implies bo h agency and passi i y. Vaccine hesi ancy can
be demons a ed no only by e usal, bu also by delay, slowness, and
selec i i y. The discussion on he de ini ion o accine hesi ancy ocused
mo e on he ac o s in luencing he a i udes o indi iduals, led o he
cons uc ion o " he se on a con inuum be ween hose who accep all
accines wi hou doub , o comple e e usal wi hou doub , wi h accine
hesi an indi iduals he he e ogeneous g oup be ween hese wo ex-
emes" (MacDonald, 2015). Howe e , i u ned ou no o be sensi i e
enough o de ec a signi ican di e ence be ween delay and e usal.
Those who decide o accina e bu emain scep ical o unce ain abou
hei decision also all ou side he scope o his de ini ion. The p oblem
o indi iduals’ agency and passi eness in accine hesi ancy was dis-
cussed in he li e a u e as ela ed o heal h capi al (Schneide -Kamp,
2022). We a gue ha hesi ancy, in a b oade sense, is abou he ways in
which agency is in ol ed in he s uc u ing o ime, pa icula ly he
ela ionships be ween pas and u u e. The decision o accina e ende s
his momen in ime pas . I is i e e sible. Hesi a ion, in i s nominal
sense, is held be ween an i e e sible e en in he pas and he open
possibili y o an unce ain u u e. O cou se, his eeling o being sus-
pended in ime is illuso y - no deciding is also a kind o decision
(Rabiej-Sienicka e al., 2022; Rudek and Huang, 2024; Rudek and
Huang, 2023a,b), e en i he indi idual is no awa e o i . Time and
empo ali y as a key o unde s anding meaning-making o an unce ain
u u e in he con ex o he pandemic ha e ecen ly been discussed in
a ious ways (Chan e al., 2021; Tab izi and Le ina, 2022). The ecen
wo k o Ha ison e al. (2022) pa icula ly highligh ed he impo ance o
using ime in cons uc ing e idence o he sa e y and e iciency o
Co id-19 accines. This wo k has opened a new way o hinking abou
he ela ionships be ween accine hesi ancy and ime. Ne e heless,
he e is s ill a gap in knowledge abou hesi ancy, which can be unde -
s ood no only as a p ocess consis ing o di e en phases (Kuma e al.,
2022), bu also as a p ocess ela ed o mo e gene al empo al s uc u es:
pas , p esen , and u u e o ien a ion o human agency.
The aim o his pape is o be e unde s and how accine hesi ancy
can be co-p oduced h ough media discou ses. Ra he han analysing
accine hesi ancy as i is di ec ly discussed in mass media discou ses, i
examines how di e en ac o s isible in he public sphe e mobilise
symbolic esou ces (knowledge alida ion, au ho i y, alues, powe ) o
make sense o accines. We sugges ha he meaning-making p ocess
a ound accines is in e wined wi h accine hesi ancy. Acco ding o
ecen s udies, he sou ces o in o ma ion used by pa ien s can play an
impo an ole in accine hesi ancy and decision-making (Masche ini
and Ni akoski, 2022). Media discou ses, which simul aneously e e o
ac ual ci cums ances and specula e abou possible scena ios, con ibu e
o socially sha ed de ini ions o he si ua ion (Thomas, 1923), embed-
ding he accine somewhe e be ween ac uali y and po en iali y. Time,
and in pa icula he way people li e and expe ience i , is a key elemen
in hese p ocesses (Ha ison e al., 2022), especially because he media
can cons uc u gency, o con e sely, c ea e he condi ions o delaying
decision-making.
1.2. Vaccine discou ses and empo ali y
One no ion ha migh cla i y how a accine is de ined is agency. We
e e o Emi baye and Mische (1998), who unde s and agency as a
‘ empo ally embedded p ocess o social engagemen ’, in o med by un-
de s andings o he pas , p esen and u u e. Inspi ed by Hicks and Lloyd
(2022), we concen a e no on in o ma ion li e acy bu on discu si e
p ac ices ha cons uc social meaning in ela ion o empo al aspec s.
The e o e, he ela ional phenomenon o agency highligh ed by he
au ho s is pa icula ly ele an . The connec ions be ween indi idual
es imonies, ins i u ional da a and ope a ing wi h pa e ns ela ed o he
whole popula ions a e a he co e o media communica ion. Ope a ing
wi h he o de s o ime c ea es na a i es ha con ibu e o he con-
s uc ion o meaning. The pas cons i u es expe ience. The p esen con-
s uc s he need o u gen ac ion, which i ejec ed, o esis ed can lead
o delay. In u n, he u u e, which opens up he possibili y o ac ion, is
linked o una oidable unce ain ies. Vaccina ion as a social p ac ice is
oo ed in all empo al dimensions: he pas p o ides he e idence o i s
e ec i eness in o e coming o educing he “old” diseases, he p esen
ames i h ough p ocedu es and ou ines, while he p e en i e na u e
o accina ion makes i look ahead.
This pape ocuses on media discou ses no as an e ec on he
audience, bu as a ep esen a ion o he public sphe e. This means ha
we de ine he public sphe e as a communica ion space shaped by speci ic
no ma i e ules abou who should pa icipa e, on wha occasions, wha
he o m and con en o hei con ibu ions o public discou se should
be, and how ac o s should communica e wi h each o he (Fe ee e al.,
2002).
In his s udy, we compa e how he meaning o accines was con-
s uc ed in se en Eu opean coun ies in he pe iods be o e and du ing
he Co id e a by analysing he media discou ses in each coun y. The
mains eam news ou le s, which a e widely dis ibu ed, a e ea ed as
communica ion spaces whe e speci ic knowledge is o med based on he
co-p oduc ionis in e ac ion be ween echnology and socie y. The Co id-
19 pandemic was an unexpec ed e en ha o ced he powe ins i u ions
o all Eu opean socie ies o eac immedia ely, e-p io i ising he public
deba e on accines and s imula ing agency. As such, he pandemic
c ea ed a unique oppo uni y o sys ema ically obse e how he expe -
ise p o ided by a ious ins i u ions me people’s expe iences, expec-
a ions, alues, ea s, and desi es as e lec ed in media discou ses.
2. Vaccine hesi ancy and he media
Vaccine hesi ancy has long been s udied in he social sciences in he
con ex o a ious accina ion p og ammes ( lu, HPV and o he s) and
childhood accina ion p ocedu es. This phenomenon was explained
h ough indi idual psychological cha ac e is ics (pe cep ion o disease
as high o low isk) (MacDonald, 2015), us in he au ho i y o science
(S u gis e al., 2021), c i ical hinking skills (Canni o e al., 2022), o
h ough socie al a iables such as us in he heal hca e sys em and
medical ins i u ions (Mesch and Schwi ian, 2019).
Fo a long ime, accine hesi ancy has been unde s ood in he ligh o
he cogni i e de ici heo y (E. Dub´
e e al., 2015) as a consequence o
people’s igno ance, lack o expe ise, and lack o c i ical hinking
(Canni o e al., 2022). This claim has ecen ly been unde mined by
unde s anding he posi ion o accine hesi ancy as a p oblem ha
canno be sol ed by simply communica ing mo e in o ma ion on ac-
cines - and by jus ea ing accine hesi an people as manipulable (`
E.
Dub´
e e al., 2021). Media communica ion is a majo ocus o esea ch on
accine hesi ancy (c . (Hicks and Lloyd, 2022)), and is o en blamed o
uelling i , o example by ocusing on he sca y and emo i e s o ies
associa ed wi h accina ion. Media sou ces a e also accused o p o-
mo ing cogni i e biases and alse objec i ism, leading o accines being
p esen ed as con o e sial and aking a posi ion on hem as pa o a
wo-sided deba e (E. Dub´
e e al., 2018). Vaccine-hesi an people a e hus
unde s ood as passi e audiences a ec ed by he media na a i es. In
A. Wagne e al.
Social Science & Medicine 346 (2024) 116725
3
pa icula , accine-hesi an pa en s a e o en blamed o i esponsible
delays in immunisa ion, which has ecen ly been ecognised as a o m o
epis emic injus ice (Cassam, 2023).
Con e sely, o he s udies ha e demons a ed ha accine-hesi an
pa en s a e o en highly educa ed and scep ical owa ds heal h au ho -
i ies. They eel ha hey a e no ep esen ed in he public deba e and
he e o e c ea e hei own “islands” in he al e na i e, usually online,
media sphe es (´
Swią kiewicz-Mo´
sny e al., 2023). Fu he mo e,
Hobson-Wes wo k has e ealed he consciousness and agency o
accine-hesi an and accine-c i ical pa en s, unde lining he ole o isk
and unce ain ies (Hobson-Wes , 2003), and how Vaccine-C i ical
G oups ques ion he idea o blind ai h in public heal h ad ice (Hob-
son-Wes , 2007). Vaccine hesi ancy can also be seen in he ligh o ci ic
epis emologies (Jasano , 2007; Mille , 2004), which desc ibe he in-
luence o socie al expec a ions owa ds knowledge p oduc ion and on
he handling o unce ain y (Rudek e al., 2023b).
The Co id-19 ou b eak added new h eads o he accina ion deba e.
In he i s phase o he pandemic, he main ocus was on p oducing an
e ec i e accine and hen adminis e ing i in a ai and non-exclusi e
way. Ad oca es o accina ion as a public heal h in e en ion a gued
ha high accina ion co e age was he sa es way o ensu e he d im-
muni y (Canni o e al., 2022; Cecca o e al., 2021). The s udy o accine
hesi ancy a he ime o Co id-19 p o ided a mo e nuanced pic u e o
how in o ma ion li e acy was used by people o in o m hemsel es abou
accines, concluding ha “ accine-hesi an and hesi an -in luenced ac-
ions consequen ly o m an agen ic, in o med pe o mance ha cen es
on p o ec i e and delaying s a egies” (Hicks and Lloyd, 2022).
Ou pape adds he empo al dimension o his deba e, de ining
accine hesi ancy in he con ex o he ela ionship be ween pas and
u u e. Recei ing a accine makes his poin in ime belong o he pas
and a he same ime de e mines he u u e (in e ms o p o ec ion o
ad e se e ec s). As men ioned abo e, i is i e e sible. Thus, hesi ancy
is ela ed o he agency ha is main ained be ween an i e e sible, pas
e en and an open possibili y o he u u e.
Ci izens o en de i e hei con idence om p e-exis ing us e-
la ionships, including hei social ne wo ks, heal hca e p o essionals,
and public ins i u ions o biomedical knowledge (Goldenbe g, 2021;
La son e al., 2018). Some s udies indica ed a ole o , among o he s,
educa ional backg ound, and employmen s a us (Malik e al., 2020),
while o he s ound household income o be a s a is ically signi ican
p edic o o willingness o ecei e Co id-19 accina ion (Mu phy e al.,
2021). An in-dep h s udy o Co id-19 hesi ancy in he Uni ed Kingdom
epo ed an impo an ole o o icial ecommenda ions, social no ms
abou accina ion, and pe cep ions o e ec i eness, isk, and ease o use
(She man e al., 2021). Media discou ses can be a ehicle o he
co-p oduc ion o hese belie s. They can also con ibu e o inc eased
unce ain y abou he s eng h o he scien i ic e idence o o agains a
pa icula isk (Capu o e al., 2018; Dixon and Cla ke, 2013). The
analysis p esen ed he e examines how he media co-p oduce he de i-
ni ions o accines and accina ion in speci ic si ua ions (be o e and
du ing he pandemic). In o de o answe his gene al esea ch ques ion,
we p opose some speci ic ones:
- Wha a e he de ini ions o accines co-p oduced by he media and
how do hey ela e o agency?
- Which social ac o s a e p i ileged o ha e a oice and how do hey
ela e o each o he ?
- How is he agency o ac o s in e wined wi h empo ali ies?
This a icle also examines which esou ces suppo ac o s’ posi ions
and how hey a e linked o exp essed public expec a ions. Finally, i
econs uc s how jus i ica ion is imagined in ela ion o accina ion and
how i has been a ec ed by he u gency o he pandemic. Focusing on
he widely isible mains eam media, he pape explo es how accine
agency can be co-p oduced h ough ela ed meanings.
3. Ma e ials and me hods
The esul s p esen ed he e a e pa o a la ge esea ch p ojec VAX-
TRUST. The p ojec , unded by he Eu opean Commission unde Ho izon
2020, was di ec ly ela ed o he s udy o accine hesi ancy, and was
conduc ed in 7 Eu opean coun ies (Belgium, Czech Republic, Finland,
I aly, Poland, Po ugal, UK) selec ed o hei geog aphical, cul u al and
economic di e si y. Fo his pape , we e e only o he pa de o ed o
public discou ses in all 7 Eu opean coun ies.
The analysis ollowed a mixed-me hods app oach, beginning wi h
quan i a i e da a analysis, ollowed by quali a i e da a analysis. P o-
alis so wa e (Wo dSTAT) suppo ed he quan i a i e phase, while
manual quali a i e analysis was ca ied ou using NVi o so wa e. In
line wi h he p inciple o objec i i y, subjec i e e alua ions we e
excluded unless explici ly s a ed as such. Da a we e ga he ed om se en
coun ies: Belgium, he Czech Republic, Finland, I aly, Poland, Po ugal,
and he UK. Fo each coun y, accine- ela ed keywo ds and accina ion
discou ses we e iden i ied (see Appendix 1). Subsequen ly, he e ie ed
ex s we e ca ego ised on he basis o wo analysis pe iods: be o e he
WHO decla ed he s a o he Co id-19 pandemic (01/04/2019-03/10/
2020) and a e he announcemen (11/03/2020-10/04/2021). I is
impo an o no e ha his analysis pe iod includes he ea ly phase o he
pandemic. I is also wo h men ioning ha by he ime he da a collec-
ion o he analysis was comple ed, Co id accines we e no ully
a ailable in mos coun ies. This s udy he e o e encompasses he ini ial
s ages o nego ia ing he signi icance o new accines and es ablishing
media depic ions o hem. The P ess Se ice collec ed da a be ween
Ap il 01, 2019 and Ap il 10, 2021. Appendix 1 con ains a de ailed lis o
he media analysed, while Appendix 2 p o ides a comp ehensi e
desc ip ion o he analysis p ocess.
Wi hin he o e all amewo k o c i ical discou se analysis, his s udy
is based on explo a o y linguis ic analysis, seman ic ield analysis, and
con ex ual analysis. This h ee-way me hodology enabled us o ocus no
only on he con en ( accine de ini ions, ac o s, esou ces), bu also on
he o m o exp ession (how hese elemen s we e p esen ed, in e linked,
e alua ed). Seman ic ield analysis allows esea che s o cap u e he
meanings con eyed in wo d ne wo ks, including how wo ds ela e o
each o he in e ms o synonyms, opposi es, and associa ions. I also
e eals he hidden o ces unde lying he linguis ic s uc u es o he
concep s unde s udy. This is in line wi h Fai clough’s (2010) iew o
c i ical discou se analysis, which s a es ha i should encompass wo k
wi h language a mul iple le els: linguis ic, ex ual (including s a egies
o ep esen a ion in he ex , such as he oles o membe s o a discou se
communi y and hei in e ela ionships), and con ex ual. I s goal is o
econs uc social o ma ion and i s ans o ma ions (wi h ep esen a-
ions o social ac o s, esou ces, and hei use). Focusing on agency, his
s udy examined indi idual and social ac o s associa ed wi h accina-
ion in discou ses. The ca ego ies o coding hese ac o s we e aken
om he scien i ic li e a u e on accine hesi ancy. Indi idual ac o s
included e e ences o accine conside a ions, emo ions, expe iences,
and pe sonal belie s, while social ac o s pe ained o sha ed knowledge
(and non-knowledge), isk, alues, g oup in e es s, igh s, laws, and
social imagina ies.
4. Resul s
4.1. F om he u u e-d i en discussion o disease p e en ion o he
e ec i e go e nance o accine dis ibu ion in he he e and now
This sec ion p esen s he syn hesis o he esul s ob ained in all he
phases o he analy ical wo k in a compa a i e pe spec i e: explo a o y
linguis ic esea ch, seman ic ield analysis, and in-dep h analysis o he
agency o ac o s ela ed o accine and accina ion and i s empo al
aspec s.
The linguis ic analysis aimed a a ce ain explo a ion o he da a.
Using he compa a i e lens, we made some ca e ul p elimina y
A. Wagne e al.
Social Science & Medicine 346 (2024) 116725
4
conclusions abou he simila i ies and di e ences in he shi s o accine
discou ses a ec ed by he Co id-19 pandemic ( ega ding he con ex ual
and linguis ic speci ici ies o each coun y). These we e hen asce ained
in a quali a i e analysis.
Fi s , as could be expec ed, accine discou ses became Co id-19-
cen ed du ing he pandemic. In i s ea ly s age, we no iced a signi i-
can inc ease in he equencies o wo ds ela ed o Co id and co ona-
i us in discussions on accines and accina ion (Fig. 2), bu also o he
accine-p e en able diseases ha we e p esen in he p e-pandemic
discou ses (Fig. 1) we e ma ginalised.
The e we e also mo e wo ds ela ed o accine p oduc ion (As a-
Zeneca, P ize /BioNTech, labo a o y, con ol, p ocedu e, expe imen s, e i-
ciency, new echnology, mRNA, egula o s), es ing ( ials, isk, e idence,
sa e y, e ec s, da a, side e ec epo ing) dis ibu ion (doses, hospi als,
accina ion spo s, p ice, a ailabili y) and managemen o accines (p e-
en ion, phases, s a e o eme gency, logis ics, supply, s a , popula ions) in
he analysed pe iod o he Co id-19 pandemic. In all he discou ses
analysed, we also obse ed a highe equency o wo ds ela ed o he
s a e and go e nmen ep esen a i es. This could indica e a mo e
adminis a i e ype o discou se, ocusing on he go e nance o acci-
na ion. Indi idual expe s we e no men ioned as o en as be o e he
pandemic, while he wo k o scien i ic eams, labo a o ies o esea ch
cen es was inc easingly epo ed du ing he pandemic.
Wo ds conno ing empo ali ies (now, oday, soon, oo la e, u gen ,
u gen ly), mo e equen in all languages in he pandemic ime dis-
cou ses, sugges he p essu e o ime. Howe e , his would equi e
u he linguis ic esea ch, aking in o accoun he speci ici y o na ional
languages.
The mos isible change was he eo ien a ion o he de ini ion o
accina ion issues as mainly ela ed o pa en al decisions a ec ing
child en (less o en - as in he case o in luenza - o senio ci izens’ de-
cisions). Du ing he pandemic, p e en i e accina ion became one o
he ho opics o all publics and an issue di ec ly ela ed o all socie al
g oups.
The shi om discussing accine-p e en able diseases o discussing
ypes and p oduce s o accines (wi hin he hegemony o one disease)
was also no iceable in all coun ies. Be o e he pandemic, he names o
accine manu ac u e s we e ha dly men ioned, whe eas du ing Co id-
19, b ands such as As aZeneca, P ize , Mode na, e c. appea ed.
4.2. Towa ds a common meaning - seman ic ields o a accine in
mains eam discou ses
The compa a i e analysis o seman ic ields is limi ed by he lan-
guage speci ics ha go beyond he nominal meaning o wo ds.
1
The
de ini ions econs uc ed by he coun y eams we e ansla ed in o
English, and e en i he coun y au ho eams discussed hem ca e ully,
awa e o he challenges o ansla ion, some o he nuances may ha e
been los . Ne e heless, he ma e ial collec ed, and he seman ic de i-
ni ions econs uc ed shed ligh on how accines ela ed o he su -
ounding social eali y and we e a good s a ing poin o unde s anding
he ole o social and indi idual ac o s in accine discou ses.
The e o e, he compa ison o seman ic ields aimed a iden i ying he
phenomena, including ac o s o ins i u ions, bu also igu a i e lan-
guage ha con ibu ed o he c ea ed meaning o accines in he ana-
lysed discou ses. The seman ic ield analysis allowed us o see and
compa e how accines we e ep esen ed in he mains eam media and
p o ided us wi h a compila ion o iews on accines. These iews
di e ed and compe ed o isibili y wi hin each sample. Howe e , he e
we e also signi ican simila i ies be ween he coun ies analysed in how
accines we e de ined in mains eam discou ses, bo h be o e and du ing
he pandemic.
4.2.1. P e-co id de ini ions
In he p e-Co id pe iod, accines we e o en p esen ed in he his-
o ical con ex o educing o elimina ing/e adica ing se ious diseases.
Vaccines we e desc ibed as “sa e y bel s” (Czech Republic), o in e ms
o igh s, as a ci izens’ p i ilege (Finland). In Poland, accines we e also
associa ed wi h addi ional bu mo e speci ic p i ileges, such as ex a
poin s in kinde ga en admissions. In gene al, posi i e associa ions wi h
ci ic and scien i ic p og ess p edomina ed in all coun ies. The sa e y
and e ec i eness o accines we e emphasised, mainly in e ms o in-
di idual p e en ion and public heal h p o ec ion. The main de ini ional
h eads obse ed in all coun ies included: 1) accine as an achie emen
o ci ilisa ion; 2) accine as a ool o con ol old diseases, an e icien
“weapon” agains diseases; and 3) accine as a p e en i e bene i o he
whole popula ion (sa e y bel s, p o ec i e umb ella). A he same ime,
accines we e po ayed as h ea ened by ake news (con ol o in o -
ma ion) and an i- accina ion mo emen s. The ollowing example om
he UK shows how hose mo emen s’ ac ions may pu li es and heal h o
child en a isk by con ibu ing o a dec ease in accina ion a es:
“As I wa ched he ilm, I wonde ed i he e’s some hing o lea n he e
abou how we challenge he an i- accine conspi acy heo ies whose
esu gence is pu ing child en’s li es a isk. The Wo ld Heal h O -
ganiza ion his yea anked he an i- accine mo emen in i s op 10
global heal h h ea s, while UNICEF has highligh ed he low acci-
na ion a es ha ha e con ibu ed o a 30% global inc ease in
measles in ec ion a es in jus one yea ” (UK, The Gua dian,
28.04.2019).
Vaccine was also a subjec o aking ac ion ( accines mus be sup-
po ed, p omo ed, should be obliga o y), pu in he cen e o a en ion o a
numbe o di e en ac o s. Fo example:
(Ou goal is) “ o mo e he sys em o compulso y accina ion in he Czech
Republic away om senseless poli ically mo i a ed ep ession owa ds
Fig. 1. Pe cen age o ex s men ioning diseases in he p e-Co id pe iod.
Fig. 2. Pe cen age o ex s men ioning diseases in he Co id pe iod.
1
The de ailed econs uc ion o he seman ic ields o accines in each
coun y can be ound in he anonymised epo .
A. Wagne e al.
Social Science & Medicine 346 (2024) 116725
5
g ea e eedoms and g ea e secu i y o accina ion” (Czech, zp a y.
iDNES.cz, 22.01.2021).
A he same ime, in mos o he coun ies in ol ed, he mains eam
discou ses be o e Co id p esen ed accines as po en ially suspec and
some imes linked hem o side e ec s. The main di e ence be ween he
p e-Co id and Co id pe iods was he deg ee o isibili y o accine-
scep ical posi ions. While he mos isible de ini ions unde lined he
ac i e p o ec ion p o ided by a accine ( accines elimina e diseases,
educe isks, p o ec , immunise, e c.), he scep ical posi ions owa ds
accines we e less equen ly epo ed in he mass media. Coun e -
na a i es appea ed in mains eam discou ses as pe cei ed oices
agains compulso y accina ion, o example in de ence o indi idual
eedom and o he igh o make in o med choices:
“I am no an an i- axxe , I am jus igh ing o he sa e y o accines and
independen knowledge (Poland, Wybo cza.pl, 29.09.2019), o
appealed o peoples’ sense o com o :
"People mus eel com o able when hey decide o ge accina ed"
(Po ugal, Publico, 12.06.2019).
In e es ingly, hose coun e -na a i es, which a e e e ed o, ac u-
ally in oked some o he mos basic alues and igh s. Those we e he
igh s ha no only should be he pilla s o accina ion p ocesses, bu
also cons i u e he co e o pa ien s’ igh s (see: eg. Peled-Raz, 2017). like
eedom o choice o bodily in eg i y.
Howe e , hese dissen ing oices we e a ely discussed. In some
coun ies, such as Poland, hesi an pa en s we e s ongly c i icised:
Pa en s who do no accina e pose a isk o hei own and o he child en.
(Poland, One .pl July 01, 2019). In Belgium, he coun e -a gumen s we e
ejec ed by c i icising hei unscien i ic na u e: “The ‘an i- axxe s’ a e
a aid ha hei child en will become au is ic because o he accines o
de elop lea ning p oblems, o hey belie e ha hei child en will become
s onge i hey go h ough he disease hemsel es. The g oup seems insensi i e
o scien i ic a gumen s ha his is nonsense” (Belgium, DS,Ap il 15, 2019).
This way o e u ing a gumen s seems o p o oke e en mo e ques ions,
ins ead o add essing any possible doub s, appa en ly no eally ecog-
nised in he media discou ses.
Howe e , in o he coun ies, accines we e some imes associa ed
wi h isks and jus i ied doub s.
“He also said i is un ai o label dissen e s as ’ex emis s’ and ’an i-
axxe s’ when hey a e conce ned abou he heal h and wel a e o
hei child en” (UK, Daily Mail, 10.09.2019).
This quo e om he UK shows ha some discou ses showed mo e
unde s anding o hesi an pa en s. Indeed, he e we e no iceable di -
e ences in he pola isa ion o posi ions owa ds accines in na ional
media discou ses. In some coun ies, such as Belgium, he opposing
oices we e mo e mode a e, unde lining he isks o unp o en e icacy:
“Flu is a po en ially deadly disease, especially o ulne able popula ions,
accina ion is a simple p e en i e measu e, bu wi hou ull p o-
ec ion”(Belgium,DS,Feb ua y 19, 2019), while in o he coun ies he
scep ical oices we e p esen ed as mo e adical, some imes e en
e oking associa ions wi h genocide o unjus i ied expe imen s on chil-
d en (I aly, Poland): “Vaccines? A ee genocide” (I aly, co ie edel ene o.
co ie e.i , June 27, 2019).
This led o a highe o lowe deg ee o pola isa ion o he de ini ions
o accines in he public sphe e. The seman ic ield de ini ions, e en i
s ongly posi i e and pe suasi e in he mains eam discou ses, e lec ed
mo e pola ised a i udes owa ds accines in he Czech Republic, I aly,
Poland, Po ugal. He e a e some examples:
“Vaccines a e he sa e y bel o he wo ld” (I aly, co ie e.i ,
30.01.2020) s “The accine we a e expe imen ing wi h is he concen-
a e o ou des iny and con ains he code o ou u u e” (I aly,
epubblica.i , 03.01.2021).
“The accine is a g ea chance o immunise he socie y agains in ec ion,
i ’s a hope o e u n o no mali y (Poland, wybo cza.pl, 10.01.2021) s.
“We didn’ o icially know he composi ion, side e ec s and con aindi-
ca ions. We didn’ know any hing abou he co ona i us accine. I
someone was looking o in o ma ion, hey used he In e ne o he o eign
p ess” (Poland, se.pl, 28.12.2020).
Meanwhile, in he UK and Finland, he c ea ed meaning o he ac-
cine add essed ensions in a mo e nuanced way:
“And we know ha he in oduc ion o new accines has no always
been ouble- ee. In 1955 in he US, he e we e mo e han 40,000
cases o polio — and en dea hs — in child en gi en a de ec i e
accine. […] Bu we should also emembe ha mode n accines a e
sa e han e e , and we should also ake con idence in he ac ha
P ize ’s agen […] is building on esea ch o e 20 yea s in o s ains
o co ona i us ha cause Sa s and Me s” (UK, Daily Mail,
10.11.2020).
In Belgium, coun e -a gumen s agains accina ion in he p e-Co id-
19 sample we e mos ly ejec ed by c i icising hei unscien i ic na u e:
"The well-known i ologis Ma c Van Rans was allowed o speak,
and he pa ied he s a emen s o he gene al p ac i ione : Apa om
some edness a he si e o he injec ion and some e e a ew days
la e , he e a e no side e ec s. And people who claim ha his leads
o au ism a e mis aken. I has no hing o do wi h medicine, i has o
do wi h sca e ac ics” (Belgium HLN,11.4.19).
In Poland and I aly, accine hesi ancy was o en associa ed wi h a
lack o p ope knowledge. A he same ime, “educa ed” pa ien s we e
p aised. Howe e , being “educa ed” was only associa ed wi h aking a
p o- accine a i ude:
“I a pa ien uses p o en knowledge, i is much easie o make join de-
cisions. An educa ed pa ien is a e y aluable pa ien (Poland, one .pl,
20.09.2019),
Simila ly, in I aly accine hesi ancy was unde s ood as
i esponsibili y:
“Those who do no accina e hei child en a e sel ish people. By
ollowing hei igno ance and supe s i ion, hey a e ha ming hei
child en and socie y” (I aly, co ie edel ene o.co ie e.i ,
19.06.2019).
The p e ious quo e demons a es a end ha was p e iously
men ioned – a comple e ejec ion o hose who ha e doub s. This di-
ec ion in discou ses has esul ed in ex eme pola isa ion, e ec i ely
e adica ing any doub s (including hose o accine hesi an indi iduals)
om mains eam media discussions.
4.2.2. The beginning o Co id-19
In his sec ion, we summa ise he simila i ies ound ac oss all 7
coun ies. I is mos ly based on he igu a i eness o he na ional lan-
guages and due o space limi a ion i is no possible o p o ide de ail
exempli ica ions. The in e p e a i e analysis led us o he conclusion
ha a he beginning o pandemic, he au ho i y o science was associ-
a ed wi h hope and a e u n o a "no mal" u u e. The popula me apho
o he “weapon” was no always exp essed di ec ly bu was sugges ed by
exp essions such as “winning he ba le”, “in isible shield” o “de ence
agains a ack”. In mos o he discou ses analysed, he accines agains
Co id-19 we e desc ibed using hese me apho s:
● accine as a weapon agains he new i us.
● accine as a way o e u n o no mali y.
● accine as a passpo o a secu e u u e.
● accine as an ac o solida i y.
● accine as a game change .
A. Wagne e al.

Social Science & Medicine 346 (2024) 116725
6
A he same ime, he sa e y and a ailabili y o accines was
unde mined by:
● ush in scien i ic esea ch and p oduc ion.
● compe ing coun ies and g oup in e es s.
Due o he pandemic, he de ini ions o accine we e mo e closely
ela ed o Co id-19. We obse ed mo e e e ences o economy, poli ics,
o accine p oduc ion p ocesses. The dominan one o he mains eam
discou ses emained mainly posi i e and pe suasi e (encou aging
accina ion in he name o public sa e y and solida i y), bu he coun e -
oices became mo e isible in all coun ies. On he one hand, in addi ion
o he p e ious cha ac e is ic, we obse ed a g ea e ocus on he u u e
and hope. Vaccines – s ill p esen ed as scien i ic achie emen s, es ed
and sa e bio echnological p oduc s - we e imagined as a passpo o a
sa e u u e, a chance o e u n o no mali y and s abilise na ional eco-
nomic and social li e. On he o he hand, elemen s o scep ical coun e -
na a i es, e lec ed in he accine seman ic ields, poin ed o un-
ce ain ies and possible side e ec s in all he coun ies conside ed.
Alongside he emphasis on he scien i ic na u e o accine p oduc ion,
he issue o p oduce s’ p o i s became mo e isible. In e es ingly, in all
he econs uc ed pandemic de ini ions, we obse ed elemen s e e ing
o he ole o he s a e adminis a ion in accine managemen . Some-
imes hey we e c i ical, calling o be e o ganisa ion o accine dis-
ibu ion o p omo ion, some imes hey s essed he need o p ope
egula ion and e e ed o he public good, unde s ood as he sa e y o
he popula ion. The la e was ela ed o he con o e sy: s a es as eg-
ula o s e sus exe ing con ol o e he popula ion.
In he Czech Republic, Finland and Poland, he geopoli ical aspec s
appea ed in he seman ic de ini ions. This was clea ly linked o suspi-
cions abou Russia and he Russian accine.
”He asce ained ha he pu chase o Spu nik V was like ’spi ing in he
ace o Eu opean pa ne s’” (Poland, wybo cza.pl, 2.03.2021).
“[a ep esen a i e o he EMA] wa ns agains ushing o app o e he
Spu nik V accine: "I ’s like playing Russian oule e” (Finland, hs. i,
09.03.2021).
“S ong poli ical wo ds ha e al eady been add essed o Spu nik; o
example, he head o Uk ainian diplomacy, Dmy o Kuleba, called i
a ’hyb id weapon o Russia agains Uk aine’’’ (Czech, zp a y.iDNES.
cz, 08.01.2021).
Such sen imen s seem o e lec a b oade geopoli ical ou look and
esen men s owa ds Russia. Al hough beyond he scope o his a icle,
such a i udes would be wo hy o u he and mo e in-dep h analysis.
In Belgium, I aly and Po ugal, accines we e mos o en linked o
global issues such as wo ld solida i y o sus ainable de elopmen .
“We a e conce ned ha wi hou uni e sal, sus ainable, and equi able
access o medical ools, he pandemic will las longe , se e ely
impac ing no only people, bu also he abili y o heal h sys ems o
p o ide immunisa ion, ca e and ea men o o he diseases, causing
mo e dea h and su e ing. Ending he monopolies aims o pu li es
be o e p o i s, which is why we a e calling on coun ies o ac quickly
and make i a eali y” (I aly, il a oquo idiano.i , 16.01.202).
In Finland, Poland and he UK, he elemen o na ional in e es
appea ed, as in he ollowing examples:
“He added ha Polish ci izens ‘will ha e gua an eed access o a Co id-19
accine” (Poland, one .pl, 25.11.2020).
“Populis P esiden Vucic [o Se bia] c i icised he EU o ese ing
accines o i s own ci izens and igno ing poo e na ions” (Finland, yle. i,
03.02.2021).
The peak o he accine c isis, wi h a soa ing demand and an insu -
icien and abo e all unce ain supply, esul ed in he ecall o in e es s.
In some coun ies hese we e pa icula , na ional in e es s, while in
o he s, a mo e p o-egali a ian and inclusi e e lec ion appea ed.
Looking a he na ional seman ic ields o he accine c ea ed by he
mains eam discou ses du ing he pandemic, we can dis inguish se e al
dimensions:
• accine as a biomedical p oduc : p oduced, es ed, managed,
dis ibu ed accine as a public good, as such should be widely
accessible, anspa en ly in o med abou
• accine as an oppo uni y o o e come he pandemic and e u n o
no mali y.
• accine as a scien i ic achie emen ha p o ec s li e.
• accine as a commodi y ha b ings p o i s and is pa o an economic
compe i ion be ween companies.
• accine as a poli ical ool o be used a he na ional and global le els.
• accine as being h ea ened by he an i- accina ion mo emen s.
These dimensions we e in ol ed in he con o e sies conce ning:
•con ol o he popula ion
•gene ic modi ica ion and unknown side e ec s
•hidden in e es s o poli ical eli es and p i a e companies
• he p opaganda o he dominan mass media
4.3. Mass media accine discu si e landscapes
We begin his pa o he analysis by iden i ying he ac o s who we e
isible in he public sphe e, aking in o accoun hose who we e ma -
ginalised o emained in isible. Focusing on he ac o s in ol ed in he
discou ses, we also in es iga e hei ela ionships, he esou ces used,
and he social and indi idual ac o s ha in luenced accina ion de-
cisions. Finally, we econs uc he empo al aspec s in which hei
agency was oo ed.
4.3.1. Ac o s
We ha e dis inguished i e g oups o ac o s (Fig. 3) in bo h pe iods o
analysis. In his sec ion we b ie ly discuss each g oup and show how he
pandemic ou b eak changed he accine discu si e landscape.
Fig. 3 illus a es how some g oups gained isibili y and powe
h ough inc eased ecogni ion, while o he s we e ma ginalised o
igno ed. Ac o s employed di e se communica ion s a egies, used
symbolic esou ces and buil ela ionships in di e en ways. I was
he e o e c ucial o examine which ac o s we e isible in media dis-
cou ses in o de o iden i y di e ences and simila i ies in he con igu-
a ion o signi ican ac o s ac oss coun ies.
4.3.1.1. In e na ional o ganisa ions. Du ing he pandemic, in e na ional
bodies became mo e isible in all analysed media discou ses. The WHO
and he Eu opean Medicines Agency (EMA), which in he p e-pandemic
discou ses we e mainly men ioned as ins i u ions p o iding de ini ions,
hygiene ecommenda ions and some basic educa ion, we e mo e o en
men ioned by go e nmen al ac o s as main sou ces o in o ma ion. They
we e used as au ho i y igu es in pe suasi e p o- accine discou ses. In
gene al, hese in e na ional o ganisa ions amed he agency wi hin a
cogni i e amewo k ha legi imised accines as scien i ic achie e-
men s ha me public expec a ions ( alida ed, socially use ul knowl-
edge). They se ed as en y poin s o aming accines as uni e sal,
sup ana ional goods o humani y. In e es ingly, his kind o p e en i e
ac ion was based on bo h he pas expe ience (old diseases, collec i e
memo ies o p e ious pandemics) and u u e o ien a ion, which mean
ha a e u n o he pas could no be allowed.
In some coun ies, such as Belgium, Finland, and Poland, he WHO
played an impo an ole in he ea ly s ages o he pandemic. I was
iewed as a powe ul en i y, decla ing he pandemic, c ea ing a sense o
u gency, and in luencing a common unde s anding o he cu en si u-
a ion. The EMA was men ioned in ela ion o accine egis a ion
A. Wagne e al.
Social Science & Medicine 346 (2024) 116725
7
p ocedu es and he issuance o accina ion guidelines. Such ac o s we e
used in discou ses o legi imise he p essu e o ime, which is e iden in
exp essions such as " igh ing agains ime" and " sh inking ime". P e-
iously, a e u n o he pas (old diseases) was undesi able, bu hen
" e u ning o no mali y" was one o he mos widely used ph ases
wo ldwide. This change in he pe cep ion o ime led o a ecogni ion o
u gency, which was essen ial o legi imise adical and apid changes
ac oss all le els, including popula ions, ins i u ions, and indi iduals.
Some coun ies e e ed o in e na ional ins i u ions o ame a mo e
global con ex o accina ion. Ga i (Global Vaccine Alliance) appea ed
in he communica ion (Finland, I aly) as a uni e sal need o p o ec
child en. The Belgian discou se e e ed o he WHO’s COVAX p o-
g amme and made i esponsible o he equi able dis ibu ion o Co id
accines wo ldwide.
Ne e heless, in he Czech discou se, he EMA, he WHO and he
Eu opean Union we e closely linked o he Na ional Vaccine S a egy,
p o iding s a is ical da a essen ial o he au ho i ies o manage he
immunisa ion p ocesses.
4.3.1.2. NGOs and local ac i is s. Na ional NGOs eme ged as ac o s wi h
mo e posi i e a i udes owa ds accina ion, some imes e en ad oca ing
o be e access o accines. This ype o agency was ela ed o widely
held alues o solida i y and public esponsibili y. Howe e , some imes
he same alues se ed o adop mo e scep ical posi ions. In he Czech
Republic, some o ganisa ions, such as “Medici PRO oˇ
cko aní” (Doc o s
o Vaccina ion), Uˇ
cen´
a spoleˇ
cnos ˇ
CR (Scien i ic Socie y o he Czech
Republic), o Mladí p ak ici (Young GPs) we e gene ally ‘p o- accina-
ion’, bu c i ical o he go e nmen ’s app oach o accines and he
accina ion p og amme.
Some NGOs we e ep esen ed in he discou se ou side he amewo k
o he agency. In Po ugal, he only NGO iden i ied as opposing
compulso y Co id accina ion, was no p esen as an ac i e ac o , bu
was only e e ed o, desc ibed, and idiculed by he o he ac o s. This
con as s wi h Poland. The STOP NOP associa ion, which ques ioned he
need o accina ion despi e being ac i e be o e he pandemic, was
igno ed by he mains eam discou se. This changed du ing Co id-19 and
his ac o became mo e isible. I also b oadened i s ac i i ies by
o ming wide “an i-pandemic” coali ions, e.g. wi h en ep eneu s and
o he s a ec ed by he pandemic es ic ions, wi h whom i p o es ed
agains he sani a y egime and accina ion.
4.3.1.3. S a e au ho i ies and public adminis a ion. S a e au ho i ies and
policymake s did no play a pa icula ly impo an ole in he p e-Co id
discou ses. Al hough he impo ance and isibili y o public policies and
adminis a i e ac o s di e ed, he same cen al pa e n p e ailed. Na-
ional ins i u ions, such as he Supe io Heal h Council o Belgium, he
Finnish Ins i u e o Heal h and Wel a e o he Sani a y and Epidemio-
logical S a ion (Sanepid) in Poland, ep esen ed s a e au ho i ies in he
p e-Co id discou ses: hey s ood as sou ces o knowledge on accina ion
co e age o de elopmen and we e desc ibed in he con ex o acci-
na ion inancing. In all coun ies, public heal h ins i u ions we e based
on he knowledge o academia, i ologis s, epidemiologis s, and in e -
na ional o ganisa ions.
Coun ies whe e childhood accina ion is compulso y, such as
Poland, p esen an in e es ing case. He e, he heal h au ho i ies we e
also a po en ial sou ce o en o cemen agains hose who did no
accina e hei child en. In I aly, heal h ins i u ions we e shown o be a
sou ce o law ha empowe ed school s a o en o ce legal equi emen s
o childhood accina ion. School s a as an ac o was unique in I aly.
He e, s a e au ho i ies based hei a gumen s on biomedical knowledge,
Fig. 3. The g oups o ac o s in ol ed in he accine discou ses ac oss coun ies.
A. Wagne e al.
Social Science & Medicine 346 (2024) 116725
8
o icial da a and s a is ics, and law. They p o ided heal h ins i u ions
and local school s a wi h a gumen s abou he dange s o non-
accina ion and jus i ied he need o block admission o schools o
kinde ga ens wi hou he equi ed accina ion eco ds.
Go e nmen s, poli icians, policymake s, and s a e o ganisa ions
became mo e isible in he pandemic discou ses. Go e nmen s had o
eac quickly, o mula e new ules, and o ganise a new "pandemic
o de ”, p o iding o icial s a is ics o keep he public in o med. Thei
main ask, ca ied ou in di e en ways in each coun y, became accine
managemen . Poli icians o en quo ed expe s o jus i y hei ac ions o
legi imise new ules. Fo example, he Czech s a e was po ayed as
being in ol ed in p omo ing accina ion, campaigns, supply, building
accina ion cen es and making decisions abou p io i y g oups, elying
on WHO and EMA ecommenda ions o c ea e he Na ional Vaccine
S a egy.
4.3.1.4. Expe s: academia and HCPs. Be o e he pandemic, academic
ac o s ( i ologis s, immunologis s) we e po ayed as expe s – in
possession o co ec and alid knowledge - in all he coun ies analysed.
Thei main ole was o espond o he a gumen s o accine opponen s,
using easoning based on scien i ic, usually biomedical, knowledge. A
he same ime, he oices o ac o s who disag eed wi h he expe s’
s a emen s we e ei he silenced, labelled, o idiculed. In e es ingly,
expe knowledge was ela ed o he isks associa ed wi h non-
accina ion. This pa e n cha ac e ised one o he mos common
communica ion s a egies in he p e-Co id samples. In Poland, some
expe s also men ioned he economic bene i s as an addi ional a gumen
in a ou o o a i us accina ion.
Co id-19 media discou ses s ill po ayed expe s as powe ul. They
ended o in luence go e nmen decisions and public opinion by
speaking om a posi ion o possessing legi ima ed knowledge and
powe . Academics, i ologis s and immunologis s o en spoke on behal
o ins i u ions (e.g. Ox o d Uni e si y) and scien i ic communi ies ha
hey ep esen ed, so hei opinions we e alid om an ins i u ional poin
o iew. Thei posi ion was p edominan ly used o legi imise he p o-
accina ion posi ions. This kind o discou se se ed o c ea e he ule
o knowledge alida ion and o de ine who was expec ed o speak. The
legi imacy o public go e nance is hus based on us in he expe
sys em. On he o he hand, unde mining he ules o knowledge ali-
da ion (bo h in e ms o hei e iciency and hei in en ion) leads o he
eme gence o new o di e en expe s. No only i ologis s and epide-
miologis s, bu also public heal h au ho i ies became mo e isible du -
ing he pandemic. They we e p esen ed as ha ing he mos eliable
knowledge. Go e nmen s and s a e au ho i ies o en e e ed o expe
knowledge o legi imise hei ac ions and egula ions. Expe s com-
men ed, ga e ad ice, and explained he unp eceden ed p oblems. They
played a legi imising ole in he discou ses. In he Czech Republic and
Po ugal, i was clea ha he oice o expe s was gi en mo e space han
be o e. Expe knowledge was also signi ican in he Belgian discou se.
Thei ole was o expose he alsi y o some sensa ional o "conspi acy
heo ies". Discou ses in Finland, I aly, and Poland can be desc ibed as
expe -d i en, e e ing o biomedical knowledge, expe knowledge,
esea ch, scien i ic and s a is ical da a. In I aly, expe knowledge
depended on he p og ess o accine esea ch. The opinions o expe s o
heal h au ho i ies o en e e ed o es s and ials. Al hough in gene al
expe s p omo ed accines in he pandemic discou ses, some hesi an
expe s also appea ed.
HCPs we e a key elemen o all p e-Co id discou ses. They p o ided
p ac ical knowledge abou accina ion schedules and legi imised he
posi i e ou comes o childhood accina ion. They we e po ayed as
c ucial: able o pe suade people o accina e. HCPs employed biomed-
ical knowledge, bu also hei own expe ience, o some imes e en
emo ions, such as ea , by showing he esu gence o diseases such as
measles. In he UK, HCPs we e key ac o s in commen ing on accina ion
policies. Thei posi ion o au ho i y was based on hei esponsibili y o
bo h policies and people’s decisions abou accina ion.
Doc o s, nu ses, and o he heal hca e p o essionals we e on he on
line o he pandemic ac oss Eu ope. Fo his eason, hei pe sonal
p esence was mo e isible in he Co id-19 accina ion discou se, espe-
cially h ough indi idual s o ies and opinions exp essed in he media.
Doc o s we e po ayed as he he oes o he pandemic. They ac ed as
expe s in implemen ing accina ion s a egies, commen ing on hei
e ec i eness, epo ing on he si ua ion om he bo om up (based on
hei daily expe ience) and discussing accina ion p io i ies. They we e
almos unanimously p esen ed as p o- accine: wi h knowledge and
compe ences, coope a ing wi h s a e ac o s o suppo accine man-
agemen , bu also wo king wi h pa ien s and obse ing he pandemic
om a di e en pe spec i e. They wo ked wi h he go e nmen on
accina ion and pe suaded hose who we e eluc an o accina e, as in
Belgium, whe e hei ole was o legi imise accina ion as an e ec i e,
sa e and necessa y means o comba ing his c isis. They used no only
expe knowledge, bu also emo ional ac ics o mo i a e people,
d awing on alues such as solida i y wi h heal h p o essionals o espec
o hei ha d wo k du ing he heal h c isis. The Polish discou se was
simila , wi h doc o s b a ely igh ing he pandemic and encou aging
people o ge accina ed. The e was no oom o doc o s o ques ion any
aspec o accina ion. Bu his was no he case e e ywhe e. In some
coun ies, such as he Czech Republic, he e was space o hesi ance o
scep icism. In he UK, doc o s’ ac ions we e e alua ed ei he posi i ely
(e.g. educing was age o accine doses) o nega i ely (delibe a ely no
using all a ailable accine doses). In Finland, HCPs we e mainly asso-
cia ed wi h accine managemen . This was also he case in I aly, whe e
HCPs we e equen ly men ioned in a icles abou accina ion p io i y
and hei a ailabili y and commi men as olun a y accina o s.
4.3.1.5. Ci izens: indi iduals s. socie y. In he p e-Co id e a, ci izens
we e cons uc ed mainly as hesi an pa en s o hose who openly esis-
ed accina ion schemes. In mos mains eam discou ses, s a e au ho -
i ies, expe s, in e na ional o ganisa ions, and NGOs ocused on
p esen ing accines as p o ec i e ools o he sa e y o child en. In
con as , accine opponen s we e cha ac e ised as indi iduals wi h only
hei s o ies o ell. By p esen ing lay knowledge and indi idual es i-
monies, he mains eam media in eg a ed scep ics in o he discou ses. In
his con ex , some g oups we e po ayed as a public h ea - in mos
coun ies hese we e so-called an i- axxe s, in some coun ies like
Poland o Po ugal hose we e mig an s who had no ollowed he
accina ion schedule.
In he UK, pa en s’ a i udes o accina ion we e seen h ough he
lens o hei class o wo k o whe e hey li ed. In Poland, on he o he
hand, eligious a i udes we e some imes linked o accina ion p ac-
ices. In I aly, he ocus was on pa en s and school s a in ol ed in
pe suading pa en s and moni o ing he legal and adminis a i e conse-
quences o non- accina ion.
While in he p e-Co id discou ses pa en s we e he mos isible and
ac i e ci izens in all coun ies, du ing he pandemic hey we e ma gin-
alised and eplaced by o he ulne able g oups. In e es ingly, du ing he
Co id pe iod, ulne abili y was de ined in e ms o biophysical condi-
ions (age, diseases, immunocomp omise) o ype o ac i i y ( eache s,
heal h p o essionals, shop assis an s, e c). The Czech media used he
e m " isk g oup" - and encou aged i s membe s o be accina ed agains
Co id-19. Belgian media e e ed o he "gene al popula ion" (a he
same ime la ge g oups o mig an s and young people we e ma ginal-
ised, as “ he discussion is aking place o e hei heads” (Belgium:
HLN,1.2.21)). In Poland, senio ci izens (70+and hen 60+) and
eache s became isible and ac i e ac o s when he p io i y o acci-
na ion was discussed.
Du ing he pandemic, he e was mo e space o ci izens o sha e hei
expe iences and es imonies. The la e se ed mainly as posi i e ex-
amples in suppo o accina ion, bu s o ies o side e ec s we e also
published. Howe e , du ing his pe iod, b oad coali ions p omo ing
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Social Science & Medicine 346 (2024) 116725
9
posi i e a i udes owa ds Co id-19 accines we e obse ed in all
coun ies s udied. S a e ep esen a i es, unde ime p essu e, sough
suppo om in e na ional o ganisa ions, NGOs and expe s. Con a y o
he p e-Co id pe iod, when expe s we e o en indi idual scien is s,
i ologis s o epidemiologis s, du ing he pandemic expe s o en ep-
esen ed public ins i u ions o bio ech companies.
4.3.2. Agency in ol ed in empo ali ies
The signi ican shi s in he p e- and Co id-19 accina ion discou ses
analysed can be obse ed in he empo al dimension. The mos ob ious
change cons uc ed in he la e is u gency - he need o “ igh he i us”,
o “ac immedia ely” and he sense o “ ime sh inking”, o “lack o ime”.
Howe e , he e we e some excep ions whe e ime p essu e was in o-
duced as dange ous. I was ela ed o us o lack o us in a pa icula
subjec , as in he example: “[a ep esen a i e o he EMA] wa ns no o ush
he app o al o he Spu nik V accine” (Finland, hs. i, Ma ch 09, 2021).
In he p e-Co id pe iod, no ma i e and p e en i e o ien a ions we e
in ended o in luence pa en s’ indi idual choices. Al hough p e en i e
measu es a e usually u u e-o ien ed ( isk educ ion), in his case he
pas was also in ol ed. This ype o discou se, legi imised by he
powe ul in e na ional ins i u ions, appealed o he common good, un-
de s ood as “no e u ning o he pas ”, which mean old diseases, high
mo ali y and ou b eaks spinning ou o con ol.
“An example o a success ul accina ion agains a common disease is
he measles accine. Be o e accina ion, all child en go measles, a
nas y childhood disease. Bu a e he accina ion, he e is no mea-
sles” (Belgium, DS, 17.2.2020).
Howe e , pas expe iences become less angible and can he e o e
lose hei p e en i e powe .
“The cu en gene a ion o pa en s has ne e been con on ed wi h
se ious in ec ious diseases such as poliomyeli is o diph he ia.
The e o e, he a i ude ha i is supe luous o accina e child en
agains such a e diseases is gaining g ound” (Belgium, HLN,
2.12.2019).
As a esul , he pas success o he accine’s p e en i e powe can
u n ou o be a u u e h ea , as in he ollowing example om he Czech
media. This example also e okes he no ion o a " ich Wes e n" socie y,
as i spoil by he success o accina ion.
“On he o he hand, he moods a e changing in a ich Wes e n socie y,
whe e people no longe see he consequences o epidemics” (Czech,
no inky.cz, 20.06.2019).
The pas , i no p e en ed, can come back and become he p esen . In
his sense, he pas is no i e e sible, bu i can happen again, which is
why i needs people’s agency and con ol. The ollowing quo es illus-
a e how he media in di e en coun ies e e ed o pas h ea s and
p esen ed hem as possible u u e scena ios. Scena ios ha we may no
be p epa ed and able o con ol i accina ion p og ammes a e
comp omised:
“Un o una ely, he h ea o new epidemics is e u ning oday. E en
diph he ia canno be conside ed comple ely e adica ed. I we
s opped accina ing agains i , i would ce ainly e u n, simila o
wha is happening now wi h measles” (Czech, no inky.cz,
25.07.2019).
“A a ime when smallpox was dis igu ing and killing housands o people,
he b illian mind o his scien is ealised ha anyone who wo ked wi h
dai y p oduc s and con ac ed cowpox (wi h e y mild e ec s on humans)
was immune o smallpox in i s mos se ious o m” (Po ugal, Público,
6.12.2020).
A he beginning o he Co id-19 pandemic, he need o new ac-
cines – de ined as a “weapon” – was p esen ed as he mos u gen need o
all humani y. Howe e , he accele a ion o he p ocesses o accine
in en ion, p oduc ion and dis ibu ion was a odds wi h he slow and
long- e m p ocesses o scien i ic and clinical alida ion o accines o
which we we e accus omed. The cons uc ed u gency, e icien in
legi imising he adical op-down solu ions such as lockdowns, ace
masks and social dis ancing, was coun e -p oduc i e in he case o
con idence in he sa e y o new biomedical p oduc s. The ension be-
ween he unce ain ies o new accines and hei possible unknown
long- e m nega i e consequences, on he one hand, and he h ea o an
unknown new disease, on he o he , led o a u n away om “secu ing
he u u e” and a ocus on he p esen in ela ion o he pas . Con a y o
he p e-Co id accine discou ses, he pas was now amed as “no mal
e e yday li e” ins ead o “dange ous ime o old diseases”. This was
exp essed in all discou ses in he desi e o “ge back o no mal”.
Looking h ough he lens o media discou ses, we can see an i-Co id
accines as a bundle o inequali ies, no only in e ms o access o ac-
cines, isk o in ec ion o possible side e ec s, bu also in e ms o
agency. Some o he ac o s po ayed in he media discou ses a e p i -
ileged, wi h he abili y o de ine he si ua ions and delibe a e on solu-
ions, while o he s a e simply called upon o ac , which o en means
accep ing he gi en solu ions.
5. Discussion and conclusion
As we a gued a he s a o he pape , people who make o do no
make decisions abou accines a e exposed o accine discou ses. This
exposi ion may be in en ional (when people seek in o ma ion) o un-
in en ional (acciden al exposu e) (Gil De Zú˜
niga e al., 2017). In any
case, he su ounding discou ses in luence he con ex in which people
ac . And no aking a decision, as has been a gued, mus also be
conside ed as a kind o ac ion. Media discou ses mobilise di e en e-
sou ces (s a is ics, indi idual expe iences, emo ions, alues, mains eam
scien i ic knowledge, and i s unde mining) ha could co-p oduce bo h
accep ance and con o e sy a ound accines. Fo his eason, i is
impo an o encou age wo k which explo es he way in which acci-
na oin is co e ed in he mains eam media.
The p ocess o accine p oduc ion and dis ibu ion is complex,
in ol ing poli ical, inancial, echnological, and scien i ic issues. The
compa ison o se en Eu opean media discou ses has led o he conclu-
sion ha hese discou ses a e closed in he “black box o echnology”:
he e a e nume ous e e ences o he p ocesses o p oduc ion and dis-
ibu ion, bu he unce ain y su ounding hem is minimised. This can
be seen as a wide p oblem o media co e age o scien i ic isk and
unce ain y (Ashe, 2013; G an , 2007). I we de ine isk as a ea u e o
a eas whe e we ha e a good scien i ic basis o assigning p obabili ies,
and unce ain y as a eas whe e we ha e a well-de ined sense o expec ed
ou comes bu li le basis o assigning p obabili ies (S i ling, 2010), he
obse ed ma ginalisa ion o he discussion o unce ain y may esul in a
si ua ion whe e he mechanism o educing unce ain y by ans o ming
i in o isk has no been ini ia ed. This has consequences because he
quan i ica ion o unce ain y in e ms o isk, i s calculable p obabili ies
and ways o mi iga ing i has been a pilla o decision making (Cox,
2021; Rudek e al., 2023a; Rudek e al., 2023b) and a c ucial p ocess in
dealing wi h he unknown. Mo eo e , in a si ua ion o adical unce -
ain y, which e e s o si ua ions whose de e minan s a e no well
enough unde s ood o be desc ibed in e ms o p obabili y o p edic ion
(Kay and King, 2020), scien i ic p edic ion can lose i s disciplina y
powe in a ou o he es imonies o he pas : unique bu eliable
h ough hei ma e ialisa ion. This obse a ion o he media deba e
a ound accines may e lec impo an and mo e gene al public expec-
a ions abou he ways in which impo an collec i e decisions a e
legi imised.
The p o- accine de ini ions econs uc ed om he analysed main-
s eam discou ses in he p e-Co id and Co id pe iods despi e o being
nuanced, e lec ed a ce ain shi om dealing wi h ac s o e e ing o
desi es. Fac s we e unde s ood as some hing cons uc ed as ha ing
al eady happened, con i med by he di e ence be ween he p esen and
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