Agency in urgency and uncertainty. Vaccines and vaccination in European media discourses

Social Science & Medicine 346 (2024) 116725 Available online 28 February 2024 0277-9536/© 2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/bync/4.0/). Agency in urgency and uncertainty. Vaccines and vaccination in European media discourses Aleksandra Wagner a , Paulina Polak a , * , Tadeusz J´ ozef Rudek a , Maria ´ Swiątkiewicz-Mo´ sny a , Alistair Anderson b , Marlies Bockstal c , Luigi Gariglio d , Jaroslava Hasmanov´ a Marh´ ankov´ a e , Ana Patrícia Hil´ ario f , Pru Hobson-West b , Juliana Iorio f , Aappo Kuusipalo g , Dino Numerato e , Alice Scavarda d , Pedro Alcˆ antara da Silva f , Eva Soares Moura e , Pia Vuolanto g a Jagiellonian University in Krakow, Poland b University of Nottingham, United Kingdom c University of Canterbury, New Zealand d Universit` a Degli Studi di Torino, Italy e Charles University in Prague, Czech Republic f Instituto de Ciˆ encias Sociais da Universidade de Lisboa, Portugal g Tampere University, Finland ARTICLE INFO Handling editor: Medical Sociology Office ABSTRACT Although Covid-19 was not the first pandemic, it was unique in the scale and intensity with which societies responded. Countries reacted differently to the threat posed by the new virus. The public health crisis affected European societies in many ways. It also influenced the way the media portrayed vaccines and discussed factors related to vaccine hesitancy. Europeans differed in their risk perceptions, attitudes towards vaccines and vaccine uptake. In European countries, Covid-19-related discourses were at the centre of media attention for many months. This paper reports on a media analysis which revealed significant differences as well as some similarities in the media debates in different countries. The study focused on seven European countries and considered two dimensions of comparison: between the pre-Covid period and the beginning of the Covid pandemic period, and between countries. The rich methodological approach, including linguistics, semantic field analysis and discourse analysis of mainstream news media, allowed the authors to explore the set of meanings related to vaccination that might influence actors’ agency. This approach led the authors to redefine vaccine hesitancy in terms of characteristics of the “society in the situation” rather than the psychological profile of individuals. We argue that vaccine hesitancy can be understood in terms of agency and temporality. This dilemma of choice that transforms the present into an irreversible past and must be taken in relation to an uncertain future, is particularly acute under the pressure of urgency and when someone’s health is at stake. As such, it is linked to how vaccine meaning is co-produced within public discourses. * Corresponding author. E-mail addresses: [email protected] (A. Wagner), [email protected] (P. Polak), [email protected] (T.J. Rudek), maria.swiatkiewicz- [email protected] (M. ´ Swiątkiewicz-Mo´ sny), [email protected] (A. Anderson), [email protected] (M. Bockstal), luigi. [email protected] (L. Gariglio), [email protected] (J. Hasmanov´ a Marh´ ankov´ a), [email protected] (A.P. Hil´ ario), Pru.Hobson-West@ nottingham.ac.uk (P. Hobson-West), [email protected] (J. Iorio), [email protected] (A. Kuusipalo), [email protected] (D. Numerato), alice. [email protected] (A. Scavarda), [email protected] (P. Alcˆ antara da Silva), [email protected] (E. Soares Moura), [email protected] (P. Vuolanto). Contents lists available at ScienceDirect Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed https://doi.org/10.1016/j.socscimed.2024.116725 Received 30 October 2023; Received in revised form 19 February 2024; Accepted 23 February 2024 Social Science & Medicine 346 (2024) 116725 2 1. Introduction 1.1. Vaccine hesitancy Vaccine hesitancy is a long-lasting phenomenon. It is often identified by policymakers as a threat to public safety (E. Dub´ e et al., 2013, 2015; Galagali et al., 2022). Literally, a hesitant person is defined as: "slow to begin or proceed with an action because of doubt or uncertainty" (Merriam-Webster Dictionary, n.d.). In healthcare, however, a hesitant patient is much more active - refusing to make a decision or choosing not to be vaccinated. The World Health Organization (WHO) defines vaccine hesitancy as the delay in accepting or refusing safe vaccines despite the availability of vaccination services (WHO, 2015). The “3 Cs” model, based on comfort, confidence and convenience, first proposed by the WHO EURO Vaccine Communication Working Group in 2011 (MacDonald, 2015), implies both agency and passivity. Vaccine hesitancy can be demonstrated not only by refusal, but also by delay, slowness, and selectivity. The discussion on the definition of vaccine hesitancy focused more on the factors influencing the attitudes of individuals, led to the construction of "the set on a continuum between those who accept all vaccines without doubt, to complete refusal without doubt, with vaccine hesitant individuals the heterogeneous group between these two extremes" (MacDonald, 2015). However, it turned out not to be sensitive enough to detect a significant difference between delay and refusal. Those who decide to vaccinate but remain sceptical or uncertain about their decision also fall outside the scope of this definition. The problem of individuals’ agency and passiveness in vaccine hesitancy was discussed in the literature as related to health capital (Schneider-Kamp, 2022). We argue that hesitancy, in a broader sense, is about the ways in which agency is involved in the structuring of time, particularly the relationships between past and future. The decision to vaccinate renders this moment in time past. It is irreversible. Hesitation, in its nominal sense, is held between an irreversible event in the past and the open possibility of an uncertain future. Of course, this feeling of being suspended in time is illusory - not deciding is also a kind of decision (Rabiej-Sienicka et al., 2022; Rudek and Huang, 2024; Rudek and Huang, 2023a,b), even if the individual is not aware of it. Time and temporality as a key to understanding meaning-making of an uncertain future in the context of the pandemic have recently been discussed in various ways (Chan et al., 2021; Tabrizi and Levina, 2022). The recent work of Harrison et al. (2022) particularly highlighted the importance of using time in constructing evidence for the safety and efficiency of Covid-19 vaccines. This work has opened a new way of thinking about the relationships between vaccine hesitancy and time. Nevertheless, there is still a gap in knowledge about hesitancy, which can be understood not only as a process consisting of different phases (Kumar et al., 2022), but also as a process related to more general temporal structures: past, present, and future orientation of human agency. The aim of this paper is to better understand how vaccine hesitancy can be co-produced through media discourses. Rather than analysing vaccine hesitancy as it is directly discussed in mass media discourses, it examines how different actors visible in the public sphere mobilise symbolic resources (knowledge validation, authority, values, power) to make sense of vaccines. We suggest that the meaning-making process around vaccines is intertwined with vaccine hesitancy. According to recent studies, the sources of information used by patients can play an important role in vaccine hesitancy and decision-making (Mascherini and Nivakoski, 2022). Media discourses, which simultaneously refer to actual circumstances and speculate about possible scenarios, contribute to socially shared definitions of the situation (Thomas, 1923), embedding the vaccine somewhere between actuality and potentiality. Time, and in particular the way people live and experience it, is a key element in these processes (Harrison et al., 2022), especially because the media can construct urgency, or conversely, create the conditions for delaying decision-making. 1.2. Vaccine discourses and temporality One notion that might clarify how a vaccine is defined is agency. We refer to Emirbayer and Mische (1998), who understand agency as a ‘temporally embedded process of social engagement’, informed by understandings of the past, present and future. Inspired by Hicks and Lloyd (2022), we concentrate not on information literacy but on discursive practices that construct social meaning in relation to temporal aspects. Therefore, the relational phenomenon of agency highlighted by the authors is particularly relevant. The connections between individual testimonies, institutional data and operating with patterns related to the whole populations are at the core of media communication. Operating with the orders of time creates narratives that contribute to the construction of meaning. The past constitutes experience. The present constructs the need for urgent action, which if rejected, or resisted can lead to delay. In turn, the future, which opens up the possibility of action, is linked to unavoidable uncertainties. Vaccination as a social practice is rooted in all temporal dimensions: the past provides the evidence of its effectiveness in overcoming or reducing the “old” diseases, the present frames it through procedures and routines, while the preventive nature of vaccination makes it look ahead. This paper focuses on media discourses not as an effect on the audience, but as a representation of the public sphere. This means that we define the public sphere as a communication space shaped by specific normative rules about who should participate, on what occasions, what the form and content of their contributions to public discourse should be, and how actors should communicate with each other (Ferree et al., 2002). In this study, we compare how the meaning of vaccines was constructed in seven European countries in the periods before and during the Covid era by analysing the media discourses in each country. The mainstream news outlets, which are widely distributed, are treated as communication spaces where specific knowledge is formed based on the co-productionist interaction between technology and society. The Covid19 pandemic was an unexpected event that forced the power institutions of all European societies to react immediately, re-prioritising the public debate on vaccines and stimulating agency. As such, the pandemic created a unique opportunity to systematically observe how the expertise provided by various institutions met people’s experiences, expectations, values, fears, and desires as reflected in media discourses. 2. Vaccine hesitancy and the media Vaccine hesitancy has long been studied in the social sciences in the context of various vaccination programmes (flu, HPV and others) and childhood vaccination procedures. This phenomenon was explained through individual psychological characteristics (perception of disease as high or low risk) (MacDonald, 2015), trust in the authority of science (Sturgis et al., 2021), critical thinking skills (Cannito et al., 2022), or through societal variables such as trust in the healthcare system and medical institutions (Mesch and Schwirian, 2019). For a long time, vaccine hesitancy has been understood in the light of the cognitive deficit theory (E. Dub´ e et al., 2015) as a consequence of people’s ignorance, lack of expertise, and lack of critical thinking (Cannito et al., 2022). This claim has recently been undermined by understanding the position of vaccine hesitancy as a problem that cannot be solved by simply communicating more information on vaccines - and by just treating vaccine hesitant people as manipulable (` E. Dub´ e et al., 2021). Media communication is a major focus of research on vaccine hesitancy (cf. (Hicks and Lloyd, 2022)), and is often blamed for fuelling it, for example by focusing on the scary and emotive stories associated with vaccination. Media sources are also accused of promoting cognitive biases and false objectivism, leading to vaccines being presented as controversial and taking a position on them as part of a two-sided debate (E. Dub´ e et al., 2018). Vaccine-hesitant people are thus understood as passive audiences affected by the media narratives. In A. Wagner et al. Social Science & Medicine 346 (2024) 116725 3 particular, vaccine-hesitant parents are often blamed for irresponsible delays in immunisation, which has recently been recognised as a form of epistemic injustice (Cassam, 2023). Conversely, other studies have demonstrated that vaccine-hesitant parents are often highly educated and sceptical towards health authorities. They feel that they are not represented in the public debate and therefore create their own “islands” in the alternative, usually online, media spheres (´ Swiątkiewicz-Mo´ sny et al., 2023). Furthermore, Hobson-West work has revealed the consciousness and agency of vaccine-hesitant and vaccine-critical parents, underlining the role of risk and uncertainties (Hobson-West, 2003), and how Vaccine-Critical Groups question the idea of blind faith in public health advice (Hobson-West, 2007). Vaccine hesitancy can also be seen in the light of civic epistemologies (Jasanoff, 2007; Miller, 2004), which describe the influence of societal expectations towards knowledge production and on the handling of uncertainty (Rudek et al., 2023b). The Covid-19 outbreak added new threads to the vaccination debate. In the first phase of the pandemic, the main focus was on producing an effective vaccine and then administering it in a fair and non-exclusive way. Advocates of vaccination as a public health intervention argued that high vaccination coverage was the safest way to ensure herd immunity (Cannito et al., 2022; Ceccato et al., 2021). The study of vaccine hesitancy at the time of Covid-19 provided a more nuanced picture of how information literacy was used by people to inform themselves about vaccines, concluding that “vaccine-hesitant and hesitant-influenced actions consequently form an agentic, informed performance that centres on protective and delaying strategies” (Hicks and Lloyd, 2022). Our paper adds the temporal dimension to this debate, defining vaccine hesitancy in the context of the relationship between past and future. Receiving a vaccine makes this point in time belong to the past and at the same time determines the future (in terms of protection or adverse effects). As mentioned above, it is irreversible. Thus, hesitancy is related to the agency that is maintained between an irreversible, past event and an open possibility of the future. Citizens often derive their confidence from pre-existing trust relationships, including their social networks, healthcare professionals, and public institutions or biomedical knowledge (Goldenberg, 2021; Larson et al., 2018). Some studies indicated a role for, among others, educational background, and employment status (Malik et al., 2020), while others found household income to be a statistically significant predictor of willingness to receive Covid-19 vaccination (Murphy et al., 2021). An in-depth study of Covid-19 hesitancy in the United Kingdom reported an important role for official recommendations, social norms about vaccination, and perceptions of effectiveness, risk, and ease of use (Sherman et al., 2021). Media discourses can be a vehicle for the co-production of these beliefs. They can also contribute to increased uncertainty about the strength of the scientific evidence for or against a particular risk (Capurro et al., 2018; Dixon and Clarke, 2013). The analysis presented here examines how the media co-produce the definitions of vaccines and vaccination in specific situations (before and during the pandemic). In order to answer this general research question, we propose some specific ones: - What are the definitions of vaccines co-produced by the media and how do they relate to agency? - Which social actors are privileged to have a voice and how do they relate to each other? - How is the agency of actors intertwined with temporalities? This article also examines which resources support actors’ positions and how they are linked to expressed public expectations. Finally, it reconstructs how justification is imagined in relation to vaccination and how it has been affected by the urgency of the pandemic. Focusing on the widely visible mainstream media, the paper explores how vaccine agency can be co-produced through related meanings. 3. Materials and methods The results presented here are part of a larger research project VAXTRUST. The project, funded by the European Commission under Horizon 2020, was directly related to the study of vaccine hesitancy, and was conducted in 7 European countries (Belgium, Czech Republic, Finland, Italy, Poland, Portugal, UK) selected for their geographical, cultural and economic diversity. For this paper, we refer only to the part devoted to public discourses in all 7 European countries. The analysis followed a mixed-methods approach, beginning with quantitative data analysis, followed by qualitative data analysis. Provalis software (WordSTAT) supported the quantitative phase, while manual qualitative analysis was carried out using NVivo software. In line with the principle of objectivity, subjective evaluations were excluded unless explicitly stated as such. Data were gathered from seven countries: Belgium, the Czech Republic, Finland, Italy, Poland, Portugal, and the UK. For each country, vaccine-related keywords and vaccination discourses were identified (see Appendix 1). Subsequently, the retrieved texts were categorised on the basis of two analysis periods: before the WHO declared the start of the Covid-19 pandemic (01/04/2019-03/10/ 2020) and after the announcement (11/03/2020-10/04/2021). It is important to note that this analysis period includes the early phase of the pandemic. It is also worth mentioning that by the time the data collection for the analysis was completed, Covid vaccines were not fully available in most countries. This study therefore encompasses the initial stages of negotiating the significance of new vaccines and establishing media depictions of them. The Press Service collected data between April 01, 2019 and April 10, 2021. Appendix 1 contains a detailed list of the media analysed, while Appendix 2 provides a comprehensive description of the analysis process. Within the overall framework of critical discourse analysis, this study is based on exploratory linguistic analysis, semantic field analysis, and contextual analysis. This three-way methodology enabled us to focus not only on the content (vaccine definitions, actors, resources), but also on the form of expression (how these elements were presented, interlinked, evaluated). Semantic field analysis allows researchers to capture the meanings conveyed in word networks, including how words relate to each other in terms of synonyms, opposites, and associations. It also reveals the hidden forces underlying the linguistic structures of the concepts under study. This is in line with Fairclough’s (2010) view of critical discourse analysis, which states that it should encompass work with language at multiple levels: linguistic, textual (including strategies of representation in the text, such as the roles of members of a discourse community and their interrelationships), and contextual. Its goal is to reconstruct social formation and its transformations (with representations of social actors, resources, and their use). Focusing on agency, this study examined individual and social factors associated with vaccination in discourses. The categories for coding these factors were taken from the scientific literature on vaccine hesitancy. Individual factors included references to vaccine considerations, emotions, experiences, and personal beliefs, while social factors pertained to shared knowledge (and non-knowledge), risk, values, group interests, rights, laws, and social imaginaries. 4. Results 4.1. From the future-driven discussion of disease prevention to the effective governance of vaccine distribution in the here and now This section presents the synthesis of the results obtained in all the phases of the analytical work in a comparative perspective: exploratory linguistic research, semantic field analysis, and in-depth analysis of the agency of actors related to vaccine and vaccination and its temporal aspects. The linguistic analysis aimed at a certain exploration of the data. Using the comparative lens, we made some careful preliminary A. Wagner et al. Social Science & Medicine 346 (2024) 116725 4 conclusions about the similarities and differences in the shifts of vaccine discourses affected by the Covid-19 pandemic (regarding the contextual and linguistic specificities of each country). These were then ascertained in a qualitative analysis. First, as could be expected, vaccine discourses became Covid-19centred during the pandemic. In its early stage, we noticed a significant increase in the frequencies of words related to Covid and coronavirus in discussions on vaccines and vaccination (Fig. 2), but also other vaccine-preventable diseases that were present in the pre-pandemic discourses (Fig. 1) were marginalised. There were also more words related to vaccine production (AstraZeneca, Pfizer/BioNTech, laboratory, control, procedure, experiments, efficiency, new technology, mRNA, regulators), testing (trials, risk, evidence, safety, effects, data, side effect reporting) distribution (doses, hospitals, vaccination spots, price, availability) and management of vaccines (prevention, phases, state of emergency, logistics, supply, staff, populations) in the analysed period of the Covid-19 pandemic. In all the discourses analysed, we also observed a higher frequency of words related to the state and government representatives. This could indicate a more administrative type of discourse, focusing on the governance of vaccination. Individual experts were not mentioned as often as before the pandemic, while the work of scientific teams, laboratories or research centres was increasingly reported during the pandemic. Words connoting temporalities (now, today, soon, too late, urgent, urgently), more frequent in all languages in the pandemic time discourses, suggest the pressure of time. However, this would require further linguistic research, taking into account the specificity of national languages. The most visible change was the reorientation of the definition of vaccination issues as mainly related to parental decisions affecting children (less often - as in the case of influenza - to senior citizens’ decisions). During the pandemic, preventive vaccination became one of the hot topics for all publics and an issue directly related to all societal groups. The shift from discussing vaccine-preventable diseases to discussing types and producers of vaccines (within the hegemony of one disease) was also noticeable in all countries. Before the pandemic, the names of vaccine manufacturers were hardly mentioned, whereas during Covid19, brands such as AstraZeneca, Pfizer, Moderna, etc. appeared. 4.2. Towards a common meaning - semantic fields of a vaccine in mainstream discourses The comparative analysis of semantic fields is limited by the language specifics that go beyond the nominal meaning of words. 1 The definitions reconstructed by the country teams were translated into English, and even if the country author teams discussed them carefully, aware of the challenges of translation, some of the nuances may have been lost. Nevertheless, the material collected, and the semantic definitions reconstructed shed light on how vaccines related to the surrounding social reality and were a good starting point for understanding the role of social and individual factors in vaccine discourses. Therefore, the comparison of semantic fields aimed at identifying the phenomena, including actors or institutions, but also figurative language that contributed to the created meaning of vaccines in the analysed discourses. The semantic field analysis allowed us to see and compare how vaccines were represented in the mainstream media and provided us with a compilation of views on vaccines. These views differed and competed for visibility within each sample. However, there were also significant similarities between the countries analysed in how vaccines were defined in mainstream discourses, both before and during the pandemic. 4.2.1. Pre-covid definitions In the pre-Covid period, vaccines were often presented in the historical context of reducing or eliminating/eradicating serious diseases. Vaccines were described as “safety belts” (Czech Republic), or in terms of rights, as a citizens’ privilege (Finland). In Poland, vaccines were also associated with additional but more specific privileges, such as extra points in kindergarten admissions. In general, positive associations with civic and scientific progress predominated in all countries. The safety and effectiveness of vaccines were emphasised, mainly in terms of individual prevention and public health protection. The main definitional threads observed in all countries included: 1) vaccine as an achievement of civilisation; 2) vaccine as a tool to control old diseases, an efficient “weapon” against diseases; and 3) vaccine as a preventive benefit for the whole population (safety belts, protective umbrella). At the same time, vaccines were portrayed as threatened by fake news (control of information) and anti-vaccination movements. The following example from the UK shows how those movements’ actions may put lives and health of children at risk by contributing to a decrease in vaccination rates: “As I watched the film, I wondered if there’s something to learn here about how we challenge the anti-vaccine conspiracy theories whose resurgence is putting children’s lives at risk. The World Health Organization this year ranked the anti-vaccine movement in its top 10 global health threats, while UNICEF has highlighted the low vaccination rates that have contributed to a 30% global increase in measles infection rates in just one year” (UK, The Guardian, 28.04.2019). Vaccine was also a subject for taking action (vaccines must be supported, promoted, should be obligatory), put in the centre of attention of a number of different actors. For example: (Our goal is) “to move the system of compulsory vaccination in the Czech Republic away from senseless politically motivated repression towards Fig. 1. Percentage of texts mentioning diseases in the pre-Covid period. Fig. 2. Percentage of texts mentioning diseases in the Covid period. 1 The detailed reconstruction of the semantic fields of vaccines in each country can be found in the anonymised report. A. Wagner et al. Social Science & Medicine 346 (2024) 116725 5 greater freedoms and greater security of vaccination” (Czech, zpravy. iDNES.cz, 22.01.2021). At the same time, in most of the countries involved, the mainstream discourses before Covid presented vaccines as potentially suspect and sometimes linked them to side effects. The main difference between the pre-Covid and Covid periods was the degree of visibility of vaccinesceptical positions. While the most visible definitions underlined the active protection provided by a vaccine (vaccines eliminate diseases, reduce risks, protect, immunise, etc.), the sceptical positions towards vaccines were less frequently reported in the mass media. Counternarratives appeared in mainstream discourses as perceived voices against compulsory vaccination, for example in defence of individual freedom and of the right to make informed choices: “I am not an anti-vaxxer, I am just fighting for the safety of vaccines and independent knowledge (Poland, Wyborcza.pl, 29.09.2019), or appealed to peoples’ sense of comfort: "People must feel comfortable when they decide to get vaccinated" (Portugal, Publico, 12.06.2019). Interestingly, those counter-narratives, which are referred to, actually invoked some of the most basic values and rights. Those were the rights that not only should be the pillars of vaccination processes, but also constitute the core of patients’ rights (see: eg. Peled-Raz, 2017). like freedom of choice or bodily integrity. However, these dissenting voices were rarely discussed. In some countries, such as Poland, hesitant parents were strongly criticised: Parents who do not vaccinate pose a risk to their own and other children. (Poland, Onet.pl July 01, 2019). In Belgium, the counter-arguments were rejected by criticising their unscientific nature: “The ‘anti-vaxxers’ are afraid that their children will become autistic because of the vaccines or develop learning problems, or they believe that their children will become stronger if they go through the disease themselves. The group seems insensitive to scientific arguments that this is nonsense” (Belgium, DS,April 15, 2019). This way of refuting arguments seems to provoke even more questions, instead of addressing any possible doubts, apparently not really recognised in the media discourses. However, in other countries, vaccines were sometimes associated with risks and justified doubts. “He also said it is unfair to label dissenters as ’extremists’ and ’antivaxxers’ when they are concerned about the health and welfare of their children” (UK, Daily Mail, 10.09.2019). This quote from the UK shows that some discourses showed more understanding for hesitant parents. Indeed, there were noticeable differences in the polarisation of positions towards vaccines in national media discourses. In some countries, such as Belgium, the opposing voices were more moderate, underlining the risks or unproven efficacy: “Flu is a potentially deadly disease, especially for vulnerable populations, vaccination is a simple preventive measure, but without full protection”(Belgium,DS,February 19, 2019), while in other countries the sceptical voices were presented as more radical, sometimes even evoking associations with genocide or unjustified experiments on children (Italy, Poland): “Vaccines? A free genocide” (Italy, corrieredelveneto. corriere.it, June 27, 2019). This led to a higher or lower degree of polarisation of the definitions of vaccines in the public sphere. The semantic field definitions, even if strongly positive and persuasive in the mainstream discourses, reflected more polarised attitudes towards vaccines in the Czech Republic, Italy, Poland, Portugal. Here are some examples: “Vaccines are the safety belt of the world” (Italy, corriere.it, 30.01.2020) vs “The vaccine we are experimenting with is the concentrate of our destiny and contains the code of our future” (Italy, repubblica.it, 03.01.2021). “The vaccine is a great chance to immunise the society against infection, it’s a hope to return to normality (Poland, wyborcza.pl, 10.01.2021) vs. “We didn’t officially know the composition, side effects and contraindications. We didn’t know anything about the coronavirus vaccine. If someone was looking for information, they used the Internet or the foreign press” (Poland, se.pl, 28.12.2020). Meanwhile, in the UK and Finland, the created meaning of the vaccine addressed tensions in a more nuanced way: “And we know that the introduction of new vaccines has not always been trouble-free. In 1955 in the US, there were more than 40,000 cases of polio — and ten deaths — in children given a defective vaccine. […] But we should also remember that modern vaccines are safer than ever, and we should also take confidence in the fact that Pfizer’s agent […] is building on research over 20 years into strains of coronavirus that cause Sars and Mers” (UK, Daily Mail, 10.11.2020). In Belgium, counter-arguments against vaccination in the pre-Covid19 sample were mostly rejected by criticising their unscientific nature: "The well-known virologist Marc Van Ranst was allowed to speak, and he parried the statements of the general practitioner: Apart from some redness at the site of the injection and some fever a few days later, there are no side effects. And people who claim that this leads to autism are mistaken. It has nothing to do with medicine, it has to do with scare tactics” (Belgium HLN,11.4.19). In Poland and Italy, vaccine hesitancy was often associated with a lack of proper knowledge. At the same time, “educated” patients were praised. However, being “educated” was only associated with taking a pro-vaccine attitude: “If a patient uses proven knowledge, it is much easier to make joint decisions. An educated patient is a very valuable patient (Poland, onet.pl, 20.09.2019), Similarly, in Italy vaccine hesitancy was understood as irresponsibility: “Those who do not vaccinate their children are selfish people. By following their ignorance and superstition, they are harming their children and society” (Italy, corrieredelveneto.corriere.it, 19.06.2019). The previous quote demonstrates a trend that was previously mentioned – a complete rejection of those who have doubts. This direction in discourses has resulted in extreme polarisation, effectively eradicating any doubts (including those of vaccine hesitant individuals) from mainstream media discussions. 4.2.2. The beginning of Covid-19 In this section, we summarise the similarities found across all 7 countries. It is mostly based on the figurativeness of the national languages and due to space limitation it is not possible to provide detail exemplifications. The interpretative analysis led us to the conclusion that at the beginning of pandemic, the authority of science was associated with hope and a return to a "normal" future. The popular metaphor of the “weapon” was not always expressed directly but was suggested by expressions such as “winning the battle”, “invisible shield” or “defence against attack”. In most of the discourses analysed, the vaccines against Covid-19 were described using these metaphors: ● vaccine as a weapon against the new virus. ● vaccine as a way to return to normality. ● vaccine as a passport to a secure future. ● vaccine as an act of solidarity. ● vaccine as a game changer. A. Wagner et al. Social Science & Medicine 346 (2024) 116725 6 At the same time, the safety and availability of vaccines was undermined by: ● rush in scientific research and production. ● competing countries and group interests. Due to the pandemic, the definitions of vaccine were more closely related to Covid-19. We observed more references to economy, politics, or vaccine production processes. The dominant tone of the mainstream discourses remained mainly positive and persuasive (encouraging vaccination in the name of public safety and solidarity), but the countervoices became more visible in all countries. On the one hand, in addition to the previous characteristic, we observed a greater focus on the future and hope. Vaccines – still presented as scientific achievements, tested and safe biotechnological products - were imagined as a passport to a safe future, a chance to return to normality and stabilise national economic and social life. On the other hand, elements of sceptical counternarratives, reflected in the vaccine semantic fields, pointed to uncertainties and possible side effects in all the countries considered. Alongside the emphasis on the scientific nature of vaccine production, the issue of producers’ profits became more visible. Interestingly, in all the reconstructed pandemic definitions, we observed elements referring to the role of the state administration in vaccine management. Sometimes they were critical, calling for better organisation of vaccine distribution or promotion, sometimes they stressed the need for proper regulation and referred to the public good, understood as the safety of the population. The latter was related to the controversy: states as regulators versus exerting control over the population. In the Czech Republic, Finland and Poland, the geopolitical aspects appeared in the semantic definitions. This was clearly linked to suspicions about Russia and the Russian vaccine. ”He ascertained that the purchase of Sputnik V was like ’spitting in the face of European partners’” (Poland, wyborcza.pl, 2.03.2021). “[a representative of the EMA] warns against rushing to approve the Sputnik V vaccine: "It’s like playing Russian roulette” (Finland, hs.fi, 09.03.2021). “Strong political words have already been addressed to Sputnik; for example, the head of Ukrainian diplomacy, Dmytro Kuleba, called it a ’hybrid weapon of Russia against Ukraine’’’ (Czech, zpravy.iDNES. cz, 08.01.2021). Such sentiments seem to reflect a broader geopolitical outlook and resentments towards Russia. Although beyond the scope of this article, such attitudes would be worthy of further and more in-depth analysis. In Belgium, Italy and Portugal, vaccines were most often linked to global issues such as world solidarity or sustainable development. “We are concerned that without universal, sustainable, and equitable access to medical tools, the pandemic will last longer, severely impacting not only people, but also the ability of health systems to provide immunisation, care and treatment for other diseases, causing more death and suffering. Ending the monopolies aims to put lives before profits, which is why we are calling on countries to act quickly and make it a reality” (Italy, ilfattoquotidiano.it, 16.01.202). In Finland, Poland and the UK, the element of national interest appeared, as in the following examples: “He added that Polish citizens ‘will have guaranteed access to a Covid-19 vaccine” (Poland, onet.pl, 25.11.2020). “Populist President Vucic [of Serbia] criticised the EU for reserving vaccines for its own citizens and ignoring poorer nations” (Finland, yle.fi, 03.02.2021). The peak of the vaccine crisis, with a soaring demand and an insufficient and above all uncertain supply, resulted in the recall of interests. In some countries these were particular, national interests, while in others, a more pro-egalitarian and inclusive reflection appeared. Looking at the national semantic fields of the vaccine created by the mainstream discourses during the pandemic, we can distinguish several dimensions: •vaccine as a biomedical product: produced, tested, managed, distributed vaccine as a public good, as such should be widely accessible, transparently informed about •vaccine as an opportunity to overcome the pandemic and return to normality. •vaccine as a scientific achievement that protects life. •vaccine as a commodity that brings profits and is part of an economic competition between companies. •vaccine as a political tool to be used at the national and global levels. •vaccine as being threatened by the anti-vaccination movements. These dimensions were involved in the controversies concerning: •control of the population •genetic modification and unknown side effects •hidden interests of political elites and private companies •the propaganda of the dominant mass media 4.3. Mass media vaccine discursive landscapes We begin this part of the analysis by identifying the actors who were visible in the public sphere, taking into account those who were marginalised or remained invisible. Focusing on the actors involved in the discourses, we also investigate their relationships, the resources used, and the social and individual factors that influenced vaccination decisions. Finally, we reconstruct the temporal aspects in which their agency was rooted. 4.3.1. Actors We have distinguished five groups of actors (Fig. 3) in both periods of analysis. In this section we briefly discuss each group and show how the pandemic outbreak changed the vaccine discursive landscape. Fig. 3 illustrates how some groups gained visibility and power through increased recognition, while others were marginalised or ignored. Actors employed diverse communication strategies, used symbolic resources and built relationships in different ways. It was therefore crucial to examine which actors were visible in media discourses in order to identify differences and similarities in the configuration of significant factors across countries. 4.3.1.1. International organisations. During the pandemic, international bodies became more visible in all analysed media discourses. The WHO and the European Medicines Agency (EMA), which in the pre-pandemic discourses were mainly mentioned as institutions providing definitions, hygiene recommendations and some basic education, were more often mentioned by governmental actors as main sources of information. They were used as authority figures in persuasive pro-vaccine discourses. In general, these international organisations framed the agency within a cognitive framework that legitimised vaccines as scientific achievements that met public expectations (validated, socially useful knowledge). They served as entry points for framing vaccines as universal, supranational goods for humanity. Interestingly, this kind of preventive action was based on both the past experience (old diseases, collective memories of previous pandemics) and future orientation, which meant that a return to the past could not be allowed. In some countries, such as Belgium, Finland, and Poland, the WHO played an important role in the early stages of the pandemic. It was viewed as a powerful entity, declaring the pandemic, creating a sense of urgency, and influencing a common understanding of the current situation. The EMA was mentioned in relation to vaccine registration A. Wagner et al. Social Science & Medicine 346 (2024) 116725 7 procedures and the issuance of vaccination guidelines. Such actors were used in discourses to legitimise the pressure of time, which is evident in expressions such as "fighting against time" and " shrinking time". Previously, a return to the past (old diseases) was undesirable, but then "returning to normality" was one of the most widely used phrases worldwide. This change in the perception of time led to a recognition of urgency, which was essential to legitimise radical and rapid changes across all levels, including populations, institutions, and individuals. Some countries referred to international institutions to frame a more global context of vaccination. Gavi (Global Vaccine Alliance) appeared in the communication (Finland, Italy) as a universal need to protect children. The Belgian discourse referred to the WHO’s COVAX programme and made it responsible for the equitable distribution of Covid vaccines worldwide. Nevertheless, in the Czech discourse, the EMA, the WHO and the European Union were closely linked to the National Vaccine Strategy, providing statistical data essential for the authorities to manage the immunisation processes. 4.3.1.2. NGOs and local activists. National NGOs emerged as actors with more positive attitudes towards vaccination, sometimes even advocating for better access to vaccines. This type of agency was related to widely held values of solidarity and public responsibility. However, sometimes the same values served to adopt more sceptical positions. In the Czech Republic, some organisations, such as “Medici PRO oˇ ckovaní” (Doctors for Vaccination), Uˇ cen´ a spoleˇ cnost ˇ CR (Scientific Society of the Czech Republic), or Mladí praktici (Young GPs) were generally ‘pro-vaccination’, but critical of the government’s approach to vaccines and the vaccination programme. Some NGOs were represented in the discourse outside the framework of the agency. In Portugal, the only NGO identified as opposing compulsory Covid vaccination, was not present as an active actor, but was only referred to, described, and ridiculed by the other actors. This contrasts with Poland. The STOP NOP association, which questioned the need for vaccination despite being active before the pandemic, was ignored by the mainstream discourse. This changed during Covid-19 and this actor became more visible. It also broadened its activities by forming wider “anti-pandemic” coalitions, e.g. with entrepreneurs and others affected by the pandemic restrictions, with whom it protested against the sanitary regime and vaccination. 4.3.1.3. State authorities and public administration. State authorities and policymakers did not play a particularly important role in the pre-Covid discourses. Although the importance and visibility of public policies and administrative actors differed, the same central pattern prevailed. National institutions, such as the Superior Health Council of Belgium, the Finnish Institute for Health and Welfare or the Sanitary and Epidemiological Station (Sanepid) in Poland, represented state authorities in the pre-Covid discourses: they stood as sources of knowledge on vaccination coverage or development and were described in the context of vaccination financing. In all countries, public health institutions were based on the knowledge of academia, virologists, epidemiologists, and international organisations. Countries where childhood vaccination is compulsory, such as Poland, present an interesting case. Here, the health authorities were also a potential source of enforcement against those who did not vaccinate their children. In Italy, health institutions were shown to be a source of law that empowered school staff to enforce legal requirements for childhood vaccination. School staff as an actor was unique in Italy. Here, state authorities based their arguments on biomedical knowledge, Fig. 3. The groups of actors involved in the vaccine discourses across countries. A. Wagner et al. Social Science & Medicine 346 (2024) 116725 8 official data and statistics, and law. They provided health institutions and local school staff with arguments about the dangers of nonvaccination and justified the need to block admission to schools or kindergartens without the required vaccination records. Governments, politicians, policymakers, and state organisations became more visible in the pandemic discourses. Governments had to react quickly, formulate new rules, and organise a new "pandemic order”, providing official statistics to keep the public informed. Their main task, carried out in different ways in each country, became vaccine management. Politicians often quoted experts to justify their actions or legitimise new rules. For example, the Czech state was portrayed as being involved in promoting vaccination, campaigns, supply, building vaccination centres and making decisions about priority groups, relying on WHO and EMA recommendations to create the National Vaccine Strategy. 4.3.1.4. Experts: academia and HCPs. Before the pandemic, academic actors (virologists, immunologists) were portrayed as experts – in possession of correct and valid knowledge - in all the countries analysed. Their main role was to respond to the arguments of vaccine opponents, using reasoning based on scientific, usually biomedical, knowledge. At the same time, the voices of actors who disagreed with the experts’ statements were either silenced, labelled, or ridiculed. Interestingly, expert knowledge was related to the risks associated with nonvaccination. This pattern characterised one of the most common communication strategies in the pre-Covid samples. In Poland, some experts also mentioned the economic benefits as an additional argument in favour of rotavirus vaccination. Covid-19 media discourses still portrayed experts as powerful. They tended to influence government decisions and public opinion by speaking from a position of possessing legitimated knowledge and power. Academics, virologists and immunologists often spoke on behalf of institutions (e.g. Oxford University) and scientific communities that they represented, so their opinions were valid from an institutional point of view. Their position was predominantly used to legitimise the provaccination positions. This kind of discourse served to create the rule of knowledge validation and to define who was expected to speak. The legitimacy of public governance is thus based on trust in the expert system. On the other hand, undermining the rules of knowledge validation (both in terms of their efficiency and their intention) leads to the emergence of new or different experts. Not only virologists and epidemiologists, but also public health authorities became more visible during the pandemic. They were presented as having the most reliable knowledge. Governments and state authorities often referred to expert knowledge to legitimise their actions and regulations. Experts commented, gave advice, and explained the unprecedented problems. They played a legitimising role in the discourses. In the Czech Republic and Portugal, it was clear that the voice of experts was given more space than before. Expert knowledge was also significant in the Belgian discourse. Their role was to expose the falsity of some sensational or "conspiracy theories". Discourses in Finland, Italy, and Poland can be described as expert-driven, referring to biomedical knowledge, expert knowledge, research, scientific and statistical data. In Italy, expert knowledge depended on the progress of vaccine research. The opinions of experts or health authorities often referred to tests and trials. Although in general experts promoted vaccines in the pandemic discourses, some hesitant experts also appeared. HCPs were a key element of all pre-Covid discourses. They provided practical knowledge about vaccination schedules and legitimised the positive outcomes of childhood vaccination. They were portrayed as crucial: able to persuade people to vaccinate. HCPs employed biomedical knowledge, but also their own experience, or sometimes even emotions, such as fear, by showing the resurgence of diseases such as measles. In the UK, HCPs were key actors in commenting on vaccination policies. Their position of authority was based on their responsibility for both policies and people’s decisions about vaccination. Doctors, nurses, and other healthcare professionals were on the front line of the pandemic across Europe. For this reason, their personal presence was more visible in the Covid-19 vaccination discourse, especially through individual stories and opinions expressed in the media. Doctors were portrayed as the heroes of the pandemic. They acted as experts in implementing vaccination strategies, commenting on their effectiveness, reporting on the situation from the bottom up (based on their daily experience) and discussing vaccination priorities. They were almost unanimously presented as pro-vaccine: with knowledge and competences, cooperating with state actors to support vaccine management, but also working with patients and observing the pandemic from a different perspective. They worked with the government on vaccination and persuaded those who were reluctant to vaccinate, as in Belgium, where their role was to legitimise vaccination as an effective, safe and necessary means of combating this crisis. They used not only expert knowledge, but also emotional tactics to motivate people, drawing on values such as solidarity with health professionals or respect for their hard work during the health crisis. The Polish discourse was similar, with doctors bravely fighting the pandemic and encouraging people to get vaccinated. There was no room for doctors to question any aspect of vaccination. But this was not the case everywhere. In some countries, such as the Czech Republic, there was space for hesitance or scepticism. In the UK, doctors’ actions were evaluated either positively (e.g. reducing wastage of vaccine doses) or negatively (deliberately not using all available vaccine doses). In Finland, HCPs were mainly associated with vaccine management. This was also the case in Italy, where HCPs were frequently mentioned in articles about vaccination priority and their availability and commitment as voluntary vaccinators. 4.3.1.5. Citizens: individuals vs. society. In the pre-Covid era, citizens were constructed mainly as hesitant parents or those who openly resisted vaccination schemes. In most mainstream discourses, state authorities, experts, international organisations, and NGOs focused on presenting vaccines as protective tools for the safety of children. In contrast, vaccine opponents were characterised as individuals with only their stories to tell. By presenting lay knowledge and individual testimonies, the mainstream media integrated sceptics into the discourses. In this context, some groups were portrayed as a public threat - in most countries these were so-called anti-vaxxers, in some countries like Poland or Portugal those were migrants who had not followed the vaccination schedule. In the UK, parents’ attitudes to vaccination were seen through the lens of their class of work or where they lived. In Poland, on the other hand, religious attitudes were sometimes linked to vaccination practices. In Italy, the focus was on parents and school staff involved in persuading parents and monitoring the legal and administrative consequences of non-vaccination. While in the pre-Covid discourses parents were the most visible and active citizens in all countries, during the pandemic they were marginalised and replaced by other vulnerable groups. Interestingly, during the Covid period, vulnerability was defined in terms of biophysical conditions (age, diseases, immunocompromise) or type of activity (teachers, health professionals, shop assistants, etc). The Czech media used the term "risk group" - and encouraged its members to be vaccinated against Covid-19. Belgian media referred to the "general population" (at the same time large groups of migrants and young people were marginalised, as “the discussion is taking place over their heads” (Belgium: HLN,1.2.21)). In Poland, senior citizens (70+and then 60+) and teachers became visible and active actors when the priority of vaccination was discussed. During the pandemic, there was more space for citizens to share their experiences and testimonies. The latter served mainly as positive examples in support of vaccination, but stories of side effects were also published. However, during this period, broad coalitions promoting A. Wagner et al. Social Science & Medicine 346 (2024) 116725 9 positive attitudes towards Covid-19 vaccines were observed in all countries studied. State representatives, under time pressure, sought support from international organisations, NGOs and experts. Contrary to the pre-Covid period, when experts were often individual scientists, virologists or epidemiologists, during the pandemic experts often represented public institutions of biotech companies. 4.3.2. Agency involved in temporalities The significant shifts in the preand Covid-19 vaccination discourses analysed can be observed in the temporal dimension. The most obvious change constructed in the latter is urgency - the need to “fight the virus”, to “act immediately” and the sense of “time shrinking”, or “lack of time”. However, there were some exceptions where time pressure was introduced as dangerous. It was related to trust or lack of trust in a particular subject, as in the example: “[a representative of the EMA] warns not to rush the approval of the Sputnik V vaccine” (Finland, hs.fi, March 09, 2021). In the pre-Covid period, normative and preventive orientations were intended to influence parents’ individual choices. Although preventive measures are usually future-oriented (risk reduction), in this case the past was also involved. This type of discourse, legitimised by the powerful international institutions, appealed to the common good, understood as “not returning to the past”, which meant old diseases, high mortality and outbreaks spinning out of control. “An example of a successful vaccination against a common disease is the measles vaccine. Before vaccination, all children got measles, a nasty childhood disease. But after the vaccination, there is no measles” (Belgium, DS, 17.2.2020). However, past experiences become less tangible and can therefore lose their preventive power. “The current generation of parents has never been confronted with serious infectious diseases such as poliomyelitis or diphtheria. Therefore, the attitude that it is superfluous to vaccinate children against such rare diseases is gaining ground” (Belgium, HLN, 2.12.2019). As a result, the past success of the vaccine’s preventive power can turn out to be a future threat, as in the following example from the Czech media. This example also evokes the notion of a "rich Western" society, as if spoilt by the success of vaccination. “On the other hand, the moods are changing in a rich Western society, where people no longer see the consequences of epidemics” (Czech, novinky.cz, 20.06.2019). The past, if not prevented, can come back and become the present. In this sense, the past is not irreversible, but it can happen again, which is why it needs people’s agency and control. The following quotes illustrate how the media in different countries referred to past threats and presented them as possible future scenarios. Scenarios that we may not be prepared and able to control if vaccination programmes are compromised: “Unfortunately, the threat of new epidemics is returning today. Even diphtheria cannot be considered completely eradicated. If we stopped vaccinating against it, it would certainly return, similar to what is happening now with measles” (Czech, novinky.cz, 25.07.2019). “At a time when smallpox was disfiguring and killing thousands of people, the brilliant mind of this scientist realised that anyone who worked with dairy products and contracted cowpox (with very mild effects on humans) was immune to smallpox in its most serious form” (Portugal, Público, 6.12.2020). At the beginning of the Covid-19 pandemic, the need for new vaccines – defined as a “weapon” – was presented as the most urgent need of all humanity. However, the acceleration of the processes of vaccine invention, production and distribution was at odds with the slow and long-term processes of scientific and clinical validation of vaccines to which we were accustomed. The constructed urgency, efficient in legitimising the radical top-down solutions such as lockdowns, face masks and social distancing, was counter-productive in the case of confidence in the safety of new biomedical products. The tension between the uncertainties of new vaccines and their possible unknown long-term negative consequences, on the one hand, and the threat of an unknown new disease, on the other, led to a turn away from “securing the future” and a focus on the present in relation to the past. Contrary to the pre-Covid vaccine discourses, the past was now framed as “normal everyday life” instead of “dangerous time of old diseases”. This was expressed in all discourses in the desire to “get back to normal”. Looking through the lens of media discourses, we can see anti-Covid vaccines as a bundle of inequalities, not only in terms of access to vaccines, risk of infection or possible side effects, but also in terms of agency. Some of the actors portrayed in the media discourses are privileged, with the ability to define the situations and deliberate on solutions, while others are simply called upon to act, which often means accepting the given solutions. 5. Discussion and conclusion As we argued at the start of the paper, people who make or do not make decisions about vaccines are exposed to vaccine discourses. This exposition may be intentional (when people seek information) or unintentional (accidental exposure) (Gil De Zú˜ niga et al., 2017). In any case, the surrounding discourses influence the context in which people act. And not taking a decision, as has been argued, must also be considered as a kind of action. Media discourses mobilise different resources (statistics, individual experiences, emotions, values, mainstream scientific knowledge, and its undermining) that could co-produce both acceptance and controversy around vaccines. For this reason, it is important to encourage work which explores the way in which vaccinatoin is covered in the mainstream media. The process of vaccine production and distribution is complex, involving political, financial, technological, and scientific issues. The comparison of seven European media discourses has led to the conclusion that these discourses are closed in the “black box of technology”: there are numerous references to the processes of production and distribution, but the uncertainty surrounding them is minimised. This can be seen as a wider problem of media coverage of scientific risk and uncertainty (Ashe, 2013; Grant, 2007). If we define risk as a feature of areas where we have a good scientific basis for assigning probabilities, and uncertainty as areas where we have a well-defined sense of expected outcomes but little basis for assigning probabilities (Stirling, 2010), the observed marginalisation of the discussion of uncertainty may result in a situation where the mechanism of reducing uncertainty by transforming it into risk has not been initiated. This has consequences because the quantification of uncertainty in terms of risk, its calculable probabilities and ways of mitigating it has been a pillar of decision making (Cox, 2021; Rudek et al., 2023a; Rudek et al., 2023b) and a crucial process in dealing with the unknown. Moreover, in a situation of radical uncertainty, which refers to situations whose determinants are not well enough understood to be described in terms of probability or prediction (Kay and King, 2020), scientific prediction can lose its disciplinary power in favour of the testimonies of the past: unique but reliable through their materialisation. This observation of the media debate around vaccines may reflect important and more general public expectations about the ways in which important collective decisions are legitimised. The pro-vaccine definitions reconstructed from the analysed mainstream discourses in the pre-Covid and Covid periods despite of being nuanced, reflected a certain shift from dealing with facts to referring to desires. Facts were understood as something constructed as having already happened, confirmed by the difference between the present and A. Wagner et al.