Vaccination in the Age of Memes: An Exploration of Digital Health Communication.

This study explores how internet memes serve as digital communication tools in public health discourse, influencing public perceptions by spreading both accurate and misleading health information. Utilizing a dual qualitative approach, Qualitative Content Analysis (QCA) and Reflexive Thematic Analysis (RTA), this study examined 99 vaccine-related memes shared online during the 2019 and 2025 measles outbreaks and the 2020 COVID-19 pandemic. QCA analyzed rhetorical tones (pathos, ethos, and logos) and vaccine stances (pro, anti, and neutral), while RTA identified key themes. Memes were sampled from Google Images using broad vaccine-related search terms (e.g., "vaccine meme," "vaccination meme"), allowing inclusion of memes related to a wide range of vaccine-preventable diseases rather than limiting the dataset to any single condition. While memes predominantly targeted emotional appeals (pathos), emergent themes include increased use of logical appeals (logos), political polarization, and anti-vaccine sentiments. Nurses and other public health communicators must counter misinformation and foster evidence-based dialogue to shape digital health literacy. Rhetorical patterns (e.g., humor, emotional resonance, and appeals to credibility) are communication strategies that transcend national boundaries. These findings, therefore, provide a foundation for understanding how similar dynamics might appear in other linguistic and cultural settings, while highlighting the need for ongoing research.