In the early part of the twentieth century in the United States, nearly every child contracted measles before his or her fifteenth birthday. Of every 1,000 cases between 1912 and 1916, 26 people died, accounting for 6,000 measles-related deaths, on average, each year. By the 1950s, both nutrition and disease treatment had improved, but measles was no less common, infecting three to four million people each year in the United States, killing 400 to 500 and leading to 48,000 hospitalizations. About 4,000 cases each year resulted in encephalitis, a swelling of the brain that can lead to deafness and intellectual disability (Centers for Disease Control and Prevention, 2014, 2015b; Pearce, 2015). In 1963, however, the U.S. government licensed the first measles vaccine. By the late 1960s and early 1970s, state laws required all children to be vaccinated against measles before they started school (Pearce, 2015). The average number of annual measles cases dropped from 530,217 (with 440 deaths) between 1953 and 1962 (Roush et al., 2007) to 3,411 cases and three deaths in 1988 (Centers for Disease Control and Prevention, 1989). From 1989 to 1991, the United States experienced a measles outbreak: 55,000 cases leading to 123 deaths and 11,000 hospitalizations (Pearce, 2015) and costing the country $100 million in direct medical costs (“The Measles Epidemic,” 1991); some of those infected during this outbreak had been vaccinated, which prompted the initiation of

requirements for a “booster” vaccine. As parents, pediatricians and schools adopted this two-vaccine regimen, the incidence of U.S. measles infections dropped so low that, by 2000, the CDC declared that measles had been eliminated in the United States, although it remained common in other countries, especially in the developing world (Pearce, 2015). However, in February 1998, the highly respected journal The Lancet published a paper by a team of British researchers, led by physician Andrew Wakefield. The article described case histories of 12 children and linked the development of “behavioral problems” among eight of the children with MMR (measles, mumps, rubella) vaccination. In essence, the article suggested that receiving the MMR vaccine could cause autism in children (Ziv, 2015). Few scientists ever thought Wakefield’s theory to be worth considering seriously, and by 2010 researchers and journalists had determined that Wakefield’s article was a fraud based on manipulated and even falsified data. An investigative journalist provided evidence that Wakefield and his colleagues had created the findings as a money-making scheme related to a lawsuit against the vaccine manufacturer (Deer, 2011a, 2011b). In February 2010, The Lancet retracted Wakefield’s original paper after the British General Medical Council (GMC) found him guilty of dishonesty and other ethics violations (Dyer, 2010); later in 2010, the GMC revoked Wakefield’s medical license (Brainard, 2013). By the time Wakefield’s claims had been debunked and his article retracted, however, the damage had largely been done already. Parents had begun to worry that vaccination was not safe. By 2009, data from the U.S. National Immunization Survey showed that 60.2 percent of parents with children aged 24 to 35 months had had their children vaccinated as recommended and on time; more than a quarter (25.8%) had delayed their children’s vaccinations, 8.2 percent had refused the vaccinations outright and 5.8 percent had delayed and refused vaccinations. Parents who delayed or refused vaccinations were significantly less likely to agree that vaccinations were safe for their children (Smith et al., 2011). By the 2013/2014 school year, fewer than 90 percent of children in eight states had received appropriate doses of the MMR vaccine; in Colorado, only 81.7 percent of kindergarteners had received the recommended MMR vaccination (Seither et al., 2014). Worse yet, low vaccination rates have contributed to the worst measles outbreaks in the United States in 20 years. In 2014, there were

668 cases in 27 states, and between December 28, 2014, and April 24, 2015, the CDC already had identified 147 measles cases in seven states, all linked to an outbreak that began at California’s Disneyland (Centers for Disease Control and Prevention, 2015c, 2015d). Fortunately, no deaths had been reported as a result of the outbreak, at least up until April 2015 (Clemmons et al., 2015). Of course, few parents would have read Wakefield’s original Lancet article; and yet 29 percent of 1,000 adults participating in a November 2012 YouGov.com survey said they believe autism is linked to vaccination. During a Congressional hearing that same month, a number of Congress members expressed similar beliefs (Berinsky, 2012). Where would people have learned about the alleged link between vaccination and autism, and why would they continue to see the claim as credible, despite overwhelming scientific consensus to the contrary? The answer, scholars and journalism critics argue, is news coverage that has continued to present “balanced” coverage of the controversy, implying that scientists disagree about the validity of the autism-vaccination link when, in fact, no credible scientific research has supported Wakefield’s theory and his own data have been proven unreliable at best (Brainard, 2013; Clarke, 2008; Dixon & Clarke, 2013; Smith et al., 2008; Speers & Lewis, 2004). The entire episode illustrates the power news media can have in influencing public awareness of, beliefs about and behavioral responses to health research and health claims – whether empirically supported or not. Unlike some of the media effects discussed earlier (e.g., media violence, tobacco and alcohol advertising), news coverage can influence individual health behaviors in both positive and negative ways, depending on the specific topic. For instance, recent data suggest that Americans’ consumption of carbonated beverages – especially “diet” sodas like Diet Coke and Diet Pepsi – is on the decline, largely due to increased consumer concerns about possible links between artificial sweeteners and cancer, and recent news coverage of research suggesting that consumption of diet soda leads to more, not less, weight gain (Esterl, 2014). News coverage of the recent measles outbreaks in the United States also may have pushed some anti-vaccination parents to agree to have their children immunized; sales of the Merck measles vaccine grew rapidly as news of the outbreak spread, peaking at levels four times the normal rates in February 2015 (Koons & Armstrong, 2015).