Evaluating online vaccination imagery: how misleading photos could impact safety

BACKGROUND: Vaccine administration errors, particularly those involving incorrect site and route, pose a significant concern for vaccine efficacy and patient safety. These errors can lead to clinical consequences like the formation of lumps, nerve damage, shoulder injury related to vaccine administration (SIRVA), and reduced immunity. Erroneous images of intramuscular and subcutaneous injection technique can inadvertently shape public and provider understanding of proper immunisation practices and may erode patients' confidence in vaccination. Since vaccine administration errors can impact patient safety, it is important for vaccine training materials and public images of vaccination to be accurate. This includes accurate depictions of vaccine administration, given that images play a key role in how people learn, including in medical education. METHOD: We investigated 375 online images, retrieved from 34 Vaccine Safety Net (VSN) member websites, 12 international health organizations, 11 international news websites, four medical websites and two government health websites. RESULTS: Images of incorrect vaccination techniques were widespread across trusted online resources. Common errors included the use of incorrect injection angle and technique (n = 67), as well as injections given too high (n = 31), too low (n = 46), too posterior (n = 7), and too anterior (n = 6). CONCLUSION: The common incorrect misrepresentation of immunisation injection technique may help "normalise" incorrect vaccine administration and pose an independent risk factor for increasing vaccine errors. Identifying common missteps in visual representations of vaccination could facilitate the development of automated tools to detect misleading content, ultimately promoting safe vaccination practices.