Abstract

Objective: This study examines Vaccine Discourse Champions (VDCs), highly active social media users committed to a vaccine stance, and analyzes how they shape the discursive landscape. Using agenda-setting theory, we investigate who VDCs are, what issues they prioritize, how they frame those issues, and how issue salience and framing vary across VDC categories. Materials and Methods: Structural Topic Modeling (STM) was applied to 6.6 million X posts (formerly Twitter) from 654 VDCs (January 2022–January 2023) to extract 58 topics. A topic-ownership framework was used to assess issue salience and framing across VDC groups. Results: Three categories emerged: anti-vaccine, anti-mandate, and pro-vaccine. Although pro-vaccine VDCs produced the largest share of posts (44%), they owned only six topics, remaining confined to a health-centric agenda. Oppositional VDCs (anti-vaccine and anti-mandate) owned 27 topics and dominated the discourse. They employed a two-tiered strategy by anchoring their discourse in high-volume core themes (vaccine safety and health autonomy) while sustaining engagement through a long tail of event-specific political topics. Discussion: VDCs function as micro-media agenda-setters, shaping issue salience and framing. Oppositional VDCs’ politicized frames illustrate how public health discourse can become embedded in broader ideological agendas and highlight the need for value-aligned communication strategies. The stance-sensitive STM and topic-ownership approach provides a method for mapping agenda-setting at scale. Conclusion: Oppositional VDCs framed vaccination as a civil liberty struggle. Effective communication must move from one-way broadcasting toward strategic value convergence by identifying and engaging with the underlying values that drive these communities rather than correcting them.

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