tag:theconversation.com,2011:/ca/topics/anti-vaccination-47547/articlesAnti-vaccination – The Conversation2024-03-22T02:10:41Ztag:theconversation.com,2011:article/2261182024-03-22T02:10:41Z2024-03-22T02:10:41ZConspiracy theorist tactics show it’s too easy to get around Facebook’s content policies<figure><img src="https://images.theconversation.com/files/583342/original/file-20240321-26-joql1y.jpg?ixlib=rb-1.1.0&rect=40%2C148%2C4257%2C2849&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/kuala-lumpur-malaysia-august-25-2013-1168328122">MavardiBahar/Shutterstock</a></span></figcaption></figure><p>During the COVID pandemic, social media platforms were swarmed by far-right and anti-vaccination communities that spread dangerous conspiracy theories.</p>
<p>These included the false claims that <a href="https://www.bbc.com/news/54893437">vaccines are a form of population control</a>, and that the virus was a <a href="https://theconversation.com/qanon-conspiracy-theories-about-the-coronavirus-pandemic-are-a-public-health-threat-135515">“deep state” plot</a>. Governments and the World Health Organization redirected precious resources from vaccination campaigns to debunk these falsehoods. </p>
<p>As the tide of misinformation grew, platforms were accused of not doing enough to stop the spread. To address these concerns, Meta, the parent company of Facebook, made several policy announcements in 2020–21. However, it hesitated to remove “<a href="https://www.facebook.com/notes/751449002072082/?hc_location=ufi">borderline</a>” content, or content that didn’t cause direct physical harm, save for one <a href="https://about.fb.com/news/2020/04/covid-19-misinfo-update/">policy change</a> in February 2021 that expanded the content removal lists.</p>
<p>To stem the tide, Meta continued to rely more heavily on algorithmic moderation techniques to reduce the visibility of misinformation in users’ feeds, search and recommendations – known as shadowbanning. They also used fact-checkers to label misinformation.</p>
<p>While shadowbanning is widely seen as a <a href="https://theconversation.com/what-is-shadowbanning-how-do-i-know-if-it-has-happened-to-me-and-what-can-i-do-about-it-192735">concerningly opaque technique</a>, our <a href="https://journals.sagepub.com/doi/10.1177/1329878X241236984">new research</a>, published in the journal Media International Australia, instead asks: was it effective?</p>
<h2>What did we investigate?</h2>
<p>We used two measures to answer this question. First, after identifying 18 Australian far-right and anti-vaccination accounts that consistently shared misinformation between January 2019 and July 2021, we analysed the performance of these accounts using key metrics.</p>
<p>Second, we mapped this performance against five content moderation policy announcements for Meta’s flagship platform, Facebook.</p>
<p>The findings revealed two divergent trends. After March 2020 the <em>overall</em> performance of the accounts – that is, their <em>median</em> performance – suffered a decline. And yet their <em>mean</em> performance shows increasing levels after October 2020. </p>
<p>This is because, while the majority of the monitored accounts underperformed, a few accounts overperformed instead, and strongly so. In fact, they continued to overperform and attract new followers even after the alleged policy change in February 2021.</p>
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<h2>Shadowbanning as a badge of pride</h2>
<p>To examine why, we scraped and thematically analysed comments and user reactions from posts on these accounts. We found users had a high motivation to stay engaged with problematic content. Labelling and shadowbanning were viewed as motivating challenges.</p>
<p>Specifically, users frequently used “<a href="https://doi.org/10.1177/01634437221111923">social steganography</a>” – using deliberate typos or code words for key terms – to evade algorithmic detection. We also saw <a href="https://www.tandfonline.com/doi/full/10.1080/21670811.2021.1938165">conspiracy “seeding”</a> where users add links to archiving sites or less moderated sites in comments to re-distribute content Facebook labelled as misinformation, and to avoid detection.</p>
<p>In one example, a user added a link to a <a href="https://www.pewresearch.org/short-reads/2023/02/17/key-facts-about-bitchute/">BitChute</a> video with keywords that dog-whistled support for QAnon style conspiracies. As terms such as “vaccine” were believed to trigger algorithmic detection, emoji or other code names were used in their place:</p>
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<p>A friend sent me this link, it’s [sic.] refers to over 4000 deaths of individuals after getting 💉 The true number will not come out, it’s not in the public’s interest to disclose the amount of people that have died within day’s [sic.] of jab.</p>
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<p>While many conspiracy theories were targeted at government and public health authorities, platform suppression of content fuelled further conspiracies regarding big tech and their complicity with “Big Pharma” and governments.</p>
<p>This was evident in the use of keywords such as MSM (“mainstream media”) to reference QAnon style agendas: </p>
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<p>MSM are in on this whole thing, only report on what the elites tell them to. Clearly you are not doing any research but listening to msm […] This is a completely experimental ‘vaccine’.</p>
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<p>Another comment thread showed reactions to Meta’s <a href="https://about.fb.com/news/2020/08/addressing-movements-and-organizations-tied-to-violence/">dangerous organisations policy update</a>, where accounts that regularly shared QAnon-content were labelled “extremist”. In the reactions, MSM and “the agenda” appeared frequently. </p>
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Read more:
<a href="https://theconversation.com/qanon-is-spreading-outside-the-us-a-conspiracy-theory-expert-explains-what-that-could-mean-198272">QAnon is spreading outside the US – a conspiracy theory expert explains what that could mean</a>
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<p>Some users recommended that sensitive content be moved to alternative platforms. We observed one anti-vaccination influencer complain that their page was being shadowbanned by Facebook, and calling on their followers to recommend a “good, censorship free, livestreaming platform”.</p>
<p>The replies suggested moderation-lite sites such as <a href="https://rumble.com/">Rumble</a>. Similar recommendations were made for Twitch, a livestreaming site popular with gamers which has since attracted <a href="https://www.nytimes.com/2021/04/27/us/politics/twitch-trump-extremism.html">far-right political influencers</a>.</p>
<p>As one user said:</p>
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<p>I know so many people who get censored on so many apps especially Facebook and Twitch seems to work for them. </p>
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<h2>How can content moderation fix the problem?</h2>
<p>These tactics of coordination to detect shadowbans, resist labelling and fight the algorithm provide some insight into why engagement didn’t dim on some of these “overperforming” accounts despite all the policies Meta put in place. </p>
<p>This shows that Meta’s suppression techniques, while partially effective in containing the spread, do nothing to prevent those invested in sharing (and finding) misinformation from doing so.</p>
<p>Firmer policies on content removal and user banning would help address the problem. However, <a href="https://about.fb.com/news/2022/07/oversight-board-advise-covid-19-misinformation-measures/">Meta’s announcement last year suggests</a> the company has little appetite for this. Any loosening of policy changes will all but ensure this misinformation playground will continue to thrive.</p>
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Read more:
<a href="https://theconversation.com/a-researcher-asked-covid-anti-vaxxers-how-they-avoid-facebook-moderation-heres-what-they-found-186406">A researcher asked COVID anti-vaxxers how they avoid Facebook moderation. Here's what they found</a>
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<p class="fine-print"><em><span>Amelia Johns has received funding from Meta content policy award for some of the research presented in this article. She has also received funding from the Australian Research Council.</span></em></p><p class="fine-print"><em><span>Emily Booth is supported by funding from the Australian Department of Home Affairs and the Defence Innovation Network.</span></em></p><p class="fine-print"><em><span>Francesco Bailo has received funding from Meta content policy award for some of the research presented in this article. He receives funding from the Defence Innovation Network. </span></em></p><p class="fine-print"><em><span>Marian-Andrei Rizoiu receives funding from the Australian Department of Home Affairs, the Defence Science and Technology Group, the Defence Innovation Network and the Australian Academy of Science.</span></em></p>New research shows that even after Facebook made changes to stem the tide of dangerous pandemic misinformation, some accounts continued to thrive.Amelia Johns, Associate Professor, Digital and Social Media, School of Communication, University of Technology SydneyEmily Booth, Research assistant, University of Technology SydneyFrancesco Bailo, Lecturer, Digital and Social Media, University of SydneyMarian-Andrei Rizoiu, Associate Professor in Behavioral Data Science, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2039412023-06-07T16:43:38Z2023-06-07T16:43:38ZCOVID has highlighted the connection between spirituality and vaccine scepticism<p>In the two and a half years since the first COVID vaccines were administered, anti-vaccination sentiment has grown exponentially. Scepticism about vaccines has been voiced, in particular, in <a href="https://www.motherjones.com/politics/2021/09/a-wildly-popular-app-for-churches-is-now-an-antivax-hotbed">religious communities</a> across the world, from <a href="https://www.theguardian.com/world/2021/nov/24/south-korea-cult-whose-leader-heals-by-poking-eyes-at-centre-of-covid-outbreak/">South Korea</a> and <a href="https://theconversation.com/spirit-of-resistance-why-destiny-church-and-other-new-zealand-pentecostalists-oppose-lockdowns-and-vaccination-170193">New Zealand</a> to <a href="https://www.theguardian.com/global-development/2021/nov/01/the-sects-hampering-southern-africa-covid-vaccine-rollout">South Africa</a>, the <a href="https://www.england.nhs.uk/south-east/wp-content/uploads/sites/45/2021/05/Vaccination-and-race-religion-and-belief-A4.pdf">UK</a> and prominently among white evangelicals, in <a href="https://www.pewresearch.org/ps_2021-09-15_covid19-restrictions_a-01/">the US</a>. </p>
<p>In my own church, people have expressed disbelief and denial. Some have claimed the pandemic is a lie and that the solutions proffered are proof of <a href="https://www.mdpi.com/2076-393X/9/6/593">governmental population control</a> and the formation of a <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3805612">“new world order”</a>.</p>
<p>This clearly isn’t the case for all religious people. But research confirms there is a strong correlation between spirituality and COVID-19 vaccine hesitancy, scepticism, and outright rejection. Among some religious and spiritual groups, the scepticism about vaccination is rooted in low faith in science. Among others, it overlaps with wider conspiracy theories.</p>
<h2>Low faith in science</h2>
<p>Between late 2020 and the summer of 2021, psychologists conducted a series of studies <a href="https://pubmed.ncbi.nlm.nih.gov/36446652/">online</a> in the UK. In the first two studies they surveyed 296 and 289 participants respectively, almost all of whom (456) then took part in a follow-up study. </p>
<p>This research found that people who were more spiritual were more hesitant or indecisive about getting the COVID vaccine. The researchers identified low science literacy and, particularly, low faith in science as causes. </p>
<p>To explore these issues in a different religious and non-Western context, the authors of that research conducted a subsequent study in Greece. There too, they <a href="https://pubmed.ncbi.nlm.nih.gov/34847810/">found</a> a similar relationship between low faith in science and vaccine scepticism. </p>
<p>Another study conducted in the Netherlands found also <a href="https://journals.sagepub.com/doi/full/10.1177/0963662520908534?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org">a strong connection</a> between contemporary, non-religious forms of spirituality and distrust in science. The distrust, however, was not applied to all aspects of science. Participants voiced little doubt about climate change. But they did strongly question the COVID vaccine. </p>
<p>In some instances, this spiritually informed scepticism of vaccine efficacy has been rooted not only in low faith in science but wider <a href="https://theconversation.com/conspiracy-theories-why-are-they-thriving-in-the-pandemic-153657">conspiracy theories</a>. </p>
<p>In a 2011 paper entitled <a href="https://www.iser.essex.ac.uk/research/publications/publication-520482">“The emergence of conspirituality”</a> conspiracy theory experts Charlotte Ward and David Voas detailed what they described as a new, hybrid system of belief. They called it “conspirituality”, a word borrowed from a Canadian <a href="https://ourstage.com/profile/conspirituality">hip-hop group</a> of that name, famous for their radical, politically conscious lyrics. </p>
<p>Ward and Voas defined conspirituality as marrying “the female-dominated New Age (with its positive focus on self) and the male-dominated realm of conspiracy theory (with its negative focus on global politics)”. They said:</p>
<blockquote>
<p>Proponents believe that the best strategy for dealing with the threat of a totalitarian ‘new world order’ is to act in accordance with an awakened ‘new paradigm’ worldview.</p>
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<p>As far as the COVID-19 vaccine is concerned, <a href="https://theconversation.com/vaccines-are-being-portrayed-as-limiting-personal-freedom-but-this-can-mask-the-true-reasons-for-hesitancy-176813">conspiratorial antivax campaigners</a> across the globe <a href="https://theconversation.com/coronavirus-and-conspiracies-how-the-far-right-is-exploiting-the-pandemic-145968">cite</a> government, ‘big pharma’ companies and western medicine as the objects of their mistrust. They posit that the body and its immune system is sacred. They see the supposedly toxic materials they claim are in vaccines as posing an existential threat. </p>
<h2>Disaster spirituality</h2>
<p>In May 2020, a journalist, a cult researcher and a yoga expert launched the <a href="https://www.conspirituality.net/">Conspirituality Podcast</a>, aiming to dissect where the wellness industry overlaps with new age cults and conspiracy theorists. Episodes have covered everything from <a href="https://theconversation.com/qanon-and-the-storm-of-the-u-s-capitol-the-offline-effect-of-online-conspiracy-theories-152815">QAnon</a> to Robert F. Kennedy Jr as the <a href="https://theconversation.com/the-truther-playbook-tactics-that-explain-vaccine-conspiracy-theorist-rfk-jrs-presidential-momentum-205588">antivax candidate</a> of US presidential campaigns. </p>
<p>They provide listeners, as one reviewer <a href="https://www.theguardian.com/tv-and-radio/2021/apr/16/a-riveting-tale-of-electoral-podcasts-of-the-week">has noted</a>, with updates on “disaster spirituality” and interviews with guests “who have either been part of, or are experts on, online cult-like communities where a desire to live more naturally has become a form of paranoia”.</p>
<p>Though people holding these conspiratorial views <a href="https://journals.sagepub.com/doi/10.1177/1367549419886045">generally criticise</a> scientific authority, they nonetheless cite supposedly “scientific” findings as supporting evidence for their claims. </p>
<p>They appeal for individual sovereignty and consciousness. They claim they are breaking away from mind control by the world’s elite. This dualistic outlook sets “us” (the entlightened) against “them” (the politicians and corporations). </p>
<p>Researchers at Deakin University in Australia <a href="https://journal.equinoxpub.com/JASR/article/view/22810/25609">have identified</a> 12 characteristics of what they term the “(con)spirituality of religious extremism”, including COVID-19 vaccine hesitancy or refusal. </p>
<p>The researchers say (con)spiritualists, in common with adherents of many other religious extremist movements, uphold “exclusive religious and spiritual narratives which frame them as being exceptional and privy to the real, hidden, one and only truth and as more enlightened than mainstream society”. They bracketed the word (con) in order to underline the complexity of the issue. </p>
<p>They explain that some people within spiritual and wellness circles actually question modernity in legitimate and informed ways. Others, though, are out to con their followers, spreading disinformation that “poses significant risks to society, sometimes for financial gain”. </p>
<p>Spirituality is a complex, multi-faceted thing. And people are sceptical of science for all kinds of reasons, not only spiritual ones. But in order to adequately prepare for the <a href="https://www.cgdev.org/blog/the-next-pandemic-could-come-soon-and-be-deadlier">next pandemic</a>, we need to be able to address diverse opinions <a href="https://theconversation.com/misinformation-why-it-may-not-necessarily-lead-to-bad-behaviour-199123">wisely</a>. We need to understand where people’s spirituality and science scepticism overlap – and why.</p>
<p><em>This article was amended on June 8 2023 to correctly caption the photograph of the London protest in 2020 as being anti-lockdown, and not antivax.</em></p><img src="https://counter.theconversation.com/content/203941/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tamas Lestar does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>To adequately prepare for the next pandemic, we need to understand where people’s spirituality and science scepticism overlap – and why.Tamas Lestar, Senior Lecturer in Responsible Management & Leadership, University of WinchesterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1905182023-04-27T12:31:56Z2023-04-27T12:31:56Z‘Got polio?’ messaging underscores a vaccine campaign’s success but creates false sense of security as memories of the disease fade in US<figure><img src="https://images.theconversation.com/files/523213/original/file-20230427-22-64ll1p.jpg?ixlib=rb-1.1.0&rect=55%2C130%2C3285%2C2434&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For much of the 20th century, Americans were used to seeing people bearing the signs of past polio infection.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/boy-helps-his-brother-a-polio-victim-confined-to-a-news-photo/526756448">Genevieve Naylor/Corbis via Getty Images</a></span></figcaption></figure><p>“<a href="https://twitter.com/sofia_vignolo/status/1129501200716636160">Got Polio? Me neither. Thanks, Science.</a>”</p>
<p>Messages like this are used in memes, posters, T-shirts and even some billboards to promote routine vaccinations. As this catchy statement reminds people of once-feared diseases of the past, it – perhaps unintentionally – conveys the message that polio has been relegated to the history books.</p>
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<a href="https://images.theconversation.com/files/520043/original/file-20230410-5132-hx8ppo.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Leonardo DiCaprio meme 'Remember that time you got polio? Nope? Me neither? Thanks Science!'" src="https://images.theconversation.com/files/520043/original/file-20230410-5132-hx8ppo.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/520043/original/file-20230410-5132-hx8ppo.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520043/original/file-20230410-5132-hx8ppo.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520043/original/file-20230410-5132-hx8ppo.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520043/original/file-20230410-5132-hx8ppo.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520043/original/file-20230410-5132-hx8ppo.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520043/original/file-20230410-5132-hx8ppo.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">This pro-science message uses a popular ‘cheers’ meme format.</span>
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<p>Phrasing that aims to encourage immunizations by highlighting their accomplishments implies that some diseases are no longer a threat.</p>
<p>Few people today know much about polio. In 2022, only one-third of surveyed adults in the U.S. were <a href="https://www.annenbergpublicpolicycenter.org/what-u-s-adults-know-and-believe-about-polio-and-the-bivalent-covid-booster/">aware that polio has no cure</a>. Moreover, a 2020 poll had found that <a href="https://news.gallup.com/poll/276929/fewer-continue-vaccines-important.aspx">84% of adults viewed vaccinating children as important</a>, a 10% decline from 2001. The COVID-19 pandemic amplified anti-vaccination messaging, while also <a href="https://doi.org/10.1002/hsr2.516">delaying routine immunization</a>.</p>
<p>Vaccine-preventable diseases are far from eradicated. Measles outbreaks in unvaccinated or under-vaccinated American communities have begun resurfacing in the past few years, despite a <a href="https://www.cdc.gov/measles/elimination.html">2000 declaration</a> that the virus had been eliminated in the U.S. <a href="https://wonder.cdc.gov/nndss/static/2019/annual/2019-table2l.html">Pertussis cases have been on the rise</a>, with more than 18,000 cases reported in 2019. And in July 2022, polio reappeared in an unvaccinated New York man – the first U.S. diagnosis since 1979. This case helped return attention to polio, causing at least some young adults to <a href="https://www.nytimes.com/2022/08/17/health/polio-vaccine-history-millennials.html">wonder about their own vaccination status</a>.</p>
<p>A shift in focus to <a href="https://polioeradication.org">immunization in developing countries</a> has further lulled Americans into a false sense of security. While global approaches have been effective and are certainly needed, as the author of “<a href="https://www.umasspress.com/9781625345288/constructing-the-outbreak/">Constructing the Outbreak: Epidemics in Media and Collective Memory</a>,” I suggest that the celebratory messaging is no longer as effective as it once was and runs the risk of making it seem as if polio only lives in history books.</p>
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<a href="https://images.theconversation.com/files/523214/original/file-20230427-560-ekoj1v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="semicircle of patients in iron lungs use mirrors to watch a TV" src="https://images.theconversation.com/files/523214/original/file-20230427-560-ekoj1v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/523214/original/file-20230427-560-ekoj1v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=463&fit=crop&dpr=1 600w, https://images.theconversation.com/files/523214/original/file-20230427-560-ekoj1v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=463&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/523214/original/file-20230427-560-ekoj1v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=463&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/523214/original/file-20230427-560-ekoj1v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=582&fit=crop&dpr=1 754w, https://images.theconversation.com/files/523214/original/file-20230427-560-ekoj1v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=582&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/523214/original/file-20230427-560-ekoj1v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=582&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Polio patients at Baltimore’s Children’s Hospital watched television from inside the iron lungs that breathed for them.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/iron-lung-victims-get-television-set-baltimore-md-iron-lung-news-photo/515427562">Bettmann via Getty Images</a></span>
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<h2>Campaigning against a devastating disease</h2>
<p>Before vaccines, polio – called infantile paralysis or poliomyelitis – was the most feared childhood disease in the U.S. Frequently affecting elementary school kids, the disease sometimes presented like a cold or flu – fever, sore throat and headache. In other cases, limb or spinal pain and numbness first indicated that something was wrong. Paralysis of legs, arms, neck, diaphragm or a combination could occur and, depending on the area affected, render patients unable to walk, lift their arms, or breathe outside of an iron lung.</p>
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<a href="https://images.theconversation.com/files/520095/original/file-20230410-3779-u51y6h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="magazine add with images of kids with polio asks for donations" src="https://images.theconversation.com/files/520095/original/file-20230410-3779-u51y6h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/520095/original/file-20230410-3779-u51y6h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=780&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520095/original/file-20230410-3779-u51y6h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=780&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520095/original/file-20230410-3779-u51y6h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=780&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520095/original/file-20230410-3779-u51y6h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=980&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520095/original/file-20230410-3779-u51y6h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=980&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520095/original/file-20230410-3779-u51y6h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=980&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Full page ads like this one from 1953 solicited funds to help polio patients.</span>
<span class="attribution"><span class="source">March of Dimes</span></span>
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<p>Only time could <a href="https://doi.org/10.1136%2Fbmj.1.4602.465">reveal whether the paralysis was permanent</a> or would recede, sometimes to return decades later as <a href="https://www.ninds.nih.gov/health-information/disorders/post-polio-syndrome">Post-Polio Syndrome</a>. Enough people were infected in outbreaks in the 1930s, 1940s and early 1950s that the effects of paralytic polio were quite visible in everyday life in the form of braces, crutches, slings and other mobility devices.</p>
<p>Thanks to the National Foundation for Infantile Paralysis, beating polio became a national priority. The NFIP grew out of President Franklin Delano Roosevelt’s Warm Springs Foundation. <a href="https://theconversation.com/what-fdrs-polio-crusade-teaches-us-about-presidential-leadership-amid-crisis-137215">Roosevelt himself had been partially paralyzed</a> by polio, and the NFIP provided funds for public education, research and survivors’ rehabilitation.</p>
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<a href="https://images.theconversation.com/files/523215/original/file-20230427-986-uvz7nc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Eleanor Roosevelt smiles with a young boy holding a 'Mothers March on Polio' scroll" src="https://images.theconversation.com/files/523215/original/file-20230427-986-uvz7nc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/523215/original/file-20230427-986-uvz7nc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=760&fit=crop&dpr=1 600w, https://images.theconversation.com/files/523215/original/file-20230427-986-uvz7nc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=760&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/523215/original/file-20230427-986-uvz7nc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=760&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/523215/original/file-20230427-986-uvz7nc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=955&fit=crop&dpr=1 754w, https://images.theconversation.com/files/523215/original/file-20230427-986-uvz7nc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=955&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/523215/original/file-20230427-986-uvz7nc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=955&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Eleanor Roosevelt helped inaugurate the Mothers’ March on Polio to raise money to fight the disease.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/the-mothers-march-on-polio-was-inaugurated-december-10-1953-news-photo/535083978">Bettmann/CORBIS via Getty Images</a></span>
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<p>Its campaigns were prolific and diverse, combining interpersonal and mass communication strategies.</p>
<p>From FDR “Birthday Ball” celebrations to parades and elementary school fundraising competitions, various groups raised money. <a href="https://www.umasspress.com/9781625345288/constructing-the-outbreak/">High schoolers performed polio-themed plays</a>, putting the disease itself on trial in “The People vs. Polio.” People passed around collection boxes at movie theaters and other public gatherings.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/520093/original/file-20230410-18-dbduj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="text of three 'I will not' and 'I will' points" src="https://images.theconversation.com/files/520093/original/file-20230410-18-dbduj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/520093/original/file-20230410-18-dbduj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1569&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520093/original/file-20230410-18-dbduj8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1569&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520093/original/file-20230410-18-dbduj8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1569&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520093/original/file-20230410-18-dbduj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1972&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520093/original/file-20230410-18-dbduj8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1972&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520093/original/file-20230410-18-dbduj8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1972&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">An ad placed in Vogue in 1952 laid out the ‘Polio Pledge.’</span>
<span class="attribution"><span class="source">National Foundation for Infantile Paralysis</span></span>
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</figure>
<p>Campaigns used every medium. Brochures and short films raised awareness of the threat of polio, emphasizing the need for funding to support patient rehabilitation and scientific research. The National Foundation for Infantile Paralysis generated scores of radio scripts and hired Frank Sinatra, Elvis Presley and other famous voices to read them. <a href="https://youtu.be/fOkJAIPkxRA">Judy Garland, Mickey Rooney</a>, <a href="https://www.youtube.com/watch?v=BOXw-Px-X-8&t=4s">Lucille Ball</a> and other Hollywood stars also joined the fight. Comic strips and cartoons featuring Mickey Mouse and Donald Duck rallied for March of Dimes funds to help polio patients.</p>
<p>Starting in 1946, the NFIP featured children with crutches and braces who had survived polio as “<a href="https://www.marchofdimes.org/about/news/memoriam-donald-anderson-first-poster-child-1940-2014">poster children</a>” asking for funds to help them walk again. News stories covered outbreaks and polio epidemics, detailing the devastation of the disease on individuals, families and communities, while advising families how to reduce risk through the “Polio Pledge for Parents,” which provided a <a href="https://nyshistoricnewspapers.org/lccn/sn83031653/1952-07-17/ed-1/seq-4/">list of do’s and don'ts</a> during summer months.</p>
<h2>From public enemy No. 1 to success story</h2>
<p>The work of the National Foundation for Infantile Paralysis yielded unprecedented and continuous success, providing hospitals with equipment during epidemics and supporting the development of vaccines. Following the largest vaccine trial in history, on April 12, 1955, the Poliomyelitis Vaccine Evaluation Center announced that Jonas Salk’s vaccine was <a href="https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.45.5_Pt_1.575">80%-90% effective</a> against paralytic polio and officially <a href="https://theconversation.com/the-great-polio-vaccine-mess-and-the-lessons-it-holds-about-federal-coordination-for-todays-covid-19-vaccination-effort-152806">ready for general use</a>.</p>
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<a href="https://images.theconversation.com/files/523216/original/file-20230427-27-uurxai.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="families in line outside a school with a sign 'Entrance for polio shots' in 1955" src="https://images.theconversation.com/files/523216/original/file-20230427-27-uurxai.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/523216/original/file-20230427-27-uurxai.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=449&fit=crop&dpr=1 600w, https://images.theconversation.com/files/523216/original/file-20230427-27-uurxai.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=449&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/523216/original/file-20230427-27-uurxai.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=449&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/523216/original/file-20230427-27-uurxai.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=565&fit=crop&dpr=1 754w, https://images.theconversation.com/files/523216/original/file-20230427-27-uurxai.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=565&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/523216/original/file-20230427-27-uurxai.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=565&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Once a vaccine was available, people lined up to protect themselves and their families from the virus.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/san-diego-california-first-and-second-graders-at-the-kit-news-photo/514704620">Bettmann via Getty Images</a></span>
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<p>Over the next decade, the NFIP shifted its focus to widespread immunization, again using both mass media and local campaigns. With Salk’s vaccine, and then Albert Sabin’s, polio cases fell quickly, from the peak of 57,879 cases in 1952 to <a href="https://doi.org/10.2307/4593032">only 72 cases in 1965</a>, with the <a href="https://www.cdc.gov/polio/what-is-polio/polio-us.html">last naturally occurring U.S. case in 1979</a>.</p>
<p>The repeated declaration of what polio vaccines could and were accomplishing was <a href="https://www.npr.org/sections/health-shots/2021/05/03/988756973/cant-help-falling-in-love-with-a-vaccine-how-polio-campaign-beat-vaccine-hesitan">strategically effective</a> in persuading more people to get their shots. The American public of the 1960s and 1970s had lived through repeated polio epidemics and knew both the fear of contracting the disease and its visible aftereffects. As of 2021, <a href="https://immunizationdata.who.int/pages/coverage/POL.html?CODE=USA&ANTIGEN=POL3&YEAR=">92.7% of Americans</a> were fully protected by the vaccine, though these rates have been in decline since 2010 and <a href="https://www.cdc.gov/vaccines/imz-managers/coverage/schoolvaxview/data-reports/index.html">fluctuate by region</a>.</p>
<p>Public health rhetoric that <a href="https://doi.org/10.1016/j.vaccine.2011.10.005">focused on this vaccine success story</a> worked around the world in the late 1980s and 1990s. Gradually, though, the perceived threat in the U.S. of polio and other vaccine-preventable diseases dissipated over generations as vaccinations largely eliminated the risk. Most people in developed countries <a href="https://www.fda.gov/consumers/consumer-updates/vaccines-protect-children-harmful-infectious-diseases">lack firsthand experiences</a> of just how terrifying these diseases are, having never experienced polio, diphtheria, measles or pertussis, or lost family members to them.</p>
<p>At the same time that polio has been largely forgotten in the U.S., <a href="https://theconversation.com/covid-19-misinformation-scientists-create-a-psychological-vaccine-to-protect-against-fake-news-153024">anti-vaccination messages have been spreading disinformation</a> that distorts the risk of vaccines, ignoring the realities of the diseases they immunize against.</p>
<p>Rhetoric from polio vaccine campaigns in the 1950s and 1960s emphasized the risks of not getting immunized – acute illness, life-changing pain and paralysis or even death. In the 21st century U.S., immunization campaigns no longer emphasize these risks, and it’s easy to forget the potentially deadly repercussions of skipping vaccines.</p>
<p>I believe pervasive public health messaging can counter anti-vaccination disinformation. A reminder for the American public about this still dangerous disease can help ensure that “Got Polio?” does not become a serious question.</p><img src="https://counter.theconversation.com/content/190518/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katherine A. Foss does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Polio vaccines have been a massive public health victory in the US. But purely celebratory messaging overlooks the ongoing threat if vaccination rates fall.Katherine A. Foss, Professor of Media Studies, Middle Tennessee State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1933702023-02-17T06:05:56Z2023-02-17T06:05:56ZI bonded with COVID vaccine sceptics over saunas and Mother Earth rituals – this is what they taught me<p>I was standing in a forest at night, by a dark lake taking part in a Mother Earth ritual. Shaman drums echoed between the cliffs. The witch leading the ritual suddenly encouraged us to sound like wild animals. The other women seemed to greet this as something predictable and expected. “Stand up, let your inner spirit out, the wild animal within you!” the witch called out. And then she laughed out loud into the darkness – and just howled.</p>
<p>A woman in her 60s, with long blonde tangled hair, looking tough and slender-limbed at the same time, rose to her feet, and with something wild glittering in her eyes, she followed the witch into this transcendental phase of the ritual, and started to howl too.</p>
<p>I was in Hälsingland, a region in southern Sweden’s Norrland (Northland). I travelled there in September 2021, to find out more about a group of people who were staunchly against COVID-19 vaccinations, as part of a four-year <a href="https://lucris.lub.lu.se/ws/portalfiles/portal/131561070/ES_52_2022_Hammarlin_PUBLISHED_VERSION.pdf">research project</a>. A well-known pundit working at a national newspaper had called vaccine sceptics, like the ones I was to meet, “egoistic, ill-bred tearaway teenagers” in a <a href="https://www.dn.se/ledare/hanne-kjoller-vaccinvagrarna-visar-att-det-ar-jaget-inte-laget-som-ar-svenskarnas-ledstjarna/">national newspaper</a>. I knew there would be more to them than that, so I wanted to meet them and try my best to understand them.</p>
<p>Understanding Hälsingland itself is key to that understanding, as the lack of work opportunities and the ongoing migration of people to the big cities are big issues for the local population. The same goes for the high death rates connected to drugs among young adults as well as the high (by national standards) <a href="https://ki.se/en/nasp/suicide-in-the-counties-of-sweden">suicide rates</a> in the Gävleborg county, to which Hälsingland belongs. The people I met were doing their best to adjust to these issues, but it seemed difficult for them to fully accept the changes which had been wrought over their communities in recent years.</p>
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<img alt="" src="https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/288776/original/file-20190820-170910-8bv1s7.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><strong><em>This story is part of Conversation Insights</em></strong>
<br><em>The Insights team generates <a href="https://theconversation.com/uk/topics/insights-series-71218">long-form journalism</a> and is working with academics from different backgrounds who have been engaged in projects to tackle societal and scientific challenges.</em></p>
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<p>On my first day I met a group of middle-aged women who drove me to a tired old house, painted with “Falu rödfärg”, a traditional red paint used to cover wooden buildings. It was here, ahead of any transcendental ceremonies, where we were going to sauna bathe together.</p>
<p>Darkness was falling over the fields and meadows, sparsely located houses and wide-ranging forests. The September evening light tucked in the landscape like a soft blanket. Nowadays, this part of Sweden is connected to words like “depopulated” rather than “rural”. The unemployment rate is high, government welfare has been greatly reduced and some hospitals have been shut down. Some years ago (in a region further north of Hälsingland) parents were even offered <a href="https://www.sbs.com.au/topics/voices/health/article/2017/01/17/swedish-parents-are-being-taught-how-deliver-baby-car">courses</a> on how to deliver babies in their car. </p>
<p>The <a href="https://www.bbc.com/news/world-europe-62913356">Swedish election</a> that took place in September 2022 exposed the division between the countryside and the cities. People, mostly men, living in rural areas voted for the populist right-wing party, <em>Sverigedemokraterna</em> (The Swedish Democrats) in <a href="https://sverigesradio.se/artikel/sweden-democrats-grow-in-previous-centre-party-strongholds-in-countryside">higher numbers</a> than those living in the cities. </p>
<p>The Swedish Democrats are now Sweden’s second biggest party. This means that Sweden follows in the footsteps of the political development of other Nordic countries, such as Norway and Denmark, towards a less social-liberal politics and more conservative ideology. Immigration and crime have become the topics that all parties, from left to right, seem to identify as the most important.</p>
<p>Still, Scandinavia’s high willingness to take vaccinations against many infectious diseases bear witness of a well-functioning welfare state model. The documented <a href="https://onlinelibrary.wiley.com/doi/10.1111/1467-9477.t01-1-00077">high trust</a> in public authorities certainly played a role when people <a href="https://www.nature.com/articles/s41598-022-21055-0">chose to take</a> the recommended COVID-19 jabs.</p>
<p>My fieldwork among vaccine critical people in Hälsingland took place over a week in a cultural environment that in one sense was familiar to me. My grandmother and her siblings were born in a small Hälsingland-village. I’m Swedish, so there were no language barriers that the women I was with had to overcome, and we share the same national culture. But within cultures, more cultures unfold kaleidoscopically. So, at the same time it was a place I didn’t belong to.</p>
<p>I was a stranger, an academic from the city. Despite this, I was warmly invited into this community of friends that, among many other things, nurtured a strong reluctance towards vaccines. In one way or another, these women were hesitant or critical towards all kinds of vaccinations.</p>
<h2>Sauna stories</h2>
<p>We started out with some sweating in a hot sauna. The women thought a sauna would be a good start to my trip. They often do this together so it seemed like a natural thing to do. Lit candles decorated the entrance. It felt a bit awkward to undress in front of people I had just met; there is a paradox in being both professional and naked, even for an ethnologist. But the crackling sound of the fire and the overwhelming heat soothed my nerves.</p>
<p>When sitting in this small, hot space together with people I didn’t know and who didn’t know me, I could physically feel how the energy was directed towards me, the stranger coming from the university in the south. Later during the week they gave me the nickname “Lund University”. I spoke to them about my own attitude towards vaccinations: that I take them all without reflecting too much and my children do too. I explained that I was genuinely interested in why they had refrained from vaccines that are voluntary and free of charge in Sweden. I had no mission whatsoever in trying to influence their choice. </p>
<p>I didn’t know the cultural codes in this particular sauna, but sauna bathing is a <a href="https://www.routesnorth.com/sweden/planning-your-trip/sauna-etiquette-in-sweden/">well-established ritual</a> in Scandinavia that I’ve taken part in enough times to know the procedure. When minutes turned into quarter of an hour, the sweat was forming a small pool on my stomach, and then the natural flow in and out of the sauna began. Litres of water were consumed in greedy gulps. We took outdoor showers, stark naked in the increasing darkness of the garden. The ice-cold water evoked sounds of joy, high-pitched screams and laughter embedded in the surrounding nature.</p>
<p>Half-consciously, I studied their behaviour so that I would blend in as much as possible. Slowly but steadily, I felt more and more included. I could relax, let my guard down. </p>
<p>Suddenly the light chit-chat turned into stories of pain, loss and sorrow. Little by little, this led us into questions of health and vaccines. </p>
<h2>Natural and unnatural</h2>
<p>Anna* explained that she relied upon the presumption that a natural way of living will protect her and her children from harm. Fresh air, long walks in nature, food that comes directly from the surrounding forest, yoga and meditation, and spending lots of time with your loved ones – all these offer a much better health protection than vaccinations, she claimed. She felt that, in comparison, vaccines were something unnatural. </p>
<p>She explained that living close to nature made her and her friends “better suited” for a stable contact with their inner selves and that, in turn, reflected their contact with nature and their belief in the immune system as “naturally powerful” – as long as you don’t interfere with it. This gave the immune system more of a spiritual meaning.</p>
<p>A low humming sound came from her friends in agreement. The immune system becomes naturally strong here, they all agreed, not due to the national vaccination programmes but because of the closeness to nature in everyday life. Nature was repeatedly referred to as something inherently benign, a Nordic idea that <a href="https://books.google.se/books?id=6_H-dsz1locC&lpg=PP1&dq=culture%20builders&pg=PP1#v=onepage&q=culture%20builders&f=false">researchers</a> like Jonas Frykman and Orvar Löfgren have investigated as a romantic response to urbanisation.</p>
<p>It also became clear that some of the women had taken the decision to refrain from vaccinations decades ago when their children were small. That was when – as in many other parts of the world – there was a worry that the <a href="https://pubmed.ncbi.nlm.nih.gov/17168157/">measles vaccine</a> could cause neurological diseases, like autism. That charge has since been debunked, but its effects appear to have been long-lasting. And now, the unvaccinated sons and daughters of the women I interviewed had left this sparsely populated area to live in bigger cities.</p>
<p>Even though spiritually oriented, these women did not belong to any religious community and were not involved in organised political activities. They were just friends, that, for similar reasons were convinced that vaccinations may be harmful to their health.</p>
<p>When I asked them to describe this conviction in more detail, I was told stories about how nobody knows for sure what vaccines do to the immune system in the long run. Vaccines might even destroy the immune system, depriving it of its natural force to combat diseases, leaving the body unprotected and vulnerable. According to them, vaccines have only one winner – the pharmaceutical industry.</p>
<p>I recognised some of these stories from the internet and from literature I’d read. The fear of vaccinations seems to be formed by and in between information from the public authorities, pro and anti-vaccination campaigns, traditional media, digital forums, discussions at kitchen tables, conspiracies, rumours and contemporary legends. All these blend the rational and emotional reasoning into a personal mixture.</p>
<h2>Mother Earth</h2>
<p>One windy night at a steep cliff in the forest, where the lake surrounded us in three directions, we gathered to celebrate “Mother Earth”. A middle-aged woman with a warm smile came up to me. She wore a long poncho and bird feathers in her black dyed hair. In her right hand, she held a long feather that she stroked over my coat, from head to toe. Anna, who was accompanying me, told me that this ritual leader was a witch and that the feather stroking is a way of releasing unwelcome spirits. The witch did this to everyone that wanted to join the ritual. A dozen people, mostly women, had parked their cars some 100 metres away and were now gathered among the trees.</p>
<p>We sat in a circle around an unlit bonfire. Being as flexible as a refrigerator, I had severe problems sitting in the lotus position, which most of the other participants managed with ease. When unfolding my aching legs so that they were stretched into the circle, I felt clumsy and undignified. Anna, a yoga instructor, sat beside me with her legs in a neat knot and her fine-limbed spine straight as a tree stem. Her curly, unruly hair was like a halo around her head. I was glad to be there with her. She knew what was about to happen, and I trusted in her to lead me through the experience with kindness.</p>
<p>Then came time to light the bonfire and the torches. The witch rose, seemingly surrounded by flames. Standing for a while in all four points of the compass, she honoured Mother Earth by thanking her for her richness and patience, talking to her rhythmically in a strong and clear voice. Mother Earth was addressed as a subject: not only was she invited to the ritual but she formed the very ground on which it was built. The witch sometimes glanced at her mobile phone to remember the words correctly. I could feel the increasing chilly wind in my hair and small raindrops landed on the backs of my hands. Then the singing in minor began.</p>
<blockquote>
<p>A river runs slowly, slowly as a human, a river runs slowly, home to its ocean, give me strength, give me courage to live on this earth, give me strength, give me power, as a river.</p>
</blockquote>
<p>A while later we sang a well-known Nordic folksong about a young girl who is herding sheep, one of many similar songs in the Scandinavian folklore treasure chest. The girl in the song walks and walks together with the herd over heaths and mountains. Her stomach is empty but she keeps her spirit up by singing. </p>
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<p>Wild animals follow her at a distance, offering protection and evoking fear. In solitude for days, the girl moves slowly between birches, aspen and linden trees, over crystal clear and cold streams, among lynx and eagles. These songs remind us of our peasant cultural heritage. Sweden in the 1850s was entirely dominated by the <a href="https://www.informationsverige.se/en/om-sverige/att-komma-till-sverige/sveriges-historia.html">agrarian sector</a>.</p>
<h2>Nostalgia</h2>
<p>In the Nordic countries the industrial revolution happened later than elsewhere in Europe and even though people were crouching under heavy problems (poverty, starvation, and <a href="https://www.swensoncenter.org/swedishimmigrationhistory">violent strikes</a>), the industrial transformation of this part of Sweden has slowly turned into nostalgic stories about a time when the countryside was thriving. For elderly and middle-aged people who grew up in Hälsingland, or other parts of rural Norrland in northern Sweden for that matter, a common cultural reference point is a sort of golden era – at least it’s perceived as such when looking in the rear-view mirror. Times when the fertile soil and the vibrant sawmill industry nurtured flourishing villages and cities, forming nostalgic stories passed on to children and grandchildren. </p>
<p>It’s said that sawmills fought against each other to find enough workers. People moved to Norrland from the big cities in the south, even from the capital, to settle down and build houses and families. The schools were full of pupils, the story goes. Thriving bakeries and butchers were meeting places where people shared everyday gossip. </p>
<p>Around here, the Swedish word storbonde, which is translated to “big farmer” in different language apps, encompasses the large-scale, prosperous farms that can still be recognised in the landscape. In the 21st century however, many of the impressive wooden two-storey houses and barns have been left to crumble. Many were painted in that traditional red paint which distinguishes Swedish peasant cultural history more than any other aesthetic expression (these red buildings were depicted abundantly in Astrid Lindgren’s books about <a href="https://www.goodreads.com/book/show/25980302-that-boy-emil">That Boy Emil</a>).</p>
<p>From a distance they appear intact but when you get closer the lack of care strikes you: worn windows, flaked paint, overgrown gardens. Nowadays, the activities in the barns have been replaced by well-meaning governmental actions to resurrect “<a href="http://umu.diva-portal.org/smash/get/diva2:1048922/FULLTEXT01.pdf">a living countryside</a>”.</p>
<p>My grandmother and her siblings belonged to the adventurous pioneers who left their shoemaker heritage at a young age in the 1920s to move to Stockholm and make a living as housemaids and factory workers. None of them returned to Norrland other than to visit. One could say that they embodied the <a href="https://www.routledge.com/Rural-Development/Pain-Hansen/p/book/9781138775664#">flight from the countryside</a>, which through the years led to sparsely populated villages.</p>
<p>This change from “rural” to “depopulation” has turned into a discourse in Swedish culture: a development that is taken for granted and rarely questioned, and that we share with many other countries. The philosopher Simone Weil <a href="https://books.google.se/books?id=zacmeILjLvIC&lpg=PP1&dq=simone%20weil&pg=PP1#v=onepage&q=simone%20weil&f=false">wrote</a> about this in the 1940s. She means that the depopulation of the countryside leads to the death of society as a whole, and nothing seems to slow it down.</p>
<p>Against this background, it’s fair to say that Hälsingland today “finds itself caught in a present that began some time ago”, to <a href="https://books.google.se/books?id=ZXQMrC-U9pEC&lpg=PP1&dq=ordinary%20affects&pg=PP1#v=onepage&q=ordinary%20affects&f=false">borrow a phrase</a> from the American anthropologist Kathleen Stewart. </p>
<p>The consequences of a century characterised by urbanisation and globalisation are ubiquitous and easily spotted in the landscape through the contours of disused factories, empty industrial buildings and closed shops. Abandoned houses line the roads. I find them hard to describe without flirting with the desolation and melancholy both captured and constructed by a special <a href="https://www.svd.se/a/4obKmV/stilig-dansk-modernism-med-kraftfullt-grafiskt-bildsprak">Nordic art genre</a> – as the Finnish photographer <a href="https://www.svd.se/a/z9z4O/bilder-fran-landet-dar-stjarnorna-ar-narmare-an-grannen">Esko Männikkö’s</a> compassionate photography of men living by themselves in depopulated villages, far away from the big industries and technological achievements – that many associate Sweden with.</p>
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<h2>Wolf howls</h2>
<p>The Mother Earth ritual went into a new phase when shaman drums made our hearts beat faster, and then the howling began. The trees and the flames from the fire surrounded the witch. She moved her body to the sound of the drums. Other women joined, they let their heads drop backwards, and just howled towards the night sky.</p>
<p>I couldn’t help myself from smiling at “them”. I immediately hated myself a little bit for that smile: the constant need to be on top of things, controlling things, planning every inch of my existence, not being able to relax and go with the flow. The inability to be absorbed by special moments, like this one, is a disadvantage when doing ethnography. As an ethnologist you strive to “be there” – open, attentive, curious and never, ever condescending. </p>
<p>The last time I experimented with spiritual rituals was at the age of 11 together with my classmates. We were three girls who hid in the woods near school, performing black magic – very innocent black magic I should add, we didn’t get much further than genie in the bottle and attempted hypnosis. But we were so obsessed by our frightening and captivating games, where we explored our spiritual strength, or so we believed, that we forgot to return to the classroom when the school bell called. The teachers and the principal acted in the way you could expect them to act in Sweden in the early 1980s: they informed our parents about the inappropriate play and told us to immediately stop with this stupidness.</p>
<p>Nothing was offered to us in return that could still our spiritual longing, except one yearly visit to church before summer holidays. It seems like the Swedish people’s spiritual needs have been starved for quite some time now. The renowned Swedish author <a href="https://www.norstedts.se/116763-agneta-pleijel">Agneta Pleijel</a>, born in 1940, has written beautifully about her religiously anaemic childhood. Fostered by a father who was a professor in mathematics, she was taught that the world consisted of things that you could see, hear and feel and – above all – count and measure. </p>
<p>Scientific discoveries could cause a sense of wonder, yes, but Pleijel’s yearning for something bigger – destiny, fate, God or at least a feeling of meaning with it all – was met with snorts from her parents. It didn’t fit into the technocratic paradigm of our modern times which still reflects Sweden’s self-view to a higher degree than in many other more <a href="https://www.pewresearch.org/global/2020/07/20/the-global-god-divide/">religiously oriented</a> countries in Europe. </p>
<h2>A female network-culture</h2>
<p>During my stay in Hälsingland, I was literally swimming in overwhelming spiritual experiences. We meditated together in medieval churches, we practised yoga, we took long walks in the forest together with horses that the owner (a trained natural horsemanship practitioner) released among the trees. The horses ran off by themselves and returned to the herd when called for. The intelligent, attentive, and stunningly beautiful half-tonne animals moved with surprising softness and suppleness over the moss. “We do this regularly as you rarely meet any people in the forest”, I was told. So, this is what it might look like when the ordinary meets the extraordinary.</p>
<p>Over and above, intimate places emerged during the fieldwork, namely the female network-culture taking place through outdoor activities and long dinners in each other’s houses. This was a micro culture, that in subtle ways was interrelated with a local economy consisting of plenty of spare time, long car drives, low housing costs, handpicked mushrooms and moose meat served at the table and stored in the freezer. The women gathered food in the forest and took care of the meat that men brought to the household. They took active part of this modern hunting culture. And they had a tendency to answer my questions about vaccine reluctance in similar wording, told in determined yet soft voices. </p>
<blockquote>
<p>Nobody will tell me what to do, because it’s <em>my</em> body. The same goes for our children – we know best what they need.</p>
</blockquote>
<p>In my view, this underscores that people will act in accordance with recognised solidarity. In other words, what they believe that the majority of people in <em>their</em> community would do in a similar situation. The spirit fostered in these tight-knit communities became the trusted source of news and attitudes. This community of women trusted each other’s opinions more than anonymous national governing bodies. A strong local sense of belonging, as to a village or a landscape, and the loyalty with an intimate group of friends, in this particular case triumphed over the solidarity with a more anonymous, imagined community of the nation. And these bonds became even stronger because of the pandemic.</p>
<p>Some people said the main reason they got the vaccine was to express <a href="https://regionvasterbotten.se/en-handling-av-solidaritet">“solidarity”</a> with the rest of their country. That may be a genuine reason for some. But I think it would be wrong to assume that all vaccine reluctant people lack feelings of solidarity.</p>
<p>However provocative it might come across, they might be loyal to other, more regional, local and intimate fellowships, as well as to like-minded people across the globe, and there are complex cultural and political reasons for this.</p>
<p>Or as Bernice Hausman, a professor at Pennsylvania State University, <a href="https://www.cornellpress.cornell.edu/book/9781501735622/antivax/#bookTabs=1">puts it</a> from an American vantage point: “How, as a society, we deal with these circumstances of fundamental disagreement reflects how well our social contract is working.”</p>
<p>All things considered, <a href="https://lucris.lub.lu.se/ws/portalfiles/portal/131561070/ES_52_2022_Hammarlin_PUBLISHED_VERSION.pdf">my investigation</a> underscores the importance of studying vaccine reluctance as something that is culturally specific. To make any sense it needs to be investigated less as de-contextualised opinions and arguments, and more as a socially and culturally embedded phenomenon. </p>
<p>Democracies are not one singular coherent public sphere, but many differing and conflicting public spheres. </p>
<p>The people I met were not “egoistic, ill-bred tearaway teenagers”, they were generous and considerate people. That I do not share their views about vaccinations does not mean that I cannot see myself reflected in them. They are my fellow human beings after all.</p>
<p><em>Names changed to protect the anonymity of those involved.</em></p>
<hr>
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<img alt="" src="https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=112&fit=crop&dpr=1 600w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=112&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=112&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=140&fit=crop&dpr=1 754w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=140&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/313478/original/file-20200204-41481-1n8vco4.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=140&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p class="fine-print"><em><span>Mia-Marie Hammarlin receives funding from Riksbankens Jubileumsfond, an independent foundation with the goal of promoting and supporting research in the Humanities and Social Sciences.</span></em></p>I was in a region in southern Sweden’s Northland in September 2021 to find out more about a group of people who were staunchly against COVID-19 vaccinations.Mia-Marie Hammarlin, Senior Lecturer in Media and Communication Studies, Associate Professor of Ethnology and fellow at The Birgit Rausing Centre for Medical Humanities, Lund UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1898592022-09-19T12:22:46Z2022-09-19T12:22:46ZConspiracy theories are dangerous even if very few people believe them<figure><img src="https://images.theconversation.com/files/484680/original/file-20220914-18-utbv87.jpg?ixlib=rb-1.1.0&rect=247%2C7%2C4745%2C1863&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Lies don't have to spread far to cause problems.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/people-garthered-around-one-outstanding-person-royalty-free-image/1365164005">numismarty/iStock/Getty Images Plus</a></span></figcaption></figure><p>There is an open question among pundits and researchers: Do <a href="https://www.theatlantic.com/shadowland/">more Americans</a> <a href="https://doi.org/10.1086/717850">believe in conspiracy theories</a> now <a href="https://www.washingtonpost.com/politics/2022/05/18/buffalo-shooting-great-replacement-qanon">than ever before</a>?</p>
<p>But as a <a href="https://scholar.google.com/citations?user=Q13nvXwAAAAJ&hl=en&oi=ao">scholar of conspiracy theories</a> and their believers, I am concerned that focusing on how many Americans believe conspiracy theories can distract from their dangers.</p>
<p>Even if most people dismiss conspiracy theories or accept them only in <a href="https://press.princeton.edu/books/hardcover/9780691178707/not-born-yesterday">some limited sense</a>, leaving very <a href="https://doi.org/10.1086/717850">small numbers of true believers</a>, the high visibility of these false ideas can still make them dangerous.</p>
<h2>Association without belief</h2>
<p>Philosophers often suppose people can <a href="https://www.jstor.org/stable/2253760">explain their actions</a> in terms of what they want to do or get, and what they <a href="https://plato.stanford.edu/entries/belief/">believe</a>. However, many of people’s actions are guided not by explicit beliefs but rather by <a href="https://www.theguardian.com/lifeandstyle/2010/jun/19/oliver-burkeman-aliefs-beliefs">gut feelings</a>. These feelings aren’t set in stone. They can be influenced by experience. </p>
<p>This principle is taken to heart by advertisers who aim to influence behavior, <a href="https://www.theatlantic.com/business/archive/2011/10/thinking-vs-feeling-the-psychology-of-advertising/247466/">not by changing how people think but how they feel</a>. Manipulating feelings in this way can be accomplished by subtly associating a product with desirable outcomes like status and sex.</p>
<p>This can also take a negative form, as in political attack ads that aim to <a href="https://www.jstor.org/stable/3647684">associate an opponent</a> with threatening imagery and descriptions. Forging similar mental associations is one way in which conspiracy theories, <a href="https://doi.org/10.1007/s11229-021-03379-y">like other misinformation</a>, might have consequences even without being believed.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/dDTBnsqxZ3k?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">One of the earliest political attack ads, placed by Lyndon Johnson in 1964, never even mentions its target’s name.</span></figcaption>
</figure>
<h2>Some examples</h2>
<p>Consider conspiracy theories alleging that the 2020 U.S. presidential election was rigged. Some people no doubt <a href="https://www.theguardian.com/us-news/2022/jan/05/america-biden-election-2020-poll-victory">believe that</a>. But even if people don’t buy the whole lie, they may still believe that something about the 2020 election doesn’t <a href="https://www.theatlantic.com/ideas/archive/2022/04/trump-voters-big-lie-stolen-election/629572/">“feel right,” “seem right” or “smell right.”</a> They might, therefore, be more inclined to support efforts politicians claim will protect election integrity – even if such efforts result in <a href="https://www.theguardian.com/us-news/2022/aug/17/florida-republicans-black-voters-justice-department">targeted voter suppression</a>. </p>
<p>Next, consider anti-vaccination conspiracy theories. Anti-vaccination content, whether about <a href="https://doi.org/10.1001/jama.287.24.3245">vaccines in general</a> or specifically about the <a href="https://www.wired.co.uk/article/covid-vaccine-misinformation-facebook">COVID-19 vaccines</a>, often takes the form of pictures and videos purporting to illustrate disturbing side effects of vaccines. Material of this sort can proliferate rapidly across social media and, by relying on disturbing imagery rather than explicit false claims, can often <a href="https://www.vice.com/en/article/v7ek3d/anti-vaxxers-are-learning-how-to-game-tiktoks-algorithm-and-theyre-going-viral">escape moderation</a>. </p>
<p>Exposure to anti-vaccination information might give readers or viewers a vague feeling of unease, and consequent hesitancy concerning vaccines, even without producing explicit anti-vaccination beliefs. In fact, previous studies have shown that people who tend to rely on their intuition and who have negative emotions toward vaccines <a href="https://doi.org/10.1080/08870446.2019.1673894">are more likely to refuse vaccination</a>. While that research involved other vaccines, it’s likely that similar factors help explain why <a href="https://www.nytimes.com/interactive/2020/us/covid-19-vaccine-doses.html">many Americans have gone without full COVID-19 vaccination, and most have gone without boosters</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/484683/original/file-20220914-11733-spyrev.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A crowd storms the U.S. Capitol building." src="https://images.theconversation.com/files/484683/original/file-20220914-11733-spyrev.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/484683/original/file-20220914-11733-spyrev.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/484683/original/file-20220914-11733-spyrev.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/484683/original/file-20220914-11733-spyrev.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/484683/original/file-20220914-11733-spyrev.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/484683/original/file-20220914-11733-spyrev.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/484683/original/file-20220914-11733-spyrev.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Whether they were true believers or not, Capitol rioters were influenced by conspiracy theories.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/SocialMediaConservativeVoices/1714e596e04b4367956e142598025532/photo">AP Photo/John Minchillo</a></span>
</figcaption>
</figure>
<h2>Pretense and coordination</h2>
<p>Scholars often suggest that many people merely pretend to believe in <a href="https://doi.org/10.1093/oso/9780192895325.003.0001">conspiracy theories</a> and <a href="https://doi.org/10.1093/poq/nfx042">other forms of misinformation</a> as a way of expressing their political loyalties. But even pretense can be costly. Consider an analogy.</p>
<p>When a child declares that “the floor is lava,” few if any believe the declaration. But that child, and others, begin to act as if the declaration were true. Those who do may clamber onto furniture, and repeat the declaration to others who enter the space. Some children play just for fun, some play to show off their climbing and jumping skills, and some play to appease the child who initiated the game.</p>
<p>Some kids quickly tire of the game and wish to stop playing, but like or respect the child who initiated the game, and don’t want to upset that person by stopping. As the game progresses, some take it too seriously. Furniture is damaged, and some get injured while attempting to leap from one raised surface to another. The lava is fake, but real things get broken. </p>
<p>More seriously, when Donald Trump claimed that the 2020 presidential election was “<a href="https://abcnews.go.com/Politics/trump-longstanding-history-calling-elections-rigged-doesnt-results/story?id=74126926">rigged</a>,” some officials and ordinary citizens acted accordingly. Whether out of <a href="https://www.npr.org/2021/03/02/972564176/antifa-didnt-storm-the-capitol-just-ask-the-rioters">sincere belief</a>, partisanship, loyalty to Trump or <a href="https://www.texasmonthly.com/news-politics/true-the-vote-election-fraud/">financial opportunism</a>, many Americans behaved as if the 2020 election was unfairly decided.</p>
<p>Some people acting as if the election conspiracy theory were true assembled in Washington, D.C., some stormed the Capitol building and, behind the scenes, some developed a scheme to submit <a href="https://www.nytimes.com/2022/07/27/us/politics/fake-electors-explained-trump-jan-6.html">fake slates of electors</a> supporting Trump’s reelection despite his loss at the ballot box. The people involved in these activities could count on the support of others who endorsed the rigged election claim, even if these endorsements were largely insincere. </p>
<h2>The price of pretending</h2>
<p>The costs of acting as if the 2020 election were rigged are no doubt greater than those for acting as if the floor is lava. The costs of acting as if the 2020 election were rigged led to <a href="https://www.politico.com/minutes/congress/04-8-2022/jan-6-costs/">millions of dollars</a> worth of damage to the Capitol building, led to <a href="https://time.com/6133336/jan-6-capitol-riot-arrests-sentences/">hundreds of arrests</a> for Capitol rioters, <a href="https://www.nytimes.com/2022/01/05/us/politics/jan-6-capitol-deaths.html">led to multiple deaths</a> and <a href="https://www.theguardian.com/us-news/2021/jan/06/trump-election-attacks-collapse-faith-democracy">imperiled American democracy</a>.</p>
<p>Given the severe risks involved, it’s worth wondering why people who did not sincerely believe the election was unfair would risk pretending. This question highlights the unique danger of conspiracy theories endorsed by those in power: There can be much to gain from pretending to believe them.</p><img src="https://counter.theconversation.com/content/189859/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Keith Raymond Harris receives funding from The Ministry of Culture and Science of North Rhine Westphalia. </span></em></p>Worrying about how many people believe false ideas misses the real danger – that people are influenced by them whether they believe them or not.Keith Raymond Harris, Postdoctoral Research Fellow in Philosophy, Ruhr University BochumLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1864062022-08-17T03:28:47Z2022-08-17T03:28:47ZA researcher asked COVID anti-vaxxers how they avoid Facebook moderation. Here’s what they found<figure><img src="https://images.theconversation.com/files/479091/original/file-20220815-21-uvsojl.jpeg?ixlib=rb-1.1.0&rect=30%2C23%2C5090%2C3386&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Dan Himbrechts/AP</span></span></figcaption></figure><p>How are social media platforms managing vaccine misinformation at this stage in the pandemic? </p>
<p>Anti-vaccine sentiment has been building since 2020, and hasn’t gone anywhere. In fact, it will have intensified following the recent approval of COVID-19 vaccinations for some <a href="https://www.tga.gov.au/media-release/provisional-determination-granted-pfizer-relation-covid-19-vaccine-comirnaty-use-individuals-6-months-5-years">babies and children under five</a>, and the recommendation for a fourth booster shot for people <a href="https://www.abc.net.au/news/2022-07-07/covid-fourth-dose-booster-vaccine-to-be-recommended/101212636">over 30</a>. </p>
<p>And although anti-vaxxers can be found in most online spaces, Facebook has historically been one of <a href="https://www.nature.com/articles/s41586-020-2281-1">their platforms</a> of choice. </p>
<p>Swinburne PhD student Damilola Ayeni has been interviewing anti-vaccine activists since 2019, to learn about how they grow their audience on Facebook and how they evade moderation. </p>
<p>Her findings help shed light on the tug-of-war between <a href="https://www.facebook.com/formedia/blog/together-against-covid-19-misinformation-a-new-campaign-in-partnership-with-the-who">Facebook’s</a> content moderation efforts and an unrelenting slew of vaccine misinformation.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/479098/original/file-20220815-21-lz4b8o.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A very young girl with pig-tails is wearing a mask and flashing a thumbs-up to the camera." src="https://images.theconversation.com/files/479098/original/file-20220815-21-lz4b8o.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/479098/original/file-20220815-21-lz4b8o.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/479098/original/file-20220815-21-lz4b8o.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/479098/original/file-20220815-21-lz4b8o.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/479098/original/file-20220815-21-lz4b8o.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/479098/original/file-20220815-21-lz4b8o.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/479098/original/file-20220815-21-lz4b8o.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The Australian Technical Advisory Group on Immunisation has recommended vaccinations for certain at-risk children aged six months to five years.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<h2>What’s been happening?</h2>
<p>Facebook has been moderating content under the <a href="https://www.facebook.com/help/230764881494641">COVID-19 and vaccine policy</a>. It does this by warning group admins and moderators, deleting offending accounts or groups, and flagging posts containing misinformation. </p>
<p>In its first response to Australia’s DIGI Misinformation and Disinformation Code, Facebook said it had “removed over 14 million pieces of content that constituted misinformation related <a href="https://australia.fb.com/post/facebooks-response-to-australias-disinformation-and-misinformation-industry-code/">to COVID-19</a>” – of which 110,000 were from Australian pages. </p>
<p>Despite this, Facebook’s moderation approach has loopholes that anti-vaxxers continue to exploit. For instance, the ABC recently <a href="https://www.abc.net.au/news/2022-07-29/fact-check-toddler-death-not-vaccine-related/101276874">fact-checked</a> anti-vaxxers who were spreading misinformation on Facebook by claiming COVID-19 vaccines were responsible for the sudden death of a Queensland toddler.</p>
<p>Ayeni’s research found anti-vax Facebook groups are now “self-moderating”. This means they predict what Facebook’s automated moderation tools and independent fact-checkers will be looking for, and change their posting techniques accordingly.</p>
<p>Group members share in-house “rules” to help guide content strategies. In some cases, group administrators will allow content to stay up for a short time, so there’s opportunity to see it before it’s flagged by Facebook. </p>
<p>One anti-vaxxer told Ayeni they now conduct more research on other members’ posts; if the content is obviously untrue or controversial, they delete the post themselves.</p>
<p>Ayeni also found content that’s likely to be targeted by fact-checkers or automated moderation is creatively manipulated. For instance, users may use screenshots or images to avoid text-based moderation. Or they may intentionally misspell key words such as “anti-vaccine”, or leave them out altogether.</p>
<p>Satire and sarcasm are also used in an effort to misdirect Facebook’s fact-checkers, while “signalling” the poster’s vaccine beliefs to like-minded users. One post seen by Ayeni sarcastically challenged the government to get a “real” COVID-19 vaccine before administering it to the public.</p>
<h2>Are anti-vaxxers moving away from Facebook?</h2>
<p>Interviewees said they initially gravitated towards Facebook because it met some of their privacy needs, including the ability to create private and secret groups. </p>
<p>In 2019, Facebook began a platform redesign focused on improving users’ privacy. Its <a href="https://www.nytimes.com/2019/04/30/technology/facebook-private-communication-groups.html">goal was</a> to encourage more encrypted and intimate forms of communication through Messenger and in Facebook groups. And this brought along features that attracted anti-vaxxers to the platform early in the pandemic. </p>
<p>Moderators told Ayeni Facebook groups provided an environment where they could safely offer support to other members and build communities for “like-minded” individuals.</p>
<p>However, Facebook’s increased moderation has undoubtedly made it less attractive. Some users said they want to leave altogether due to the consistent <a href="https://s3.amazonaws.com/kvaccaro.com/documents/vaccaro_cscw2020.pdf">reporting of their accounts</a> and difficulty fighting platform decisions. </p>
<p>Many were looking to migrate to less moderated platforms such as Telegram, Parler, MeWe, Mighty Networks and Wimkim. All of these are uncensored, unmoderated and all too easy to access. </p>
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Read more:
<a href="https://theconversation.com/far-right-groups-move-to-messaging-apps-as-tech-companies-crack-down-on-extremist-social-media-153181">Far-right groups move to messaging apps as tech companies crack down on extremist social media</a>
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<p>Telegram in particular is now favoured by <a href="https://www.vox.com/recode/22238755/telegram-messaging-social-media-extremists">far-right and conspiracy groups</a>. It has also attracted high-profile anti-vaxxers including former TV presenter Pete Evans and former Liberal MPs George Christensen and Craig Kelly – individuals who were repeatedly moderated and eventually de-platformed from <a href="https://www.theguardian.com/australia-news/2021/apr/26/mp-craig-kelly-absolutely-outraged-after-facebook-removes-his-page-for-misinformation">Facebook’s products</a>. </p>
<p>In April 2021, Facebook banned Kelly for breaching its misinformation policies in relation to COVID-19 and vaccinations. At the time he claimed Facebook “<a href="https://www.abc.net.au/news/2021-04-26/craig-kelly-facebook-page-removed-covid-19-misinformation/100095622">burnt and torched and incinerated</a>” his voice, but his following on Telegram has swelled from 10,000 back then to about 74,000 now. </p>
<h2>What can be done?</h2>
<p>Facebook has become increasingly reliant on automated moderation during the pandemic. This experiment has <a href="https://www.politico.eu/article/facebook-content-moderation-automation/">not gone well</a> for it. Machine-learning algorithms still can’t detect wordplay, sarcasm, and embedded messaging in images as well as human moderators can.</p>
<p>We believe platforms need to recognise anti-vaxxers’ tactics are evolving to keep pace with moderation tools. And meaningful push-back will require more investment in human moderators, not just AI.</p>
<p>At the same time, it would make sense to ensure other platforms operating in Australia – such as Telegram, for instance – are subject to the same regulatory scrutiny as Facebook is. Until these smaller platforms also take responsibility for vaccine misinformation, they will continue to be a magnet for it.</p>
<hr>
<p><a href="https://theconversation.com/au/topics/social-media-and-society-125586" target="_blank"><img src="https://images.theconversation.com/files/479539/original/file-20220817-20-g5jxhm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=144&fit=crop&dpr=1" width="100%"></a></p><img src="https://counter.theconversation.com/content/186406/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Anti-vaccine group moderators said Facebook provided an environment where they could safely offer support to others.Damilola Ayeni, PhD Candidate, Swinburne University of TechnologyBelinda Barnet, Senior Lecturer in Media and Communications, Swinburne University of TechnologyDiana Bossio, Associate Professor, Media and Communications, Swinburne University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1856662022-06-24T11:53:22Z2022-06-24T11:53:22ZMisinformation will be rampant when it comes to COVID-19 shots for young children – here’s what you can do to counter it<figure><img src="https://images.theconversation.com/files/470619/original/file-20220623-51620-sao1c0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Talking about vaccines with trusted health care providers and with family can help wade through the sea of information – and misinformation. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/pediatrician-with-girl-in-clinic-during-covid-19-royalty-free-image/1318834248?adppopup=true">Morsa Images/DigitalVison via Getty Images</a></span></figcaption></figure><p>When the Centers for Disease Control and Prevention endorsed both the Pfizer-BioNTech and Moderna COVID-19 vaccines for <a href="https://www.cdc.gov/media/releases/2022/s0618-children-vaccine.html">all children ages 6 months to 5 years</a> on June 18, 2022, it opened the door for <a href="https://theconversation.com/at-last-covid-19-shots-for-little-kids-5-essential-reads-185007">nearly 20 million children to get vaccinated</a>.</p>
<p>While this news comes as a relief to many parents who have been anxiously waiting to get their young children vaccinated, a May 2022 survey found that the majority of parents with children under 5 <a href="https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-february-2022/">feel they don’t have enough information</a> about the safety and efficacy of COVID-19 vaccines for this age group. About 40% also said that information from federal health agencies, such as the CDC and the Food and Drug Administration, about vaccines for this age group was confusing.</p>
<p>This is particularly concerning because confusing messaging from public health agencies opens the door for anti-vaccine activities on social media that target vulnerable parents.</p>
<p>We are a team of <a href="https://www.pediatrics.pitt.edu/people/maya-indira-ragavan-md-mph-ms">medical</a> and <a href="https://publichealth.pitt.edu/home/directory/jaime-sidani">public health</a> professionals at the University of Pittsburgh. We have <a href="https://doi.org/10.1016/j.vaccine.2019.03.003">extensive experience</a> researching <a href="https://scholar.google.com/citations?user=-wHMfaIAAAAJ&hl=en">vaccine misinformation on social media</a> and <a href="https://www.pediatrics.pitt.edu/about-us/diversity-equity-and-inclusion/community-and-culture/pittsburgh-community-vaccine;%20https://grants.nih.gov/grants/forms/biosketch.htm">working with community partners</a> to <a href="https://doi.org/10.1016/j.jadohealth.2021.08.021">address vaccine hesitancy</a>, counter misinformation and <a href="https://scholar.google.com/citations?view_op=view_citation&hl=en&user=8RBqepAAAAAJ&cstart=20&pagesize=80&citation_for_view=8RBqepAAAAAJ:TQgYirikUcIC">promote vaccine equity</a>. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/yhsLob344MY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Social media is a ripe breeding ground for vaccine misinformation.</span></figcaption>
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<p>Through this work, we have seen and studied the ways that anti-vaccine activists on social media target vulnerable parents who are trying to navigate the challenges of digesting health information to make appropriate choices for their children.</p>
<h2>Social media and vaccine misinformation</h2>
<p>Anti-vaccine activists are a small but vocal group. According to research conducted by the nonprofit Center for Countering Digital Hate, <a href="https://www.counterhate.com/disinformationdozen">just 12 social media accounts</a> – the “disinformation dozen” – are <a href="https://www.npr.org/2021/05/13/996570855/disinformation-dozen-test-facebooks-twitters-ability-to-curb-vaccine-hoaxes">behind the majority</a> of anti-vaccine posts on Facebook. Studies also show that only <a href="https://doi.org/10.1377/hlthaff.2011.0396">about 2% of parents</a> reject all vaccines for their children. <a href="https://doi.org/10.1542/peds.2020-007609">A larger group</a>, or about 20% of parents, can more accurately be described as vaccine hesitant, which means they are undecided about having their children receive vaccines <a href="https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html">as recommended by the U.S. Centers for Disease and Control and Prevention</a>. </p>
<p>When it comes to COVID-19 shots, as of May 2022 about 20% of parents with children ages 6 months to 5 years said they would <a href="https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-february-2022/">get their child vaccinated right away</a>. Another 25% said they would wait to see how the vaccine is working, and 35% said they would definitely not get their child vaccinated.</p>
<p>It can be difficult for parents to sort through the large amount of information available about COVID-19 vaccines – both true and untrue. In their search for answers, <a href="https://doi.org/10.1016/j.acap.2019.09.009">some parents turn to social media platforms</a>. The problem is, these parents are often targeted by anti-vaccine activists who are better organized and <a href="https://doi.org/10.1038/s41586-020-2281-1">more skilled at tailoring their messages</a> to the <a href="https://doi.org/10.1016/j.vaccine.2019.03.003">varied concerns of people who are vaccine hesitant</a> than are pro-vaccine activists. </p>
<p>Social media, in particular, has been <a href="https://doi.org/10.1016/S1473-3099(20)30565-X">a primary vehicle</a> for the spread of misinformation. Although sometimes misinformation is blatantly false, <a href="https://doi.org/10.1016/j.amepre.2019.03.009">other times it is more like a game of telephone</a>. A kernel of truth gets modified slightly as it is retold, which ends up becoming something untrue. Unfortunately, exposure to COVID-19 misinformation has been shown to <a href="https://doi.org/10.1038/s41562-021-01056-1">reduce people’s intent to get vaccinated</a>.</p>
<h2>Addressing parents’ vaccine concerns</h2>
<p>So how can pediatricians and other health care professionals empower parents to feel confident in the choice to get their children vaccinated for COVID-19? </p>
<p>The answer may lie in working with communities to promote the vaccine as trustworthy instead of simply asking communities to trust it. We are part of the Pittsburgh Community Vaccine Collaborative, which is a community-academic partnership that seeks to ensure equitable access to the COVID-19 vaccines. Through that effort, we have focused on <a href="https://doi.org/10.1177/15248399211029954">building trustworthiness of the vaccines</a> and of the providers and health systems that are offering the vaccines in their communities. </p>
<p><a href="https://www.pewresearch.org/fact-tank/2020/03/13/amid-coronavirus-threat-americans-generally-have-a-high-level-of-trust-in-medical-doctors/">Health care providers are a trusted source of information</a> for COVID-19 vaccine information, but they are not the only sources. <a href="https://doi.org/10.1080/21645515.2017.1394533">Research has found</a> that it is important to lean on the expertise and voices of community partners, community health workers and religious leaders.</p>
<p>Our research suggests that pediatricians and public health professionals <a href="https://doi.org/10.1016/j.jadohealth.2021.08.021">can effectively use social media</a> to promote vaccination and provide families with reputable scientific information to address their questions and concerns. Results of a survey that was <a href="https://doi.org/10.1016/j.acap.2019.09.009">published in Academic Pediatrics</a> found that 96% of parents used social media. Of those, 68% reported using it for health information.</p>
<p>For example, <a href="https://kidspluspgh.com/">a pediatric group</a> we partner with <a href="https://people.com/human-interest/dr-todd-wolynn-takes-on-anti-vaxxers-science-singing-silly/">uses comedy combined with information</a> to combat myths and answer questions about the COVID-19 vaccines. </p>
<iframe src="https://www.tiktok.com/embed/v2/6940691573801749765?lang=en-US" style="border:0;width:100%;min-height:825px;" width="100%" height="400"></iframe>
<p><a href="https://doi.org/10.1177/00099228211046499">Research shows</a> that parents who report high COVID-19 vaccine intention for themselves also report high COVID-19 vaccine intention for their children. Therefore, talking about vaccines as a family may be helpful in combating misinformation around the COVID-19 vaccine. In addition, parents who have had their children vaccinated can use social media to share their experiences and <a href="https://doi.org/10.1016/j.econlet.2021.109979">make it feel more normal</a> and accepted among their peers.</p>
<p>We have also learned that promoting <a href="https://www.commonsensemedia.org/news-and-media-literacy/what-is-media-literacy-and-why-is-it-important">media literacy</a>, which encourages people to question the media information they come into contact with, can empower parents to sift through the “<a href="https://www.who.int/health-topics/infodemic">infodemic</a>” of COVID-19 vaccine information. </p>
<p>While social media platforms have announced policies of removing vaccine misinformation, <a href="https://doi.org/10.2105/AJPH.2021.306288">research suggests</a> this is not always effective at reducing the influence of such misinformation. Learning how to find the source of a piece of information and thinking about who are the intended targets may help people determine whether the information is true or distorted.</p>
<h2>Next steps</h2>
<p>Addressing COVID-19 vaccine misinformation can feel overwhelming. The <a href="https://www.aap.org/en/">American Academy of Pediatrics</a> has <a href="https://healthychildren.org/English/tips-tools/ask-the-pediatrician/Pages/when-can-children-get-the-COVID-19-vaccine.aspx;%20https://www.healthychildren.org/English/news/Pages/aap-applauds-approval-of-safe-effective-covid-19-vaccines-for-children-ages-6-months-and-older.aspx">helpful information for parents</a> to support making decisions around the COVID-19 vaccine. Parents can also have conversations with their children about media literacy and evaluating information. And they can talk to their children – especially adolescent-age children – about how getting the COVID-19 vaccine can protect them and others. </p>
<p>For questions around COVID-19 vaccines for children of all ages, we recommend you talk with your pediatrician or another health care provider. During that visit, you can also make sure your child is up to date on other vaccines, as <a href="http://dx.doi.org/10.15585/mmwr.mm6919e2">studies have shown</a> that vaccine rates for routine childhood vaccines have decreased during the COVID-19 pandemic.</p>
<p>Increasing COVID-19 vaccine rates for children is important to promote their health and wellness, as well as to move closer to ending the pandemic. </p>
<p><em>This is an updated version of <a href="https://theconversation.com/covid-19-vaccines-for-children-how-parents-are-influenced-by-misinformation-and-how-they-can-counter-it-173212">an article originally published</a> on Dec. 15, 2021.</em></p><img src="https://counter.theconversation.com/content/185666/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jaime Sidani receives funding from the Richard King Mellon Foundation, the American Heart Association, and the National Institutes of Health. </span></em></p><p class="fine-print"><em><span>Beth Hoffman receives funding from the Richard King Mellon Foundation and the National Institutes of Health</span></em></p><p class="fine-print"><em><span>Maya Ragavan currently received funding from the Centers for Disease Control and Prevention. She received funding from a National Center for Advancing Translational Sciences KL2 and an Allegheny County Health Department grant. </span></em></p>With COVID-19 shots finally available for infants and preschoolers, knowing how to combat misinformation on social media and elsewhere could be more important than ever.Jaime Sidani, Assistant Professor of Public Health, University of PittsburghBeth Hoffman, Postdoctoral Associate in Behavioral and Community Health Sciences, University of PittsburghMaya Ragavan, Assistant Professor of Pediatrics, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1785872022-03-21T18:54:18Z2022-03-21T18:54:18ZResearch dispels myth that COVID-19 vaccines cause infertility, but misinformation persists<figure><img src="https://images.theconversation.com/files/453231/original/file-20220321-19-10uqz5z.jpg?ixlib=rb-1.1.0&rect=714%2C14%2C4191%2C3130&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Misinformation about COVID-19 vaccines affecting fertility have no realistic basis.</span> <span class="attribution"><span class="source"> (AP Photo/John Locher)</span></span></figcaption></figure><p><a href="https://theconversation.com/the-fault-in-our-stars-aaron-rodgers-reminds-us-why-celebrity-shouldnt-trump-science-171648">Misinformation</a> about <a href="https://www.npr.org/sections/health-shots/2021/07/20/1016912079/the-life-cycle-of-a-covid-19-vaccine-lie">COVID-19 vaccines and fertility</a> has propagated online despite the vaccines’ <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/safety-of-vaccines.html">clear safety profile</a>. </p>
<p>Fortunately, those considering having kids can relax when it comes to these crucial shots. These claims <a href="https://doi.org/10.1001/jama.2022.2404">lack any realistic basis</a>. As a medical doctor and a COVID-19 genetics researcher, I’d like to discuss what the evidence says.</p>
<h2>Misinformation about fertility</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption"></span>
<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
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</figure>
<p>Some sources of <a href="https://www.factcheck.org/2021/06/scicheck-research-rebuts-baseless-claims-linking-covid-19-vaccines-to-male-infertility/">misinformation claim that the COVID-19 vaccines cause male sterility</a>. For this to be true, the vaccines would have to damage sperm quality, drastically reduce sperm count or interfere with the mechanisms inherent in male ejaculation. Quality clinical evidence has demonstrated that none of these parameters are affected by the vaccine, so men are not being made sterile. </p>
<p>A <a href="https://doi.org/10.1001/jama.2021.9976">study in Florida</a> recruited around 45 men and compared their sperm measures before and after receiving a COVID-19 vaccine. Interestingly, the study found that men who received the vaccine had more sperm, greater semen volume, and sperm more able to move around and fertilize an egg.</p>
<p>Pregnancy can be an exciting time but can also <a href="https://www.anxietycanada.com/articles/common-worries-during-pregnancy/">provoke worry</a> about the the safety of anything that enters the body, including vaccines. Fortunately, the COVID-19 vaccines are safe during pregnancy. </p>
<p>Sources of misinformation have claimed that COVID-19 vaccines can lead to loss of pregnancy, <a href="https://www.bbc.com/news/health-57552527">with vague references to antibody responses or other concepts that sound scientific</a>. However, the COVID-19 vaccines will not make a pregnant woman any more likely to have a miscarriage. </p>
<figure class="align-center ">
<img alt="A pregnant woman sitting a table across from a health-care worker in scrubs and a face mask who is preparing to give her a shot." src="https://images.theconversation.com/files/453237/original/file-20220321-17-qf3rlx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/453237/original/file-20220321-17-qf3rlx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=405&fit=crop&dpr=1 600w, https://images.theconversation.com/files/453237/original/file-20220321-17-qf3rlx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=405&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/453237/original/file-20220321-17-qf3rlx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=405&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/453237/original/file-20220321-17-qf3rlx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=509&fit=crop&dpr=1 754w, https://images.theconversation.com/files/453237/original/file-20220321-17-qf3rlx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=509&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/453237/original/file-20220321-17-qf3rlx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=509&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">COVID-19 vaccines do not increase the risk of miscarriage.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>A group of physicians spanning the United States <a href="https://doi.org/10.1001/jama.2021.15494">studied the pregnancy outcomes for over 100,000 pregnancies</a>. When the study was done, around 14 per cent of everyone investigated had received at least one dose of the COVID vaccine. They found that women who had the shot were no more likely to have a miscarriage than those who did not. </p>
<p><a href="https://doi.org/10.1001/jama.2022.2404">There are other misinformation claims along the lines of antibodies attacking the placenta, shots equating with infertility or interference with hormones</a>. Unsurprisingly, all of these have been debunked.</p>
<h2>The real danger is COVID-19 infection</h2>
<p>While there is no evidence that the COVID-19 vaccine can impact fertility or pregnancy, there is evidence that a COVID-19 infection can cause harm. At its extreme, the disease can be fatal — <a href="https://doi.org/10.1136/bmj.m3320">an outcome that is more likely if COVID-19 infection happens during pregnancy</a>. </p>
<p><a href="https://doi.org/10.1371/journal.pone.0255994">Multiple studies have also documented an increased risk of miscarriage following a COVID-19 infection</a>. However, miscarriage is not the only risk. The respiratory distress that can come with COVID-19, as well as the inflammation, can affect fetal growth, which could lead to <a href="https://doi.org/10.1016/j.brainres.2011.01.032">health and developmental problems</a> in a baby carried to term. </p>
<p>Carried to term is an important point here because pregnant women with COVID-19 are more likely to <a href="https://doi.org/10.1136/bmj.m3320">deliver their babies early</a>. This is associated with health risks for the baby, including an increased risk of <a href="https://www.ncbi.nlm.nih.gov/books/NBK11385/">requiring intensive care</a>.</p>
<h2>The case for COVID-19 vaccination</h2>
<p>It makes sense to get a COVID-19 vaccine. The risk of developing COVID-19 still exists and is still dangerous. This remains true while the case counts have trended downwards in North America to the tens of thousands from nearly one million a day in January. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A line graph showing decreasing COVID-19 cases since the end of December 2021 until March 19, 2022." src="https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=532&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">As COVID-19 remains a danger, vaccination remains the best protection.</span>
<span class="attribution"><span class="source">(Johns Hopkins University CSSE COVID-19 Data)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Fortunately, the <a href="https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html">vaccine offers excellent protection</a> against developing an infection. It also dramatically decreases the chance of severe disease if infection does occur. When considering what poses the greatest danger to a pregnant woman or a couple looking to have children, severe illness poses the most significant risk of causing fertility or pregnancy problems.</p>
<p>COVID-19 misinformation is not going to go away. Previous vaccine misinformation has lingered despite a complete lack of evidence. For example, <a href="https://dx.doi.org/10.1503/cmaj.109-3179">the myth of a vaccine-autism link was debunked in 1998</a>, but vaccine hesitancy has persisted despite copious amounts of clinical evidence that these claims lack any sound basis. Articles like this one will not change some people’s minds, but ultimately that is not the goal. </p>
<p>The goal of sharing medical information from a physician’s point of view is to provide people with the knowledge that they need to make an informed health-care decision. While I strongly recommend the vaccine to everyone, individuals are the ones who choose what they seek to do with their bodies. </p>
<p>Public health can appropriately guide individuals towards making decisions in their and their community’s best interests, as with vaccine mandates. Individuals still maintain their autonomy, even if accompanied by consequences like employment issues. If one reflects on what is best for a baby, the evidence is clear. It is an individual’s prerogative on what to do with that information.</p><img src="https://counter.theconversation.com/content/178587/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julian Daniel Sunday Willett does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Some of the most persistent myths about COVID-19 vaccination have been false rumours that it can affect fertility in men or women. There has never been any evidence to support this misinformation.Julian Daniel Sunday Willett, PhD Candidate, Quantitative Life Sciences, McGill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1756702022-02-14T15:16:15Z2022-02-14T15:16:15ZCOVID: how anti-vaccine influencers exploit mothers<figure><img src="https://images.theconversation.com/files/445069/original/file-20220208-19-1nl8stv.jpg?ixlib=rb-1.1.0&rect=16%2C0%2C902%2C633&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/tiny-baby-boy-having-pleasant-dreams-721921375">Cookie Studio/Shutterstock</a></span></figcaption></figure><p>Opposition to vaccination has existed for as long as vaccination itself. Ever since widespread <a href="https://www.who.int/news-room/feature-stories/detail/smallpox-vaccines">smallpox vaccination</a> began in the early 1800s, there have been <a href="https://www.khaleejtimes.com/health/two-centuries-of-anti-vax-sentiment-from-smallpox-to-covid-19-vaccine-hostility-is-not-new">cycles of questioning</a> the safety and efficacy of particular vaccines. </p>
<p>The media has played a primary role in publicising these views, and social media has significantly increased the reach of the anti-vaccine movement in recent years. The internet has also given rise to a series of <a href="https://journals.sagepub.com/doi/full/10.1177/13675494211062623">alternative health influencers</a>, many of whom create anti-vaccination content on social media. </p>
<p>Our <a href="https://www.tandfonline.com/doi/full/10.1080/1369118X.2021.2021269">new research</a> has found that these influencers often strategically target mothers on social media to build support for their cause. This is because when it comes to children’s health generally – and vaccinations specifically – mothers tend to be perceived as the primary care givers.</p>
<p>The social media accounts we analysed included the promotional account for 1986: The Act, an anti-vaccination film directed by <a href="https://theconversation.com/the-media-mmr-and-autism-a-cautionary-tale-23321">Andrew Wakefield</a>, the former medical practitioner who authored the discredited 1998 study that falsely linked the MMR vaccine and autism, as well as the accounts of several of the <a href="https://www.counterhate.com/disinformationdozen">Disinformation Dozen</a>, 12 influencers estimated to be responsible for 65% of anti-vaccine content shared online during the pandemic.</p>
<h2>Three tactics for targeting mothers</h2>
<p>Among the influencers we analysed, a prominent theme they use to promote anti-vaccine messaging is that of the protective mother. Here, the mother’s primary role is defined in terms of ensuring their child’s safety and protecting them from harm. This theme is commonly communicated in terms of dietary and lifestyle choices – a <a href="https://www.instagram.com/p/CMvv9BinGm3/">“good” mother</a> protecting her child from the state, corporate interests and unnatural chemicals in food and vaccines.</p>
<p>Common techniques used by these influencers to promote this theme include posting evocative imagery of mothers cradling their child accompanied by anti-vaccine messaging. Video updates and <a href="https://www.instagram.com/1986theact/">handwritten letters allegedly written by mothers</a> apologising to their children for failing to protect them from harm also feature prominently on these accounts. Fathers are strikingly absent from these portrayals.</p>
<figure class="align-center ">
<img alt="A mother cradling her child" src="https://images.theconversation.com/files/446261/original/file-20220214-25314-19um975.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/446261/original/file-20220214-25314-19um975.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/446261/original/file-20220214-25314-19um975.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/446261/original/file-20220214-25314-19um975.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/446261/original/file-20220214-25314-19um975.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/446261/original/file-20220214-25314-19um975.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/446261/original/file-20220214-25314-19um975.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Images like this may be overlaid with anti-vaccine messaging.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/loving-young-caucasian-mother-lull-put-2021632562">fizkes/Shutterstock</a></span>
</figcaption>
</figure>
<p>We also found that the influencers we examined co-opt hashtags on social media to associate the anti-vaccination movement with other popular causes. The account for 1986: The Act has <a href="https://www.instagram.com/p/CBokTx5HoN9/">used the Black Lives Matter hashtag</a> to try to frame vaccination as a form of <a href="https://www.weforum.org/agenda/2020/07/medical-racism-history-covid-19/">medical racism</a> – what another anti-vaccine influencer, Robert F. Kennedy Jr, describes as “<a href="https://www.mcgill.ca/oss/article/covid-19-health-pseudoscience/anti-vaccine-propaganda-robert-f-kennedy-jr">The New Apartheid</a>”. However, this framing didn’t result in greater public engagement. </p>
<p>On the other hand, the account’s use of the <a href="https://www.savethechildren.org.uk/?cid=pse-gp_A17038001-go_001-8B98797FQ&ppc=true&matchtype=e&s_keyword=save%20the%20children%20donations&adposition=&s_kwcid=AL!9048!3!548437157001!e!!g!!save%20the%20children%20donations&&ppc=true&matchtype=e&s_keyword=save%20the%20children%20donations&adposition=&gclid=Cj0KCQiAmKiQBhClARIsAKtSj-lnNUtykvrGLorailg7N5bjq0fNlqq-UiEp-odVRtBfBiL5rNQO88caAmONEALw_wcB&gclsrc=aw.ds">Save the Children</a> hashtag resulted in a significant increase in engagement with its posts, which doubled after the organisation began using the hashtag. By co-opting the hashtag, the account not only made its posts more discoverable, it aligned the charity and the anti-vaccination movement as common efforts to protect innocent children from harm. </p>
<p>The <a href="https://www.instagram.com/p/CGDaOGynjgv/?utm_source=ig_web_copy_link">intuitive mother</a> is another trope anti-vaccine influencers use to encourage vaccine refusal. It celebrates maternal intuition as a superior form of knowledge that is derived from raw emotion and <a href="https://theconversation.com/the-online-wellness-industry-why-its-so-difficult-to-regulate-131847">lived experience</a>, in contrast to the <a href="https://theconversation.com/the-scandal-that-should-force-us-to-reconsider-wellness-advice-from-influencers-117041">abstract, professionalised knowledge</a> put forward by the medical establishment. Posts featuring this trope are used to persuade mothers that their own doubts and fears about vaccines are more valid than scientific and medical expertise.</p>
<p>The theme of maternal intuition is often communicated via personal anecdotes in the form of quotes, video updates and letters addressed to expectant mums. Personal stories of vaccine injury are used to sow and reinforce doubts regarding the safety of vaccines. </p>
<p>The influencers we studied use hashtags – such as #TrustTheMoms, #MotherKnowsBest and #Mothersintuition – to present their messaging about the innate wisdom of maternal intuition as part of a collective narrative about vaccine refusal.</p>
<p>By aligning themselves with the intuitive mother, these influencers – many of whom have medical credentials – are able to exploit their medical authority while criticising the medical establishment. Wakefield himself, for example, describes 1986: The Act as, “a story about one of the most powerful forces in the universe: maternal intuition”. </p>
<figure class="align-center ">
<img alt="A woman on her phone" src="https://images.theconversation.com/files/446262/original/file-20220214-21-13ujxg1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/446262/original/file-20220214-21-13ujxg1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/446262/original/file-20220214-21-13ujxg1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/446262/original/file-20220214-21-13ujxg1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/446262/original/file-20220214-21-13ujxg1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/446262/original/file-20220214-21-13ujxg1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/446262/original/file-20220214-21-13ujxg1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Hashtags are used to try and associate anti-vaccination with other bigger, more positive narratives.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-hands-woman-using-her-cell-152196302">LDprod/Shutterstock</a></span>
</figcaption>
</figure>
<p>The doting mother is the final theme the influencers we examined use to encourage vaccine refusal. In posts of this kind mothers express unwavering devotion to their children. This variant is commonly associated with influencers who themselves are mothers and who advocate anti-vaccine sentiments.</p>
<p>One anti-vaccine influencer we analysed exemplified this theme by using personal posts that portrayed her at home with her daughter prior to their “mummy and daughter date”. These posts were accompanied by hashtags promoting the influencer’s paid-for disinformation documentary series about vaccines and cancer. </p>
<p>In such posts, being staunchly opposed to vaccines is depicted as part of being a doting mother. Yet for this influencer, these ostensibly personal posts were essentially marketing for her documentaries.</p>
<h2>The wrong target</h2>
<p>There’s a common assumption, perpetuated in the media, that mothers are <a href="https://slate.com/human-interest/2015/02/women-and-vaccine-resistance-mothers-make-health-care-decisions-for-their-families-including-whether-to-vaccinate.html">largely to blame</a> for the anti-vaccine movement. Our research interrogates this view, revealing how mothers are deliberately targeted by anti-vaccine influencers, who profit financially from sowing doubt by advertising products, services and alternative medical “cures” to the vaccine hesitant.</p>
<p>Rather than conceiving of mothers as solely responsible for their decision not to vaccinate their children, we should scrutinise those strategically attempting to influence and manipulate their decision making. Our findings reveal clear patterns in how mothers are targeted by anti-vaccine influencers online.</p>
<p>Knowing this, we should be less ready to judge mothers if they appear vaccine hesitant, and instead do more to prevent them from being targeted.</p><img src="https://counter.theconversation.com/content/175670/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Anti-vaccination Instagram posts deliberately depict mothers in a certain way to drive up rates of vaccine hesitancy.Stephanie Alice Baker, Senior Lecturer in Sociology, City, University of LondonMichael James Walsh, Associate Professor in Social Sciences, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1748562022-01-13T23:01:03Z2022-01-13T23:01:03ZCOVID-19 vaccine mandates would likely face legal hurdles in Canada<figure><img src="https://images.theconversation.com/files/440781/original/file-20220113-25-xw3ik0.JPG?ixlib=rb-1.1.0&rect=329%2C100%2C5774%2C3913&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People gather in Kingston, Ont., to protest COVID-19 vaccine mandates and masking measures on Nov. 14, 2021.
</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Lars Hagberg </span></span></figcaption></figure><iframe style="width: 100%; height: 175px; border: none; position: relative; z-index: 1;" allowtransparency="" src="https://narrations.ad-auris.com/widget/the-conversation-canada/covid-19-vaccine-mandates-would-likely-face-legal-hurdles-in-canada" width="100%" height="400"></iframe>
<p>Federal Health Minister Jean-Yves Duclos wants <a href="https://www.cbc.ca/news/politics/duclos-mandatory-vaccination-policies-on-way-1.6307398">provinces to make vaccination mandatory</a>. Québec has <a href="https://www.cbc.ca/news/canada/montreal/unvaccinated-health-contribution-quebec-1.6311054">proposed a health tax for the unvaccinated</a>. And other democracies have proposed similar laws. But <a href="https://theconversation.com/greece-to-make-covid-vaccines-mandatory-for-over-60s-but-do-vaccine-mandates-work-172672">fining or taxing the unvaccinated raises practical</a> and legal problems. Here, I focus on the legal issues.</p>
<p>As the pandemic wears on, governments are bringing in more and more vaccine mandates. First you needed a vaccine to go to <a href="https://toronto.ctvnews.ca/ontario-reveals-vaccine-passport-system-for-restaurants-gyms-and-theatres-here-s-what-you-need-to-know-1.5569198">bars, restaurants and gyms</a>. Then there were workplace mandates, then mandates to travel on trains and airplanes. <a href="https://www.theglobeandmail.com/canada/article-quebecs-expansion-of-covid-19-vaccine-passports-to-liquor-pot-stores/">Québec has recently required vaccines to enter liquor and cannabis stores</a>. </p>
<p>With <a href="https://health-infobase.canada.ca/covid-19/vaccination-coverage/">vaccination rates barely budging in recent weeks</a>, governments are looking for new ways to get needles in arms.</p>
<h2>Penalties for the unvaccinated</h2>
<p>The latest proposal is to require vaccination, full stop. But it’s important to note that this doesn’t mean forcing people to be vaccinated. Rather, the most likely scenario is a provincial law making it an offence not to be vaccinated. The penalty would most likely be a fine, though jail time is not out of the question. </p>
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<img alt="Health Minister Jean-Yves Duclos at a news conference with Canadian flags behind him." src="https://images.theconversation.com/files/440788/original/file-20220113-3374-1jpm7t1.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/440788/original/file-20220113-3374-1jpm7t1.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/440788/original/file-20220113-3374-1jpm7t1.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/440788/original/file-20220113-3374-1jpm7t1.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/440788/original/file-20220113-3374-1jpm7t1.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/440788/original/file-20220113-3374-1jpm7t1.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/440788/original/file-20220113-3374-1jpm7t1.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Federal Minister of Health Jean-Yves Duclos has suggested that provinces consider mandatory COVID-19 vaccination.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Justin Tang</span></span>
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<p>Consider what some European countries have done. <a href="https://www.bloomberg.com/news/articles/2021-12-09/how-austria-plans-to-enforce-eu-s-first-mandatory-vaccine-policy">Austria was the first in Europe to require vaccination with fines for non-compliance</a> of up to 3,600 euros ($5,150). In Greece, <a href="https://theconversation.com/greece-to-make-covid-vaccines-mandatory-for-over-60s-but-do-vaccine-mandates-work-172672">a monthy fine of 100 euros will be imposed on those over 60 who are unvaccinated</a>, starting Jan. 16. In Italy, <a href="https://www.reuters.com/world/europe/italy-make-covid-jab-mandatory-over-50s-tighten-curbs-draft-2022-01-05/">those over 50 will face fines if they’re not vaccinated</a>. While the penalty is still being determined, it appears it will be <a href="https://www.cnn.com/2022/01/06/europe/italy-vaccine-mandatory-intl/index.html">at least 100 euros</a>. </p>
<h2>Can Canada mandate vaccines?</h2>
<p>Whether a government can mandate vaccines depends on what exactly a new law says. Canadians have rights to make decisions about vaccination but these rights are not absolute. And having rights does not mean there will be no consequences for your decisions.</p>
<p>If a province tried to impose a fine or other penalty on the unvaccinated, a challenge under the Canadian Charter of Rights and Freedoms would surely follow. The argument would be that this violates people’s <a href="https://www.justice.gc.ca/eng/csj-sjc/rfc-dlc/ccrf-ccdl/check/art7.html">right to life, liberty and security of the person</a>, and perhaps other rights like <a href="https://www.justice.gc.ca/eng/csj-sjc/rfc-dlc/ccrf-ccdl/check/art2a.html">freedom of conscience</a>. </p>
<p>Whether the law is constitutional would come down to issues like whether it’s as narrow as possible, whether it would significantly increase vaccination rates and whether the government had done enough to promote voluntary vaccination. </p>
<p>For example, laws with exceptions for those with medical reasons not to be vaccinated would be more likely to be constitutional. Those limited to people over a certain age (as in Italy and Greece) would be easier to justify. And first making all other reasonable efforts to promote voluntary vaccination would help make the law constitutional.</p>
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<img alt="People protesting vaccine mandates. One holds a sign reading 'Vaccine mandates are coercion'" src="https://images.theconversation.com/files/440790/original/file-20220113-15-27kl6f.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/440790/original/file-20220113-15-27kl6f.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/440790/original/file-20220113-15-27kl6f.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/440790/original/file-20220113-15-27kl6f.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/440790/original/file-20220113-15-27kl6f.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/440790/original/file-20220113-15-27kl6f.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/440790/original/file-20220113-15-27kl6f.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">If a province tried to impose a fine or other penalty on the unvaccinated, a Charter challenge would surely follow.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Lars Hagberg</span></span>
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<p>As for significantly increasing vaccination rates, it is debatable whether a vaccine mandate would do that. Many people may prefer to pay a fine than to be vaccinated. If the fine were high enough to change people’s minds, it may also be unduly harsh — especially for marginalized populations. </p>
<p>Governments should avoid a scenario in which the rich pay to avoid vaccination, while the poor have fewer options. One possibility is to have the amount of the fine or tax depend on one’s income.</p>
<p>Also at play in the effectiveness of a vaccine mandate is timing. A mandate likely wouldn’t take effect until after the peak of the fifth wave. The benefit of current vaccines for future waves or variants is unknown. </p>
<p>That will make it harder for governments to argue that such a law doesn’t erode rights any more than necessary — an important part of the constitutional analysis. That said, vaccines will surely continue to be a vitally important tool in fighting COVID-19.</p>
<h2>Encouraging vaccination vs. recovering costs</h2>
<p>A final issue, raised by Québec’s approach, is whether the law is meant to increase vaccination rates or recover health-care costs. Both fines and taxes add to a province’s bottom line but a law’s purpose matters in constitutional law. </p>
<p>A mandate is more likely to incentivize vaccinations while a health tax is primarily meant to recover health-care costs. (Singapore went further by <a href="https://www.theguardian.com/world/2021/nov/09/singapore-to-start-charging-covid-patients-who-are-unvaccinated-by-choice">charging the unvaccinated for their own hospital costs should they become hospitalized</a>.) </p>
<p>Mandates more directly implicate one’s right to bodily autonomy. A tax could be said only to affect one’s finances. <a href="https://nationalpost.com/news/politics/quebec-working-on-new-significant-health-tax-for-the-unvaccinated">This may make a tax more constitutionally sound</a>.</p>
<p>That said, it raises serious policy issues. Universal health care does not cost more for citizens simply because they are more likely to need health care. That’s part of what makes it universal. It’s not like private insurance that ties premiums to risk. Tobacco and alcohol may be heavily taxed, but we don’t tax dangerous sporting activities, unhealthy eating, having a stressful job or lack of exercise. </p>
<p>Charging more for universal health care based on personal choices is controversial and raises important moral and practical issues. Governments should think carefully about the implications before eroding the principle of universality.</p><img src="https://counter.theconversation.com/content/174856/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hilary Young does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Can the government mandate vaccines? Canadians have rights to make decisions about vaccination, but these rights are not absolute, and do not mean those decisions will have no consequences.Hilary Young, Professor, Law, University of New BrunswickLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1716482021-11-12T00:38:32Z2021-11-12T00:38:32ZThe fault in our stars: Aaron Rodgers reminds us why celebrity shouldn’t trump science<figure><img src="https://images.theconversation.com/files/431590/original/file-20211111-27-13d17uz.jpg?ixlib=rb-1.1.0&rect=44%2C13%2C2815%2C1971&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Green Bay Packers quarterback Aaron Rodgers implied he was vaccinated against COVID-19 when he was not, and made statements about the vaccines based on misinformation.</span> <span class="attribution"><span class="source">(AP Photo/Rick Scuteri) </span></span></figcaption></figure><p>They say never meet your heroes. Take football hero Aaron Rodgers. The Green Bay Packers quarterback is undeniably great at playing football. He has won <a href="https://www.si.com/college/cal/news/aaron-rodgers-wins-third-mvp">Most Valuable Player</a> of the National Football League (NFL) three times. His team <a href="https://www.britannica.com/biography/Aaron-Rodgers">won the Superbowl</a> in 2011 and he holds numerous records.</p>
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<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
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<p>But it’s what’s happening above the shoulder pads that has recently received attention: <a href="https://www.theglobeandmail.com/sports/football/article-aaron-rodgers-sought-treatments-instead-of-covid-19-vaccine/">After insinuating that he was protected against COVID-19</a>, it turns out that he never received a vaccine. And he has recently tested positive for COVID-19. </p>
<h2>Celebrity platforms</h2>
<p>As a doctor, I am not here to take pleasure in his misfortune or say, “We told you so,” even if getting vaccinated is <a href="https://laist.com/news/health/health-experts-urge-people-to-get-vaccinated-as-covid-cases-continue-to-climb">exactly what medical experts have recommended as the best protection against COVID-19</a>. I am not here to challenge Rodgers’ freedom of speech. </p>
<p>I am here to say that my colleagues and I are burned out by the pandemic’s effects on an already-broken system and that misinformation from Rodgers and others with a celebrity platform or a large following is harmful. </p>
<p>Misinformation emboldens those who believe falsehoods and has led to <a href="https://www.theglobeandmail.com/opinion/article-as-a-doctor-promoting-vaccination-i-live-in-fear/">physical violence against doctors</a>, <a href="https://vancouver.citynews.ca/2021/02/24/conspiracists-fantasizing-henry-execution/">death threats against</a> public health officials and <a href="https://www.cbc.ca/news/canada/toronto/covid-hospital-protests-canada-1.6173437">protesters blocking cancer patients</a> from entering hospitals.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/nicki-minajs-covid-19-vaccine-tweet-about-swollen-testicles-signals-the-dangers-of-celebrity-misinformation-and-fandom-168242">Nicki Minaj’s COVID-19 vaccine tweet about swollen testicles signals the dangers of celebrity misinformation and fandom</a>
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<p>Since the scientific triumph of safe and effective vaccines against the SARS-CoV-2 virus I have had many discussions with patients. The ones that start with “I’m not an anti-vaxxer” inevitably lead to vaccine denial. Similarly, Rodgers defends his celebrity credibility as someone who is “<a href="https://www.si.com/college/cal/news/aaron-rodgers-responds-to-critics">not some sort of anti-vaxx flat Earther. I am somebody who’s a critical thinker</a>” who “did his own research.” </p>
<p>Yet he has amplified dangerous and disproven myths about the COVID-19 vaccine. </p>
<h2>Myth-busting Rodgers’ statements</h2>
<p>Rodgers said that vaccines <a href="https://www.miamiherald.com/news/coronavirus/article255644891.html">could impact fertility</a>; there is <a href="https://doi.org/10.1007/s11845-021-02807-9">neither proof nor plausibility</a> to this statement. </p>
<p>He said he’s “allergic to an ingredient” in both the Pfizer and Moderna products, despite no mention of having these <a href="http://doi.org/10.1001/jamanetworkopen.2021.22255">rare allergies</a> confirmed by an allergist. </p>
<p>He said “we don’t know a whole lot about” the vaccine although after <a href="https://www.bloomberg.com/graphics/covid-vaccine-tracker-global-distribution/">seven billion doses</a> we know a lot. And so far the evidence is clear: the vaccine is effective against a <a href="https://coronavirus.jhu.edu">virus that has killed over five million people globally and more than 750,000 in Rodgers’ America</a>.</p>
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<img alt="Green Bay Packers quarterback Aaron Rodgers leaving the field giving the No. 1 sign, with photographers behind him" src="https://images.theconversation.com/files/431591/original/file-20211111-17-kb64ra.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/431591/original/file-20211111-17-kb64ra.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/431591/original/file-20211111-17-kb64ra.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/431591/original/file-20211111-17-kb64ra.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/431591/original/file-20211111-17-kb64ra.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/431591/original/file-20211111-17-kb64ra.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/431591/original/file-20211111-17-kb64ra.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Aaron Rodgers was fined US$14,650 by the NFL for violating the league’s COVID-19 protocol.</span>
<span class="attribution"><span class="source">(AP Photo/Ross D. Franklin)</span></span>
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<p>Rodgers also repeats other common unfounded anti-vaccine arguments in saying, “this idea that it’s the pandemic of the unvaccinated is just a total lie … If the vaccine is so great, then how come people are still getting COVID and spreading COVID?” </p>
<p>Studies show that unvaccinated people <a href="https://www.cdc.gov/media/releases/2021/p0607-mrna-reduce-risks.html">are more likely to get COVID-19</a>. They’re more likely to <a href="https://doi.org/10.1101/2021.09.28.21264260">spread COVID-19</a> (the research awaiting peer review). And are more likely to get really sick and die from COVID-19. The vaccine is not perfect, but it leads to <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7032e1.htm?s_cid=mm7032e1_w">better protection than “natural immunity.”</a> Avoiding vaccination because some vaccinated people get sick is like saying that impaired driving laws are useless because some sober drivers still have car accidents.</p>
<p>Rodgers believes strongly in “bodily autonomy.” Others care about that too. Like people most at risk of COVID-19, such as those with cancer or autoimmune diseases that both increase their risk of infection while also diminishing their ability make antibodies after immunization. Know who else cares? Parents like me with young children who are not yet eligible to get the vaccine. </p>
<p>Rodgers also dogwhistles his followers in citing <a href="https://www.cbsnews.com/news/aaron-rodgers-packers-covid-vaccine-ivermectin-woke-mob/">ivermectin and homeopathy</a>. Ivermectin <a href="https://theconversation.com/ivermectin-whether-formulated-for-humans-or-horses-is-not-a-treatment-for-covid-19-167340">has not been shown in studies</a> to improve COVID-19 outcomes and a rare publication that did show an effect was <a href="https://retractionwatch.com/2021/11/02/ivermectin-covid-19-study-retracted-authors-blame-file-mixup/">retracted because the authors fabricated trial participants</a> that didn’t exist. <a href="https://dx.doi.org/10.15252%2Fembr.201947761">Homeopathy has not proven better than placebo</a> for any condition. </p>
<p>Further to his anti-science and anti-vaccine statements, Rodgers has shown anti-mask behaviour, appearing without facial covering indoors at work and in the community, endangering himself and others. The NFL <a href="https://www.nfl.com/news/packers-fined-300k-aaron-rodgers-allen-lazard-fined-14k-for-violation-of-covid-p">fined Rodgers US$14,650</a>, or 0.04 per cent of his US$33.5 million salary. </p>
<h2>Science-informed celebrities</h2>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1377251952304750593"}"></div></p>
<p>I get that vaccination is an emotional subject; if the battle were about facts then anti-vaccine sentiments would have been eradicated years ago like smallpox. Trust is vitally important. And for every Aaron Rodgers who is free to speak untruths, we need more science-informed celebrities like <a href="https://twitter.com/VancityReynolds/status/1377251952304750593?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1377251952304750593%7Ctwgr%5E%7Ctwcon%5Es1_&ref_url=https%3A%2F%2Fwww.buzzfeed.com%2Fmorgansloss1%2Fcelebrities-for-covid-vaccine-and-against-it">Ryan Reynolds</a>, <a href="https://www.instagram.com/p/CN3FEvRLG3z/?utm_source=ig_embed&ig_rid=39439f39-cda4-4ab6-a9c6-56fc71d0b22b">Mindy Kaling</a>, <a href="https://twitter.com/ArianaGrande/status/1421890761939984388?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1421890761939984388%7Ctwgr%5E%7Ctwcon%5Es1_&ref_url=https%3A%2F%2Fwww.buzzfeed.com%2Fmorgansloss1%2Fcelebrities-for-covid-vaccine-and-against-it">Ariana Grande</a>, <a href="https://people.com/movies/tyler-perry-sets-up-covid-vaccination-site-studio-staff-crew-250-vaccinated/">Tyler Perry</a> and <a href="https://www.usatoday.com/story/news/factcheck/2020/11/21/fact-check-dolly-parton-donated-modernas-covid-19-vaccine-studies/6373339002/">Dolly Parton, who also helped fund Moderna vaccine research</a>. </p>
<p>Historically, <a href="https://www.npr.org/sections/health-shots/2021/05/03/988756973/cant-help-falling-in-love-with-a-vaccine-how-polio-campaign-beat-vaccine-hesitan">Elvis Presley, Sammy Davis Jr., Louis Armstrong and Ella Fitzgerald</a> were critical in instilling trust in the government’s vaccine rollout when polio vaccine hesitancy was 50 per cent.</p>
<p>So when it comes to meeting your heroes, maybe it’s a good thing. Rather than supporting the view that they are untouchable stars up high, they remind us that we are all human and susceptible to viruses and viral misinformation alike.</p>
<p><em>Do you have a question about COVID-19 vaccines? Email us at <a href="mailto:ca-vaccination@theconversation.com">ca-vaccination@theconversation.com</a> and vaccine experts will answer questions in upcoming articles.</em></p><img src="https://counter.theconversation.com/content/171648/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eric Cadesky does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>NFL star Aaron Rodgers has amplified dangerous and disproven myths about the COVID-19 vaccine. Here’s why his statements are not only untrue, but also harmful because they spread misinformation.Eric Cadesky, Clinical Associate Professor, Faculty of Medicine, University of British ColumbiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1716692021-11-11T05:14:21Z2021-11-11T05:14:21ZPeople who choose not to get vaccinated shouldn’t have to pay for COVID care in hospital<figure><img src="https://images.theconversation.com/files/431422/original/file-20211111-27-1tk1ujl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/healthcare-worker-protective-equipment-performs-coronavirus-1753344953">Shutterstock</a></span></figcaption></figure><p>When I went out in Melbourne for a coffee with a friend earlier this week, the waiter verified my vaccination status before allowing me to sit down. But for the unvaccinated in Victoria and New South Wales, it’s a case of no clubbing, no coffee catch-ups, no movies. </p>
<p>Many employers have even gone beyond the government-mandated minimum and required all staff to be vaccinated as part of <a href="https://ozsage.org/working_group/business/">ensuring a safe workplace</a>.</p>
<p>These mandates are designed to reduce the number of COVID-19 outbreaks and their consequences as Australia’s “lockdown states” open up. Introducing different rules for the vaccinated and the unvaccinated also gives people an incentive to get vaccinated as soon as possible. </p>
<p>Singapore went a step further this week, announcing people <a href="https://www.moh.gov.sg/news-highlights/details/calibrated-adjustments-in-stabilisation-phase_8Nov20210%E2%80%99">who are unvaccinated by choice</a> will have to pay for their own health care. </p>
<p>This isn’t the right way to encourage vaccination, and shouldn’t be replicated in Australia.</p>
<h2>What if an unvaccinated Singaporean gets COVID?</h2>
<p>Singapore has a complicated system of health insurance which includes “<a href="https://www.moh.gov.sg/cost-financing/healthcare-schemes-subsidies/medisave">medical savings accounts</a>” from which people can pay for their health care and keep the balance for <a href="https://www.cpf.gov.sg/member/account-services/providing-for-your-loved-ones/making-a-cpf-nomination">distribution to their estate when they die</a>.</p>
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Read more:
<a href="https://theconversation.com/creating-a-better-health-system-lessons-from-singapore-30607">Creating a better health system: lessons from Singapore</a>
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<p>Under the new policy, unvaccinated Singaporeans will still get care, but could be substantially out-of-pocket when or if they recover. COVID-related hospital care can be expensive and so could easily wipe out a medical savings account balance. </p>
<p>Singapore’s new policy is implemented with the best intentions – to reduce demand on a stretched health system by reducing the number of avoidable hospital admissions among the unvaccinated. </p>
<h2>Why some are calling for us to follow Singapore’s lead</h2>
<p>Despite high rates of vaccination in Australia (<a href="https://covidbaseau.com/">more than 80% of over-16s are double-dose vaccinated</a>) and COVID cases trending down, hospitals in NSW and Victoria are still under pressure. </p>
<p>And even though the unvaccinated are only a small proportion of the population in those jurisdictions, <a href="https://www.health.vic.gov.au/media-releases/coronavirus-update-for-victoria-10-november-2021">almost everyone</a> with COVID in an intensive care unit bed is unvaccinated.</p>
<p>Former NSW premier <a href="https://www.news.com.au/lifestyle/health/health-problems/you-pay-for-your-wilful-stupidity-bob-carr-calls-for-unvaccinated-to-be-denied-free-healthcare/news-story/4d8cdb8319d20dda21fbc1acf0d7a5e3">Bob Carr endorsed the Singaporean approach</a> and called for Australia to follow suit. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1457977588299689987"}"></div></p>
<p>Others have <a href="https://www.crikey.com.au/2021/11/11/vaccine-refuseniks-need-to-pay-for-the-pressure-their-actions-put-on-public-hospitals/">hopped on the bandwagon</a>. I strongly disagree.</p>
<h2>The importance of universal coverage – for everyone</h2>
<p>Australia’s Medicare system provides universal coverage for medical and public hospital care. It’s not a system just for the poor, or just for the well-behaved. It promotes social solidarity. </p>
<p>Widespread vaccination was always going to be the best way out of lockdowns and the path to reopening Australian and state borders. Grattan Institute’s <a href="https://grattan.edu.au/report/race-to-80/">Race to 80</a> report supported vaccine passports and other strategies to encourage vaccination. But <a href="https://www.sciencedirect.com/science/article/pii/S0264410X15003564">how far</a> should these nudges to increase vaccination rates go?</p>
<p>Undermining Medicare’s universality – by excluding the unvaccinated from its financial protection – is a bridge too far. </p>
<figure class="align-center ">
<img alt="Hospital trolly in a dark corridor." src="https://images.theconversation.com/files/431427/original/file-20211111-13-tdkl73.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/431427/original/file-20211111-13-tdkl73.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=340&fit=crop&dpr=1 600w, https://images.theconversation.com/files/431427/original/file-20211111-13-tdkl73.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=340&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/431427/original/file-20211111-13-tdkl73.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=340&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/431427/original/file-20211111-13-tdkl73.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=428&fit=crop&dpr=1 754w, https://images.theconversation.com/files/431427/original/file-20211111-13-tdkl73.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=428&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/431427/original/file-20211111-13-tdkl73.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=428&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Unvaccinated Australians should have access to free hospital care, just like the rest of the population.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/empty-hospital-hallway-611606933">Shutterstock</a></span>
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<p>Sure, I think anti-vaxxers should know better; their vaccination status poses a risk to themselves and all of us.</p>
<p>But the Singaporean policy statement has hidden in it the root of the problem – it is targeted at those who are unvaccinated by choice.</p>
<p>The evidence shows vaccination in Australia – like other aspects of health care – <a href="https://csrm.cass.anu.edu.au/sites/default/files/docs/2021/9/Determinants_of_COVID-19_vaccination_and_views_of_parents_about_vaccination_of_children_in_Australia_-_August_2021_-_For_web.pdf">suffers from a distinct social gradient</a>. Poorer people and those less well educated have lower rates of vaccination. </p>
<p>This may be because their lives are less well organised, and they can’t take time off from precarious employment to get vaccinated. It may be they are more susceptible to misinformation campaigns. </p>
<p>Whatever the case, their “choice” may not be a fully informed and freely made one. </p>
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Read more:
<a href="https://theconversation.com/just-the-facts-or-more-detail-to-battle-vaccine-hesitancy-the-messaging-has-to-be-just-right-155953">Just the facts, or more detail? To battle vaccine hesitancy, the messaging has to be just right</a>
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<h2>Failures in the government’s vaccination program</h2>
<p>Penalising unvaccinated Australians by excluding them from Medicare would be a convenient way of shifting responsibility on to individuals for government failures. </p>
<p>Early on, the federal government did not make vaccination easy to get. And the government has failed to ensure the whole population has all the information it needs to make good vaccination decisions. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1409718358505791516"}"></div></p>
<p>If the unvaccinated were barred from Medicare, these government failures would magically become a problem for a small number of individuals, and no longer a political failure.</p>
<h2>If we exclude unvaccinated people, where to next?</h2>
<p>If we exclude the unvaccinated from Medicare’s protection today, <a href="https://academic.oup.com/phe/article/12/2/133/5528519">tomorrow we might exclude the smoker, the day after the drinker</a>, or the person who did not go out jogging, or has not taken up private health insurance.</p>
<p>Hospital emergency department staff regularly have to care for a drink driver and their victim on the same day. They have an ethical obligation to treat everybody equally. Similarly, as frustrating as it might seem, the health system must still be there for the unvaccinated. </p>
<p>The health system needs to be there for everyone, not just people who look like us, nor just for people we like, nor just for people whose choices we endorse.</p>
<p>Nudges to encourage people to get vaccinated are good public policy. But if they undermine the universality of health care, these well-intentioned policies would cause more harm than good.</p>
<p><em>Correction: an earlier version of this article incorrectly said unvaccinated people in the ACT were subject to certain restrictions and ACT hospitals were under pressure.</em></p><img src="https://counter.theconversation.com/content/171669/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Grattan Institute began with contributions to its endowment of $15 million from each of the Federal and Victorian Governments, $4 million from BHP Billiton, and $1 million from NAB. In order to safeguard its independence, Grattan Institute’s board controls this endowment. The funds are invested and contribute to funding Grattan Institute's activities. Grattan Institute also receives funding from corporates, foundations, and individuals to support its general activities, as disclosed on its website.</span></em></p>Singapore will start charging people who choose not to be vaccinated for any COVID-related hospital care. While Australia’s hospitals are also under pressure, we shouldn’t follow suit.Stephen Duckett, Director, Health and Aged Care Program, Grattan InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1714742021-11-09T18:17:45Z2021-11-09T18:17:45ZHow do NZ’s vaccinated teachers have those hard conversations with their anti-vax colleagues?<figure><img src="https://images.theconversation.com/files/430944/original/file-20211109-25-ny278s.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C5982%2C3988&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The news that all staff members at a small King Country school were <a href="https://www.rnz.co.nz/news/national/455243/covid-19-all-staff-at-small-king-country-school-refusing-vaccine-by-next-week-s-deadline">still unvaccinated</a> a week out from the government’s November 15 mandatory deadline underlines how challenging the weeks ahead might be.</p>
<p>Next <a href="https://covid19.govt.nz/covid-19-vaccines/vaccinations-and-work/mandatory-vaccinations-for-workers/education-sector-vaccinations/">Monday marks the day</a> teachers will need to have received at least one dose of the COVID-19 vaccine if they want to continue to work with students in a face-to-face learning environment.</p>
<p>It will also be the day educational leaders find out with some certainty who their vaccine-hesitant colleagues are, and when the career pathways of many committed educators will come to a crossroads.</p>
<p>With it looking likely some schools will face significant staff shortages, the teaching profession now has to seriously wrestle with how to demonstrate the value of <a href="https://maoridictionary.co.nz/search?keywords=manaakitanga">manaakitanga</a> to all colleagues, including the unvaccinated.</p>
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<h2>The code of responsibility</h2>
<p>As a fully registered teacher (as well as an academic) I will be free to teach in New Zealand schools, alert levels allowing, because I am double vaccinated. But I know that is not the case for some of my very talented and committed colleagues who have refused the Pfizer jab.</p>
<p>I can only imagine the professional identity crises these colleagues must be experiencing.</p>
<p>I’m thinking of those teachers who sincerely believe they are honouring their commitment to society – espoused in the Teaching Council of Aotearoa New Zealand (<a href="https://teachingcouncil.nz/">TCANZ</a>) Code of Professional Responsibility – by standing up for the human rights of New Zealanders to bodily autonomy.</p>
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<strong>
Read more:
<a href="https://theconversation.com/to-be-truly-ethical-vaccine-mandates-must-be-about-more-than-just-lifting-jab-rates-169612">To be truly ethical, vaccine mandates must be about more than just lifting jab rates</a>
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<p>I’m thinking of those teachers who passionately believe they are honouring their commitment to society by displaying the ethical integrity to stand up to a power they believe is misleading the public.</p>
<p>I’m thinking of those teachers who believe they are “walking the talk” of a critically reflective practitioner by refusing to be vaccinated.</p>
<p>And I’m thinking of my own commitment to those teachers as my professional colleagues, notwithstanding my fundamental disagreement with their anti-vaccination beliefs.</p>
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<h2>Teaching as an ethical activity</h2>
<p>The TCANZ guiding document for teachers – <a href="https://teachingcouncil.nz/professional-practice/our-code-our-standards/">Our Code, Our Standards</a> – outlines the ethical commitments of all teachers. The council recognises that for the code to be “owned”, the professional commitments should not be seen as a list of prescribed rules.</p>
<p>Rather, it is a set of agreed aspirations that encourage collaborative conversations between practitioners about the ethical nature of their work.</p>
<p>There is no doubt the vaccine mandate will demand some of the most ethically challenging conversations teachers from both vaccination camps will have in their professional careers.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/are-employers-and-workers-at-odds-over-nzs-workplace-vaccine-mandates-our-research-suggests-they-might-be-170431">Are employers and workers at odds over NZ's workplace vaccine mandates? Our research suggests they might be</a>
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<p>However, that’s no reason to shy away from collegial awkwardness. One of New Zealand’s pre-eminent educational thinkers, the late Ivan Snook, believed teaching is an innately ethical activity as it involves close personal relationships, not least between colleagues.</p>
<p>Snook also provides us with some wise guidance on how we might go about these challenging discussions. He addresses the fundamental tension teachers face when trying to persuade others to take a on a point of view they believe is demonstrably rational. </p>
<p>Snook frames this tension as the “conflicting obligations to respect the learner’s state of mind and also move her towards a more adequate understanding and a more enlightened practice”.</p>
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<h2>An ethic of care</h2>
<p>As colleagues in discussion with those who disagree with us on the vaccine mandate, we must be ready to respect the ethical integrity of alternative viewpoints, while providing rational alternatives based on reputable scientific evidence.</p>
<p>Nor should we decry those who distrust authority. As Snook argues, a major task of educators is to help others come to understand the importance, and limitations, of all authorities.</p>
<p>It is my hope that over the next few months we will see the code truly become “our code” as it guides vaccinated and unvaccinated teachers to have these respectful conversations about what it is to be a critically reflective, ethical teacher in a society in the grip of a global pandemic.</p>
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Read more:
<a href="https://theconversation.com/protesting-during-a-pandemic-new-zealands-balancing-act-between-a-long-tradition-of-protests-and-covid-rules-171104">Protesting during a pandemic: New Zealand's balancing act between a long tradition of protests and COVID rules</a>
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<p>But if the code is to guide teachers through these difficult conversations it needs to be used with care. If it’s simply a weapon of entrenched positions there is nothing to be gained.</p>
<p>Educational philosopher Nel Noddings said conversations of this complexity need to happen within an “ethic of care” that is sensitive to the relationships in which we must all continue to live.</p>
<p>In the spirit of <a href="https://maoridictionary.co.nz/word/10068">whanaungatanga</a>, I encourage my vaccinated and unvaccinated colleagues to be courageous and use the code to discuss the vaccine mandate within such an ethic of care.</p>
<p>Let us decide together what that is, and what it means to be an ethical teacher in Aotearoa New Zealand in this watershed moment for our profession.</p><img src="https://counter.theconversation.com/content/171474/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>I have publicly commented on the development and implementation of the Teaching Council Document 'Our Codes, Our Standards' in the media.</span></em></p>With vaccine mandates kicking in next Monday, the Teaching Council code of professional responsibility offers a guide to handling staffroom divides – if it’s used with care.Paul Heyward, Head of Initial Teacher Education, University of Auckland, Waipapa Taumata RauLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1701932021-10-28T19:13:12Z2021-10-28T19:13:12ZSpirit of resistance: why Destiny Church and other New Zealand Pentecostalists oppose lockdowns and vaccination<figure><img src="https://images.theconversation.com/files/428952/original/file-20211028-19-alease.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C5455%2C3645&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Destiny Church leader Brian Tamaki speaks at an anti-lockdown protest in Auckland.</span> <span class="attribution"><span class="source">GettyImages </span></span></figcaption></figure><p>Was anyone surprised when New Zealand’s self-made Apostle Brian Tamaki courted controversy and arrest by participating in two anti-lockdown protests in Auckland recently? Or that during one of these events he <a href="https://www.youtube.com/watch?v=TLxkKIaBPNA">declared</a> he would rather live in “dangerous freedom than peaceful slavery” and <a href="https://www.youtube.com/watch?v=UaPja7Fwr7Q">likened</a> the director-general of health to Hitler? </p>
<p>This was, after all, the same Brian Tamaki whose Destiny Church followers wanted to <a href="https://www.stuff.co.nz/national/christchurch-shooting/112268320/destiny-church-members-reclaim-christchurch-for-jesus">reclaim Christchurch</a> “for Jesus” in the immediate aftermath of the 2019 terrorist attacks. And who <a href="https://www.nzherald.co.nz/nz/comments-by-brian-tamaki-blaming-gays-murderers-and-sinners-for-earthquakes-called-ridiculous/5BBK77ZXCW7FE2VZSZAUYM22JE/">blamed</a> the Christchurch earthquakes on “gays, sinners and murderers”.</p>
<p>Those familiar with the branch of modern Christianity known as Pentecostalism would not have been surprised at all. Tamaki’s Destiny Church is part of the fastest-growing religious movement in the world, with an estimated 500 million adherents.</p>
<p>Today the average Pentecostal is as likely to be Nigerian, Fijian, Korean or Brazilian as they are to be British, American, Australian or Kiwi. </p>
<p>Aotearoa New Zealand is just one of many places Pentecostalism is flourishing. As well as the more prominent churches such as Destiny, City Impact, the Assemblies of God (AOG) and Elim, a host of smaller congregations exist throughout the country. </p>
<p>Here and elsewhere, Pentecostals’ steadfast assertion that the raw power of the Holy Spirit will prevail over the principalities of darkness has run up against the cultural and environmental realities of the modern world.</p>
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<img alt="" src="https://images.theconversation.com/files/428953/original/file-20211028-15-putidz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/428953/original/file-20211028-15-putidz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/428953/original/file-20211028-15-putidz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/428953/original/file-20211028-15-putidz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/428953/original/file-20211028-15-putidz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/428953/original/file-20211028-15-putidz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/428953/original/file-20211028-15-putidz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Brian Tamaki leaves the Waitakere police station on October 20 after being charged with breaching bail conditions for attending a second anti-lockdown rally.</span>
<span class="attribution"><span class="source">GettyImages</span></span>
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<h2>A record of resistance</h2>
<p>Nowhere is this more obvious than in their responses to COVID-19. As nation-states have rolled out public health measures, Pentecostals have seemed unwilling and unable to accept epidemiological explanations and strategies.</p>
<p>Tamaki’s actions are the tip of an iceberg of global resistance. Pentecostals have been at the <a href="https://timesofsandiego.com/crime/2020/07/23/chula-vista-church-renews-challenge-to-states-covid-19-restrictions/">forefront</a> of legal pushbacks against gathering restrictions and <a href="https://www.washingtonpost.com/religion/2020/03/30/tampa-megapastor-howard-browne-charged-coronavirus/">insisted</a> only the second coming of Christ would force churches to close their doors.</p>
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Read more:
<a href="https://theconversation.com/explainer-what-is-pentecostalism-and-how-might-it-influence-scott-morrisons-politics-103530">Explainer: what is Pentecostalism, and how might it influence Scott Morrison's politics?</a>
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<p>They have <a href="https://brill.com/downloadpdf/journals/pneu/42/3-4/article-p430_6.xml">proclaimed</a> COVID cannot survive in the bodies of the faithful, <a href="https://www.ofcom.org.uk/__data/assets/pdf_file/0024/195621/Loveworld-Sanction.pdf">declared</a> a link between the virus and 5G mobile technology, and maintained the pandemic is God’s yardstick for distinguishing his loyal servants from pretenders.</p>
<p>While these claims and interpretations can appear outlandish and dangerous, they are not entirely incomprehensible. Rather than view them as nonsense, it is more helpful to see them as a different kind of sense altogether.</p>
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<img alt="" src="https://images.theconversation.com/files/428954/original/file-20211028-15-70e1mr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/428954/original/file-20211028-15-70e1mr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/428954/original/file-20211028-15-70e1mr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/428954/original/file-20211028-15-70e1mr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/428954/original/file-20211028-15-70e1mr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/428954/original/file-20211028-15-70e1mr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/428954/original/file-20211028-15-70e1mr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A Pentecostal congregation in New York: one of the world’s fastest-growing religious movements.</span>
<span class="attribution"><span class="source">GettyImages</span></span>
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<h2>Miracles and wonder</h2>
<p>Specifically, Pentecostal values are a religious response to the pandemic and a spiritualisation and demonisation of the virus. This goes directly to the Pentecostal obsession with the Holy Spirit.</p>
<p>Pentecostalism is defined, above all, by its intense experientialism. More than any other Christian variant, it is concerned with saturating human existence in otherworldly power. </p>
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Read more:
<a href="https://theconversation.com/pentecostals-and-the-spiritual-war-against-coronavirus-in-africa-137424">Pentecostals and the spiritual war against coronavirus in Africa</a>
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<p>The Pentecostal vocabulary is not one of ritual, liturgy or structure, but of ecstasy, surprise, miracles and wonder.</p>
<p>From this standpoint, any stricture, rule or earthly imposition that impedes a life in the Spirit is, by default, suspect and anathema. This sets up an overall opposition between the spiritual and the worldly that helps define the difference between good and evil or God and Satan.</p>
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<h2>Defining Pentecostalism</h2>
<p>For the devoted Pentecostal, everything is either one or the other, and to be on the side of the world is to collaborate with the enemy. Several features of this theology directly shape Pentecostal responses to COVID-19.</p>
<p><strong>Triumphalism:</strong> Pentecostals are fearless combatants in a spiritual war against Satan. The Holy Spirit is the ultimate weapon in this charge, providing absolute confidence in a Biblically preordained victory. With its long shadow of sickness and fear, COVID-19 bears the Devil’s signature.</p>
<p>Framed as an active demonic force, the virus is something that should not – must not – be feared. The triumphalism determined by a total faith in the Spirit to conquer evil immediately establishes an ethos that spurns caution, regulation and withdrawal.</p>
<p><strong>Deliverance and healing:</strong> The former expels demonic forces threatening well-being, while the latter cleanses a diseased body affected by those same powers. These religious tools are brought to bear against the pandemic, warding off the Satanic viral threat while healing the afflicted. Logically, vaccination becomes unnecessary, misguided and a betrayal of faith.</p>
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Read more:
<a href="https://theconversation.com/how-religions-and-religious-leaders-can-help-to-combat-the-covid-19-pandemic-indonesias-experience-140342">How religions and religious leaders can help to combat the COVID-19 pandemic: Indonesia's experience</a>
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<p><strong>Tribulation:</strong> Pentecostals are deeply concerned with the end of human history as the precursor to Christ’s return and the establishment of God’s paradisical kingdom. The Tribulation is a seven-year nightmare of evil and suffering featuring the rise of a nefarious “new world order”. </p>
<p>Within this end times scenario, all humanity is branded with the mark of the beast, a process authorised by Satan. An apocalyptic plague and Satanic mandates for vaccination provide further prophetic justification for a pro-healing, anti-vaccination position.</p>
<p><strong>The Kingdom:</strong> Pentecostals are not huge fans of worldly entities and human rules. They prefer divine authority, spiritual inspiration and Biblically sanctified morality. The Kingdom of God is juxtaposed with the debased platforms of government and capitalism (even if countless Pentecostals embrace a divinely sanctioned materialism).</p>
<p>Translated into the pandemic context, the continual legislative and policy directives of the government are, by virtue of their human origin, tainted with iniquity. As always, paramount trust must be placed in the Holy Spirit and the Bible.</p>
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Read more:
<a href="https://theconversation.com/are-you-there-god-whether-we-pray-harder-or-endure-wrath-depends-on-the-religious-doctrine-of-providence-134139">Are you there God? Whether we pray harder or endure wrath depends on the religious doctrine of Providence</a>
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<h2>Faith and science</h2>
<p>It may be tempting to see Pentecostalism as its own worst enemy by denying the science and leaving its followers vulnerable to epidemiological catastrophe.</p>
<p>But it is also a relatively young branch of Christianity and not necessarily uniform in its beliefs. As has been <a href="https://brill.com/view/journals/pneu/43/1/article-p5_2.xml">observed</a> elsewhere, “medical science and divine healing […] have never been considered mutually exclusive by the entire movement”.</p>
<p>The question therefore becomes, can Pentecostalism reach a détente with the world, as mainstream Protestant, Anglican and Catholic churches have done?</p>
<p>It would seem the tide can be turned, even if compelled by tragedy. For example, after the death of one of its congregants, the Pentecostal church at the centre of the largest sub-cluster of Auckland’s current Delta outbreak <a href="https://www.rnz.co.nz/international/pacific-news/453216/pasifika-church-members-urge-others-to-get-covid-19-vaccine">embraced vaccination</a>, having initially denied its validity.</p>
<p>This is a pattern now being repeated across many pockets of the Pentecostal world, albeit within a church still fixated on spiritual dynamism and miraculous cures. For now, however, it may take more than faith in worldly reason to persuade Brian Tamaki and his flock that vaccines and lockdowns are a blessing and not a curse.</p><img src="https://counter.theconversation.com/content/170193/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Fraser Macdonald does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Pentecostalism puts its faith in the Holy Spirit more than Pfizer, but there are signs the fast-growing religious movement is not totally immune to scientific reason.Fraser Macdonald, Senior Lecturer in Anthropology, University of WaikatoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1688992021-10-22T12:39:13Z2021-10-22T12:39:13ZParents were fine with sweeping school vaccination mandates five decades ago – but COVID-19 may be a different story<figure><img src="https://images.theconversation.com/files/427788/original/file-20211021-14-cn140n.jpg?ixlib=rb-1.1.0&rect=197%2C8%2C2645%2C1814&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Children and parents lined up for polio vaccines outside a Syracuse, New York school in 1961.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/LinedUpForPolioVaccine1961/4da7b3b42ecd4a68a089a5985f951f32/photo?Query=school%20vaccine&mediaType=photo&sortBy=arrivaldatetime:asc&dateRange=Anytime&totalCount=1077&currentItemNo=9">AP Photo</a></span></figcaption></figure><p>The ongoing battles over COVID-19 vaccination in the U.S. are likely to get more heated when the Food and Drug Administration authorizes emergency use of a vaccine for children ages 5 to 11, expected later this fall.</p>
<p>California <a href="https://www.gov.ca.gov/2021/10/01/california-becomes-first-state-in-nation-to-announce-covid-19-vaccine-requirements-for-schools/">has announced</a> it will require the vaccine for elementary school attendance once it receives full FDA approval after emergency use authorization, and other states may follow suit. COVID-19 vaccination mandates in workplaces and colleges have sparked controversy, and the possibility that a mandate might extend to younger children is <a href="https://www.kff.org/coronavirus-covid-19/press-release/most-parents-dont-want-their-schools-to-require-covid-19-vaccination-but-most-favor-requiring-masks-for-unvaccinated-children-and-staff/">even more contentious</a>.</p>
<p>Kids are already required to get a host of other vaccines to attend school. School vaccination mandates have been around since the 19th century, and they became a fixture in all 50 states in the 1970s. Vaccine requirements are among the <a href="https://pubmed.ncbi.nlm.nih.gov/12508514/">most effective means of controlling infectious diseases</a>, but they’re currently under attack by small but vocal minorities of parents who consider them unacceptable intrusions on parental rights.</p>
<p>As a public health historian who studies the <a href="https://www.ucpress.edu/book/9780520247499/state-of-immunity">evolution of vaccination policies</a>, I see stark differences between the current debates over COVID-19 vaccination and the public response to previous mandates.</p>
<h2>Compulsory vaccination in the past</h2>
<p>The <a href="https://doi.org/10.1353/bhm.2004.0062">first legal requirements for vaccination</a> date to the early 1800s, when gruesome and deadly diseases routinely terrorized communities. A loose patchwork of local and state laws were enacted to stop epidemics of smallpox, the era’s only vaccine-preventable disease. </p>
<p>Vaccine mandates initially applied to the general population. But in the 1850s, as universal public education became more common, people recognized that schoolhouses were likely sites for the spread of disease. Some states and localities began enacting <a href="https://doi.org/10.1093/jhmas/XXXIII.3.344">laws tying school attendance to vaccination</a>. The smallpox vaccine was crude by today’s standards, and concerns about its safety led to numerous lawsuits over mandates.</p>
<p>The U.S. Supreme Court upheld compulsory vaccination in two decisions. The first, in 1905, <a href="https://supreme.justia.com/cases/federal/us/197/11/">affirmed that mandates are constitutional</a>. The second, in 1922, <a href="https://supreme.justia.com/cases/federal/us/260/174/">specifically upheld school-based requirements</a>. In spite of these rulings, many states lacked a smallpox vaccination law, and some states that did have one failed to enforce it consistently. Few states updated their laws as new vaccines became available.</p>
<p>School vaccination laws underwent a major overhaul beginning in the 1960s, when health officials grew frustrated that <a href="https://doi.org/10.1177/0033354919826558">outbreaks of measles were continuing to occur in schools</a> even though a safe and effective vaccine had recently been licensed.</p>
<p>Many parents mistakenly believed that measles was an annoying but mild disease from which most kids quickly recovered. In fact, it often caused <a href="https://www.cdc.gov/measles/symptoms/complications.html">serious complications</a>, including potentially fatal pneumonia and swelling of the brain.</p>
<p>With encouragement from the Centers for Disease Control and Prevention, all states updated old laws or enacted new ones, which generally covered all seven childhood vaccines that had been developed by that time: diphtheria, pertussis, tetanus, polio, measles, mumps and rubella. In 1968, just half the states <a href="https://www.ucpress.edu/book/9780520247499/state-of-immunity">had school vaccination requirements; by 1981, all states did</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/427792/original/file-20211021-27-psl61q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Smiling boy rolls up his sleeve to get a shot from a nurse" src="https://images.theconversation.com/files/427792/original/file-20211021-27-psl61q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427792/original/file-20211021-27-psl61q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=404&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427792/original/file-20211021-27-psl61q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=404&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427792/original/file-20211021-27-psl61q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=404&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427792/original/file-20211021-27-psl61q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=508&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427792/original/file-20211021-27-psl61q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=508&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427792/original/file-20211021-27-psl61q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=508&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Sometimes, students even received vaccinations from nurses at school.</span>
<span class="attribution"><a class="source" href="http://resource.nlm.nih.gov/101447463">NIH U.S. National Library of Medicine</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<h2>Expanding requirements, mid-20th century</h2>
<p>What is most surprising about this major expansion of vaccination mandates is how little controversy it provoked.</p>
<p>The laws did draw scattered court challenges, usually over the question of exemptions – which children, if any, should be allowed to opt out. These lawsuits were often brought by chiropractors and other adherents of alternative medicine. <a href="https://pubmed.ncbi.nlm.nih.gov/15868682/">In most instances, courts turned away these challenges</a>.</p>
<p>There was scant public protest. In contrast to today’s vocal and well-networked anti-vaccination activists, organized resistance to vaccination remained on the fringes in the 1970s, the period when these school vaccine mandates were largely passed. Unlike today, when <a href="https://www.cdc.gov/vaccinesafety/concerns/index.html">fraudulent theories of vaccine-related harm</a> – such as the discredited notion that vaccines cause autism – <a href="https://theconversation.com/anti-vaccination-mothers-have-outsized-voice-on-social-media-pro-vaccination-parents-could-make-a-difference-120572">circulate endlessly on social media</a>, public discussion of the alleged or actual risks of vaccines was largely absent.</p>
<p>Through most of the 20th century, <a href="https://doi.org/10.1353/bhm.2013.0047">parents were less likely to question</a> pediatricians’ recommendations than they are today. In contrast to the empowered “patient/consumer” of today, an attitude of “doctor knows best” prevailed. All these factors contributed to overwhelmingly positive views of vaccination, with more than 90% of parents in a 1978 poll reporting that <a href="https://www.ucpress.edu/book/9780520247499/state-of-immunity">they would vaccinate their children even if</a> there were no law requiring them to do so.</p>
<p>Widespread public support for vaccination enabled the laws to be passed easily – but it took more than placing a law on the books to control disease. Vaccination rates <a href="https://doi.org/10.1177/0033354919826558">continued to lag in the 1970s</a>, not because of opposition, but because of complacency.</p>
<p>Thanks to the success of earlier vaccination programs, most parents of young children lacked firsthand experience with the suffering and death that diseases like polio or whooping cough had caused in previous eras. But public health officials recognized that those diseases were far from eradicated and would continue to threaten children unless higher rates of vaccination were reached. Vaccines were already becoming a victim of their success. The better they worked, the more people thought they were no longer needed.</p>
<p>In response to this lack of urgency, <a href="https://press.uchicago.edu/ucp/books/book/chicago/V/bo14237741.html">the CDC launched a nationwide push in 1977</a> to help states enforce the laws they had recently enacted. Around the country, health officials partnered with school districts to audit student records and provide on-site vaccination programs. When push came to shove, they would exclude unvaccinated children from school until they completed the necessary shots.</p>
<p>The lesson learned was that making a law successful requires ongoing effort and commitment – and continually reminding parents about the value of vaccines in keeping schools and entire communities healthy.</p>
<h2>Add COVID-19 to vaccine list for school?</h2>
<p>Five decades after school mandates became universal in the U.S., <a href="https://www.pewresearch.org/science/2017/02/02/vast-majority-of-americans-say-benefits-of-childhood-vaccines-outweigh-risks/">support for them remains strong overall</a>. But misinformation spread over the internet and social media has weakened the public consensus about the value of vaccination that allowed these laws to be enacted.</p>
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<a href="https://images.theconversation.com/files/427942/original/file-20211022-39064-z486w0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="adults and kids with signs protesting COVID-19 vaccines" src="https://images.theconversation.com/files/427942/original/file-20211022-39064-z486w0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427942/original/file-20211022-39064-z486w0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427942/original/file-20211022-39064-z486w0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427942/original/file-20211022-39064-z486w0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427942/original/file-20211022-39064-z486w0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427942/original/file-20211022-39064-z486w0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427942/original/file-20211022-39064-z486w0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Some anti-vaccination activists are vocal opponents of vaccine mandates for kids.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/with-her-daughter-ella-baindourov-nara-varderesyan-leads-news-photo/1235967787?adppopup=true">Sarah Reingewirtz/MediaNews Group/Los Angeles Daily News via Getty Images</a></span>
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<p>COVID-19 vaccination has become politicized in a way that is unprecedented, with sharp partisan divides over whether <a href="https://www.pewresearch.org/fact-tank/2020/07/22/republicans-remain-far-less-likely-than-democrats-to-view-covid-19-as-a-major-threat-to-public-health/">COVID-19 is really a threat</a>, and whether the <a href="https://news.gallup.com/poll/352397/democratic-republican-confidence-science-diverges.aspx">guidance of scientific experts can be trusted</a>. The attention focused on COVID-19 vaccines has given new opportunities for anti-vaccination conspiracy theories to reach wide audiences. </p>
<p>[<em>Over 115,000 readers rely on The Conversation’s newsletter to understand the world.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=100Ksignup">Sign up today</a>.] </p>
<p>Fierce opposition to COVID-19 vaccination, powered by <a href="https://www.npr.org/2021/10/17/1046598351/the-political-fight-over-vaccine-mandates-deepens-despite-their-effectiveness">anti-government sentiment and misguided notions of freedom</a>, could undermine support for time-tested school requirements that have protected communities for decades. Although vaccinating school-aged children will be critical to controlling COVID-19, lawmakers will need to proceed with caution.</p><img src="https://counter.theconversation.com/content/168899/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James Colgrove has received funding from the National Library of Medicine, the Greenwall Foundation, the Milbank Memorial Fund, and the William T. Grant Foundation. </span></em></p>Public health experts know that schools are likely sites for the spread of disease, and laws tying school attendance to vaccination go back to the 1800s.James Colgrove, Professor of Sociomedical Sciences, Mailman School of Public Health; Dean of the Postbaccalaureate Premedical Program, Columbia School of General Studies, Columbia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1689472021-10-06T14:18:09Z2021-10-06T14:18:09ZCombating COVID-19 anti-vaxxers: lessons from political philosophy<figure><img src="https://images.theconversation.com/files/424223/original/file-20211001-22-1otz9lz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Challenging the scepticism and resistance in the public response to the COVID-19 vaccine is deeply important to the state of public health. This is a critical conversation because people are protesting the COVID-19 vaccines not just in South Africa, but globally too. </p>
<p>As a teacher of political philosophy, I think it’s important to dispel the notion that the call to vaccinate is an infringement on acceptable liberal freedoms. </p>
<p>Based on a significant number of years of studying, reading and teaching the works of the world’s most important philosophies, I am of the view that the anti-vaxxer position that being “forced to take the vaccine is an infringement on their liberal rights” is a misinformed stance. </p>
<p>Through a liberal lens that looks at <a href="https://www.open.edu/openlearn/history-the-arts/culture/philosophy/two-concepts-freedom/content-section-3.3">positive freedom</a> versus <a href="https://plato.stanford.edu/entries/liberty-positive-negative/">negative freedom</a>, I want to show how taking the vaccine essentially creates positive (or nett) freedom. Anti-vaxxers against the COVID-19 vaccine may be considered selfish by demanding freedom in an absolute sense. Negative freedom supports the idea that there should be no restrictions or boundaries on any free activity. This can become incredibly problematic when it comes to public health.</p>
<p>For example, think of restricting where people can smoke. These are in place to ensure that the majority of people (non-smokers) are protected from the risks associated with passive smoke inhalation.</p>
<p>In a similar vein, anti-vaxxers should perhaps be reprimanded and regulated for not willingly taking the COVID-19 vaccine. The ethical focus is to promote universal immunisation and positive freedom for everyone in society.</p>
<p>The liberal philosophies that we might use to challenge the “anti-vaxxer’s freedom to choose” position are <a href="https://philpapers.org/rec/BENITT">Jeremy Bentham’s (1789) Utilitarianism</a>, <a href="https://plato.stanford.edu/entries/mill-moral-political/">JS Mill’s (1859) Harm Principle</a> and <a href="https://www.jstor.org/stable/3877074">Isiah Berlin’s (1969) reflections on Positive Freedom</a>. </p>
<p>This trajectory of liberal thought over the last 200 years is pivotal to the development of the liberal democratic freedoms we experience today. Let’s unpack the theories a little more.</p>
<h2>What the philosophers have to say</h2>
<p>Let me start by addressing the philosophical dilemma of the anti-vaxxer’s “freedom to choose”.</p>
<p>The need to maintain individual freedoms is the most important mandate of the modern liberal state. </p>
<p>Today’s liberal democratic understanding of freedom (with acceptable restraint) was an idea first conceived over 200 years ago. In political philosophy, Jeremy Bentham’s (1789) Utilitarianism suggests that policies should be created to provide the greatest amount of felicity (or happiness) for the largest portion of society. </p>
<p>This forms the crux of the conversation surrounding COVID-19 vaccinations. </p>
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Read more:
<a href="https://theconversation.com/south-africas-immunisation-record-risks-being-dented-by-anti-vaccination-views-153549">South Africa's immunisation record risks being dented by anti-vaccination views</a>
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<p>Presently, it is understood that for the sake of public health and the “common good”, all citizens should take one of the certified COVID-19 vaccinations. The reason for this is that it will create a greater nett freedom for everyone in that given society. </p>
<p>The alternative is absolute and unrestrained freedom not to vaccinate, which puts pressure on our common freedoms and could prolong lockdown measures.</p>
<p>Continuing this theme on a positive application of freedom, J.S. Mill (1859) provides us with a sophisticated ethical proposition, the <a href="https://www.cambridge.org/core/journals/utilitas/article/john-stuart-mills-harm-principle-and-free-speech-expanding-the-notion-of-harm/F1D77D5D5F9A4B8AA3BAD4058A9708B4">Harm Principle</a>. This principle suggests simply that we should be free to pursue our individual will, as long as it does not cause harm to someone else. </p>
<p>Whereas it may be an indirect influence, this principle nestles neatly into the ethical position held by many laws and policies passed in liberal democratic societies.</p>
<p>Many countries, including South Africa, have used it in public smoking legislation for instance, by regulating smokers to confined areas in public so that they do not bring harm to non-smokers.</p>
<p>This leads us to ask the same questions about the freedom of movement of unvaccinated people in public. It is unquestionable that someone who refuses the COVID-19 vaccine could effectively bring harm to their broader community. The science is clear on this, crowded hospitals all over South Africa are reporting that almost all COVID-19 related hospitalisations are presently coming from the unvaccinated portion of society. This creates a further detriment to the implementation of positive freedom in society.</p>
<p><a href="https://plato.stanford.edu/entries/berlin/">Isaiah Berlin</a>’s (1969) thoughts on positive freedom best diagnoses the dilemma of the anti-vaxxer, as it allows us to ponder their desire for the unrestrained “freedom to choose”. </p>
<p>Absolute and unrestrained freedom is also known by theorists as negative freedom. While negative freedom may sound enticing, it could be severely detrimental to society and communities if applied strictly. It is acceptable in a progressive society that we accept limitations on our freedom, so as not to infringe on the freedoms of others. </p>
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<strong>
Read more:
<a href="https://theconversation.com/compulsory-covid-19-vaccination-in-nigeria-why-its-illegal-and-a-bad-idea-167396">Compulsory COVID-19 vaccination in Nigeria? Why it's illegal, and a bad idea</a>
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<p>It is important then to convey that the verifiable science on vaccines should not be politicised further.</p>
<p>There is also a link to be made between the African communitarian philosophy of <a href="https://theconversation.com/what-archbishop-tutus-ubuntu-credo-teaches-the-world-about-justice-and-harmony-84730">Ubuntu</a> (Humaneness) and positive freedom. Ubuntu remains somewhat of a clichéd call to civic nationalism and the fostering of a mutual help society in a fractured South Africa. </p>
<p>However, the isiZulu phrase, <em>Umuntu ngumuntu ngabantu</em>, (I am, because we are) proves an important building block in society. “I am because we are” simply implies that: I am part of my community, where the good I do reflects back onto the society. This can be incredibly significant in the face of vaccine scepticism and anti-vaccination ideas. </p>
<p>South Africans in particular should heed the call of Ubuntu to mobilise toward vaccination, as it advocates for the “common good” and encourages communitarian benefits for broader society. This in turn promotes positive freedom.</p>
<h2>What it adds up to</h2>
<p>There are many debates to be had in an evolving society where freedom of speech and choice will take centre stage. But, in my view, the COVID-19 vaccination shouldn’t be one of them. Armed with ideas such as utilitarianism and the harm principle, the application of positive freedom might see many liberal democracies eventually prohibit the anti-vaxxer’s spread of misinformation and protests against vaccination.</p>
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<p>
<em>
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Read more:
<a href="https://theconversation.com/why-covid-19-vaccines-should-be-mandatory-in-south-africa-165682">Why COVID-19 vaccines should be mandatory in South Africa</a>
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<p>It is imperative that citizens are made to understand that this is a matter of public health, the science is verifiable, and that 99.9% of the global medical community backs the rollout of the COVID-19 vaccine. </p>
<p>Hence, getting vaccinated is for the “common good” of society and promotes the more desirable aspects of positive freedom.</p>
<h2>There is no time to delay</h2>
<p>South Africa is a tinderbox for COVID-19 outbreaks and potential virus mutation. Embracing positive freedom’s emphasis on utility and minimising harm, while emphasising the communitarian benefits of vaccinating, provides a clear imperative for action. </p>
<p>The country needs to vaccinate as quickly as possible so that its people can return to some semblance of normal life. A life where all can freely pursue their goals, remaining mindful that freedom without reasonable restraint will inevitably bring harm to others.</p><img src="https://counter.theconversation.com/content/168947/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Giovanni Poggi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many countries, including South Africa, use regulations to control smoking in public so that they do not harm non-smokers. Likewise, getting vaccinated is for the common good of society.Giovanni Poggi, Lecturer in Political Science, Nelson Mandela UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1688382021-10-03T19:01:19Z2021-10-03T19:01:19ZHealth workers are among the COVID vaccine hesitant. Here’s how we can support them safely<figure><img src="https://images.theconversation.com/files/424120/original/file-20211001-24-13bance.jpg?ixlib=rb-1.1.0&rect=34%2C11%2C3782%2C2529&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://photos-cdn.aap.com.au/Image/20210919001577621949?path=/aap_dev11/device/imagearc/2021/09-19/be/d3/15/aapimage-7hlp6mrf3fs11dhxiwbf_layout.jpg">AP Photo/Damian Dovarganes</a></span></figcaption></figure><p>Given the caring nature of their profession, the general public might assume there isn’t any vaccine hesitancy among health workers. It can surprise (and anger) the community when health workers protest the introduction of COVID vaccine mandates.</p>
<p>In France, around <a href="https://www.bbc.com/news/world-europe-58581682">3,000 health workers</a> have been suspended because they were not vaccinated. In Greece, health workers have <a href="https://apnews.com/article/europe-business-health-coronavirus-pandemic-50860f30508989bdc86a114bf48ccf98">protested</a> against mandatory vaccination plans. Similar scenes have <a href="https://globalnews.ca/news/8186681/nurses-protest-mandatory-vaccines-montreal-hospital/">played out in Canada</a> and <a href="https://www.nytimes.com/2021/09/26/nyregion/health-workers-vaccination.html?smid=fb-nytimes&smtyp=cur&fbclid=IwAR1Ze0_xgDIvtuHr7Z4Fnjp-SBtFkTsta2tHkrlJIgTgj-prcHk_flFE6qo">New York State</a>. </p>
<p>In Australia, health workers have reportedly joined protests in <a href="https://www.dailymail.co.uk/news/article-10032143/Police-forced-disband-dozens-health-workers-bizarre-Melbourne-anti-vax-protest.html">Melbourne and Perth</a>. A small number of unvaccinated staff members are <a href="https://www.abc.net.au/news/2021-09-28/7-per-cent-of-health-workers-in-nsw-are-unvaccinated/100498214">challenging</a> vaccination mandates in the NSW Supreme Court. Beyond the hospital sector, there are <a href="https://www.abc.net.au/news/2021-06-29/aged-care-worker-welcomes-mandatory-covid-vaccinations/100252720">reports</a> of staff members leaving the aged care sector following the introduction of mandates. </p>
<p>Hesitancy among health workers broadly reflects concerns in the wider community. But the risks of being unvaccinated in health settings mean we should acknowledge these concerns and support informed decision-making. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/living-with-covid-looks-very-different-for-front-line-health-workers-who-are-already-exhausted-167213">'Living with COVID' looks very different for front-line health workers, who are already exhausted</a>
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</em>
</p>
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<h2>A range of concerns</h2>
<p>Over 90% of health workers in NSW and Victoria have received a COVID vaccine. But there remains a small percentage of people who work at hospitals and other clinical settings who are vaccine hesitant or want to choose the vaccine they receive.
NSW health figures suggest that <a href="https://www.abc.net.au/news/2021-09-28/7-per-cent-of-health-workers-in-nsw-are-unvaccinated/100498214">currently</a> about 7% (or 7,350 staff members) remain unvaccinated. </p>
<p>Internationally, prevalence of COVID vaccination hesitancy in health workers <a href="https://link.springer.com/content/pdf/10.1007/s10900-021-00984-3.pdf">ranges</a> from 4.3 to 72% (average 23%). </p>
<p>In the US, <a href="https://www.webmd.com/vaccines/covid-19-vaccine/news/20210628/huge-number-of-hospital-workers.">one in four hospital workers</a> in direct contact with patients had not received a single dose of a COVID vaccine by the end of May. </p>
<p>A study conducted in the first few months of this year <a href="https://www.mcri.edu.au/sites/default/files/media/documents/covid_vaccine_preparedness_study_-_summary_of_results_25_6_21.pdf">found</a> while most health workers intended to accept a COVID vaccine, 22% were unsure or did not intend to vaccinate. These findings tallied with a <a href="https://doi.org/10.3390/v13030371">study</a> in Italy that found 33% of health workers were unsure or did not intend to vaccinate. </p>
<p>The <a href="https://www.mcri.edu.au/sites/default/files/media/documents/covid_vaccine_preparedness_study_-_summary_of_results_25_6_21.pdf">top three reasons</a> for health workers to be hesitant echo the same concerns expressed by some in the wider community: vaccine safety, efficacy and side effects. </p>
<p>Earlier <a href="https://doi.org/10.3390/v13030371">surveys overseas</a> showed less than a third of health workers felt they had enough information around COVID vaccines. And, just like the wider community, <a href="https://link.springer.com/content/pdf/10.1007/s10900-021-00984-3.pdf.">health workers are vulnerable to misinformation</a> and sometimes have insufficient understanding about how vaccines are developed. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/g_bW4v8ViI4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A group who identified themselves as health workers staged a peaceful protest in Melbourne.</span></figcaption>
</figure>
<h2>The risks</h2>
<p>While hospital patients are more likely to be the source of hospital COVID outbreaks, unvaccinated health and aged care workers still pose a risk to patient and resident safety. Transmission of COVID to or between unvaccinated health workers poses a risk to the wider community including their families and friends. </p>
<p>Beyond the risk of transmission, there is also the impact vaccine-hesitant health workers have on wider vaccine confidence. Health workers are seen as credible sources of information and are trusted by the community. </p>
<p>There are videos on social media, YouTube and TikTok of individual health workers speaking about the COVID vaccines, often repeating misinformation regarding the safety or effectiveness of the vaccines or expressing uncertainty. The potential impact of these viral videos may be heightened compared to those featuring speakers who don’t work in health professions. University of Washington researcher Rachel Moran, who examines internet misinformation, <a href="https://www.nbcnews.com/tech/social-media/vaccine-mandates-spread-protests-follow-spurred-nurses-rcna1654">says such health workers are</a> </p>
<blockquote>
<p>leveraging the credibility of medical professionals to create a false impression that there is considerable debate about COVID vaccines among doctors and nurses when, in reality, there is a consensus about their efficacy and safety. </p>
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<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/424122/original/file-20211001-18-1gx3jm6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Crowd of protesters" src="https://images.theconversation.com/files/424122/original/file-20211001-18-1gx3jm6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/424122/original/file-20211001-18-1gx3jm6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=386&fit=crop&dpr=1 600w, https://images.theconversation.com/files/424122/original/file-20211001-18-1gx3jm6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=386&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/424122/original/file-20211001-18-1gx3jm6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=386&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/424122/original/file-20211001-18-1gx3jm6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=485&fit=crop&dpr=1 754w, https://images.theconversation.com/files/424122/original/file-20211001-18-1gx3jm6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=485&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/424122/original/file-20211001-18-1gx3jm6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=485&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">In New York, crowds rallied last week against city-wide COVID vaccine mandates for public school teachers and state-wide mandates for health-care workers.</span>
<span class="attribution"><a class="source" href="https://photos-cdn.aap.com.au/Image/20210928001580857678?path=/aap_dev10/device/imagearc/2021/09-28/bc/db/39/aapimage-7hq7upf75c4cz4bz14j6_layout.jpg">EPA/JUSTIN LANE</a></span>
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Read more:
<a href="https://theconversation.com/are-you-double-dosed-how-to-ask-friends-and-family-if-theyre-vaccinated-and-how-to-handle-it-if-they-say-no-168754">'Are you double dosed?' How to ask friends and family if they're vaccinated, and how to handle it if they say no</a>
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<hr>
<h2>How can we all stay safe?</h2>
<p>Moving forward, we must acknowledge three things when it comes to health workers and vaccine hesitancy:</p>
<h2>1. Don’t judge</h2>
<p>While there is a moral imperative and duty of care for health workers to receive the COVID vaccine, we should ensure unvaccinated staff members have the opportunity to discuss vaccines in a non-judgemental way. </p>
<p>As with the general public, we need to find out who health workers trust and connect them with trusted resources to alleviate their fears. This might be done via hospital websites, discussions with their primary health-care providers or evidence-based information.</p>
<h2>2. Work out what works</h2>
<p>Unlike the community setting, there has been a gap in funding to develop and test resources and interventions focused on supporting health and aged care worker vaccine uptake. </p>
<p>Understanding the specific strategies that work to support vaccine uptake, without having to move directly to mandates, is important from not only a patient safety perspective but an occupational health and safety lens. </p>
<p>These findings are relevant for COVID and other occupational vaccine programs. </p>
<h2>3. Ensure supply and access</h2>
<p>Prior to introducing a mandate, there needs to be adequate supply and equitable access to vaccines. We need to ensure people have the opportunity to review vaccine safety and effectiveness data and to get the vaccine of their free will. </p>
<p>Careful planning, consultation and communication with key groups can improve acceptability of mandates. </p>
<p>In the coming weeks, more health workers are likely to resign or be dismissed for failing to comply with the COVID mandates. There will be those in social media who will call out the situation as the “right move”. But some health workers will become privately or publicly vocal on the issue and will cast doubt on the vaccine. It is important we prepare for these situations, especially in regional areas where there may be fewer voices and greater trust in long-serving health workers. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-9-psychological-barriers-that-lead-to-covid-19-vaccine-hesitancy-and-refusal-168643">The 9 psychological barriers that lead to COVID-19 vaccine hesitancy and refusal</a>
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<img src="https://counter.theconversation.com/content/168838/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Holly Seale is an investigator on research studies funded by NHMRC and has previously received funding for investigator driven research from NSW Ministry of Health, as well as from Sanofi Pasteur and Seqirus. She is the Deputy Chair of the Collaboration on Social Science and Immunisation.</span></em></p><p class="fine-print"><em><span>Margie Danchin receives funding from the Victorian and Commonwealth Departments of Health, NHMRC, WHO and is Chair, Collaboration on Social Science and Immunisation (COSSI).</span></em></p><p class="fine-print"><em><span>Ruby Biezen was part of the research team who received funding from the Victorian Government on the project 'COVID vaccine key cohort preparedness and communication strategies'.</span></em></p>While the vast majority of health workers are prepared to accept COVID vaccinations, we need to make sure the concerns of the minority are heard and don’t compromise safety.Holly Seale, Associate professor, UNSW SydneyMargie Danchin, Paediatrician at the Royal Childrens Hospital and Associate Professor and Clinician Scientist, University of Melbourne and MCRI, Murdoch Children's Research InstituteRuby Biezen, Research Fellow, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1687542021-09-30T20:14:26Z2021-09-30T20:14:26Z‘Are you double dosed?’ How to ask friends and family if they’re vaccinated, and how to handle it if they say no<figure><img src="https://images.theconversation.com/files/423944/original/file-20210929-19363-1ktvv6k.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5306%2C3526&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The weekend is approaching, your fridge is stocked with cheese and you’re eager to organise a COVID-compliant picnic with other fully vaccinated adults which your local rules stipulate. But choose your guests wisely — only fully vaccinated people can attend, and fines apply if the rules are broken.</p>
<p>These new rules, coming into effect in New South Wales and Victoria, place the responsibility for policing vaccination on individuals. <a href="https://theconversation.com/vaccine-passports-are-coming-to-australia-how-will-they-work-and-what-will-you-need-them-for-167531">Vaccine passports</a> may eventually allow businesses to check people’s vaccination status on entry, but there is no app to scan before gathering for a picnic or home event. </p>
<p>So how do you find out who’s vaccinated, and what do you do with that information?</p>
<h2>How do you start the conversation?</h2>
<p>Vaccination can feel like a loaded topic, something you might not want to discuss if you can avoid it. But it doesn’t have to be a minefield. We can actually take some tips about approaching tricky personal topics from the field of <a href="https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/get-tested/how-do-i-talk-my-partner-about-std-testing">sexual health</a>.</p>
<p>First, try to talk about vaccination before you’ve confirmed plans with someone, and before you’ve communicated the plans to others. Once you’re already at the picnic, the stakes are much higher. You’re more likely to either go along with something that doesn’t feel right to you or end up in an argument.</p>
<p>Offer your own vaccination status first. You could say something like</p>
<blockquote>
<p>FYI, I got my second dose last month. These new rules mean everyone coming will have to be vaccinated. Have you had both doses? I want to make sure we’re OK to go ahead.</p>
</blockquote>
<p>Keep the question casual. Asking someone’s vaccination status is reasonable in these circumstances — it isn’t because you don’t trust the person. </p>
<h2>What if the person says no?</h2>
<p>Don’t jump to conclusions. Depending on your relationship with the person, you may want to find out more. When approaching a <a href="https://www.abc.net.au/news/health/2021-03-29/coronavirus-vaccines-concernes-conversation-guide/100018588">conversation about COVID-19 vaccines</a>, start with an open mind and be ready to listen. </p>
<p>Ask them if they’d like to talk about why they aren’t vaccinated. Maybe they have some specific concerns, maybe they’re waiting for an appointment or for a different vaccine to the one available to them now. </p>
<p>Let them share all their concerns before you jump in and try to answer or correct them.</p>
<p>If they’re open to it, you can help them <a href="https://www.mja.com.au/journal/2021/215/1/communicating-patients-and-public-about-covid-19-vaccine-safety-recommendations">weigh up the risks and benefits of the vaccines</a>, share some facts about <a href="https://www.vaxfacts.org.au/">safety and effectiveness</a>, or tell them what convinced you to get vaccinated. </p>
<p>Talking about your own experience can help <a href="https://theconversation.com/from-faith-leaders-to-office-workers-5-ways-we-can-all-be-covid-vaccine-champions-160454">normalise vaccination</a>. </p>
<p>The person you’re talking to might not be on fence about the vaccine — they might be strongly opposed to it. </p>
<p>If that’s the case, your best strategy may be to establish your position and close the conversation. You could say:</p>
<blockquote>
<p>OK, that’s not what I believe. But either way, we have to follow the rules.</p>
</blockquote>
<p>Arguing with people who <a href="https://theconversation.com/4-ways-to-talk-with-vaccine-skeptics-125142">strongly oppose vaccination</a> is rarely — if ever — effective, and it could ruin your relationship.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/423767/original/file-20210929-19377-1eyoza1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman looks at her phone." src="https://images.theconversation.com/files/423767/original/file-20210929-19377-1eyoza1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/423767/original/file-20210929-19377-1eyoza1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/423767/original/file-20210929-19377-1eyoza1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/423767/original/file-20210929-19377-1eyoza1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/423767/original/file-20210929-19377-1eyoza1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/423767/original/file-20210929-19377-1eyoza1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/423767/original/file-20210929-19377-1eyoza1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Try to talk about vaccination before you’ve confirmed plans with someone, and before you’ve communicated the plans to others.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>While rules are in place that exclude unvaccinated people for the time being, it’s not necessary to cut someone out of your life because they aren’t vaccinated. </p>
<p>As those rules are relaxed and we move from suppressing COVID-19 to living with COVID-19, we will need to re-calibrate our risk assessments. </p>
<p>Of course these decisions are personal, but if you and your family are fully vaccinated, the risk of catching COVID-19, particularly in an outdoor environment, is <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2108891">significantly reduced</a>.</p>
<p>If you have children too young to currently get vaccinated, the risks from COVID-19 are low except in <a href="https://theconversation.com/lets-hold-off-vaccinating-children-and-teens-against-covid-19-prioritising-adults-is-our-best-shot-for-now-162765">certain circumstances</a> so you’ll need to weigh health risks against social benefits. </p>
<p><a href="https://doi.org/10.1016/j.jesp.2016.10.003">Social exclusion leads to more conspiratorial thinking</a> — in other words, cutting people off when they believe in conspiracy theories often leaves them to go further down the rabbit hole, unchallenged by alternative views. </p>
<p>You may have more <a href="https://www.abc.net.au/news/science/2021-05-23/ex-conspiracy-theorists-reveal-how-they-got-out-qanon/100153732">positive impact</a> by maintaining a relationship, within your boundaries, and role modelling the behaviour you believe in.</p>
<h2>What about the picnic?</h2>
<p>If your friend is a bit hesitant or firmly against getting the vaccine, your picnic with them will have to wait. </p>
<p>When you explain this, you may want to distance yourself from the rules. For example, you could say:</p>
<blockquote>
<p>The new rules say… Unfortunately it sounds like we can’t get together for now. It’s only a temporary thing — we should all be able to get back to normal in a few more weeks.</p>
</blockquote>
<p>You didn’t make the rules, but we’re all living with them for now. If relevant, convey how important the relationship is. </p>
<p>From the beginning, <a href="https://theconversation.com/coronavirus-distancing-measures-are-confusing-here-are-3-things-to-ask-yourself-before-you-see-someone-134394">managing COVID-19 well</a> has required us to take the evidence, abide by public health orders and, when we can choose, weigh the risks of an activity against the benefits. </p>
<p>For these sensitive social negotiations around vaccines, masks and other measures, we will need to communicate with care to keep connecting with each other as safely as possible.</p><img src="https://counter.theconversation.com/content/168754/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jessica Kaufman receives funding from the National Health and Medical Research Foundation and the Victorian Department of Health. She is a steering committee member of the Collaboration on Social Science and Immunisation.</span></em></p><p class="fine-print"><em><span>Julie Leask receives funding from the World Health Organization and UNICEF. </span></em></p>Talking about your own experience can help normalise vaccination.Jessica Kaufman, Research Fellow, Vaccine Uptake Group, Murdoch Children's Research InstituteJulie Leask, Professor, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1663932021-09-28T11:56:22Z2021-09-28T11:56:22ZCan healthy people who eat right and exercise skip the COVID-19 vaccine? A research scientist and fitness enthusiast explains why the answer is no<figure><img src="https://images.theconversation.com/files/422695/original/file-20210922-25-11lek97.jpg?ixlib=rb-1.1.0&rect=16%2C24%2C5439%2C3612&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Several thousand protestors opposed to the COVID-19 vaccine march through the streets of midtown Manhattan in New York on Sept. 18, 2021. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/several-thousand-protestors-opposed-to-the-covid-19-vaccine-news-photo/1341164693?adppopup=true">Andrew Lichtenstein/Corbis News via Getty Images</a></span></figcaption></figure><p>I’m a fitness enthusiast. I also adhere to a nutrient-dense, “clean” eating program, which means I minimize my sugar intake and eat a lot of whole foods for the purpose of optimizing my health. </p>
<p>You might wonder how effective such a diet and exercise plan would be in the fight against COVID-19, since some <a href="https://www.washingtonpost.com/technology/2021/09/12/wellness-influencers-vaccine-misinformation/">have suggested</a> – without supporting evidence – that vaccination may be unnecessary if a detailed wellness lifestyle is closely followed. </p>
<p>As a <a href="https://scholar.google.com/scholar?hl=en&as_sdt=0%2C43&q=Bloomer+and+memphis&btnG=">research scientist</a> who has studied nutrition for close to 20 years, I have watched the wellness community’s response to the COVID-19 vaccines with great interest. While eating right can <a href="https://doi.org/10.3390/nu12061562">favorably impact the immune system</a>, it is not reasonable to expect that nutrition alone will defend against a potentially life-threatening virus. </p>
<h2>My experience with nutrition science</h2>
<p>My lab group at the <a href="https://www.memphis.edu/healthsciences/">University of Memphis</a> studies the effect of food and isolated nutrients on human health. In January 2009, we conducted an initial study of a stringent vegan diet. We enrolled 43 men and women who were allowed to eat as much plant-based food as desired, but drank only water, for 21 days. </p>
<p>The results demonstrated improvements <a href="https://doi.org/10.1186/1476-511X-9-94">in many variables</a> related to cardio-metabolic health, such as blood cholesterol, blood pressure, insulin and C-reactive protein – a protein that increases in response to inflammation. We have <a href="https://pubmed.ncbi.nlm.nih.gov/?term=bloomer+and+daniel+fast">since completed</a> multiple human and animal nutrition studies using this dietary program. </p>
<figure class="align-center ">
<img alt="A woman eating a healthy salad." src="https://images.theconversation.com/files/422240/original/file-20210920-19-log1mt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/422240/original/file-20210920-19-log1mt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/422240/original/file-20210920-19-log1mt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/422240/original/file-20210920-19-log1mt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/422240/original/file-20210920-19-log1mt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/422240/original/file-20210920-19-log1mt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/422240/original/file-20210920-19-log1mt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Diet improvements may reduce or eliminate the need for some medications, but a clean diet cannot completely protect you from COVID-19.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-eating-salad-royalty-free-image/912617718?adppopup=true">Tara Moore via Getty Images</a></span>
</figcaption>
</figure>
<p>My lab’s research has resulted in some 200 peer-reviewed scientific manuscripts and book chapters specific to <a href="https://umwa.memphis.edu/fcv/viewprofile.php?uuid=rbloomer">nutrients and exercise</a>, and the interaction between these two variables. The results of our work, as well as that of other scientists, clearly demonstrate the power of food to favorably impact health.</p>
<p>For many individuals, a positive change in eating habits results in such an improvement in clinically relevant measures like <a href="https://doi.org/10.1186/1476-511X-9-94">blood cholesterol</a> <a href="https://doi.org/10.3390/ijerph17072557">and glucose</a> that doctors can sometimes reduce or eliminate certain medications used to treat high cholesterol and diabetes. In other cases, these measures improve but the patient still requires the use of medications to control their disease. This tells us that in some situations, a great nutrition program is simply not enough to overcome the body’s challenges.</p>
<h2>Nutrition and other wellness approaches do matter</h2>
<p>Although certain <a href="https://doi.org/10.3389/fphar.2020.01189">natural products</a> have been discussed as treatments for COVID-19, little emphasis has been placed on whole food nutrition as a protective measure. I think this is unfortunate, and I believe strengthening our immune system with the goal of battling COVID-19 and other viral infections is of great importance. And the <a href="https://theconversation.com/good-nutrition-can-contribute-to-keeping-covid-19-and-other-diseases-away-145086">evidence tells us</a> that a <a href="https://doi.org/10.3390/nu12061562">nutrient dense diet</a>, <a href="http://dx.doi.org/10.1136/bjsports-2021-104080">regular exercise</a> and <a href="https://doi.org/10.1007/s00424-011-1044-0">adequate sleep</a> can all contribute to optimal immune function. </p>
<p>Regarding nutritional intake, a <a href="https://doi.org/10.1136/bmjnph-2021-000272">recently published study</a> using a sample of health care workers who contracted COVID-19 noted that those who followed a plant-based or pescatarian diet had 73% and 59% lower odds of moderate to severe COVID-19, respectively, compared to those who did not follow those diets. Although interesting, it’s important to remember that these findings represent an association rather than a causal effect. </p>
<p>While people can use nutrition to help shore up their immune system against COVID-19, diet is only one important consideration. Other <a href="https://doi.org/10.3945/an.115.010207">variables matter</a> a great deal too, including <a href="https://pubmed.ncbi.nlm.nih.gov/29306937/">stress management</a>, <a href="https://doi.org/10.3389/fimmu.2020.570122">nutritional supplements</a> and <a href="https://doi.org/10.1016/S0140-6736(20)31142-9">physical distancing and mask-wearing</a>.</p>
<p>But to be clear, all of those elements should be considered tools in the toolbox to help combat COVID-19 – not a replacement for potentially life-saving vaccines. </p>
<figure class="align-center ">
<img alt="A teenage boy at a clinic getting a COVID-19 shot." src="https://images.theconversation.com/files/422243/original/file-20210920-25-4sj241.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/422243/original/file-20210920-25-4sj241.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/422243/original/file-20210920-25-4sj241.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/422243/original/file-20210920-25-4sj241.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/422243/original/file-20210920-25-4sj241.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/422243/original/file-20210920-25-4sj241.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/422243/original/file-20210920-25-4sj241.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Charles Muro, age 13, receives a COVID-19 shot at a mass vaccination center in Hartford, Connecticut. Without the vaccine, even young people in good health are not fully protected from the virus.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/charles-muro-age-13-is-inoculated-by-nurse-karen-pagliaro-news-photo/1232871480?adppopup=true">Joseph Prezioso/AFP via Getty Images</a></span>
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</figure>
<h2>Vaccines are not perfect, but they save lives</h2>
<p>I find it interesting that nearly all parents understand the importance of having their kids <a href="https://abcnews.go.com/US/vaccine-mandates-place-attend-school-us/story?id=80046650">vaccinated against serious illnesses</a> like mumps, measles and varicella. They do not expect that certain foods, or a nurturing environment, will do the job of a vaccine. </p>
<p>Yet, when it comes to COVID-19, this thought process is abandoned by <a href="https://www.washingtonpost.com/technology/2021/09/12/wellness-influencers-vaccine-misinformation/">some who believe</a> that a healthy lifestyle will substitute for the vaccine, without seriously considering <a href="https://theconversation.com/what-happens-when-the-covid-19-vaccines-enter-the-body-a-road-map-for-kids-and-grown-ups-164624">what the vaccine actually does to provide protection</a> against the virus – something that a healthy lifestyle alone simply cannot do. </p>
<p>When contemplating whether to receive the COVID-19 vaccine, consider the following: All medications have risks, including things as <a href="https://www.huffingtonpost.co.uk/entry/daily-aspirin-causes-more-than-3000-deaths-per-year-scientists-warn_uk_593fb481e4b0b13f2c6daa10">seemingly benign as aspirin</a>. <a href="https://doi.org/10.1177/0024363918816683">Hormonal contraception</a> – something used by millions of women every month – is thought to cause an estimated 300-400 deaths annually in the U.S. The same is true for <a href="https://www.huffpost.com/entry/what-would-wendy-davis-do_b_3672484">cosmetic surgery</a>, <a href="https://doi.org/10.1007/s00266-020-02027-z">Botox injections</a> and other elective procedures. </p>
<p>Many people are willing to accept the low risks in those cases, but not with those involving <a href="https://theconversation.com/what-does-full-fda-approval-of-a-vaccine-do-if-its-already-authorized-for-emergency-use-165654">the COVID-19 vaccines</a> – despite the fact that the risk of <a href="https://www.theguardian.com/world/2021/aug/27/blood-clot-risk-greater-after-covid-infection-than-after-vaccination">serious complications or death from COVID-19</a> far outweighs the low risk of serious <a href="https://theconversation.com/new-covid-19-vaccine-warnings-dont-mean-its-unsafe-they-mean-the-system-to-report-side-effects-is-working-164455">adverse events</a> from the vaccines. </p>
<p>No lifestyle approach, including strict adherence to a holistic, nutrient-dense diet – vegan, plant-forward or otherwise – will confer total protection against COVID-19. The vaccines <a href="https://theconversation.com/medicine-is-an-imperfect-science-but-you-can-still-trust-its-process-166811">aren’t perfect</a> either; <a href="https://theconversation.com/what-is-a-breakthrough-infection-6-questions-answered-about-catching-covid-19-after-vaccination-164909">breakthrough infections</a> do occur in some cases, though the vaccines <a href="https://www.wsj.com/articles/breakthrough-cases-covid-19-delta-variant-11627596643">continue to provide robust protection</a> against <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7037e1.htm?s_cid=mm7037e1_w#T1_down">severe illness and death</a>. </p>
<p>I encourage people to do all they can to improve the health and functioning of their immune system, naturally. Then, seriously consider what additional protection would be gained from vaccination against COVID-19. When people make decisions based on the latest science – which is always evolving – rather than on emotions and misinformation, the decision should become much clearer.</p><img src="https://counter.theconversation.com/content/166393/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Richard J. Bloomer has received research support and has served as a consultant to a variety of dietary ingredient and supplement companies over the past 20 years. </span></em></p>A growing body of research shows that nutrition, sleep, exercise and a host of other lifestyle choices can help optimize the immune system. But they are no substitute for life-saving vaccines.Richard Bloomer, Dean of the College of Health Sciences, University of MemphisLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1678562021-09-23T12:28:59Z2021-09-23T12:28:59ZChanging your mind about something as important as vaccination isn’t a sign of weakness – being open to new information is the smart way to make choices<figure><img src="https://images.theconversation.com/files/422719/original/file-20210922-21-tfrslu.jpg?ixlib=rb-1.1.0&rect=376%2C106%2C4595%2C3383&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sticking to your beliefs in a rapidly changing world isn't necessarily the best choice.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/several-thousand-protestors-opposed-to-the-covid-19-vaccine-news-photo/1341164714">Andrew Lichtenstein/Corbis via Getty Images</a></span></figcaption></figure><p>Culturally, this is an era in which people are held in high esteem when they stick with their beliefs and negatively labeled as “flip-floppers” or “wishy-washy” when they change what they think.</p>
<p>While the courage of convictions can be a plus in situations where people are fighting for justice, sticking with beliefs in a dynamic world is shortsighted and dangerous, because new evidence can and should be taken into account. Rapidly changing environments are uncomfortable for people, because you can’t effectively use experience to guide choices about the future.</p>
<p>Consider the COVID-19 pandemic. All aspects of the pandemic response have evolved over time because knowledge of the disease and its prevention and treatment has changed significantly since the coronavirus made its appearance in early 2020.</p>
<p>The problem is many opponents of masking and vaccination made bold public pronouncements on social media, broadcasting positions like they’ll never get the COVID-19 shot. Once someone’s taken a strong stand like that, it can be hard to make a switch. As a <a href="https://scholar.google.com/citations?user=X3ai91IAAAAJ&hl=en&oi=sra">psychology researcher who focuses on decision-making</a>, I know there are powerful psychological and social forces that promote consistency of belief and action. Early commitments can be difficult to dislodge – though sometimes outside forces can help.</p>
<h2>Changing course once you’ve doubled down</h2>
<p>Social psychologists know that, on the one hand, people are motivated to <a href="https://doi.org/10.1017/S0140525X00057046">maintain consistency</a> across their beliefs. Because people want their <a href="https://doi.org/10.1037/0022-3514.65.3.429">web of beliefs to be coherent</a>, they tend to give a lot of weight to beliefs that are consistent with their overall worldview and to discount those that are contradictory. As a result, people will continue to hold on to a set of beliefs even in the face of mounting evidence that they should revise what they think.</p>
<p>Psychologists describe this unconscious strategy as a way for people to minimize any cognitive dissonance they experience – when things don’t add up, it can be disturbing, so to avoid those uncomfortable feelings, they ignore what doesn’t fit well with their existing beliefs as a way to maintain balance.</p>
<p>In the context of COVID-19, for example, someone who is predisposed to dislike the vaccine will give little weight to new evidence of vaccine effectiveness, because that evidence contradicts their current worldview. </p>
<p>Eventually, though, enough counterevidence can lead to what psychologists call a shift in coherence, in which people can come to believe that their initial viewpoint was wrong. But additional <a href="https://doi.org/10.1016/j.jesp.2005.04.002">social forces</a> such as the desire to appear consistent or to show solidarity with a community can still lead people to resist changing their beliefs and behavior.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/422716/original/file-20210922-25-qf8pow.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="restaurant employee hands bag of takeout to customer at counter" src="https://images.theconversation.com/files/422716/original/file-20210922-25-qf8pow.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/422716/original/file-20210922-25-qf8pow.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/422716/original/file-20210922-25-qf8pow.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/422716/original/file-20210922-25-qf8pow.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/422716/original/file-20210922-25-qf8pow.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/422716/original/file-20210922-25-qf8pow.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/422716/original/file-20210922-25-qf8pow.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Do you stick with your tried-and-true order at your favorite restaurant or explore the menu for something new?</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/restaurant-employers-giving-packed-food-away-to-a-royalty-free-image/1298685296">Vladimir Vladimirov/E+ via Getty Images</a></span>
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<p>Indeed, there is <a href="https://doi.org/10.3758/BF03193101">considerable research</a> on the trade-off between what psychologists call exploitation and exploration in decision-making. Exploitation refers to people’s tendency to pick the option that has been best in the past. As a simple example, exploitation would be choosing your usual favorite dish from a restaurant where you often order takeout.</p>
<p>Exploration describes picking options that were not optimal in the past but may now be better than the best previous choices. In the restaurant scenario, exploration involves choosing a new dish or one that you tried in the past and didn’t like as much as your old standby. Exploration gives you information about options other than your current favorite.</p>
<p>When environments change a lot, exploration is important. Good decision-makers will often forego the best-known option in order to determine whether other options are now actually better. If your favorite restaurant is constantly hiring new cooks and tinkering with the menu, then exploration is probably a good strategy. The tendency toward consistency that people display – particularly in situations where they have expressed a strong preference – is most harmful in environments that change. The COVID-19 pandemic is just such a case.</p>
<p>In these situations, helping people to change behavior requires reducing their need to feel bound to act in a way that is consistent with the attitudes they have expressed. This is where external forces come to play.</p>
<h2>When a mandate pushes against your position</h2>
<p>As an example, think about two people: Al and Barb. Both of them are opposed to getting vaccinated for COVID-19 and have a variety of reasons for that – like being mistrustful of the science and concerned about long-term safety. Both of them have also posted their opposition to vaccination to their social media sites.</p>
<p>Al doesn’t know anyone who has gotten sick from COVID-19 and hasn’t really read many stories about the effectiveness of the vaccine, so he has a strong coherent set of beliefs against vaccination.</p>
<p>Barb has friends who have gotten sick, and one died from COVID-19. She has read some of the news articles with data supporting vaccination. While this information isn’t enough to flip her opinion, she is wavering.</p>
<p>Al and Barb are likely to have different reactions to the <a href="https://theconversation.com/whos-covered-by-a-vaccine-mandate-heres-a-quick-guide-to-americas-patchwork-of-covid-19-shot-requirements-167765">government-issued mandate that employers</a> with more than 100 employees must require their staff to be vaccinated or frequently tested.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/422718/original/file-20210922-15-1ifyanh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="vaccine clinic worker seated at table near signs" src="https://images.theconversation.com/files/422718/original/file-20210922-15-1ifyanh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/422718/original/file-20210922-15-1ifyanh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=365&fit=crop&dpr=1 600w, https://images.theconversation.com/files/422718/original/file-20210922-15-1ifyanh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=365&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/422718/original/file-20210922-15-1ifyanh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=365&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/422718/original/file-20210922-15-1ifyanh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=458&fit=crop&dpr=1 754w, https://images.theconversation.com/files/422718/original/file-20210922-15-1ifyanh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=458&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/422718/original/file-20210922-15-1ifyanh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=458&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A mandate will get some vaccine holdouts to get the shot.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/health-care-worker-awaits-those-wanting-the-covid-19-news-photo/1235410337">Frederic J. Brown/AFP via Getty Images</a></span>
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<p>Al is strongly opposed to vaccination, so the mandate is outweighed by all the rest of his beliefs. He is likely to fight the mandate and to make a public display refusing to get vaccinated. </p>
<p>Barb is in a different position. The vaccination mandate fits with some of her beliefs. While Barb may be uncomfortable getting the vaccine, she is more likely to use the mandate as social cover to get vaccinated, blaming the mandate for her ultimate choice. </p>
<p>[<em>Over 110,000 readers rely on The Conversation’s newsletter to understand the world.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=100Ksignup">Sign up today</a>.]</p>
<p>For people who are on the fence about whether to get vaccinated because they have conflicting knowledge and beliefs, vaccine mandates serve two purposes. First, mandates provide one more fact that can make their pro-vaccine beliefs more consistent than their anti-vaccine beliefs. Second, even for people who are still largely anti-vaccine, it allows them to get vaccinated while still saving face by blaming the mandate for an action that they are not as strongly opposed to as they appear to be.</p>
<p>More generally, people are creatures of habit. You likely feel most comfortable doing what has worked for you in the past. The more you learn to pay attention to how much change there is in the environment, the more you can work to push yourself to explore new options and change your beliefs and behavior based on new evidence.</p><img src="https://counter.theconversation.com/content/167856/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>In the past, Arthur Markman has received funding from the National Science Foundation, National Institutes of Health, and the Air Force Office of Scientific Research for studies relating to human decision making.</span></em></p>People tend to stick with their stated beliefs. But here’s how external forces like vaccine mandates can push people to do something they don’t want to do – and provide some face-saving cover.Art Markman, Professor of Psychology, The University of Texas at AustinLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1676012021-09-14T19:08:05Z2021-09-14T19:08:05ZForceful vaccine messages backfire with holdouts – how can it be done better?<figure><img src="https://images.theconversation.com/files/420892/original/file-20210913-21-15zd52e.jpg?ixlib=rb-1.1.0&rect=0%2C44%2C942%2C579&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Protesters gather at Indiana University in June 2021 to demonstrate against mandatory COVID-19 vaccinations for students, staff and faculty. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/protesters-holding-placards-gather-at-indiana-universitys-news-photo/1233384399?adppopup=true">SOPA Images/LightRocket via Getty Images</a></span></figcaption></figure><p>With the <a href="https://theconversation.com/what-does-full-fda-approval-of-a-vaccine-do-if-its-already-authorized-for-emergency-use-165654">FDA approval of the Pfizer-BioNTech vaccine</a> and the <a href="https://www.usatoday.com/story/news/health/2021/08/24/covid-vaccines-mandates-masks-biden-fauci/8250548002/">continued surge of the delta variant</a>, governments across the world have renewed their push to increase the number of vaccinated individuals by persuading the holdouts. On Sept. 9, 2021, <a href="https://www.nytimes.com/2021/09/09/us/politics/biden-vaccine-mandates-transcript.html">President Joe Biden announced</a> sweeping vaccine mandates, expressing frustration at the vaccine holdouts: “We’ve been patient, but our patience is wearing thin. And your refusal has cost all of us.”</p>
<p>As a <a href="https://www.bellisario.psu.edu/people/individual/s.-shyam-sundar">communication scientist</a> who has studied the effects of media and health campaigns for the past 30 years, I worry that a fevered pitch in vaccine messaging may make the holdouts even more resistant. The direct, blunt messages to go get vaccinated that worked on three-quarters of Americans may not work for the remaining one-quarter. If anything, they might backfire.</p>
<p>Research has shown that some health communication techniques work more effectively than others depending on the audience. It’s a lesson that not only policymakers can apply but also members of the media, industry and even parents and relatives.</p>
<p>When it comes to embracing new ideas and practices, research has identified <a href="http://scholar.google.com/scholar_lookup?hl=en&publication_year=2003&author=EM+Rogers&title=Diffusion+of+innovations">five categories of people</a>: innovators, early adopters, early majority, late majority and laggards. With COVID-19 vaccination, it’s come down to the last two, and they are the most resistant to change.</p>
<p>This group of <a href="https://fivethirtyeight.com/features/unvaccinated-america-in-5-charts/">unvaccinated people</a> is substantial in number – there are nearly <a href="https://www.advisory.com/daily-briefing/2021/07/21/unvaccinated">80 million people</a> in the U.S. who are vaccine eligible yet remain unvaccinated – and they are the ones who could help the U.S. achieve herd immunity. But, research suggests that they are also the ones who will take offense at forceful exhortations to <a href="https://www.nytimes.com/2021/08/05/opinion/coronavirus-mask-vaccine-mandates.html">go get vaccinated</a>. </p>
<h2>Strong messaging can backfire</h2>
<p>Public health messaging can and does often influence people – but not always in the intended direction. Back in 1999, I <a href="https://books.google.com/books?id=euwjAAAAMAAJ&pg=PA155&lpg=PA155&dq=STATEMENT+BEFORE+THE+SUBCOMMITTEE+ON+CRIMINAL+JUSTICE,+DRUG+POLICY+AND+HUMAN+RESOURCES+OF+THE+UNITED+STATES+HOUSE+OF+REPRESENTATIVES+BY+S.+SHYAM+SUNDAR,+PH.D.&source=bl&ots=QAAzWaL6o7&sig=ACfU3U2zK6uWRtXCmPnOmiU5n8XSRl3tJA&hl=en&sa=X&ved=2ahUKEwirh66dmbvyAhUjEFkFHTziDREQ6AF6BAgCEAM#v=onepage&q&f=false">testified in the U.S. Congress</a> about how powerful anti-drug messages may be turning adolescents on to drugs rather than off of them. Likewise, the strong language of current vaccine messaging may be evoking resistance rather than compliance. </p>
<p>Consider <a href="https://www.nytimes.com/2021/08/05/opinion/coronavirus-mask-vaccine-mandates.html">this headline</a> from a recent New York Times editorial: “Get Masked. Get Vaccinated. It’s the Only Way Out of This.” This follows 18 months of public-health messaging urging people to stay home, wash hands and maintain social distancing.</p>
<p>They may be well intentioned, but research in health communication shows that such directive messages can be perceived as “high threat,” meaning they threaten the free will of the message receiver by dictating what they should do. They are likely to trigger <a href="https://psycnet.apa.org/record/1967-08061-000">what psychologists call “reactance”</a>. In other words, when individuals sense a threat to their freedom of action, they become motivated to restore that freedom, often by attempting to do the very thing that is prohibited or by refusing to adhere to the recommended behavior. </p>
<p><a href="https://doi.org/10.1080/00913367.2021.1927914">Recent research</a> by my communications colleagues at Penn State shows that even advertisements that include directive slogans such as “No Mask, No Ride” – from Uber – and “Socialize Responsibly to Keep Bars Open” – a Heineken message – can irritate consumers and make them less likely to engage in responsible behaviors.</p>
<p>Reactance to COVID-19 messaging is evident in the form of <a href="https://www.nytimes.com/2021/07/24/world/france-protests-covid-health-pass.html?smid=em-share">widespread protests</a> around the world. Many have gone to the streets and social media, <a href="https://www.malheurenterprise.com/posts/8849/covid-surge-malheur-county-goes-back-to-school-local-health-experts-ask-community-to-vaccinate">with slogans</a> such as “my body, my choice,” “let me call my own shots” and “coercion is not consent.” </p>
<p>These responses demonstrate not simply hesitation to get vaccinated, but rather active resistance to vaccine messaging, reflecting an effort to protect personal agency by asserting one’s freedom of action. </p>
<h2>Flipping the script</h2>
<p>Freedom is a critical concept in the anti-vaccination rhetoric. “Freedom, not force” is the battle cry of the protesters. “If we lose medical freedom, we lose all freedom,” <a href="https://www.nytimes.com/2021/08/22/nyregion/staten-island-covid-vaccine-workers.html">reads a poster</a>. “Choose freedom,” urged Sen. Rand Paul in a <a href="https://www.paul.senate.gov/fox-news-op-ed-sen-rand-paul-mask-mandates-and-lockdowns-petty-tyrants-no-not-again-choose-freedom">recent op-ed</a> expressing his resistance to mask mandates and lockdowns. “We will make our own health choices. We will not show you a passport, we will not wear a mask, we will not be forced into random screening and testing.”</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/420895/original/file-20210913-27-kozdbl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Anti-vaccination protester holds a sign and a flag during a rally against COVID-19 vaccines" src="https://images.theconversation.com/files/420895/original/file-20210913-27-kozdbl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/420895/original/file-20210913-27-kozdbl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420895/original/file-20210913-27-kozdbl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420895/original/file-20210913-27-kozdbl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420895/original/file-20210913-27-kozdbl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420895/original/file-20210913-27-kozdbl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420895/original/file-20210913-27-kozdbl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Freedom of choice has been a constant theme throughout the pandemic, whether it be about masking, school and business closures or vaccination.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/an-anti-vaccination-protester-holds-a-sign-and-a-flag-as-news-photo/1234951009?adppopup=true">Ringo Chiu/AFP via Getty Images</a></span>
</figcaption>
</figure>
<p>One way to counter such reactance is by changing the communication strategy. Health communication researchers have found that simple changes to message wording can make a big difference. In <a href="https://doi.org/10.1080/03637750500111815">one study</a> by my Penn State colleagues who study health persuasion, the researchers tested participants’ responses to sensible health behaviors such as flossing: “If you floss already, don’t stop even for a day. And, if you haven’t been flossing, right now is the time to start. … Flossing: It’s easy. Do it because you have to!” Study participants reacted to such messages by expressing their disagreement through anger and by defying the advocated behavior.</p>
<p>But then the researchers reworded the same advocacy to be less threatening, such as: “If you floss already, keep up the good work. And if you haven’t been flossing, now might be a good time to start.” And “Flossing: It’s easy. Why not give it a try?” They found that the participants’ reactance was significantly lower and their message acceptance higher. </p>
<p>In the same way, softening the message and using less dogmatic language could be the key to persuading some of the unvaccinated. This is because suggestive, rather than directive, messages allow room for people to exercise their own free will. <a href="https://doi.org/10.3389/fcomm.2019.00056">Studies in health communication</a> also suggest several other strategies for reducing reactance, ranging from providing choices to evoking empathy.</p>
<h2>Bandwagon effects</h2>
<p>Perhaps more important – given people’s reliance on smartphones and social networking – is to make better use of the technological features of interactive media, which includes websites, social media, mobile apps and games. Clever use of digital media can help convey strong health messages without triggering reactance.</p>
<p><a href="https://doi.org/10.1016/j.chb.2020.106270">Research in our lab</a> shows that people’s responses to media messages can be influenced by the approval of anonymous others on the internet, in the same way that <a href="https://doi.org/10.1145/1358628.1358873">consumers rely</a> on other people’s opinions and star ratings for making purchasing decisions online. In a <a href="https://doi.org/10.1080/10410236.2021.1888450">recent study</a>, we discovered that freedom-threatening health messages can be made more palatable if they are accompanied by a large number of likes on social media from other people. When a lot of others were seen as supporting the advocacy message, the forceful language did not seem any more threatening to their freedom than the gentler version. </p>
<p>In other words, we found that the number of likes has a strong “bandwagon effect” in reducing reactance. We also discovered that providing an option to comment on the health message imbues a higher sense of personal agency and greater acceptance of the message.</p>
<p>In another <a href="https://doi.org/10.1080/10410236.2021.1885772">recent experiment</a>, we found that customization, or the ability to tailor one’s phone or online site to one’s liking, can also aid health communication. Whether it is a phone app, dating site or social media feed, customizing a digital space allows people to reflect their personality. Seeing a health advocacy message in such a personalized space does not pose as much of a threat in such venues because people feel secure in their identity. We found that customization helps reduce negative reactions to health messages by increasing one’s sense of identity.</p>
<p>A communication strategy that is sensitive to psychological reactance could empower the holdouts to willingly get vaccinated instead of grudgingly comply with a mandate.</p>
<p>[<em>Understand new developments in science, health and technology, each week.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-understand">Subscribe to The Conversation’s science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/167601/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>S. Shyam Sundar receives funding from U. S. National Science Foundation. </span></em></p>Subtly shifting the crafting and delivery of public health messaging on COVID-19 vaccines could go a long way toward persuading many of the unvaccinated to get the shot.S. Shyam Sundar, James P. Jimirro Professor of Media Effects & Co-Director, Media Effects Research Laboratory, Penn StateLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1676672021-09-10T22:01:43Z2021-09-10T22:01:43ZBiden’s pandemic plan overlooks mask mandates and vulnerable populations<figure><img src="https://images.theconversation.com/files/420366/original/file-20210909-25-qm8y20.jpg?ixlib=rb-1.1.0&rect=0%2C446%2C7427%2C4628&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">President Joe Biden addresses the nation on latest coronavirus plan.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/president-joe-biden-speaks-about-combatting-the-coronavirus-news-photo/1339350253?adppopup=true">Kevin Dietsch/Getty Images</a></span></figcaption></figure><p>President Joseph Biden on Sept. 9, 2021, unveiled his <a href="https://www.whitehouse.gov/covidplan/#testing-masking">revamped strategy</a> to confront the pandemic, outlining an approach that focuses heavily on attempting to reduce the number of unvaccinated Americans.</p>
<p>The new plan comes at a crucial time. The delta variant continues to spread in states across America. The virus is currently taking <a href="https://www.nytimes.com/interactive/2021/us/covid-cases.html">more than 1,500 lives</a> each day, and new <a href="https://covid.cdc.gov/covid-data-tracker/#new-hospital-admissions">hospital admissions</a> <a href="https://www.cnn.com/2021/09/08/health/delta-variant-in-kids/index.html">of children</a> are higher now than at any other point during the pandemic. Concern is especially high in states with low vaccination rates. High transmission is also harming economic recovery as people <a href="https://www.wsj.com/articles/u-s-airlines-warn-of-dimming-outlook-amid-delta-variant-11631188178">stay home</a> to avoid the virus.</p>
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<p>As such, policies aimed at getting people vaccinated make sense – vaccination is a proven way to <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7034e1.htm">protect populations from hospitalizations</a> <a href="https://www.nih.gov/news-events/nih-research-matters/vaccines-prevented-140000-covid-19-deaths-us">and death</a> from coronavirus infection.</p>
<p>To encourage vaccination, <a href="https://www.cbsnews.com/live-updates/biden-covid-19-vaccine-mandates-announcement/">the president is mandating</a> that employees at companies with more than 100 workers are either vaccinated or test for the virus every week. His new plan also includes <a href="https://www.politico.com/video/2021/09/09/biden-invokes-the-defense-production-act-to-supply-mainstream-retailers-with-rapid-covid-tests-324182">enhanced production of rapid tests</a> and <a href="https://theconversation.com/over-the-counter-rapid-antigen-tests-for-covid-19-can-help-slow-the-spread-of-the-delta-variant-heres-when-to-use-them-166869">making them available</a> either free to Medicaid recipients or at cost via retailers such as Walmart and Amazon.</p>
<p>As <a href="https://www.bu.edu/sph/profile/julia-raifman/">leaders of a team</a> of <a href="https://statepolicies.com/about/team-members/">health policy researchers</a> that track policy responses to COVID-19, we know there is no perfect approach to preventing the virus. It is certainly encouraging that the administration has acknowledged that more needed to be done – and the measures outlined by the president are likely to encourage vaccinations. But we believe they would work better if supplemented by further actions – be it at a federal or state level – that would protect vulnerable people through stronger mask mandates and improved vaccine delivery. </p>
<p>We are also concerned that the headline policy – mandating workplace vaccinations – may have only a limited impact in low-income communities where many workers are <a href="https://home.treasury.gov/system/files/131/WP-114.pdf">independent contractors</a> like gig workers and agricultural workers. <a href="https://www.statnews.com/2021/07/01/essential-workers-getting-vaccinated-something-to-celebrate/">Analyses show</a> unvaccinated rates tend to be higher in such communities.</p>
<h2>No federal mask policies</h2>
<p>Biden’s plan would continue to require the use of masks on interstate transit and federal property and <a href="https://www.businessinsider.com/biden-covid-plan-doubles-tsa-fines-refusing-mask-mandate-airplanes-2021-9">doubles the fine</a> for failure to comply. But it fell short of calling for universal mask policies.</p>
<p>This is despite internal documents from the Centers for Disease Control and Prevention <a href="https://context-cdn.washingtonpost.com/notes/prod/default/documents/54f57708-a529-4a33-9a44-b66d719070d9/note/753667d6-8c61-495f-b669-5308f2827155.#page=1">in which scientists made clear</a> that “universal masking is essential to reduce transmission.”</p>
<p>Stronger mask policies would be especially helpful for <a href="https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00818">immediately reducing</a> the transmission of the delta variant, especially in <a href="https://www.pnas.org/content/118/17/e2018995118">higher-risk indoor spaces</a> and among children who are not eligible for vaccines. Hospitalizations in the U.S. of children went from record lows to record highs – and climbing – in a span of <a href="https://covid.cdc.gov/covid-data-tracker/#new-hospital-admissions">just four weeks</a>.</p>
<p>Mask mandates can reduce community transmission, allowing more time to intensify vaccine delivery efforts and messaging.</p>
<p>A data-driven approach to mask mandates would supplement the measures Biden has laid out in his path out of the pandemic. Such a policy has been put to good use in <a href="https://theconversation.com/state-policies-can-provide-clear-guidance-on-when-to-put-on-and-take-off-masks-with-benefits-to-health-education-and-the-economy-165521">Nevada</a>, where mask mandates come into effect in counties with high numbers of infections and are then removed when cases fall below a certain level.</p>
<h2>Vaccine mandates may still miss population groups</h2>
<p>The administration’s plan includes a <a href="https://federalnewsnetwork.com/workforce/2021/09/biden-will-now-require-vaccines-for-all-federal-employees-via-new-executive-order/">vaccine mandate for federal employees</a> and health care workers at Medicaid and Medicare serving hospitals. The administration also asked the Occupational Safety and Health Administration to <a href="https://www.nytimes.com/2021/09/09/business/osha-vaccine-biden-mandate.html">develop a rule</a> that would require these employers to provide paid time off for vaccination and recovery. </p>
<p>While many federal employees, health care workers and higher-income workers are already vaccinated, even modest increases could make a difference, especially in regions with low vaccination rates.</p>
<p>The new vaccine mandates are less likely to reach low-income workers, many of whom are considered <a href="https://home.treasury.gov/system/files/131/WP-114.pdf">independent contractors</a> or who work in small restaurants or other businesses and as such will not be covered.</p>
<p>Research has shown that <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7022e1.htm">vaccination rates tend to be lower in lower-income communities</a>. This may be because lower-paid workers are focused on meeting other needs like <a href="https://www.nytimes.com/2021/08/06/opinion/covid-delta-vaccines-unvaccinated.html">food, housing and child care for their families</a>, have less time because they are working more than one job or cannot afford <a href="https://www.washingtonpost.com/us-policy/2021/08/16/paid-leave-covid-vaccine/">unpaid time off work</a> to get a shot.</p>
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<p>The delta variant continues to spread rapidly through the U.S. State leaders can play an important role in speeding up vaccine delivery efforts at schools, <a href="https://www.washingtonpost.com/outlook/2021/08/05/vaccine-block-party-lowell-massachusetts/">neighborhoods</a> and <a href="https://www.statnews.com/2021/07/01/essential-workers-getting-vaccinated-something-to-celebrate/">workplaces</a>. Efforts that are directed toward low-income communities and workers where vaccination rates remain lowest are more likely to yield greater results. And mask policies could slow the spread of COVID-19 until more adults and children can be vaccinated.</p><img src="https://counter.theconversation.com/content/167667/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julia Raifman receives funding from the NIH and Robert Wood Johnson Foundation</span></em></p><p class="fine-print"><em><span>Alexandra Skinner does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>President Biden outlined a six-point strategy to confront the pandemic. But two public health scholars believe it would work better with help from states.Julia Raifman, Assistant Professor of Health Law, Policy and Management, Boston UniversityAlexandra Skinner, Research Fellow of Health Law, Policy and Management, Boston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1670312021-09-02T12:23:52Z2021-09-02T12:23:52ZEducation debates are rife with references to war – but have they gone too far?<figure><img src="https://images.theconversation.com/files/418940/original/file-20210901-21-kphqzy.jpg?ixlib=rb-1.1.0&rect=21%2C28%2C4627%2C3682&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Battlefield analogies are a long-standing feature of public debates about education.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/caucasian-soldier-overlooking-combat-zone-royalty-free-image/187139415?adppopup=true">Colin Anderson Productions pty ltd/Getty</a></span></figcaption></figure><p>As President Joe Biden <a href="https://www.nytimes.com/2021/08/29/us/politics/biden-dignified-transfer.html">oversaw the transfer of the remains of the U.S. soldiers</a> killed in a <a href="https://www.wsj.com/articles/afghanistan-kabul-airport-explosion-11629976397">suicide bomb attack</a> at Afghanistan’s Kabul airport on Aug. 26, 2021, former Education Secretary Arne Duncan took to Twitter. Appearing to weigh in on the <a href="https://apnews.com/article/lifestyle-health-education-coronavirus-pandemic-only-on-ap-0440d83602da918c571d506a3de9f44b">controversy over mask mandates in public schools</a>, Duncan compared “anti-mask and anti-vax people” with “the suicide bombers at Kabul’s airport.”</p>
<p>“Have you noticed how strikingly similar both the mindsets and actions are between the suicide bombers at Kabul’s airport, and the anti-mask and anti-vax people here?” <a href="https://nypost.com/2021/08/30/arne-duncan-compares-anti-maskers-to-kabul-suicide-bomber/">Duncan wrote</a> in a since-deleted tweet. “They both blow themselves up, inflict harm on those around them, and are convinced they are fighting for freedom.”</p>
<figure class="align-right ">
<img alt="A man stands at a podium while two other men stand nearby." src="https://images.theconversation.com/files/418951/original/file-20210901-15-s7o1j8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/418951/original/file-20210901-15-s7o1j8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/418951/original/file-20210901-15-s7o1j8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/418951/original/file-20210901-15-s7o1j8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/418951/original/file-20210901-15-s7o1j8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/418951/original/file-20210901-15-s7o1j8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/418951/original/file-20210901-15-s7o1j8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Arne Duncan (center), former U.S. Secretary of Education under President Obama, shown in 2015.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/outgoing-education-secretary-arne-duncan-delivers-remarks-news-photo/491030946?adppopup=true">Chip Somodevilla / Staff/Getty</a></span>
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<p>Duncan’s tweet drew a deluge of <a href="https://www.newsweek.com/anti-maskers-are-like-kabul-suicide-bombers-obama-education-secretary-arne-duncan-says-1624133">negative reactions</a>. Some insulted the former secretary, some criticized his timing and judgment, and others offered sarcastic advice. They criticized him for <a href="https://www.indy100.com/news/arne-duncan-anti-maskers-suicide-bombers-b1911197">politicizing a tragic event</a>. But Duncan’s use of a war metaphor to make a point is, in this instance, notable for reasons that go beyond the fact that it drew a sharp rebuke.</p>
<p>As a scholar who studies the <a href="https://scholar.google.com/citations?hl=en&user=kNcjUhMAAAAJ&view_op=list_works&gmla=AJsN-F7AqVzce-aDpQlJP6rZsXUeweaMsV9-zcHkuguyexc1fizNhBfKH8wvhbzMxXVrhAog6S9dkQmWUPSg1SQDHNi6Tq7lRaP--Iisy4TmN1yPCXuCHio">rhetoric of education policy</a>, I know that war analogies are a long-standing and common feature of public discourse about U.S. education.</p>
<h2>Prominent references to war</h2>
<p>For instance, in 1955, <a href="https://www.chicagotribune.com/news/ct-xpm-1986-10-08-8603150929-story.html">author Rudolf Flesch</a> began his bestseller, “<a href="https://www.worldcat.org/title/why-johnny-cant-read-and-what-you-can-do-about-it/oclc/930703611&referer=brief_results">Why Johnny Can’t Read</a>,” by declaring that “just as war is ‘too serious a matter to be left to the generals,’ so, I think, the teaching of reading is too important to be left to the educators.”</p>
<p>Similarly, a influential 1983 federal report, “<a href="https://www2.ed.gov/pubs/NatAtRisk/risk.html">A Nation at Risk</a>,” stated that if “an unfriendly foreign power had attempted to impose on America the mediocre educational performance that exists today, we might well have viewed it as an act of war.”</p>
<p>In both cases, the authors used war analogies to emphasize the urgency of education reform.</p>
<p>Beyond these prominent examples, the everyday language of education is rife with war metaphors. Classroom teachers work on the “<a href="https://vc.bridgew.edu/marc_pubs/5/">front lines</a>” of various aspects of education. School officials frequently find themselves “<a href="https://apnews.com/article/health-san-francisco-education-coronavirus-school-boards-3f8876aef45942966ee36f49cc627f0a">embattled</a>.” Teachers unions “<a href="https://www.courthousenews.com/teachers-union-superintendent-go-to-war/">go to war</a>” with school district superintendents. Even public education itself is said to be “<a href="https://www.upenn.edu/pennpress/book/15120.html">under siege</a>.”</p>
<p>In his remarks on the reopening of the nation’s schools this fall, Secretary of Education Miguel Cardona stressed the importance of “<a href="https://www.ed.gov/news/speeches/secretary-cardonas-remarks-return-school-roadmap">winning the fight against the pandemic</a>.” In these cases, comparing some aspect of education to an aspect of war aids with clarity and meaning.</p>
<h2>Quest for dominance</h2>
<p>The modern federal role in education is itself an extension of a different kind of war. When the Soviet Union launched <a href="https://history.nasa.gov/sputnik.html">Sputnik</a> – the first artificial satellite – into space in 1957, it triggered the so-called “<a href="https://stars.library.ucf.edu/cgi/viewcontent.cgi?referer=&httpsredir=1&article=1578&context=etd">Sputnik Crisis</a>,” or a panic that America’s education system was <a href="https://www.senate.gov/artandhistory/history/minute/Sputnik_Spurs_Passage_of_National_Defense_Education_Act.htm">failing to produce enough scientists and engineers</a>.</p>
<p>The crisis <a href="https://news.harvard.edu/gazette/story/2007/10/how-sputnik-changed-u-s-education/">focused the country</a> <a href="https://eric.ed.gov/?id=EJ863681">on its schools</a> and resulted in the passage of the <a href="https://www.senate.gov/artandhistory/history/minute/Sputnik_Spurs_Passage_of_National_Defense_Education_Act.htm">National Defense Education Act of 1958</a>, which invested large sums of federal dollars into education for the first time.</p>
<h2>Rhetorical battles</h2>
<p>So, if war metaphors are common in the rhetoric of education policy, what is different about Duncan’s tweet?</p>
<p>For starters, it does not liken education to war in the abstract. Rather, it picks out specific individuals and events for comparison. Using war as an analogy for public policy such as in the <a href="https://www.history.com/topics/crime/the-war-on-drugs">war on drugs</a> or the <a href="https://www.history.com/topics/21st-century/war-on-terror-timeline">war on terror</a> can <a href="https://mchenry.house.gov/news/documentsingle.aspx?DocumentID=30984">help pass legislation</a>. However, as <a href="https://emeriti.northwestern.edu/david-zarefsky/">communication scholar David Zarefsky</a> demonstrated in his <a href="https://www.scholars.northwestern.edu/en/publications/president-johnsons-war-on-poverty-rhetoric-and-history">study of the rhetoric of the War on Poverty</a>, such metaphors can distort the implementation of those same laws as the people they aim to help get recast as enemies when their problems prove difficult to solve.</p>
<p>Also, while abstract comparisons to war are open to interpretation, Duncan’s comment brings to mind specific actors who killed or were slain in war, a clearly unpleasant subject.</p>
<p>Additionally, while some war metaphors use hyperbole, they do not usually have the punchline format of Duncan’s tweet. Although it does not seem that Duncan was trying to be humorous, beginning the tweet with “have you noticed” – the classic setup for observational humor – is an awkward way to frame a tweet about a recent suicide bombing.</p>
<p>Finally, war metaphors in education, especially when they are made by former or current public officials, usually make a unifying appeal. In Baltimore in August 2021, Secretary Cardona <a href="https://www.ed.gov/news/speeches/secretary-cardonas-remarks-return-school-roadmap">called the nation together</a> to reopen its schools. “A Nation at Risk,” even though its rhetoric was bombastic, asked Americans to see the struggles of the nation’s education system <a href="https://www.hepg.org/hep-home/books/assigning-blame">as a collective responsibility</a> that should inspire a collective response.</p>
<p>By contrast, Duncan’s tweet was divisive. It characterized people who opposed masks and vaccines as enemies on par with ISIS, rather than fellow Americans who might be persuaded to change their minds.</p>
<p>As I have <a href="https://theconversation.com/through-her-divisive-rhetoric-education-secretary-devos-leaves-a-troubled-legacy-of-her-own-152914">written</a> <a href="https://doi.org/10.1177/0031721719892968">elsewhere</a>, secretaries of education have a responsibility to help lead the public discourse on education in the United States. Improving the national discussion on schools was <a href="https://www.presidency.ucsb.edu/documents/department-education-organization-act-statement-signing-s-210-into-law">one reason</a> President Jimmy Carter gave for founding the Department of Education and elevating its secretary to a cabinet role. </p>
<p>Although Duncan is a former secretary, he continues to seek to influence education policy as a <a href="https://uei.uchicago.edu/about/staff/arne-duncan">prominent educator</a> and an <a href="https://www.communitiesinschools.org/about-us/our-leadership/profile/arne-duncan">education nonprofit board member</a>. For those reasons, his responsibility as a rhetorical leader in the field of education continues as well.</p>
<p>[<em>Insight, in your inbox each day.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=insight">You can get it with The Conversation’s email newsletter</a>.]</p><img src="https://counter.theconversation.com/content/167031/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark Hlavacik does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Are comparisons to war a good way to make a point in debates about education? A scholar of communication says it depends on the analogies and how they are used.Mark Hlavacik, Associate Professor of Communication Studies, University of North TexasLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1659602021-08-27T12:29:53Z2021-08-27T12:29:53ZVaccines could affect how the coronavirus evolves – but that’s no reason to skip your shot<figure><img src="https://images.theconversation.com/files/417696/original/file-20210824-14-e2lseo.jpg?ixlib=rb-1.1.0&rect=416%2C0%2C7762%2C5199&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Vaccines against COVID-19 are the safest – and fastest – way to prevent the spread of variants.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/doctor-preparing-flu-or-coronavirus-injection-royalty-free-image/1278800490?adppopup=true">Luis Alvarez/ DigitalVision via Getty Images</a></span></figcaption></figure><p><strong>Takeaways</strong></p>
<ul>
<li><p>A 2015 paper on a chicken virus showed vaccines could enable more deadly variants to spread – in chickens.</p></li>
<li><p>But that outcome is rare. Only a minority of human and animal vaccines have affected the evolution of a virus. In most of those cases, evolution didn’t increase the severity of the pathogen.</p></li>
<li><p>The hypothetical possibility that the COVID-19 vaccines could result in more harmful variants is no reason to avoid inoculation. Rather, it shows the need to continue developing vaccines. </p></li>
</ul>
<hr>
<p>In 2015, my collaborators and I published a <a href="https://doi.org/10.1371/journal.pbio.1002198">scientific paper</a> about a chicken virus you have likely never heard of. At the time, it got <a href="https://www.nationalgeographic.com/science/article/leaky-vaccines-enhance-spread-of-deadlier-chicken-viruses">some</a> media attention and has been <a href="https://scholar.google.com/citations?view_op=view_citation&hl=en&user=zFQh3-EAAAAJ&cstart=20&pagesize=80&sortby=pubdate&citation_for_view=zFQh3-EAAAAJ:IaI1MmNe2tcC">cited by other scientists</a> in the years since. </p>
<p>But now, by late-August 2021, the paper <a href="https://journals.plos.org/plosbiology/article/metrics?id=10.1371/journal.pbio.1002198">has been viewed</a> more than 350,000 times – and 70% of those views were in the past three weeks. It has even appeared on a <a href="https://www.youtube.com/watch?v=tiwsv51Il4k&t=52s">YouTube video</a> that’s been seen by 2.8 million people, and counting. </p>
<p>The paper has <a href="https://www.altmetric.com/details/4333559#score">gone viral</a> because <a href="https://www.theepochtimes.com/will-covid-19-vaccines-drive-mutated-variants_3910436.html">some people</a> are using it to stoke paranoia that the COVID-19 vaccines will cause the virus to evolve in the direction of even more severe variants. Doctors have told me that patients are using the paper to justify their decision to not get vaccinated. <a href="https://twitter.com/rourecentenari/status/1428647679463206912">Some</a> <a href="https://climate-science.press/2021/05/18/did-they-forget-to-tell-us-leaky-vaccines-may-trigger-an-arms-race-that-makes-covid-more-dangerous/">pundits</a> are even <a href="https://www.facebook.com/photo.php?fbid=10220062692738356&set=a.10200625587182865&type=3">using it</a> to urge an end to vaccination campaigns in order to prevent the sort of viral evolution we were studying in chickens.</p>
<p>I am receiving emails daily from people worried about getting vaccinated themselves or worried about people rejecting vaccination because of misunderstandings about the paper. </p>
<p>Nothing in our paper remotely justifies an anti-vaccine stance. That misinterpretation – if it causes people to choose not to be vaccinated – will lead to avoidable, and tragic, loss of life. A new study estimates that as of early May 2021, vaccines <a href="https://doi.org/10.1377/hlthaff.2021.00619">had already prevented nearly 140,000 deaths</a> in the U.S. </p>
<p>For over <a href="https://doi.org/10.1038/414751a">20 years</a> <a href="https://scholar.google.com/citations?user=zFQh3-EAAAAJ&hl=en">I’ve been working</a> with <a href="https://doi.org/10.1371/journal.pbio.1001368">collaborators</a> and <a href="https://doi.org/10.1098/rsif.2006.0207">colleagues</a> on how vaccines might affect the evolution of disease-causing organisms like <a href="https://doi.org/10.1111/j.1558-5646.2012.01803.x">viruses</a> and <a href="https://doi.org/10.1371/journal.pbio.1001368">malaria parasites</a>. </p>
<p>Nothing we have discovered or even hypothesized justifies avoiding or withholding vaccines. If anything, <a href="https://theconversation.com/virus-evolution-could-undermine-a-covid-19-vaccine-but-this-can-be-stopped-149234">our work adds to reasons</a> for investigating new vaccine schedules – and for developing second- and third-generation vaccines. </p>
<p>But in the context of the COVID-19 virus, our work does prompt a fair question: Could vaccination cause the emergence of even more harmful variants?</p>
<h2>From chickens to COVID-19</h2>
<p>In the <a href="https://doi.org/10.1371/journal.pbio.1002198">2015 paper</a>, we reported experiments with variants of Marek’s disease virus – the name of the chicken virus we were studying. It is <a href="https://doi.org/10.1038/nrmicro1382">a herpesvirus</a> that causes cancer in domestic chickens. A first-generation vaccine against it <a href="https://doi.org/10.1586/14760584.4.1.77">went into widespread use</a> in poultry in the early 1970s. Today, all commercial chickens and many backyard flocks are vaccinated against Marek’s.</p>
<p>Chickens with Marek’s disease virus became capable of transmitting the virus about 10 days after they get infected. In our lab experiments, we worked with variants of Marek’s disease virus that were so lethal they would kill all unvaccinated birds in 10 days or fewer. So prior to the vaccine, the birds died before they could transmit the lethal variants to other birds. But we found that the first-generation vaccine protected the birds from dying. In other words, the Marek’s-infected chickens lived and were thus able to spread the highly virulent strains to other birds. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/417701/original/file-20210824-26129-1j4qp66.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Penn State biologist Andrew Read holds chicken at poultry farm" src="https://images.theconversation.com/files/417701/original/file-20210824-26129-1j4qp66.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/417701/original/file-20210824-26129-1j4qp66.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/417701/original/file-20210824-26129-1j4qp66.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/417701/original/file-20210824-26129-1j4qp66.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/417701/original/file-20210824-26129-1j4qp66.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/417701/original/file-20210824-26129-1j4qp66.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/417701/original/file-20210824-26129-1j4qp66.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Penn State biologist Andrew Read (right) and research assistant Chris Cairns studied Marek’s disease virus in poultry chickens.</span>
<span class="attribution"><span class="source">A Chan</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>In the case of COVID-19, it’s becoming increasingly clear that even vaccinated people <a href="https://www.nature.com/articles/d41586-021-02259-2?utm_source=Nature+Briefing&utm_campaign=86c75674aa-briefing-dy-20210820&utm_medium=email&utm_term=0_c9dfd39373-86c75674aa-43257777">can contract and transmit</a> the highly transmissible delta variant. Since viral transmission from vaccinated chickens is what allowed more lethal variants to spread in Marek’s, it’s reasonable to ask whether COVID-19 transmission from vaccinated people could allow more lethal variants to spread.</p>
<h2>Evolution can go in many directions</h2>
<p>As evolutionary ecologist <a href="https://scholar.google.com/citations?user=VkV9_zoAAAAJ&hl=en">David Kennedy</a> and I have <a href="https://theconversation.com/virus-evolution-could-undermine-a-covid-19-vaccine-but-this-can-be-stopped-149234">written about</a> previously, the evolutionary path that the Marek’s disease virus took is one of many that are possible – in rare cases where vaccines drive evolution. </p>
<p>Only a minority of human and animal vaccines <a href="https://doi.org/10.1098/rspb.2016.2562">have influenced</a> pathogen evolution. In nearly all of those cases – which include the hepatitis B virus and bacteria that cause whooping cough and pneumonia – <a href="https://doi.org/10.1073/pnas.1717159115">vaccine efficacy was reduced</a> by new variants. But in contrast to Marek’s, there was no clear evidence that the evolved variants made people sicker.</p>
<p>In nature, we know of course that not all viruses are equally lethal. Biological differences in things like the linkage between disease severity and transmission can cause lethality to increase or decrease. This means that the future of one virus cannot be predicted by simply extrapolating from the past evolution of another. Marek’s and SARS-CoV-2 are very different viruses, with very different vaccines, very different hosts and very different mechanisms by which they sicken and kill. It is impossible to know whether their differences are more important than their similarities.</p>
<p>Evolutionary hypotheticals are important to consider. But up against the hugely beneficial impact of COVID-19 vaccines on reducing <a href="http://dx.doi.org/10.15585/mmwr.mm7034e4">transmission</a> and disease severity – <a href="https://doi.org/10.1056/NEJMoa2108891">even against the delta variant</a> – the possibility of silent spread of more lethal variants among the vaccinated is still no argument against vaccination. </p>
<p>As novel variants of the coronavirus spread in the months and years ahead, it will be vital to work out whether their evolutionary advantage is arising because of reduced disease severity among the vaccinated. Delta, for instance, <a href="https://doi.org/10.1038/d41586-021-02259-2">transmits more effectively</a> from both unvaccinated and vaccinated people than did earlier variants. Extrapolating from our chicken work to argue against vaccination because of the delta variant has no scientific rationale: The delta variant would have become dominant even if everyone refused vaccination.</p>
<h2>But what if?</h2>
<p>If more deadly variants of the coronavirus were to arise, lower vaccination rates would make it easier to identify and contain them because unvaccinated people would suffer more severe infections and higher death rates. But that kind of “solution” would come at considerable cost. In effect, the variants would be found and eliminated by letting people get sick, many of whom would die.</p>
<p>Sacrificing chickens was not the solution the poultry industry adopted for Marek’s disease virus. Instead, more potent vaccines were developed. Those newer vaccines provided <a href="https://doi.org/10.1016/j.prevetmed.2015.04.013">excellent disease control</a>, and no lethal breakthrough variants of Marek’s have emerged in over 20 years. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/417700/original/file-20210824-18817-l8hni4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Chickens in poultry house in Maryland" src="https://images.theconversation.com/files/417700/original/file-20210824-18817-l8hni4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/417700/original/file-20210824-18817-l8hni4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/417700/original/file-20210824-18817-l8hni4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/417700/original/file-20210824-18817-l8hni4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/417700/original/file-20210824-18817-l8hni4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/417700/original/file-20210824-18817-l8hni4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/417700/original/file-20210824-18817-l8hni4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Marek’s disease, a cancer-causing herpesvirus in domestic chickens, took a heavy toll on the poultry industry before vaccines were developed against it.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/broiler-chickens-in-poultry-house-royalty-free-image/159235695?adppopup=true">Edwin Remsberg/The Image Bank via Getty Images</a></span>
</figcaption>
</figure>
<p>There are probably ways the available COVID-19 vaccines could be improved in the future to <a href="https://theconversation.com/virus-evolution-could-undermine-a-covid-19-vaccine-but-this-can-be-stopped-149234">better reduce transmission</a>. Booster shots, larger doses or different intervals between doses might help; so too, <a href="https://theconversation.com/a-mix-and-match-approach-to-covid-19-vaccines-could-provide-logistical-and-immunological-benefits-161974">combinations of existing vaccines</a>. Researchers are working hard on these questions. Next-generation vaccines might be even better at blocking transmission. Nasal vaccines, for instance, might effectively curtail transmission because they more specifically target the location of transmissible virus.</p>
<p>As of late August 2021, <a href="https://covid.cdc.gov/covid-data-tracker/#datatracker-home">more than 625,000 Americans have died</a> from a disease that is now largely vaccine-preventable. It is sobering for me to think that some of the next to die might have avoided lifesaving vaccines because people are stoking evolutionary fears extrapolated from our research in chickens. </p>
<p>In the history of human and animal vaccines, there have not been many cases of vaccine-driven evolution. But in every one of them, individuals and populations have <a href="https://doi.org/10.1073/pnas.1717159115">always been better off</a> when vaccinated. At <a href="https://doi.org/10.1016/j.prevetmed.2015.04.013">every point</a> in the 50-year history of vaccination against Marek’s disease, an individual chicken exposed to the virus was healthier if it was vaccinated. Variants may have reduced the benefit of vaccination, but they never eliminated the benefit. Evolution is no reason to avoid vaccination.</p><img src="https://counter.theconversation.com/content/165960/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Read received funding for the chicken work from Institute of General Medical Sciences, National Institutes of Health (R01GM105244) and the UK Biotechnology and Biological Sciences Research Council as part of the joint NSF-NIH-USDA Ecology and Evolution of Infectious Diseases program. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of this article.</span></em></p>A 2015 paper on chicken virus evolution is being taken out of context and used to fuel fears about COVID-19 vaccines. Its lead author aims to clarify the science in hopes of saving lives.Andrew Read, Professor of Biology, Entomology and Biotechnology, Penn StateLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1659172021-08-12T12:27:31Z2021-08-12T12:27:31ZEmotion is a big part of how you assess risk – and why it’s so hard to be objective about pandemic precautions<figure><img src="https://images.theconversation.com/files/415747/original/file-20210811-25-2qub9a.jpg?ixlib=rb-1.1.0&rect=112%2C17%2C2613%2C1886&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It can be hard to see eye to eye when people don't see risk the same way.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/maskless-supporter-of-sean-feucht-argues-with-a-protester-news-photo/1230366959">Ringo Chiu/AFP via Getty Images</a></span></figcaption></figure><p>People tend to overestimate or underestimate risk. The pandemic brings this into stark relief. Picture someone wearing an N95 mask while walking their dog through a deserted park. Contrast that with someone entering a crowded bar maskless in an area with high coronavirus transmission rates.</p>
<p>Risk is a function of logical and physical factors, both qualitative and quantitative. A computer could combine them all into a measure that captures the likelihood, benefits and cost of an event occurring. </p>
<p>But people are prone to assess risk emotionally. This tendency explains why many view flying as riskier than driving, even though <a href="https://traveltips.usatoday.com/air-travel-safer-car-travel-1581.html">the reverse is true</a>.</p>
<p>What people often confuse with risk is <a href="https://www.fairinstitute.org/blog/control-deficiencies-are-not-risks">lack of control</a>. That’s one reason many have concerns about <a href="https://www.natlawreview.com/article/dangers-driverless-cars">self-driving vehicles</a>, where <a href="https://www.technologyreview.com/2020/12/16/1014672/building-a-self-driving-car-that-people-can-trust/">artificial intelligence algorithms</a> control the steering and braking.</p>
<p>People accept risks when they favorably <a href="https://www.investopedia.com/terms/c/cost-benefitanalysis.asp">weigh the perceived or potential benefits against the associated costs</a>. That trade-off explains why people gamble on casino games and lotteries, even though their <a href="https://www.ncsl.org/research/financial-services-and-commerce/lottery-payouts-and-state-revenue-2010.aspx">expected return is negative</a>.</p>
<p><a href="https://scholar.google.com/citations?user=ZLTSUtsAAAAJ&hl=en&oi=ao">As a data scientist</a> with expertise in data-driven decision-making under uncertainty, I’ve been watching how people react to coronavirus risks since the beginning of the pandemic. Choosing to be vaccinated, for instance, involves numerous factors – personal and public – that must be weighed to inform decisions. For some, this decision is obvious. For others, it is shrouded in fog. </p>
<p>At the heart of all such decisions is how you as an individual assess risk and make decisions based on your assessments. What are the different perspectives that lead to different ways to assess risk? Building bridges between such perspectives is crucial to reach a healthy societal compromise.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/415748/original/file-20210811-27-1k7u77m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="two masked people hold homemade sign that reads 'Respect the virus, it kills'" src="https://images.theconversation.com/files/415748/original/file-20210811-27-1k7u77m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/415748/original/file-20210811-27-1k7u77m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415748/original/file-20210811-27-1k7u77m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415748/original/file-20210811-27-1k7u77m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415748/original/file-20210811-27-1k7u77m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415748/original/file-20210811-27-1k7u77m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415748/original/file-20210811-27-1k7u77m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">When making decisions, one part of the population focuses on the threat from the coronavirus.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/anti-protestors-rena-demeo-left-and-gail-simms-argue-with-news-photo/1214038309">Erin Clark/The Boston Globe via Getty Images</a></span>
</figcaption>
</figure>
<h2>One pandemic, different perspectives</h2>
<p>There are two general COVID-19 perspectives; let’s call them receptive and skeptical. A wide schism of risk beliefs about the virus and the vaccines separate these two groups.</p>
<p>As a whole, the receptive faction views the pandemic scientifically. In general, they are emotionally charged when considering its impact and the path forward, viewing it as a major public health crisis. They know that many lives have been lost in the U.S., and support the societal responses taken so far – actions like stay-at-home orders, school closings and indoor dining shutdowns. They view the delta variant as the most recent emerging threat. They accept the value of wearing face coverings in public and feel everyone should be vaccinated.</p>
<p>In contrast, the skeptical faction generally views the virus to be on the same level of concern as seasonal influenza or the common cold. They recognize that many have died, but believe that these people likely already had other health problems, so the virus just hastened their demise. They question the benefits of the societal responses taken so far. Many believe a previous infection will protect them against the delta variant and that face coverings are ineffective for stopping the spread of the virus. They are wary of the vaccines – except possibly for people who really need it, like the elderly – preferring natural immunity as their best defense.</p>
<p>Both perceptions contain a mix of valid observations, flawed beliefs and misinformation.</p>
<p>The receptive perception reflects an aversion to risk. Those in this group overestimate the risk of the virus at the personal level. As such, they treat worst-case scenarios as expected outcomes. For this group, the benefits of responses outweigh their costs.</p>
<p>The skeptical perception reflects a high tolerance for risk. Their actions suggest that they underestimate the risk of the virus at the population level. As such, they treat best-case scenarios as expected outcomes. This group believes that the benefits of responses in the past did not warrant their costs.</p>
<h2>Finding a risk compromise</h2>
<p>The middle ground is where the truth lies, and risk can be assessed. So what is this fact-based middle ground?</p>
<ul>
<li><p>To date, over <a href="https://covid.cdc.gov/covid-data-tracker/#trends_dailytrendscases">615,000 people have died in the U.S.</a>, with <a href="https://covid.cdc.gov/covid-data-tracker/#demographics">95% of them over 50 years old</a>. This vulnerability helps explain why those in <a href="https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-total-admin-rate-total">older age groups have been most receptive to vaccination</a>.</p></li>
<li><p><a href="https://www.epa.gov/covid19-research/evaluating-effectiveness-facial-coverings-and-masks">Face coverings</a> and <a href="https://doi.org/10.1371/journal.pone.0252963">social distancing</a> have been effective in reducing virus transmission. Anecdotally, if they were not, other <a href="https://www.npr.org/sections/health-shots/2021/03/30/981303287/should-masking-last-beyond-the-pandemic-flu-and-colds-are-down-spurring-a-debate">infectious diseases like influenza and the common cold</a> would not have virtually disappeared over the past year.</p></li>
<li><p>Every person infected presents a new opportunity for the <a href="https://www.nature.com/articles/d41586-020-02544-6">virus to mutate</a>. This is how the delta variant came about.</p></li>
<li><p>The vaccines available have provided the <a href="https://theconversation.com/what-is-a-breakthrough-infection-6-questions-answered-about-catching-covid-19-after-vaccination-164909">most reliable way to prevent hospitalizations and deaths</a> from the virus.</p></li>
</ul>
<p>With so many factors contributing to the vaccine benefits and costs nexus, informed decision-making requires risk assessment that at best is challenging and at worst is simply overwhelming. This pushes people to simplify their decision process down to a single factor, effectively narrowing their risk assessment.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/415749/original/file-20210811-21-lybfel.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="man with child holds homemade signs that read 'pandemic is a fraud' and 'government is criminal'" src="https://images.theconversation.com/files/415749/original/file-20210811-21-lybfel.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/415749/original/file-20210811-21-lybfel.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415749/original/file-20210811-21-lybfel.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415749/original/file-20210811-21-lybfel.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415749/original/file-20210811-21-lybfel.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415749/original/file-20210811-21-lybfel.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415749/original/file-20210811-21-lybfel.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Another part of the population perceives public health guidelines as government overstepping.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/supporters-of-president-donald-trump-and-their-children-news-photo/1213387624">David McNew/Getty Images News via Getty Images</a></span>
</figcaption>
</figure>
<p>The field of <a href="https://www.investopedia.com/terms/d/decision-analysis.asp">decision analysis</a> was created to inform such complex processes. It provides a set of tools to systematically balance multiple criteria when making a decision.</p>
<p>Even with all the data available, both receptive and skeptical factions base their assessment of risk on emotion. Receptive people are <a href="https://doi.org/10.1016/j.intimp.2021.107724">fearful of the virus’s impact</a> on themselves and the population, and are willing to accept interventions recommended by public health officials to ameliorate any such outcomes. The end result are behaviors that help reduce, but not stop, the spread of the virus.</p>
<p><a href="https://doi.org/10.1038/s41467-020-20226-9">Skeptical people are distrustful</a> of interventions espoused by government agencies like the U.S. Centers for Disease Control and Prevention, <a href="https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-profile-of-the-unvaccinated/">believing they are unnecessary</a> and threaten livelihoods, personal well-being and personal choice. The end result are behaviors that do not help reduce the spread of the virus, since they believe the need to stop it is exaggerated.</p>
<p>People with receptive and skeptical perceptions of the virus have not been able to find much common ground. The same conflicts exist around solutions to <a href="https://www.forbes.com/sites/michaelshellenberger/2019/11/25/why-everything-they-say-about-climate-change-is-wrong/?sh=9ff669912d6a">climate change</a> and other political policies in the U.S. related to things like <a href="https://www.jec.senate.gov/public/_cache/files/309cc8e1-b971-45c6-ab52-29ffb1da9bf5/jec-fact-sheet---the-economy-under-democratic-vs.-republican-presidents-june-2016.pdf">economic growth</a> and <a href="https://en.wikipedia.org/wiki/U.S._economic_performance_under_Democratic_and_Republican_presidents">job creation</a>.</p>
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<p>Overcoming philosophical divides requires each faction to <a href="https://www.jec.senate.gov/public/_cache/files/309cc8e1-b971-45c6-ab52-29ffb1da9bf5/jec-fact-sheet---the-economy-under-democratic-vs.-republican-presidents-june-2016.pdf">feel safe in its position and be provided with the opportunity to be heard</a>. Using <a href="https://phys.org/news/2017-12-facts-consensus-bridges-conservative-liberal-climate.html">data and facts to build consensus</a> can be effective. With multiple criteria weighted differently by each faction, everyone can be a decision analyst to help reach common ground for compromise. </p>
<p>Steps like these would help bridge the coronavirus-response divide – and possibly even help end the social chaos that erupted in response to the pandemic. It’s hard to imagine enough Americans setting aside the emotion at this point, though, to dispassionately calculate costs and benefits around vaccination, masking and all the other public health interventions.</p>
<p>There is a path forward – the key to ending the pandemic is getting both factions to walk it together.</p><img src="https://counter.theconversation.com/content/165917/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sheldon H. Jacobson receives funding from the Air Force Office of Scientific Research, "Optimal Real-time Decision-making in an Uncertain World,” FA9550-19-1-0106.</span></em></p>How you respond to a risk depends on how you weigh the costs and benefits of an action. The problem is you’re not just a logical computer, and emotions bias your interpretation of the facts.Sheldon H. Jacobson, Professor of Computer Science, University of Illinois at Urbana-ChampaignLicensed as Creative Commons – attribution, no derivatives.