tag:theconversation.com,2011:/id/topics/immunization-16966/articlesImmunization – The Conversation2022-12-16T19:21:22Ztag:theconversation.com,2011:article/1942312022-12-16T19:21:22Z2022-12-16T19:21:22Z‘Vaccinating’ frogs may or may not protect them against a pandemic – but it does provide another option for conservation<figure><img src="https://images.theconversation.com/files/501430/original/file-20221215-22-xp9m5j.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1280%2C850&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">California red-legged frogs are threatened with extinction.</span> <span class="attribution"><a class="source" href="https://flic.kr/p/4KnwCD">KQED QUEST/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>When the COVID-19 pandemic first emerged, many <a href="https://scholar.google.com/citations?user=qnBAFpMAAAAJ&hl=en">wildlife disease researchers like me</a> were not too surprised. Some were intrigued it hadn’t happened sooner; after all, it is our job to observe, describe and study pandemic dynamics in animals.</p>
<p>Amphibians, for example, have been undergoing a global panzootic – the animal version of a pandemic – for decades. In the late 1990s, researchers identified the <a href="https://www.amphibianark.org/the-crisis/chytrid-fungus/">amphibian chytrid fungus</a>, which causes the often-lethal disease <a href="https://doi.org/10.1073/pnas.95.15.9031">chytridiomycosis</a>, as the probable culprit behind frog and salamander declines and extinctions from <a href="https://www.nespthreatenedspecies.edu.au/news-and-media/media-releases/these-frogs-need-our-help-scientists-name-the-australian-frogs-at-greatest-risk-of-extinction-four-likely-already-lost">Australia</a> to <a href="https://www.americanscientist.org/article/lessons-of-the-lost">Central America</a> and elsewhere that began 10, 20 or even <a href="https://doi.org/10.1002/ece3.3468">30 years before</a>.</p>
<p>Scientists have found this pathogen on <a href="https://www.researchgate.net/publication/26645573_Fisher_MC_Garner_TWJ_Walker_SF_Global_emergence_of_Batrachochytrium_dendrobatidis_and_amphibian_Chytridiomycosis_in_space_time_and_host_Ann_Rev_Microbiol_63_291-310">every continent that amphibians inhabit</a>, and the extensive <a href="https://deepblue.lib.umich.edu/bitstream/handle/2027.42/94283/mec5710.pdf;jsessionid=4E641E9F7DC2CEBA5C05B6777315B37A?sequence=1">global amphibian trade</a> has likely spread highly lethal strains around the world. The amphibian chytrid fungus is widespread in some <a href="https://doi.org/10.1371/journal.pone.0222718">geographic regions</a>, and, like the virus that causes COVID-19, it can <a href="https://doi.org/10.1534/g3.115.021808">mutate rapidly</a> and take new forms that cause varying disease severity.</p>
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<figcaption><span class="caption">Many amphibians are disappearing around the world.</span></figcaption>
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<p><a href="https://www.gov.uk/guidance/species-reintroductions-and-other-conservation-translocations">Conservation translocation</a> is an increasingly popular way to recover species that have experienced extensive population declines. It involves moving organisms to reestablish populations that have gone extinct, supplement existing ones or establish new ones in areas where the species was not previously present. However, when the amphibian chytrid fungus is prevalent in the landscape, frogs are likely to get sick again, hampering the success of translocation.</p>
<p>To avoid the setbacks of disease, researchers are <a href="https://ucnrs.org/inoculating-frogs-against-an-amphibian-pandemic/">using a tool</a> often employed against human pandemics: <a href="https://www.kqed.org/science/959844/can-a-new-vaccine-stem-the-frog-apocalypse">inoculations akin to vaccines</a>.</p>
<p>In <a href="https://doi.org/10.1002/ecs2.4294">our recent study</a>, my research team and I inoculated threatened <a href="https://ecos.fws.gov/ecp/species/2891">California red-legged frogs</a> against chytrid fungus before translocation by exposing them to the chytrid fungus in the laboratory. We wanted to see if we could activate their immune systems and give them an advantage over the fungus once they are released. Our results were unexpected.</p>
<h2>Nothing a cocktail won’t cure</h2>
<p>Since 2017, Yosemite National Park has been actively translocating California red-legged frogs to <a href="https://www.nps.gov/yose/learn/news/threatened-california-red-legged-frogs-making-a-comeback-in-yosemite-national-park-after-a-50-year-absence.htm">Yosemite Valley</a>, where the chytrid fungus is already present. We used a <a href="https://doi.org/10.1002/ecs2.4294">small subset</a> of these translocated frogs in our study.</p>
<p>We collected wild frog eggs at a place where the species is thriving, about 100 miles northwest of Yosemite Valley, then raised them in captivity at the San Francisco Zoo. Once they metamorphosed into juvenile frogs, we bathed 20 in a “cocktail” of four live, active strains of the fungus. After three weeks, they were given a bath of an antifungal drug to halt the infection. Another 40 frogs that were not exposed to the fungus were also given a bath of an antifungal drug. </p>
<p>Then we reexposed the 20 previously infected frogs to the fungus a second time, while 20 previously uninfected frogs were exposed to the fungus for the first time. We wanted to see how frogs with a second infection – namely, those that were “vaccinated” – compared with those that were infected only once.</p>
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<a href="https://images.theconversation.com/files/501438/original/file-20221215-15-uz70p9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Scanning electron micrograph of chytrid fungus" src="https://images.theconversation.com/files/501438/original/file-20221215-15-uz70p9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/501438/original/file-20221215-15-uz70p9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=482&fit=crop&dpr=1 600w, https://images.theconversation.com/files/501438/original/file-20221215-15-uz70p9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=482&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/501438/original/file-20221215-15-uz70p9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=482&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/501438/original/file-20221215-15-uz70p9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=605&fit=crop&dpr=1 754w, https://images.theconversation.com/files/501438/original/file-20221215-15-uz70p9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=605&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/501438/original/file-20221215-15-uz70p9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=605&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 chytrid fungus has devastated frog populations globally.</span>
<span class="attribution"><a class="source" href="https://www.scienceimage.csiro.au/image/1392">Alex Hyatt/CSIRO</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>What we found was surprising: 35% of frogs infected only once successfully cleared the infection without vaccination or an antifungal drug. This suggested that they have some measure of <a href="https://www.ncbi.nlm.nih.gov/books/NBK26846/">innate immunity</a>, meaning their immune system’s first line of defense was able to fight off the fungus. In addition, frogs infected a second time had a 31% overall lower rate of infection than those that were infected only once. This suggested that the vaccinelike treatment also works by stimulating <a href="https://www.ncbi.nlm.nih.gov/books/NBK21070/">adaptive immunity</a>, meaning their immune system learned to recognize the fungus from their first exposure and fight it off more efficiently. None of the frogs died from their fungal infections.</p>
<p>Before releasing them to the wild, we treated the frogs with an antifungal drug and monitored to make sure they were disease-free. We attached tiny transmitters with beaded belts around their waists so we could track their infections and survival over three months.</p>
<p>Unexpectedly, we found no difference in disease burden between the frogs that had never been infected and those that had been previously infected in the laboratory. This suggests that immunizing this species for chytrid fungus, at least in Yosemite, may be unnecessary to ensure their survival after reintroduction.</p>
<p>Indeed, the California red-legged frogs released into Yosemite Valley are thriving three years after our experiment and six years after their first translocation. They are hibernating successfully through the cold winters and emerging early in the spring for reproduction.</p>
<h2>Hope for the future</h2>
<p>Our study takes a new approach to the emerging tool of inoculation against the chytrid fungus. By combining ex situ, or laboratory, experiments with in situ, or in the field, implementation, we put lab observations to the test in the real world. This type of work strengthens collaborations between wildlife managers and zoos, which are increasingly needed as the <a href="https://www.un.org/sustainabledevelopment/blog/2019/05/nature-decline-unprecedented-report/">biodiversity crisis accelerates</a>.</p>
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<a href="https://images.theconversation.com/files/501435/original/file-20221215-17-59fogl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="California red-legged frog floating in grassy water" src="https://images.theconversation.com/files/501435/original/file-20221215-17-59fogl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/501435/original/file-20221215-17-59fogl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/501435/original/file-20221215-17-59fogl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/501435/original/file-20221215-17-59fogl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/501435/original/file-20221215-17-59fogl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/501435/original/file-20221215-17-59fogl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/501435/original/file-20221215-17-59fogl.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">Preservation efforts for the California red-legged frogs are in progress.</span>
<span class="attribution"><a class="source" href="https://flic.kr/p/aw8gBV">Greg Schechter/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Though California red-legged frogs in Yosemite Valley didn’t seem to need vaccinations, this doesn’t mean that other imperiled amphibian species around the world do not. Research on chytrid inoculations in other species have had mixed results, ranging from <a href="https://doi.org/10.1371/journal.pone.0093356">not improving survival</a> to <a href="https://pubmed.ncbi.nlm.nih.gov/25008531/">reducing infection burden</a> associated with increased survival. One of the primary challenges of this approach to conservation is that even if vaccination increases survival after initial release, this immunity does not carry forward to successive generations.</p>
<p>There is hope, however. Researchers are working to identify the <a href="https://doi.org/10.1111/acv.12459">genetic signatures associated with immunity</a> to the chytrid fungus. If successful, breeding programs can artificially select for – and perhaps even <a href="https://www.sciencedirect.com/science/article/pii/S0169534721003384">gene-edit</a> – protective traits to give frogs a leg up on a pathogen that has devastated amphibian populations worldwide.</p><img src="https://counter.theconversation.com/content/194231/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrea Adams previously received funding from the Yosemite Conservancy for conducting this research as a postdoctoral researcher at Yosemite National Park. Funding for her current academic appointment is received from the U.S. Fish and Wildlife Service.</span></em></p>Amphibians have been devastated by a chytrid fungus pandemic. Researchers immunized California red-legged frogs in Yosemite to give them a fighting chance at survival, with surprising results.Andrea J. Adams, Researcher in Ecology, University of California, Santa BarbaraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1874962022-07-21T22:44:14Z2022-07-21T22:44:14ZBiden tests positive for COVID-19: An infectious disease doctor explains the risks and treatments available for the 79-year-old president<figure><img src="https://images.theconversation.com/files/475533/original/file-20220721-9733-d32d24.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5946%2C3862&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">President Joe Biden tested positive for COVID-19 on July 21, 2022, but was reportedly feeling well enough to work and take calls, as seen in this photo released by the White House.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakBidenCOVID/81ebae96118f4047846a19e4b36e2315/photo?Query=biden%20covid&mediaType=photo&sortBy=&dateRange=now-24h&totalCount=39&currentItemNo=35">Adam Schultz/The White House via AP</a></span></figcaption></figure><p><em>On July 21, 2022, U.S. President Joe Biden said he had <a href="https://www.cnn.com/2022/07/21/politics/joe-biden-covid-19/index.html">tested positive for COVID-19 and was experiencing mild symptoms</a>. In a letter to the public, Biden’s doctor explained that the president had a slight runny nose, some fatigue and the occasional dry cough, and that Biden had already begun taking the antiviral drug Paxlovid. <a href="https://scholar.google.com/citations?user=NAnp8WsAAAAJ&hl=en&oi=ao">Patrick Jackson</a>, an assistant professor of infectious diseases at the University of Virginia, explains the risks that someone like Biden faces from a bout of COVID-19 and the treatments available.</em></p>
<h2>1. What are the important risk factors for Biden?</h2>
<p>The most important risk factor for developing severe COVID-19 is age. If you are 79 years old when you become infected with COVID-19, like President Biden, you are <a href="https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-age.html">eight times more likely to become hospitalized and 140 times more likely to die</a> compared with someone who gets COVID-19 at age 20. Preexisting health conditions – like obesity, cancer and chronic kidney or lung disease – also increase the risk of severe illness. But Biden is <a href="https://www.whitehouse.gov/wp-content/uploads/2021/11/President-Biden-Current-Health-Summary-November-2021.pdf">reported to be fairly healthy</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1550179049598861314"}"></div></p>
<p>Fortunately, preexisting immunity from vaccination or from a previous episode of COVID-19 is <a href="https://doi.org/10.1056/NEJMoa2203965">highly protective against severe disease</a>. Researchers only have limited data on the BA.5 variant that is responsible for <a href="https://covid.cdc.gov/covid-data-tracker/#variant-proportions">most recent COVID-19 cases in the U.S.</a> – and likely Biden’s, too – but the level of protection from vaccines is likely similar to that of the previous strains BA.1 and BA.2. While the BA.1 and BA.2 omicron variants of SARS-CoV-2 were very adept at infecting people who are vaccinated and boosted, the data shows that prior immunity from vaccines provides strong <a href="https://doi.org/10.1056/NEJMoa2203965">protection against severe or fatal disease</a>. During the first omicron wave in California, COVID-19 patients who did not have immunity from vaccination or previous infection were <a href="https://doi.org/10.1016/j.lana.2022.100297">much more likely to be hospitalized, be admitted into an intensive care unit or die</a> compared with people who were vaccinated and boosted.</p>
<h2>2. What is the first line of treatment for someone like Biden, and why?</h2>
<p>Current best medical practice is to give antiviral treatments to patients who have recently developed mild to moderate COVID-19 symptoms and are at higher risk of severe illness. The goal of antivirals is to stop the virus from replicating in the body in order to prevent hospitalization or death. </p>
<p>Currently there are four antiviral drugs available in the U.S. for the treatment of COVID-19 in outpatients: nirmatrelvir-ritonavir, better known by the brand name <a href="https://www.fda.gov/media/155051/download">Paxlovid</a>, <a href="https://www.gilead.com/-/media/files/pdfs/medicines/covid-19/veklury/veklury_patient_pi.pdf">remdesivir</a>, <a href="https://www.fda.gov/media/156153/download">bebtelovimab</a> and <a href="https://www.fda.gov/media/155055/download">molnupiravir</a>. The best drug for a particular patient depends on preexisting health conditions, accessibility and drug interactions with other medications. Paxlovid is widely used because it was shown to be <a href="https://doi.org/10.1056/NEJMoa2118542">highly effective in a clinical trial</a> and is available in pill form.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/475534/original/file-20220721-14443-g4gj9m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A pill packet labeled with Paxlovid leaning on a box." src="https://images.theconversation.com/files/475534/original/file-20220721-14443-g4gj9m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/475534/original/file-20220721-14443-g4gj9m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/475534/original/file-20220721-14443-g4gj9m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/475534/original/file-20220721-14443-g4gj9m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/475534/original/file-20220721-14443-g4gj9m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/475534/original/file-20220721-14443-g4gj9m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/475534/original/file-20220721-14443-g4gj9m.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">President Joe Biden is taking Paxlovid, an antiviral drug shown to reduce the risk of hospitalization and death in people infected with COVID-19.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/march-2022-berlin-the-drug-paxlovid-against-covid-19-from-news-photo/1238868437?adppopup=true">Picture Alliance/Contributor via Getty Images</a></span>
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<h2>3. How does Paxlovid work, and what are its shortcomings?</h2>
<p><a href="https://theconversation.com/what-is-paxlovid-and-how-will-it-help-the-fight-against-coronavirus-an-infectious-diseases-physician-answers-questions-on-the-covid-19-pill-181998">Paxlovid</a> is an <a href="https://doi.org/10.1126/science.abl4784">oral antiviral drug</a> that is used to treat some patients with mild to moderate COVID-19 who do not require hospitalization. Paxlovid is a combination of two medications. One is nirmatrelvir, a drug that works by <a href="https://doi.org/10.1126/science.abl4784">disrupting the coronavirus’ ability to make functioning proteins</a>. The other is ritonavir, an HIV drug that <a href="https://doi.org/10.3390/scipharm86040043">boosts the level of nirmatrelvir in the blood</a> by blocking an enzyme in the liver that breaks down nirmatrelvir.</p>
<p>A clinical trial of Paxlovid showed that the drug <a href="https://doi.org/10.1056/NEJMoa2118542">significantly reduces the risk of hospitalization or death</a> when given to infected patients within five days of their first COVID-19 symptoms. This trial looked at Paxlovid given to people who had no prior immunity to COVID-19 from vaccines or previous infection. The effectiveness of Paxlovid in the treatment of patients who have preexisting immunity from vaccination or prior infection is less clear, though <a href="https://assets.researchsquare.com/files/rs-1705061/v1/ed7100f4-9dba-4cd5-8581-3548721bfa0d.pdf?c=1654110344">some studies</a> suggest that older vaccinated patients may still benefit from the drug. Paxlovid <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-reports-additional-data-paxlovidtm-supporting">has not been found to reduce symptoms</a> or make patients feel better more quickly.</p>
<p>Paxlovid is not a panacea. It cannot be used for <a href="https://www.fda.gov/media/155050/download">some patients who have significant kidney or liver problems</a>, and it interacts negatively with a <a href="https://www.fda.gov/media/158165/download">large number of other medications</a>. Some patients cannot take Paxlovid because of the other drugs they use, but physicians can sometimes manage these interactions.</p>
<p>For example, Biden <a href="https://www.whitehouse.gov/wp-content/uploads/2021/11/President-Biden-Current-Health-Summary-November-2021.pdf">is reportedly</a> taking a blood thinner called apixaban. This drug <a href="https://www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/management-of-drug-interactions-with-nirmatrelvirritonavir-paxlovid/">interacts negatively with Paxlovid</a>. It is likely Biden’s doctor has instructed him to reduce his dose of apixaban or stop it briefly while on Paxlovid.</p>
<h2>4. What will Biden’s health care team be on the lookout for?</h2>
<p>Biden’s doctors will be monitoring his symptoms and checking his blood oxygen level. If Biden’s symptoms – like cough, shortness of breath or fever – worsen or he needs supplemental oxygen, it is possible he would be hospitalized where he may get treated with additional drugs, including steroids. </p>
<p>Some patients experience an initial improvement <a href="https://doi.org/10.1001/jama.2022.9925">followed by a “rebound” of their COVID-19 symptoms</a>. It is not clear how often rebounds happen or if they are associated with COVID-19 treatment. <a href="https://doi.org/10.1093/cid/ciac481">Rebounds appear to be generally mild</a> and not associated with hospitalization or death, though they can prolong the required period of isolation.</p>
<p>It is still too early to tell how mild or severe Biden’s bout of COVID-19 will be. With most mild cases only lasting around a week, the U.S. should only need to wait a few days to get a sense of what kind of fight the president is facing.</p><img src="https://counter.theconversation.com/content/187496/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Patrick Jackson receives research funding from the National Institutes of Health and the Ivy Foundation. He is a consultant for Moleculin Biotech. He is affiliated with Indivisible Charlottesville.</span></em></p>According to a letter from Biden’s doctor, the president has a runny nose, mild fatigue and a slight cough. The letter also noted that Biden began taking an antiviral drug the morning he tested positive.Patrick Jackson, Assistant Professor of Infectious Diseases, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1705202021-11-03T12:28:31Z2021-11-03T12:28:31ZWhat is herd immunity? A public health expert and a medical laboratory scientist explain<figure><img src="https://images.theconversation.com/files/429598/original/file-20211101-25-544rr1.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C7717%2C5140&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Experts estimate that close to 90% of the U.S. population must be vaccinated to reach herd immunity for COVID-19.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/people-fill-the-santa-monica-pier-as-crowds-gather-on-news-photo/1233207409?adppopup=true">David McNew/AFP via Getty Images</a></span></figcaption></figure><p>The term <a href="https://theconversation.com/why-herd-immunity-may-be-impossible-without-vaccinating-children-against-covid-19-154790">herd immunity</a> means that enough of a population has gained immunity to stifle a pathogen’s spread. You can think of herd immunity as being similar to fire starting in a field: If the field is dry and filled with weeds, the fire will catch and spread quickly. However, if the field is well-maintained with watering and trimming, the fire will fizzle out. Future embers that might land there will be far less likely to ignite.</p>
<p>The embers are much like SARS-CoV-2, the coronavirus that causes COVID-19. </p>
<p>Herd immunity can theoretically be achieved <a href="https://doi.org/10.1001/jama.2020.20895">either through infection and recovery or by vaccination</a>. The danger of trying to achieve herd immunity through infection is that many people will die or be forced to live with post-recovery disabilities. Moreover, research has shown that the immune response resulting from infection does not always provide <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7044e1.htm">strong enough long-term protection against COVID-19</a> and <a href="https://www.cdc.gov/coronavirus/2019-ncov/variants/variant-info.html">its evolving strains</a>. Thus, public health experts still recommend vaccination against the coronavirus to achieve the strongest and most reliable protection. </p>
<p>When the COVID-19 pandemic erupted, scientists quickly began to develop vaccines so that populations could develop immunity to <a href="https://doi.org/10.1016/j.immuni.2020.04.012">slow the firelike spread of the coronavirus</a>. In the meantime, nearly all countries mandated or encouraged social distancing, masking and other public health measures.</p>
<p>Unfortunately, the disjointed implementation of these efforts, coupled with large-scale surges and the <a href="https://theconversation.com/delta-variant-makes-it-even-more-important-to-get-a-covid-19-vaccine-even-if-youve-already-had-the-coronavirus-164203">emergence of the highly transmissible delta variant</a>, has forced public health experts to recalculate what it would take to reach “herd immunity” for COVID-19.</p>
<h2>Why herd immunity matters</h2>
<p>Prior experience with respiratory pathogens that were comparable to the new coronavirus allowed public health experts to make educated estimates of what would be needed to reach the lower threshold of herd immunity for COVID-19. Initially they believed that around 70% of the population would need to be vaccinated to <a href="https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-patients-knew-about-covid-19-herd-immunity">effectively slow or stop the spread of SARS-CoV-2</a>. </p>
<p>But with <a href="https://theconversation.com/delta-variant-makes-it-even-more-important-to-get-a-covid-19-vaccine-even-if-youve-already-had-the-coronavirus-164203">the delta variant</a> continuing to spread rapidly around the world, experts revised that estimate. Now, epidemiologists and other public health officials estimate that closer to 90% of the U.S. population would need to be vaccinated to <a href="https://www.healthline.com/health-news/how-delta-variant-has-affected-our-ability-to-reach-herd-immunity#When-might-the-U.S.-reach-herd-immunity-through-vaccinations?">reach herd immunity</a> for COVID-19. </p>
<p>Viruses like <a href="https://www.cdc.gov/polio/what-is-polio/polio-us.html">those that cause polio</a> and <a href="https://doi.org/10.1177/0033354919826558">measles required decades of education</a> and vaccination programs to achieve herd immunity and to ultimately eliminate them in the U.S. But given that new U.S. cases of COVID-19 <a href="https://covid.cdc.gov/covid-data-tracker/#trends_dailycases">continue to number in the tens of thousands</a> daily, it’s become clear that <a href="https://www.nature.com/articles/d41586-021-00396-2">COVID-19 is going to stick around</a>.</p>
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<p>There are several reasons it will take some time to achieve COVID-19 herd immunity. The COVID-19 vaccines are <a href="https://theconversation.com/the-fda-authorizes-pfizers-covid-19-vaccine-for-children-ages-5-to-11-a-pediatrician-explains-how-the-drug-was-tested-for-safety-and-efficacy-169907">currently authorized for some age groups</a> but not others. For perspective, roughly 90% of the U.S. population <a href="https://www.cdc.gov/nchs/fastats/immunize.htm">receives the measles, mumps and rubella vaccine – or MMR</a> – as children, and 93% of the population is vaccinated against polio; both of these have been routine childhood immunizations for decades. Since children make up more than <a href="https://www.census.gov/newsroom/press-kits/2020/population-estimates-detailed.html">20% of U.S. residents</a>, the country likely cannot reach COVID-19 herd immunity without widespread childhood vaccination, even if all eligible adults were vaccinated. </p>
<p>As of Nov. 1, 2021, only 67.8% of the total U.S. population ages 12 and up that are <a href="https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-total-admin-rate-total">vaccine-eligible had been fully vaccinated</a>. Experts have attributed this to multiple factors including <a href="https://www.texasmonthly.com/promotion/right-place-right-time-txst/">vaccine hesitancy</a> and the <a href="https://theconversation.com/us-is-split-between-the-vaccinated-and-unvaccinated-and-deaths-and-hospitalizations-reflect-this-divide-164460">politicization of the pandemic</a>. </p>
<p>Of course, no vaccine is perfect. Vaccinated people can have <a href="https://www.cdc.gov/vaccines/covid-19/health-departments/breakthrough-cases.html">breakthrough infections</a>, although the COVID-19 vaccines continue to effectively <a href="https://www.washingtonpost.com/health/2021/09/10/moderna-most-effective-covid-vaccine-studies/">reduce the most severe cases of COVID-19</a>. In addition, research suggests that those who experience COVID-19 after vaccination <a href="https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html#:%7E:text=Vaccinated%20people%20can%20still%20become,the%20virus%20is%20widespread">may transmit the virus at lower transmission rates</a> than those who are unvaccinated. </p>
<p><em>Read other short accessible explanations of newsworthy subjects written by academics in their areas of expertise for The Conversation U.S.<a href="https://theconversation.com/us/topics/significant-terms-105996">here</a>.</em></p><img src="https://counter.theconversation.com/content/170520/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rodney E. Rohde has received funding from the American Society of Clinical Pathologists (ASCP), American Society for Clinical Laboratory Science (ASCLS), U.S. Department of Labor (OSHA), and other public and private entities/foundations. Dr. Rohde is affiliated with ASCP, ASCLS, ASM, and serves on several scientific advisory boards. See <a href="https://rodneyerohde.wp.txstate.edu/service/">https://rodneyerohde.wp.txstate.edu/service/</a>. </span></em></p><p class="fine-print"><em><span>Ryan McNamara has received/receives funding from the National Cancer Institutes (NCI) and the National Institutes of Allergens and Infectious Diseases (NIAID). Dr. McNamara has served as a contributor for the National Technology Roadmap for Pandemic Responses and Recovery by the Advanced Regenerative Manufacturing Institute. </span></em></p>Vaccination campaigns like the ones that eventually eliminated polio and measles in the United States required decades of education and awareness in order to achieve herd immunity in the U.S. population.Rodney E. Rohde, Professor of Clinical Laboratory Science, Texas State UniversityRyan McNamara, Research Associate of Microbiology and Immunology, University of North Carolina at Chapel HillLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1661472021-08-31T12:28:01Z2021-08-31T12:28:01ZDo US teens have the right to be vaccinated against their parents’ will? It depends on where they live<figure><img src="https://images.theconversation.com/files/416860/original/file-20210818-25-1rji9gv.jpg?ixlib=rb-1.1.0&rect=29%2C14%2C2430%2C1622&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many U.S. states follow some form of "mature minor doctrine" allowing teens to make medical decisions without parental consent, including COVID-19 vaccination.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/junior-molly-day-gets-her-first-pfizer-biontech-covid-news-photo/1316145676?adppopup=true">Pete Bannan/MediaNews Group/Daily Times via Getty Images</a></span></figcaption></figure><p>The Centers for Disease Control and Prevention recommends COVID-19 vaccines for everyone aged 12 and up. And yet, <a href="https://www.usnews.com/news/health-news/articles/2021-07-14/cdc-data-coronavirus-vaccine-coverage-lowest-among-12-15-year-olds">12- to 15-year olds</a> are the least vaccinated age group in the country, with 1 in 3 having received one dose and just 1 in 4 being fully vaccinated – about half the rate of the population as a whole.</p>
<p>In some states, minors can legally decide for themselves whether they would like to get vaccinated. In Tennessee, for example, state law allows teens 14 and older to make medical treatment decisions without parental consent. But earlier this summer, state health officials <a href="https://www.npr.org/2021/07/16/1016746277/records-show-tennessees-justification-for-firing-its-vaccine-leader">fired their vaccination director</a> after she <a href="https://wpln.org/wp-content/uploads/sites/7/2021/06/MatureMinor_COVID19Coadministration_May122021.pdf">wrote a memo explaining the law</a> to state medical providers.</p>
<p>I <a href="https://news.fiu.edu/2021/vaccine-law-class">teach vaccine law</a>, so I know the principle that certain minors may be vaccinated without parental consent is woven into our country’s history.</p>
<p>It is also in line with the recommendations of the medical profession in general. In 2013, <a href="https://doi.org/10.1016/j.jadohealth.2013.07.039">the Society for Adolescent Health and Medicine advocated</a> “policies and strategies that maximize opportunities for minors to receive vaccinations when parents are not physically present.”</p>
<p>However, there’s no federal law mandating this right in the United States. Instead, there’s a state-by-state patchwork of widely varied regimes. In some, parental consent is always mandatory. In others, there are laws that establish the conditions under which minors can decide for themselves – although, <a href="https://fox17.com/news/local/tennessee-parents-upset-over-law-allowing-kids-to-get-vaccinated-without-parental-consent-mature-minor-doctrine-covid-19-coronavirus-vaccine">as the Tennessee situation shows</a>, even this right can cause controversy.</p>
<h2>Parental consent is the norm</h2>
<p>Generally, parents or legal guardians have primary legal authority to make health decisions for their children, including vaccination decisions. When a state legally allows parents to request exemptions for legally mandated childhood vaccinations, these laws universally require that the parents are the ones to take steps to obtain it. </p>
<p>When minor children disagree with their parents’ opposition to vaccination, they must look to statutes or case law for assistance, and may find it lacking. </p>
<p>As of 2021, roughly one-third of U.S. states have passed laws establishing the “mature minor doctrine”: a legal framework allowing minors to independently obtain health care without parental consent, within specified limitations. Some, but not all, specifically include vaccination.</p>
<p>In other states, minors may still be able to make their own medical decisions thanks to state court rulings establishing the mature minor doctrine. </p>
<p><iframe id="DbxQl" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/DbxQl/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>The 1928 Mississippi case of <a href="https://casetext.com/case/gulf-sir-co-v-sullivan">Gulf & S.I.R. Co. v. Sullivan</a> is one of the earliest of these rulings. In this case, the parents of a 17-year-old railroad employee sued his employer, alleging that a smallpox vaccination administered by the company physician had injured the teen. The parents had neither consented nor objected to his employment by the railroad or the vaccination, but later claimed that their consent was needed for the smallpox shot. </p>
<p>The Mississippi Supreme Court disagreed, finding that in possessing the intellectual maturity to get the railroad job, the teen also “was of sufficient intelligence to understand and appreciate the consequences of the vaccination.”</p>
<p>In 1967’s <a href="https://law.justia.com/cases/washington/supreme-court/1967/38891-1.html">Smith v. Selby</a>, the Washington State Supreme Court similarly upheld a minor’s right to make their own medical decisions – in this case, of a married teen to consent to his own vasectomy due to a medical illness. </p>
<p>Since then, courts in a number of other states have established the mature minor doctrine as well – including Tennessee, where the state supreme court’s 1987 ruling in <a href="https://law.justia.com/cases/tennessee/supreme-court/1987/724-s-w-2d-739-2.html">Cardwell v. Bechtol</a> allows teenagers aged 14 to 18 to consent to medical treatment so long as the treating physician finds the minor to be “sufficiently mature to make his or her own health care decisions.”</p>
<p>Mature minor laws can vary considerably <a href="https://www.guttmacher.org/state-policy/explore/overview-minors-consent-law">from state to state</a>. </p>
<p>Some examples: </p>
<p><a href="https://www.vaxteen.org/consent-laws-by-state">In Alaska, Arkansas and Idaho</a>, minors of any age may choose their own medical care when their doctor deems them capable of meeting standards of informed consent. </p>
<p><a href="https://www.vaxteen.org/alabama">In Alabama</a>, minors may consent to health care at the age of 14, <a href="https://www.vaxteen.org/oregon">in Oregon</a> at 15 and in Kansas <a href="https://www.vaxteen.org/south-carolina">and South Carolina</a> at 16. Montana provides this right to minors who have graduated from high school. </p>
<p>Illinois, Maine, Massachusetts, Montana, Nevada, New Jersey and Pennsylvania <a href="https://www.vaxteen.org/consent-laws-by-state">have statutes</a> permitting minors to make their own medical decisions based on a variety of factors, such as gaining legal emancipation from their parents, being married – or divorced or widowed – being pregnant or a parent, or enlisting in the military.</p>
<p>A smaller number of states have statutes specific to vaccination. <a href="https://www.vaxteen.org/new-york">In New York</a>, for example, minors of any age may consent specifically to vaccinations related to sexually transmitted diseases. <a href="https://www.vaxteen.org/california">In California</a> <a href="https://www.vaxteen.org/delaware">and Delaware</a>, those over the age of 12 can receive such vaccinations. <a href="https://www.vaxteen.org/minnesota">In Minnesota</a>, minors of any age may consent to the hepatitis B vaccination.</p>
<h2>Not just an abstract legal question</h2>
<p>When a child disagrees with their parents’ opposition to vaccination, it can deeply strain family bonds.</p>
<p>In 2019, in <a href="https://www.nbcnews.com/storyline/measles-outbreak/teen-steals-show-congress-tackles-anti-vaccine-misinformation-campaigns-n979591">testimony before the Senate Committee on Health, Education, Labor and Pensions</a>, an Ohio teenager named Ethan Lindenberger described how online misinformation about side effects frightened his mother to the point of refusing to let him get vaccinated. </p>
<p>“Her love and affection and care as a parent was used to push an agenda to create a false distress,” he said. </p>
<p>That left Lindenberger vulnerable to a number of preventable illnesses <a href="https://www.nbcnews.com/health/health-news/teen-who-got-all-his-shots-despite-anti-vaccine-mother-n978706">until he turned 18</a> and could decide for himself.</p>
<p>Lindenberger gave his testimony amid one of the worst measles outbreaks in the United States in decades. <a href="https://www.cdc.gov/measles/cases-outbreaks.html">According to the CDC</a>, 2019 saw 1,282 cases of measles in the U.S. – nearly four times higher than 2018 and the highest since 1992. The “majority of cases were among people who were not vaccinated against measles,” according to the CDC.</p>
<p>Unvaccinated teens can also be vulnerable financially. Shortly after the publication of my book “<a href="https://briandeanabramson.com/vaccine-vaccination-and-immunization-law/">Vaccine, Vaccination and Immunization Law</a>” in 2018, I met a student at Florida International University with a similar experience. By the time the student had turned 18 and chose for themselves to be vaccinated, they were too old to be covered by the federally funded <a href="https://www.cdc.gov/vaccines/programs/vfc/index.html">Vaccines For Children program</a>. This student told me they were unable to afford the cost of the numerous recommended series of vaccines.</p>
<h2>Minors’ medical rights in limbo</h2>
<p>Not all efforts by states to pass laws <a href="https://www.nytimes.com/2021/06/26/health/covid-vaccine-teens-consent.html">expanding the ability of minors to seek vaccination</a> have succeeded. Recently, these measures have met strong opposition from the anti-vaccination movement, and history suggests that this will only increase in the face of COVID-19 vaccination hesitancy.</p>
<p>In 2020, a Maryland bill to permit minors over the age of 16 to consent to vaccination <a href="https://dbknews.com/2020/02/20/maryland-vaccine-bill-annapolis-senate-minor-mature-hearing/">was withdrawn</a>. New York lawmakers also <a href="https://www.nysenate.gov/legislation/bills/2019/s4244">proposed a bill</a> that year to further expand the ability of minors over the age of 14 to consent to vaccination. So far, the bill appears to be stalled.</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>In the District of Columbia, a <a href="https://www.npr.org/local/305/2021/07/19/1017879942/parents-take-aim-at-d-c-law-that-lets-minors-get-vaccinated-without-permission">lawsuit has been filed</a> challenging legislation <a href="https://dcist.com/story/21/07/19/parents-take-aim-dc-law-allows-minors-get-vaccinated-without-parental-permission/">passed in 2020</a> permitting minors of any age – as long as they are capable of meeting standards of informed consent – to receive any vaccination recommended by the CDC’s <a href="https://www.cdc.gov/vaccines/acip/index.html">Advisory Committee on Immunization Practices</a>.</p>
<p>It now appears that anti-vaccination sentiment has stalled expansion of the mature minor doctrine. I am not aware of any current court cases involving minors seeking vaccination over parental objections, nor of any cases of minors traveling to other states to receive vaccinations under this doctrine. </p>
<p>Even in states where the mature minor doctrine is established, most teenagers are probably unaware of their rights. And as recent history in Tennessee shows, efforts to educate them about those rights may prove controversial.</p><img src="https://counter.theconversation.com/content/166147/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brian Dean Abramson 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>Some states have a legal framework allowing “mature minors” to make their own health care decisions – but they apply it in different ways, and some don’t have it at all.Brian Dean Abramson, Adjunct Professor of Vaccine Law, Florida International UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1638682021-07-22T12:14:44Z2021-07-22T12:14:44ZShould fully immunized people wear masks indoors? An infectious disease physician weighs in<figure><img src="https://images.theconversation.com/files/411976/original/file-20210719-27-wqerf3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Masking indoors will yet again be the new normal in Los Angeles County -- and possibly elsewhere in the U.S.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/happy-couple-in-love-with-face-mask-in-coffe-shop-royalty-free-image/1299333015">Lourdes Balduque/ Moment via Getty Images</a></span></figcaption></figure><p><strong><em>An updated version of this article was published on July 28, 2021. <a href="https://theconversation.com/heres-why-the-cdc-recommends-wearing-masks-indoors-even-if-youve-been-fully-vaccinated-against-covid-19-165212">Read it here</a></em></strong></p>
<hr>
<p><em>With the <a href="https://theconversation.com/whats-the-delta-plus-variant-and-can-it-escape-vaccines-an-expert-explains-163644">highly infectious delta coronavirus variant</a> spreading at an alarming rate, the <a href="https://www.nytimes.com/live/2021/06/28/world/covid-vaccine-coronavirus-mask">World Health Organization in late June 2021 urged people to</a> again wear masks indoors – even those who are fully vaccinated. And on July 15, Los Angeles County, California, announced that it would again require <a href="https://www.latimes.com/california/story/2021-07-15/l-a-county-will-require-masks-indoors-amid-covid-19-surge">masking up</a> in public indoor spaces, regardless of vaccination status. This was followed <a href="https://www.wsj.com/articles/more-california-counties-recommend-face-masks-again-11626469634">by a recommendation</a> – though not a mandate – from seven Bay Area counties for all to again don masks in public indoor settings.</em> </p>
<p><em>Notably, the U.S. Centers for Disease Control and Prevention has not yet taken a similar stance. On July 12, <a href="https://www.nationalnursesunited.org/sites/default/files/nnu/documents/0721_Letter_to_Dr_Walensky_CDC_7-12-21.pdf">National Nurses United</a>, the nation’s largest professional association for registered nurses, called on the CDC to reconsider in light of the spike in new infections and hospitalizations across the country. The Conversation asked Peter Chin-Hong, a <a href="https://scholar.google.com/citations?user=TiIQGZMAAAAJ&hl=en">physician who specializes in infectious diseases</a> at the University of California, San Francisco, to help put into context the science behind these seemingly mixed messages.</em></p>
<h2>What’s the science behind the WHO recommendation?</h2>
<p>There is clear and mounting evidence that – <a href="https://www.cdc.gov/vaccines/covid-19/health-departments/breakthrough-cases.html">though rare</a> – <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7021e3.htm">breakthrough COVID-19 infections can occur</a>, even in the fully vaccinated. This is particularly true with <a href="https://www.nature.com/articles/s41591-021-01413-7">emerging variants of concern</a>.</p>
<p>The CDC has been following these data closely. By mid-July 2021, <a href="https://covid.cdc.gov/covid-data-tracker/#vaccinations">nearly 60% of the U.S. population</a> age 18 or older had been fully vaccinated. Infections in those who are fully vaccinated are rare, and serious outcomes from COVID-19 in that population are even rarer – <a href="https://www.forbes.com/sites/brucelee/2021/06/26/cdc-4115-fully-vaccinated-have-been-hospitalized-or-died-with-breakthrough-covid-19-infections/?sh=6a75b2286993">though they do still occur</a>. However, the CDC stopped tracking nonhospitalized cases of COVID-19 for people with and without symptoms among fully vaccinated individuals on May 1, 2021. </p>
<p>The risk of infection leading to serious illness and death, however, differs starkly between vaccinated and unvaccinated people.</p>
<h2>Are breakthrough infections more likely with the delta variant?</h2>
<p>Maybe. Preliminary data suggests that the rise of variants like delta may increase the chance of breakthrough infections in people who received only their first vaccine dose. For instance, one not-yet peer-reviewed study found that a single dose of the Pfizer vaccine had an effectiveness of just <a href="https://www.medrxiv.org/content/10.1101/2021.05.22.21257658v1">34% against the delta variant, compared with 51%</a> against the older alpha variant in terms of warding off symptomatic disease.</p>
<p>But the data is more reassuring for those who have been fully vaccinated. After two doses, the Pfizer vaccine <a href="https://www.medrxiv.org/content/10.1101/2021.05.22.21257658v1">still provides strong protection</a> against the delta variant, according to real-world data from <a href="https://doi.org/10.1016/S0140-6736(21)01358-1">Scotland</a> and a variety of other countries; and in preliminary studies out of <a href="https://doi.org/10.1101/2021.06.28.21259420">Canada</a> and <a href="https://www.gov.uk/government/news/vaccines-highly-effective-against-b-1-617-2-variant-after-2-doses">England</a>, researchers noted only a “modest” decrease in effectiveness against symptomatic disease from <a href="https://doi.org/10.1101/2021.05.22.21257658">93% for the alpha variant to 88% for delta</a>. </p>
<p>One recent preliminary report from Israel is sobering, however. Before the delta variant became widespread, from <a href="https://doi.org/10.1016/S0140-6736(21)00947-8">January to April 2021</a>, Israel reported that the Pfizer vaccine was 97% effective in preventing symptomatic disease. However, <a href="https://www.gov.il/en/departments/news/05072021-03">since June 6</a>, with the delta variant circulating more widely, the Pfizer vaccine has been 64% effective in preventing symptomatic disease, according to preliminary data reported by Israel’s Ministry of Health in early July.</p>
<p>And in another <a href="https://doi.org/10.1101/2021.07.19.452771">new report that is not yet peer-reviewed</a>, researchers compared blood serum antibodies from people vaccinated with Pfizer, Moderna and J&J vaccines and found that the J&J vaccine lent <a href="https://www.nytimes.com/2021/07/20/health/coronavirus-johnson-vaccine-delta.html">much lower protection</a> against delta, beta and other variants, compared with the mRNA-based vaccines. As a result, the researchers suggest that J&J vaccine recipients would benefit from booster immunizations, ideally with one of the mRNA vaccines. However, this is a limited laboratory study that doesn’t look at whether real people got sick, and contradicts a <a href="https://doi.org/10.1056/NEJMc2108829">peer-reviewed study</a> that found the J&J vaccine was protective against delta eight months after vaccination.</p>
<p>In all reports and studies, however, vaccine efficacy is still very high against the delta variant in preventing hospitalizations and severe disease – arguably the outcomes we most care about. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/412009/original/file-20210719-27-1dk6jrp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Sign inside Target stating masks must be worn" src="https://images.theconversation.com/files/412009/original/file-20210719-27-1dk6jrp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/412009/original/file-20210719-27-1dk6jrp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/412009/original/file-20210719-27-1dk6jrp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/412009/original/file-20210719-27-1dk6jrp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/412009/original/file-20210719-27-1dk6jrp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/412009/original/file-20210719-27-1dk6jrp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/412009/original/file-20210719-27-1dk6jrp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Los Angeles County, California, is again requiring all people to mask up in indoor public spaces – only a month after fully vaccinated people were freed from wearing masks.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/signage-inside-target-reads-that-there-is-a-mask-mandate-on-news-photo/1232955651?adppopup=true">Dania Maxwell/Los Angeles Times via Getty Images</a></span>
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<p>All of this emerging data supports the WHO recommendation that even fully vaccinated individuals continue to wear masks. Most of the world still has <a href="https://www.cnn.com/interactive/2021/health/global-covid-vaccinations/">low vaccination rates</a>, uses a <a href="https://ourworldindata.org/covid-vaccinations">range of vaccines</a> with <a href="https://www.nytimes.com/2021/06/22/business/economy/china-vaccines-covid-outbreak.html">variable efficacy</a> at preventing infection and has <a href="https://content.iospress.com/articles/human-antibodies/hab200420">different burdens</a> of circulating SARS-CoV-2 virus. In this context, it makes sense that the WHO would give a conservative recommendation to mask up for all. </p>
<h2>Who’s actually protected by masking recommendations?</h2>
<p>The WHO’s latest call for fully vaccinated people to continue wearing masks is primarily intended to protect the unvaccinated – which includes kids under age 12 who are <a href="https://theconversation.com/kids-arent-just-littler-adults-heres-why-they-need-their-own-clinical-trials-for-a-covid-19-vaccine-162821">not yet eligible</a> for vaccines in the U.S. Unvaccinated people are at a substantially higher risk of getting infected with and <a href="https://doi.org/10.1056/NEJMc2107717">transmitting SARS-CoV-2</a>, and of developing complications from COVID-19.</p>
<p>And, again, there is still a <a href="https://theconversation.com/can-people-vaccinated-against-covid-19-still-spread-the-coronavirus-161166">low risk of infection for vaccinated people</a>, but this risk differs regionally. In areas of highly circulating virus and poor vaccination rates, and with highly transmissible variants, there is a higher probability of infection in vaccinated individuals compared with people living in areas with lower levels of virus in the community.</p>
<h2>Does the US situation warrant masking up (again)?</h2>
<p>I suspect the CDC is unlikely to pursue a universal U.S. recommendation to wear masks at this time. With an overall <a href="https://www.nytimes.com/interactive/2020/us/covid-19-vaccine-doses.html">high countrywide vaccination rate</a> and a <a href="https://www.nytimes.com/interactive/2021/us/covid-cases.html">low overall COVID-19</a> hospitalization and death burden, the U.S. has a COVID-19 landscape very different from <a href="https://www.bloomberg.com/graphics/covid-vaccine-tracker-global-distribution/">most of the world</a>.</p>
<p>Some experts also worry that sending an official message that the vaccinated should don masks <a href="https://www.theatlantic.com/ideas/archive/2021/01/giving-people-more-freedom-whole-point-vaccines/617829/">may dissuade</a> unvaccinated individuals from seeking vaccines. </p>
<h2>What changes would signal it’s time for the US to mask up again?</h2>
<p>There are emotional red flags and then there are more realistic red flags that may bring about a nationwide call for masking indoors for fully vaccinated people.</p>
<p>Having more than 100 cases of infection per 100,000 people per week is defined as <a href="https://covid.cdc.gov/covid-data-tracker/#county-view">“high” community transmission</a>, the worst category, by the CDC. Los Angeles County, for example, has <a href="https://www.latimes.com/california/story/2021-07-19/l-a-county-coronavirus-spike-hits-alarming-levels-with-10-000-infected-in-a-week-as-delta-variant-spreads">already surpassed</a> that mark, with <a href="https://ktla.com/news/local-news/l-a-county-would-be-in-most-restrictive-purple-tier-now-if-california-were-still-using-covid-reopening-system/">more than 10,000 coronavirus cases</a> per week.</p>
<p>A more pragmatic measure for masking is the number of hospitalizations, because it is directly related to use of health care resources. Some <a href="https://www.washingtonpost.com/outlook/2021/04/07/covid-vaccine-lift-restrictions/">researchers have proposed</a> a threshold of <a href="https://www.nytimes.com/2021/05/28/well/covid-outdoor-gathering-advice.html">five COVID-19 cases</a> – averaged over several days – hospitalized per 100,000 people, which would potentially be a more ominous signal than infection rates. Los Angeles County has also surpassed that as well. </p>
<p>Surges will likely be a regional phenomenon based on how many people are fully vaccinated in an area. As long as hospitalizations and deaths remain generally manageable nationally, and with hospital capacity intact, the U.S. as a whole may not need to return to masking indoors for the fully immunized.</p>
<p>[<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-corona-important">The Conversation’s most important coronavirus headlines, weekly in a science newsletter</a></em>]</p><img src="https://counter.theconversation.com/content/163868/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Chin-Hong 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>As Los Angeles County again mandates masking indoors – even for the fully vaccinated – local health officials in the U.S. are closely eyeing their own COVID-19 vaccination and infection rates.Peter Chin-Hong, Associate Dean for Regional Campuses, University of California, San FranciscoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1627422021-07-05T15:34:36Z2021-07-05T15:34:36ZParental COVID-19 vaccine hesitancy may be next challenge for vaccination campaigns<figure><img src="https://images.theconversation.com/files/408957/original/file-20210629-16-10pq9ku.jpg?ixlib=rb-1.1.0&rect=257%2C150%2C3935%2C2678&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Families and youth aged 12 and older lined up for a COVID-19 vaccine at Gordon A Brown Middle School in Toronto in May.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette </span></span></figcaption></figure><iframe style="width: 100%; height: 250px; border: none; position: relative; z-index: 1;" src="https://narrations.ad-auris.com/widget/the-conversation-canada/final-parental-covid-19-vaccine-hesitancy-may-be-next-challenge-for-vaccination-campaigns" width="100%" height="400"></iframe>
<p>The development of several new mRNA and viral vector vaccines in the space of a single year has changed how we understand vaccine hesitancy.</p>
<p>As a gender and social justice researcher in the health humanities, I began tracking COVID-19 vaccine hesitancy in the spring of 2020. My research assistant and I analyzed debates as they unfolded on social media and online forums.</p>
<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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<p>We found that COVID-19 vaccine hesitancy is unpredictable and unstable as new data redraws the vaccine landscape on an almost weekly basis. </p>
<p>Since the novel coronavirus had not been viewed as a threat to children until recently, public health efforts to boost vaccine confidence through the pandemic have generally focused on the adult population.</p>
<p>However, as we await the outcome of clinical trials for younger children — and as youth aged 12 and above now enter the queue — parental hesitancy is emerging as the next challenge area for vaccination programs.</p>
<p>Controversy has swirled around the measles, mumps, rubella (MMR) vaccine since an <a href="http://doi.org/10.1126/science.aal1110">unfounded and discredited report</a> first linked it with autism. Given these associations, the reception of the COVID-19 vaccine is important to consider. </p>
<h2>The face of vaccine hesitancy</h2>
<p>Since at least the 1970s, <a href="http://doi.org/10.1353/bhm.2013.0047">anxious mothers have been the face of resistance to childhood immunizations</a> as primary caregivers accustomed to making medical decisions on behalf of their children.</p>
<p>While a growing number of respondents identifying as male express skepticism — swayed perhaps by social media-spun <a href="https://doi.org/10.1017/S1743923X20000409">conspiracy theories</a> — <a href="https://osf.io/e95bc/">American polls</a> suggest that mothers (especially younger mothers) continue to disclose greater hesitancy than fathers in relation to the COVID-19 vaccine. </p>
<p><a href="https://www.pewresearch.org/science/2020/12/03/intent-to-get-a-covid-19-vaccine-rises-to-60-as-confidence-in-research-and-development-process-increases/">Early indications</a> suggested that women were more hesitant than men. However, <a href="https://health-infobase.canada.ca/covid-19/vaccination-coverage/">vaccine uptake is actually higher</a> in women in Canada and the United States. Higher hesitancy in women did not result in higher vaccine rejection. This suggests the possibility that maternal hesitancy will not necessarily translate into rejection of child vaccinations. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/407154/original/file-20210618-18-36n49.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="COVID-19 playground signs" src="https://images.theconversation.com/files/407154/original/file-20210618-18-36n49.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/407154/original/file-20210618-18-36n49.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/407154/original/file-20210618-18-36n49.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/407154/original/file-20210618-18-36n49.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/407154/original/file-20210618-18-36n49.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/407154/original/file-20210618-18-36n49.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/407154/original/file-20210618-18-36n49.png?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">Ontario playground closed by order under the Emergency Management and Civil Protection Act May 2020.</span>
<span class="attribution"><span class="license">Author provided</span></span>
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</figure>
<h2>Will vaccinated adults vaccinate their kids?</h2>
<p>Most North American adults were vaccinated as children against a range of communicable diseases from mumps to polio. However, as adults they may worry about how the ingredients of vaccines, compressed immunization schedules or adverse reactions may affect their children — even though they received many of these vaccines themselves many years earlier. </p>
<p>With the COVID-19 vaccines, the time window between parents getting vaccinated and when they take their children to be vaccinated is much narrower than with childhood shots.</p>
<p>Instead of the decades between their own MMR or polio shot and their children receiving the same vaccine, parents and children may get a COVID-19 vaccine within weeks or months of each other. With parents now receiving their first or second dose of the vaccine, will their hesitancy in regards to their children diminish?</p>
<p>One might expect that parents who sign up for their own two doses will make the same choices for their children. However, <a href="https://doi.org/10.31219/osf.io/e95bc">a report</a> that has not yet been peer reviewed from the <a href="https://covidstates.org">COVID States Project</a> — a 50-state survey of COVID-19 in the U.S. — observed that 26 per cent of parents polled indicated they may choose vaccination for themselves but not for their children. </p>
<p>There are plausible reasons for this. Respondents may believe that children “<a href="https://www.nytimes.com/2020/07/20/parenting/coronavirus-children-spread-covid-19.html">don’t get COVID</a>” because cases have been less common and less severe in young children than adults. They may have read misinformation about <a href="https://medicalxpress.com/news/2021-02-covid-vaccine-infertility-social-media.html">vaccines causing infertility</a>, or they may consider adult immune systems more robust than children’s.</p>
<p>Parents may be willing to subject themselves but not their children to possible adverse effects. They may hesitate if the vaccine designated for their child differs from the kind they received. </p>
<p>Regardless, this prospect of immune parents with unprotected children imparts new urgency to ethical questions about how we balance individual rights with our social responsibilities.</p>
<p>COVID-19 has shifted the terms of debates over <a href="https://dx.doi.org/10.1186%2F1742-7622-3-13">childhood immunization</a> that each new outbreak of measles has revived in recent years. As both <a href="https://theconversation.com/coronavirus-is-not-the-great-equalizer-race-matters-133867">the virus</a> and the <a href="https://theconversation.com/five-ways-coronavirus-lockdowns-increase-inequality-135767">attempts to contain it</a> disproportionately affect marginalized groups, the concept of “herd immunity” becomes a matter of social justice.</p>
<h2>Unevenly distributed immunity</h2>
<p>For this reason, the prospect of unevenly distributed immunity, with children over-represented among the unvaccinated, is deeply disquieting. Resolving the <a href="https://theconversation.com/the-moms-are-not-alright-how-coronavirus-pandemic-policies-penalize-mothers-144713">child-care crisis that has disproportionately affected women caregivers</a> this past year certainly depends on a successful vaccine program that would enable full reopening of schools and daycare facilities. </p>
<p>But perhaps the concerns of parents will melt away when younger children are finally eligible for vaccination. Despite some recurrent gender patterns, there are signs that parental concerns over other vaccines may not coincide with hesitancy regarding COVID-19 vaccines. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/408795/original/file-20210629-27-15oqn3e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A sign reading Free COVID vaccine ages 12+" src="https://images.theconversation.com/files/408795/original/file-20210629-27-15oqn3e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/408795/original/file-20210629-27-15oqn3e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/408795/original/file-20210629-27-15oqn3e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/408795/original/file-20210629-27-15oqn3e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/408795/original/file-20210629-27-15oqn3e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/408795/original/file-20210629-27-15oqn3e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/408795/original/file-20210629-27-15oqn3e.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">As youth aged 12 and above enter the queue, parental hesitancy is emerging as the next frontier for vaccination programs.</span>
<span class="attribution"><span class="source">(AP Photo/Jacquelyn Martin)</span></span>
</figcaption>
</figure>
<p>The pandemic has taught us that clear communication will be essential when vaccines receive emergency use approval for younger children. Parental confidence is precarious and may not withstand the <a href="https://theconversation.com/public-health-officials-are-failing-to-communicate-effectively-about-astrazeneca-160340">mixed or inconsistent messaging</a> that has dogged the roll-out of the AstraZeneca vaccine, for example. </p>
<p>Most importantly, parental vaccine hesitancy may arise from positions of both privilege and marginalization. Members of oppressed groups have not always had the option of <a href="https://harpers.org/2013/01/the-class-politics-of-vaccination/">declining vaccination in the past</a>. There are historical reasons why certain groups might have cause to distrust public health initiatives sponsored by a state that has devalued their children’s lives.</p>
<p>In the current context, unequal access and practical difficulties involved in taking time off work to take children to appointments also complicate this question of hesitancy. This is <a href="https://doi.org/10.1016/S0140-6736(20)32727-6">particularly true for mothers</a>, on whom these responsibilities typically fall.</p>
<p>In this respect, <a href="https://global.oup.com/academic/product/social-justice-9780195375138?cc=ca&lang=en&">social justice and questions of equity</a> must also be central considerations in addressing the concerns of parents and their children.</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/162742/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kelly McGuire 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>With youth ages 12 and over eligible for COVID-19 vaccination — and as trials for younger children move ahead — parental hesitancy is emerging as the new challenge for COVID-19 vaccine programs.Kelly McGuire, Associate Professor of Gender & Social Justice and English, Trent UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1591212021-06-17T12:29:35Z2021-06-17T12:29:35ZMillions are rejecting one of humanity’s best weapons for saving lives: Vaccines<figure><img src="https://images.theconversation.com/files/406175/original/file-20210614-77865-13e369c.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C7951%2C5304&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Vaccination has saved millions of lives throughout the course of history.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/women-with-face-mask-getting-vaccinated-coronavirus-royalty-free-image/1303657001">Phynart Studio/E+ from Getty Images</a></span></figcaption></figure><p>A federal judge has dismissed a lawsuit filed by <a href="https://www.npr.org/2021/06/13/1006065385/a-judge-has-thrown-out-a-lawsuit-brought-by-hospital-workers-over-a-vaccine-mand">employees at a Houston hospital who did not want to be vaccinated for COVID-19</a>, claiming that COVID-19 vaccines are unsafe. In the June 12, 2021 ruling, U.S. district Judge Lynn Hughes rejected the lead plaintiff’s claim that the vaccines are experimental and dangerous.</p>
<p>This case is indicative of how <a href="https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-april-2021/">many people</a> believe that the COVID-19 vaccine could either kill or harm them in some way. But as scientists in <a href="https://scholar.google.com/citations?user=U6Mgr6wAAAAJ&hl=en&oi=sra">public health</a>, <a href="https://www.researchgate.net/profile/Ronald-Hershow">infectious diseases</a> and <a href="https://thebiomedicalscientist.net/science/controversial-life">vaccine development</a>, we know that these claims are not just false – they are lethal. In the U.S. today, the vast majority of <a href="https://www.yahoo.com/news/people-hospitalized-covid-19-now-100140919.html">hospitalizations and deaths</a> from COVID-19 <a href="https://www.washingtonpost.com/health/interactive/2021/covid-rates-unvaccinated-people/">occur among the unvaccinated</a>.</p>
<p>Over the course of history, vaccines have allowed humanity to <a href="https://doi.org/10.1038/nm1209">successfully combat viral diseases</a> – some to the point of eradication. Here, we break down the role that vaccination plays in the fight against infectious disease, illustrate how the benefits far outweigh the risks and explain why everyone should be eager to be vaccinated against COVID-19.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/406192/original/file-20210614-125916-1u8p66n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Person about to get vaccinated by healthcare provider looks out a window." src="https://images.theconversation.com/files/406192/original/file-20210614-125916-1u8p66n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/406192/original/file-20210614-125916-1u8p66n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/406192/original/file-20210614-125916-1u8p66n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/406192/original/file-20210614-125916-1u8p66n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/406192/original/file-20210614-125916-1u8p66n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/406192/original/file-20210614-125916-1u8p66n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/406192/original/file-20210614-125916-1u8p66n.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">Vaccination is effective only if we all play our part.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/covid-19-vaccine-royalty-free-image/1306490879">andreswd/E+ at Getty Images</a></span>
</figcaption>
</figure>
<h2>Revving up the immune system</h2>
<p>Vaccines are one of the most innovative public health interventions in medical history. They activate the most effective human weapon against viruses that exists – our own immune system. </p>
<p>Vaccines show the immune system what the virus looks like so our bodies can manufacture specific <a href="https://www.newscientist.com/definition/antibodies/">antibodies</a> to that virus. These antibodies then bind to and inactivate or destroy invading viruses.</p>
<p>In addition to antibodies, the immune system also generates <a href="https://www.ncbi.nlm.nih.gov/books/NBK26921/">immune-active lymphocytes</a> programmed to specifically seek out, bind to and destroy invading viruses. Together, these antibodies and immune-active lymphocytes help the immune system quickly recognize viruses and often wipe them out before the host knows they’ve been exposed. The immune response may also reduce the consequences of infection to little more than minor symptoms.</p>
<h2>The latest weapon against viruses: mRNA vaccines</h2>
<p><a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/mRNA.html">mRNA vaccines</a> contain only the genetic code for the <a href="https://directorsblog.nih.gov/2021/05/18/human-antibodies-target-many-parts-of-coronavirus-spike-protein/">spike proteins</a> the COVID-19 virus uses to attach to cells, not the virus itself. This code primes the immune system to recognize the spike protein and manufacture antibodies against it. When the actual COVID-19 virus arrives, the immune system is then prepared to make antibodies against the invaders’ spike protein and thwart its entrance into cells.</p>
<p>This technology is new only in the sense that it had not yet been deployed when COVID-19 emerged. Tests of mRNA technology have been <a href="https://www.statnews.com/2020/11/10/the-story-of-mrna-how-a-once-dismissed-idea-became-a-leading-technology-in-the-covid-vaccine-race/">ongoing since the early 1990s</a>. </p>
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<figcaption><span class="caption">mRNA technology gives the body instructions for how to protect itself from viruses.</span></figcaption>
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<p>It took <a href="https://doi.org/10.1038/d41586-020-03626-1">under a year</a> to develop an mRNA vaccine against COVID-19. This was not because the process was rushed, but because coronaviruses had <a href="https://doi.org/10.1186/s12929-020-00695-2">already been studied</a> in detail for previous outbreaks. Scientists <a href="https://www.tampabay.com/news/health/2020/12/07/how-did-we-get-a-coronavirus-vaccine-so-fast-years-of-research/">knew in advance</a> how to block coronaviruses from infecting cells.</p>
<p>The short-term reactions most people experience when receiving the Pfizer and Moderna vaccines, like muscle soreness and fatigue, are from the body revving up its immune system to attack the protein it was just instructed to manufacture. This reaction is a good sign – it means that your immune system is working. Keep in mind that <a href="https://www.who.int/news-room/feature-stories/detail/how-do-vaccines-work">none of the vaccines</a> in use today can cause the disease they were designed to prevent.</p>
<h2>Adverse effects of vaccines</h2>
<p>That said, viral vaccines are not risk-free. Because humanity is so diverse, there will always be a tiny fraction of the population that reacts poorly to one or more of the vaccine’s <a href="https://www.pfizer.com/news/hot-topics/the_facts_about_pfizer_and_biontech_s_covid_19_vaccine">ingredients</a>. But these same risks also apply to common, <a href="https://doi.org/10.1136/bmj.316.7143.1511">frequently used medications</a>, such as aspirin or insulin, that can’t be used safely by everyone. People continue to use these medications because the benefits far outweigh the risks.</p>
<p>There have been <a href="https://www.reuters.com/article/factcheck-vaers-deaths/fact-check-vaers-reported-vaccine-deaths-have-not-been-confirmed-or-deemed-causal-by-cdc-idUSL1N2MZ2H8">reports suggesting</a> that deaths that occurred shortly after vaccine administration were due to the vaccine. But there has <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/adverse-events.html">not been any confirmed causal link</a> between these deaths and the COVID-19 vaccine. It’s likely that the great majority of these deaths are coincidental. For example, <a href="https://www.cdc.gov/nchs/fastats/deaths.htm">about 7,800 deaths</a> unrelated to COVID-19 vaccines occur every day in the U.S. If the entire population was vaccinated at the same time, it might be tempting to think that the approximately 7,800 deaths that occurred that day were caused by the vaccine. But this would not be true.</p>
<p>People should also remember that early vaccination efforts prioritized elderly, often debilitated people in <a href="http://dx.doi.org/10.15585/mmwr.mm6949e1">long-term care facilities</a>. Given their advanced age and frailty, it is not surprising that a certain number died of natural causes or other diseases common to older adults during the post-vaccination period. This doesn’t mean that the vaccine caused these deaths.</p>
<h2>Humanity’s collective responsibility to combat COVID-19</h2>
<p>Vaccines are among the safest interventions against viral disease – and they operate not by introducing synthetic drugs into our bodies, but by activating and training our own immune systems to recognize and destroy viral invaders.</p>
<p>If viral transmission pathways are blocked to a high enough level to reach <a href="https://www.who.int/news-room/q-a-detail/herd-immunity-lockdowns-and-covid-19">herd immunity</a>, the disease caused by the virus – and sometimes the virus itself – can diminish or disappear. For example, <a href="https://www.cdc.gov/smallpox/history/history.html">smallpox was eradicated</a> in 1980 due to a coordinated global vaccination effort. But not before it killed 300-500 million people in the 20th century alone.</p>
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<figcaption><span class="caption">Vaccination helped eradicate smallpox worldwide.</span></figcaption>
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<p>For viral vaccines to be fully effective, it’s not enough for only a few people to be vaccinated. Those who choose not to participate in vaccination efforts don’t just place themselves at risk of disability and death. They can also serve as reservoirs for viruses to remain active and <a href="https://doi.org/10.1039/D1SC01203G">mutate</a> to potentially become more lethal for everyone – including those already vaccinated. COVID-19 strains have already emerged that have greater <a href="https://doi.org/10.1016/S2213-2600(21)00005-9">transmissibility</a>, enhanced <a href="https://depts.washington.edu/pandemicalliance/2021/01/25/nervtag-note-on-b-1-1-7-severity/">virulence</a> and varying ability to evade <a href="https://doi.org/10.1001/jama.2021.3370">vaccine-induced immunity</a>.</p>
<p>The fact that a new weapon has been developed and deployed to combat COVID-19 means that humanity’s battle against all viral diseases can and should be renewed with increasing vigor. Choosing not to use these vaccines would be a tragic negation of our collective responsibility and squanders one of humanity’s most important public health discoveries. Winning the battle against COVID-19 and other viruses – and the disease, disability and death they cause – requires all of us to play our part.</p>
<p><em>Authors’ Note: We are curious about how we did. Would you take this <a href="https://tinyurl.com/xdz6wpa8">one question survey</a> and let us know?</em></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/159121/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>S. Jay Olshansky received funding from the National Institute on Aging, the MacArthur Foundation, and the Glenn Foundation; he serves on the Board of Directors of the American Federation for Aging Research (AFAR); and he is affiliated with Lapetus Solutions, Inc. (lapetussolutions.com) and Wealthspan Financial Partners (mywealthspan.com).</span></em></p><p class="fine-print"><em><span>Leonard Hayflick currently receives funding from no relevant organization.</span></em></p><p class="fine-print"><em><span>Ronald Hershow 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>Vaccines have successfully curtailed viral diseases for decades. But as COVID-19 vaccination hesitancy shows, mistrust and misinformation continue to put lives at risk.S. Jay Olshansky, Professor of Epidemiology and Biostatistics, University of Illinois ChicagoLeonard Hayflick, Professor of Anatomy, University of California, San FranciscoRonald Hershow, Associate Professor, Epidemiology and Biostatistics, University of Illinois ChicagoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1593212021-05-10T20:00:34Z2021-05-10T20:00:34ZHow better conversations can help reduce vaccine hesitancy for COVID-19 and other shots<figure><img src="https://images.theconversation.com/files/399076/original/file-20210505-17-jjtl9o.jpg?ixlib=rb-1.1.0&rect=452%2C331%2C5854%2C4134&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Empathetically exploring the positive motivations of people who are vaccine hesitant may help improve acceptance for COVID-19 vaccines and others.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 250px; border: none; position: relative; z-index: 1;" src="https://narrations.ad-auris.com/widget/the-conversation-canada/final-how-better-conversations-can-help-reduce-vaccine-hesitancy-for-covid-19-and-other-shots" width="100%" height="400"></iframe>
<p>New parents have many decisions to make soon after their baby is born. One of them is about vaccination.</p>
<p>Between the cooing and crying, cards and bouquets, and yet another change of clothes, parents will be asked about inoculating their infant against childhood illnesses. Where once the answer would have been “yes” by default, the past few decades <a href="https://www.canada.ca/en/public-health/services/publications/healthy-living/2017-vaccine-uptake-canadian-children-survey.html">have seen more Canadian parents hesitate</a>. </p>
<h2>Vaccine hesitancy</h2>
<p>While vaccination remains the norm, for a range of reasons exhausted mothers and nervous fathers are saying “We’ll wait” or even “No” to vaccinations in maternity wards across the country. </p>
<p>In an era of patient-centrism and individual autonomy, the parents’ right to hesitate is accepted. But health-care professionals are often worried by both the individual risks and societal consequences of the choices that are being made. Life threatening and altering diseases <a href="https://doi.org/10.1503/cmaj.109-4812">like polio</a> <a href="https://www.canada.ca/en/public-health/services/diseases/measles/measles-in-canada.html">or measles</a> — once eradicated or marginalized by vaccines — are creeping back.</p>
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<img alt="An infant being vaccinated" src="https://images.theconversation.com/files/399837/original/file-20210510-13-w2fw32.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/399837/original/file-20210510-13-w2fw32.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/399837/original/file-20210510-13-w2fw32.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/399837/original/file-20210510-13-w2fw32.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/399837/original/file-20210510-13-w2fw32.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/399837/original/file-20210510-13-w2fw32.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/399837/original/file-20210510-13-w2fw32.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">While vaccination remains the norm for babies and children, some parents have become more hesitant about vaccines.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Canadians’ attitudes towards COVID-19 vaccines suggest hesitancy and its societal consequences are not limited to the choices of newly minted parents. Recent surveys <a href="https://angusreid.org/canada-covid-vaccine-january/">in Canada</a>, <a href="https://doi.org/10.1038/s41591-020-1124-9">and globally</a>, show many of us are hesitant about vaccines that have been produced with such herculean effort and enormous cost. So many, in fact, that the immunization thresholds required to tame COVID-19 are under threat. </p>
<p>This hesitancy has been described <a href="https://doi.org/10.1016/j.vaccine.2015.04.036">in detail</a>, and linked to <a href="https://www.cnn.com/2021/02/15/politics/covid-vaccine-hesitant-partisan-split/index.html">people’s politics</a>, past <a href="https://www.thestar.com/opinion/contributors/2021/02/06/vaccine-hesitancy-in-the-black-community-is-deeply-rooted-in-a-history-of-racism-overcoming-that-lack-of-trust-will-be-a-tough-task.html">community traumas</a> and attitudes towards <a href="https://doi.apa.org/doiLanding?doi=10.1037%2Fhea0000586">science and industry</a>.</p>
<p>However, just what to do about it has been less clear. While most Canadians will say yes to COVID-19 vaccines, many of us also know a friend or a family member who is, at least for the moment, saying no. </p>
<p>Most of us know someone who mistrusts some element of the vaccine — from the speed of its production, to the intentions of its manufacturers or deliverers. Indeed, COVID-19 vaccine hesitancy is said to be on the rise, nudged upwards by the various <a href="https://doi.org/10.1136/bmj.n883">pauses, or stops, introduced by governments</a>. How, under these conditions, might we turn a “no” into a “maybe,” or even a “yes?” </p>
<h2>Motivational interviewing</h2>
<p>My research team at the University of Calgary’s School of Public Policy started our most recent work with just this question in mind. It turns out the answer was just a few provinces away in Québec, and took us back to newborns and their parents. </p>
<p>We have been working with Canadian federal and World Health Organization funding to support family doctors as they respond to the pandemic. To support better conversations about vaccine hesitancy, we met with Dr. Arnaud Gagneur, a hospital-based neo-natalogist in Sherbrooke. He and his colleagues are world leaders in improving dialogue around vaccination with new parents. </p>
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<a href="https://images.theconversation.com/files/399839/original/file-20210510-5687-1naadl8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A family doctor in a face mask talking to a patient" src="https://images.theconversation.com/files/399839/original/file-20210510-5687-1naadl8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/399839/original/file-20210510-5687-1naadl8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/399839/original/file-20210510-5687-1naadl8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/399839/original/file-20210510-5687-1naadl8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/399839/original/file-20210510-5687-1naadl8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/399839/original/file-20210510-5687-1naadl8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/399839/original/file-20210510-5687-1naadl8.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">Family doctors are well positioned to have productive conversations with patients about vaccination, including COVID-19 vaccination.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p>The technique they’ve been working with for more than a decade is called motivational interviewing and it has shown great success.</p>
<p>Described in <a href="https://doi.org/10.1016/j.vaccine.2019.03.076">academic journals</a> and <a href="https://www.nytimes.com/2021/01/31/opinion/change-someones-mind.html">media coverage</a>, a motivational interview is based on a seemingly simple idea: find a vaccine-hesitant person’s positive motivation. The art of accomplishing this lies in long and empathetic engagement with the person to get to the roots of their hesitancy. </p>
<p>Those roots will often be negatively expressed: “I don’t like the way it was made,” or “It’s a conspiracy, you know.” Under the principles of motivational interviewing, these roots are to be respected and acknowledged, regardless of how gnarled they might appear. Attempting to chop them off with arguments and facts will only encourage the person to <a href="http://doi.org/10.1001/jamapediatrics.2017.2219">sink deeper into their hesitancy</a>. Unless the person’s concerns are acknowledged as valid, facts are more likely to hinder than help. </p>
<p>The aim isn’t to chop off the negative, but rather to have the positive reveal itself. This takes conversation, close listening, empathy and above all, trust. Shifting out of the negative reason and into an expression of a positive aspiration is something that takes time, not argument. This, in motivational interviewing, is the key to moving from “I’m religiously opposed to the vaccine,” to helping someone understand that vaccination may allow them to attend worship again soon.</p>
<h2>Progress in primary care</h2>
<p>Our team was originally dismayed by this. Of course it worked for Dr. Gagneur and his team, but they have huge blocks of time to talk to new parents about their hesitancy. Neither all that time, nor the intensity of a recent birth, are common features of family medicine as practised in Canada. Could the principles of motivational interviewing be distilled into the short encounters of most primary care visits? </p>
<p>We were encouraged to seek an answer because family doctors have <a href="https://www.annfammed.org/content/18/4/349">the expertise</a> and <a href="https://doi.org/10.1136/bmj.m3898">the relationships</a> to deal with COVID-19 and its <a href="https://doi.org/10.1136/bmj.m3026">long-tailed consequences</a>. They have also been identified as <a href="https://www.milbank.org/2021/03/leveraging-trust-in-primary-care-to-promote-behavior-change-during-covid-19/">key players</a> in countering vaccine hesitancy. This is because they have the long-term relationships with patients who trust them, and the space to understand and validate the concerns those patients raise. </p>
<p>Where many people might struggle to find the positive motivation in a friend or family member’s hesitancy, a family doctor is better positioned to do so. With this in mind, our team has been working with doctors from across Canada to develop a pragmatic tool to help them navigate tricky conversations with people considering COVID-19 vaccines, or with parents making decisions about their children. </p>
<p>The tool will be web-based and stocked with helpful examples. Along with the family doctors who have been so generous with their time in developing the tool, we are hoping it will contribute to better conversations about vaccine hesitancy.</p><img src="https://counter.theconversation.com/content/159321/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Myles Leslie receives funding from SSHRC, and the WHO. </span></em></p>From maternity wards to primary care, Canadian researchers are looking to find the positive motivations of vaccine hesitant people, whether they are new parents or other adults.Myles Leslie, Associate Professor, School of Public Policy, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1547062021-03-08T21:16:49Z2021-03-08T21:16:49ZMass COVID-19 immunization: Ensuring equitable access to vaccination<figure><img src="https://images.theconversation.com/files/385489/original/file-20210222-23-1vulc7d.jpg?ixlib=rb-1.1.0&rect=89%2C62%2C2905%2C1881&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Premier Scott Moe speaks after a media tour of the COVID-19 mass immunization clinic and drive-thru immunization space in Regina on Feb. 18, 2021. The province also has mobile immunization vehicles to distribute the vaccine to remote communities. </span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Michael Bell</span></span></figcaption></figure><p>There are very few things as logistically complex as the task that is now getting underway: <a href="https://theconversation.com/covid-19-vaccine-rollout-why-a-mask-and-social-distancing-are-still-needed-even-if-you-get-the-shot-152351">universal public immunization against COVID-19</a> to as many as 70-85 per cent of the population as quickly as possible, to achieve herd immunity.</p>
<p>So what will success look like?</p>
<p>As a team of researchers dedicated to investigating how health and social systems can help achieve health equity, we have been working to understand the factors that determine vaccine uptake, and what public health systems can do to lower the barriers to immunization in general.</p>
<p>One particularly important metric by which we can measure the efficiency and effectiveness of our public health system is ensuring everyone has access to vaccinations in their own community.</p>
<h2>Mass public immunizations</h2>
<p>At its core, immunization is a service provided to every resident in a community. As a service, a mass immunization program is simple enough to imagine. </p>
<p>Much like a Boxing Day sale at a store (during non-pandemic periods), everyone lines up for their shot, first-come, first-served, with hopefully enough supply for everyone.</p>
<p>Our current situation, however, is far from straightforward. </p>
<p>For one, <a href="https://theconversation.com/the-roots-of-canadas-covid-19-vaccine-shortage-go-back-decades-154792">we do not have enough supply for everyone</a> yet. It’s also not just one vaccine, it is <a href="https://theconversation.com/how-pharma-can-build-trust-in-covid-19-vaccines-transparency-on-trials-and-side-effects-150270">at least three for now, each with its own storage and distribution requirements</a>.</p>
<p>Second, we can’t deliver vaccines in a centralized location where everyone comes to get their shots. It would likely be dangerous to do so in terms of proximity between people in crowds, but such clinics would also not be equally accessible to all residents.</p>
<h2>Access and universalism</h2>
<figure class="align-center ">
<img alt="Close-up of a woman's shoulder being injected by a health-care worker out of frame" src="https://images.theconversation.com/files/385491/original/file-20210222-23-1t3hzn9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/385491/original/file-20210222-23-1t3hzn9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=439&fit=crop&dpr=1 600w, https://images.theconversation.com/files/385491/original/file-20210222-23-1t3hzn9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=439&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/385491/original/file-20210222-23-1t3hzn9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=439&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/385491/original/file-20210222-23-1t3hzn9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=552&fit=crop&dpr=1 754w, https://images.theconversation.com/files/385491/original/file-20210222-23-1t3hzn9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=552&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/385491/original/file-20210222-23-1t3hzn9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=552&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Amanda Parsons, a registered nurse on staff at the Northwood Care facility, administers a dose of the Moderna vaccine to Ann Hicks, 77, in Halifax on Jan. 11, 2021. In a bid to control COVID-19, the federal government plans to make free vaccines available to everyone who lives in Canada over the course of 2021.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Andrew Vaughan</span></span>
</figcaption>
</figure>
<p>Mass immunization clinics will not necessarily provide the most equitable level of access to a COVID-19 vaccine. As with any health-care service, effective immunization strategies will depend on two perspectives: A patient perspective and the public health perspective. </p>
<p><a href="https://dx.doi.org/10.1186%2F1475-9276-12-18">Factors affecting access on the patient side</a> include:</p>
<ul>
<li>the patient’s ability to understand and trust health services </li>
<li>the patient’s values and culture</li>
<li>the patient’s built and social environment </li>
<li>the level of available socio-economic resources </li>
<li>ability to engage with health care and participate in treatment decisions</li>
</ul>
<p>On the public health side, health services must be approachable, acceptable, available, accommodating, affordable and appropriate to be truly accessible to every patient.</p>
<p>Regarding mass immunization clinics, not everyone has access to transportation, especially when <a href="https://theconversation.com/giving-up-public-transit-during-the-coronavirus-is-a-luxury-many-canadians-cant-afford-138875">public transit has been reduced because of the pandemic</a>. And many don’t have the luxury to wait in line all day. They may have multiple jobs or lack social support or financial resources to help with child care.</p>
<p>If we’re not careful, we may see the emergence of an “<a href="https://doi.org/10.2105/ajph.2007.114777">inequality paradox</a>,” where universal programs inadvertently reach privileged populations, and nothing much changes for disadvantaged populations. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-19-vaccine-rollout-why-a-mask-and-social-distancing-are-still-needed-even-if-you-get-the-shot-152351">COVID-19 vaccine rollout: Why a mask and social distancing are still needed, even if you get the shot</a>
</strong>
</em>
</p>
<hr>
<p>We have seen programs such as vaccine campaigns increase inequities in health outcomes rather than reduce it. For example, in Calgary, despite the universal H1N1 immunization campaign, those who provide services to homeless people reported that <a href="https://www.homelesshub.ca/sites/default/files/attachments/LessonsfromH1N1-Chapter_4.pdf">the clinics ran counter to the needs of those experiencing homelessness</a>. For example, clinics were held in the evening, when those living in shelters with strict evening sign-in times could not attend. </p>
<p>At the same time, while mass immunization clinics were rationing doses, <a href="https://www.cbc.ca/news/canada/calgary/calgary-flames-skip-flu-vaccine-lineups-1.809497">the Calgary Flames received special treatment and earlier dedicated doses</a>.</p>
<p>Our research on the <a href="https://harvest.usask.ca/handle/10388/12051">measles, mumps and rubella immunization uptake in Calgary during the 2014 measles outbreak</a> also showed that mass immunization campaigns favoured children who live in neighbourhoods that had the highest income and highest rates of home-ownership. </p>
<p>This is something we need to avoid as we may inadvertently create social groups with persistent and longer-term vulnerability to COVID-19.</p>
<h2>Needs-based approach</h2>
<figure class="align-center ">
<img alt="Shot from above of people waiting in line 6 feet apart" src="https://images.theconversation.com/files/385490/original/file-20210222-13-t657xw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/385490/original/file-20210222-13-t657xw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=419&fit=crop&dpr=1 600w, https://images.theconversation.com/files/385490/original/file-20210222-13-t657xw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=419&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/385490/original/file-20210222-13-t657xw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=419&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/385490/original/file-20210222-13-t657xw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=527&fit=crop&dpr=1 754w, https://images.theconversation.com/files/385490/original/file-20210222-13-t657xw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=527&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/385490/original/file-20210222-13-t657xw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=527&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Health-care workers wait in line at a COVID-19 vaccine clinic in Toronto on Jan. 7, 2021.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span>
</figcaption>
</figure>
<p>“<a href="http://www.healthscotland.com/documents/24296.aspx">Proportionate universalism</a>” is a model of program design that prioritizes building provisions into a universal program to account for various levels of patient access needs.</p>
<p>The proportionate universalism approach looks more closely at removing patient- and system-level barriers, community by community and social group by social group. For example, in Saskatoon during the H1N1 pandemic, <a href="https://nccdh.ca/images/uploads/Saskatoon_EN_Feb_20.pdf">public health teams deployed small clinics</a> throughout the neighbourhoods where transportation was a problem, and used a <a href="https://healthstandards.org/leading-practice/primary-health-bus-reaches-under-served-populations/">health bus to take the vaccine to communities</a>. </p>
<p>This approach can also include adapting education materials and communications about the vaccine and clinics to varying levels of literacy and language needs. </p>
<p>Conducting mass immunizations against COVID-19 in centralized locations, while convenient in principle, will not achieve immunization equity unless specific steps are taken to remove barriers to access. It might also exacerbate inequities. Equity needs to be the core principle of immunization, and enacting it needs to be planned in detail.</p><img src="https://counter.theconversation.com/content/154706/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Thilina Bandara has received funding from the Natural Sciences and Engineering Research Council, Canadian Institutes of Health Research, the Government of Saskatchewan and the Saskatchewan Health Research Foundation. He is a board member for the National Collaborating Centre for Determinants of Health and the Saskatchewan Public Health Association.</span></em></p><p class="fine-print"><em><span>Cory Neudorf receives funding from the Canadian Institutes for Health Research, the Saskatchewan Health Research Foundation. He is affiliated with the Urban Public Health Network, and serves on advisory boards and committees with the Public Health Agency of Canada, the Canadian Institute for Health Information, the Canadian Public Health Association. </span></em></p><p class="fine-print"><em><span>Nazeem Muhajarine receives funding from Canadian Institutes of Health Research, Social Sciences and Humanities Research Council of Canada, and Global Affairs Canada. He leads several studies on risk behaviour, mitigation and perceptions related to the COVID-19 pandemic, and mental health. He serves on an expert advisory panel on COVID-19 immunization, and is theme lead, Epidemiology and Public Health at CanCOVID.
</span></em></p>One important metric by which we can measure the success of our public health system: Ensuring everyone has access to immunization in their community.Thilina Bandara, Research Scientist and Adjunct Professor, Community Health and Epidemiology, University of SaskatchewanCory Neudorf, Professor, Department of Community Health and Epidemiology, College of Medicine, University of SaskatchewanNazeem Muhajarine, Professor, Department of Community Health and Epidemiology and Director, Saskatchewan Population Health and Evaluation Research Unit, University of SaskatchewanLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1523682021-02-24T20:03:36Z2021-02-24T20:03:36ZMany Black Americans aren’t rushing to get the COVID-19 vaccine – a long history of medical abuse suggests why<figure><img src="https://images.theconversation.com/files/386197/original/file-20210224-21-187jsoo.jpg?ixlib=rb-1.1.0&rect=85%2C0%2C5606%2C3285&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Black patients can be wary of the medical establishment.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/midsection-of-female-healthcare-worker-explaining-royalty-free-image/1188431796">Maskot via Getty Images</a></span></figcaption></figure><p>Black Americans have been the <a href="https://www.pewresearch.org/science/2020/12/03/intent-to-get-a-covid-19-vaccine-rises-to-60-as-confidence-in-research-and-development-process-increases/">least inclined of any racial or ethnic group</a> to say they’d get vaccinated against the coronavirus. The proportion of Black people who said they’ll probably or definitely take the shot <a href="https://www.kff.org/coronavirus-covid-19/report/kff-covid-19-vaccine-monitor-december-2020/">has risen over time</a> – but even by mid-January, with two COVID-19 vaccines <a href="https://www.nbcnews.com/health/health-news/constant-flow-vaccine-pfizer-s-covid-19-shots-begin-massive-n1251111">authorized for</a> <a href="https://www.wsj.com/articles/u-s-starts-rollout-of-modernas-covid-19-vaccine-11608460200">emergency use in the U.S.</a>, <a href="https://www.kff.org/report-section/kff-covid-19-vaccine-monitor-january-2021-vaccine-hesitancy/">only 35% of Black survey respondents</a> said they’d get it as soon as they could, or already had gotten the shot.</p>
<p><iframe id="5AEYr" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/5AEYr/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>At the same time, the COVID-19 pandemic has <a href="https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html">disproportionately harmed Black, Indigenous and other people of color</a> in comparison to white members of American society. With Black Americans being <a href="https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html">hospitalized at rates 2.9 times higher</a> than white Americans and dying from COVID-19 at rates 1.9 times higher, you might assume that Black people would be lining up at breakneck speed to receive the vaccine as soon as it’s available to them.</p>
<p>But the Black community has reasons for distrust – even beyond what might be attributed to the <a href="https://doi.org/10.1016/S0140-6736(20)30600-0">mixed messaging of the nation’s COVID-19 response</a>. And it’s not a simple or sole matter of miseducation. <a href="https://scholar.google.com/citations?user=S763T1AAAAAJ&hl=en&oi=ao">I’m a medical humanist and bioethicist</a> who studies history, ethics and literature to <a href="https://www.palgrave.com/us/book/9781137520609">understand racial and gender health disparities</a>. My research explores the <a href="https://doi.org/10.1007/978-3-319-70175-2_9">history of unethical and abusive treatment</a> Black Americans have experienced at the hands of the medical establishment. Based on past experience, Black people have many legitimate reasons to be in no hurry to get the vaccination.</p>
<h2>A troubling track record</h2>
<p>The American medical establishment has a long history of unethical treatment of Black research subjects. Medical ethicist <a href="https://scholar.google.com/citations?user=ITsy6T8AAAAJ&hl=en&oi=sra">Harriet A. Washington</a> details some of the most egregious examples in her book “<a href="https://www.penguinrandomhouse.com/books/185986/medical-apartheid-by-harriet-a-washington/">Medical Apartheid</a>.” There’s the now notorious <a href="https://doi.org/10.2307/3561468">Tuskegee syphilis experiment</a>, in which the government misled Black male patients to believe they were receiving treatment for syphilis when, in fact, they were not. That study went on for a total of 40 years, continuing even after a cure for syphilis was developed in the 1940s. </p>
<p>Perhaps less widely known are the unethical and unjustified experiments <a href="https://doi.org/10.1097/00007611-200405000-00017">J. Marion Sims performed on enslaved women</a> in 1800s U.S. that helped earn him the nickname the “father of modern gynecology.” Sims performed experimental <a href="https://doi.org/10.1007/s12262-012-0787-y">vesicovaginal fistula</a> surgery on enslaved women without anesthesia or even the basic standard of care typical for the time.</p>
<p>Sims experimented on Anarcha, a 17-year-old slave, over 30 times. His decision not to give anesthesia was based on the racist <a href="https://doi.org/10.1073/pnas.1516047113">assumption that Black people experience less pain than their white peers</a> – a belief that persists among medical professionals today. Historian Deirdre Cooper Owens elaborates on this case and many other ways Black women’s bodies have been used as guinea pigs in her book “<a href="https://ugapress.org/book/9780820354750/medical-bondage/">Medical Bondage</a>.”</p>
<p>Cases of medical malfeasance and malevolence have persisted, even after the establishment of <a href="https://doi.org/10.1001/jama.2017.10265">the Nuremburg code</a>, a set of medical ethical principles developed after World War II and subsequent trials for crimes against humanity. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/386198/original/file-20210224-19-1ohq0pq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Seated woman holds a black and white photo of a woman" src="https://images.theconversation.com/files/386198/original/file-20210224-19-1ohq0pq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/386198/original/file-20210224-19-1ohq0pq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/386198/original/file-20210224-19-1ohq0pq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/386198/original/file-20210224-19-1ohq0pq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/386198/original/file-20210224-19-1ohq0pq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/386198/original/file-20210224-19-1ohq0pq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/386198/original/file-20210224-19-1ohq0pq.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">A great-granddaughter of Henrietta Lacks poses with her portrait. The HeLa cell line used in medical research originated with a tissue sample from Lacks.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/veronica-spencer-great-granddaughter-of-henrietta-lacks-news-photo/659828336">Katherine Frey/The Washington Post via Getty Images</a></span>
</figcaption>
</figure>
<p><a href="https://voice.ons.org/stories/the-story-of-henrietta-lacks-sheds-light-on-ethical-considerations-in-genetic-testing">In 1951, doctors harvested cervical cancer cells</a> from a Black woman named <a href="https://www.penguinrandomhouse.com/books/168191/the-immortal-life-of-henrietta-lacks-by-rebecca-skloot/">Henrietta Lacks without her permission</a>. Researchers went on to use them to create the first immortal cell culture and subjected her descendants to ongoing study for years without informed consent. Investigative journalist Rebecca Skloot details the cascade of ethical violations in her book “<a href="http://rebeccaskloot.com/the-immortal-life/">The Immortal Life of Henrietta Lacks</a>.” Despite heightened awareness after the book’s publication, the ethical violations continued when a group of <a href="https://www.smithsonianmag.com/smart-news/scientists-published-henrietta-lacks-genome-without-the-consent-of-her-family-9022347/">scientists mapped the HeLa genome without her family’s knowledge or consent</a>.</p>
<p>Advances in genomics are still being used to resuscitate theories of racial “science.” For example, a now-debunked 2007 study purported to isolate a <a href="https://www.nzherald.co.nz/nz/scientist-debunks-warrior-gene/6MZXNWSRMPOGZESKJKCHJ2AIJU/">so-called “warrior gene” in Maori Indigenous men</a> and argued they are genetically “hard-wired” for violence. Scientists and news outlets in the U.S. jumped on board, suggesting there’s a <a href="https://www.newscientist.com/article/dn17337-gangsta-gene-identified-in-us-teens/">genetic predisposition for Black and Latino males to engage in gang activity</a>.</p>
<p>Legal scholar <a href="https://www.law.upenn.edu/cf/faculty/roberts1/">Dorothy E. Roberts</a> explains in her book “<a href="https://thenewpress.com/books/fatal-invention">Fatal Invention</a>” how incidents like this one perpetuate the harm of race-based science. Using biological data and flawed reasoning tainted by racial stereotyping reinforces racist beliefs about Black people. Such logic focuses on purely biological factors and ignores the social and systemic factors that produce negative and inequitable health outcomes. </p>
<p>While there is now an ample body of scholarly research that reveals these truths about racism in the medical establishment, Black Americans need only to gather around the kitchen table with a few friends and family to share and hear personally experienced stories of medical malfeasance. </p>
<h2>Present-day persistence of racism in health care</h2>
<p>Even though their experiences at the hands of researchers like J. Marion Sims were central to advances in modern gynecology, today Black women have not benefited from these advances to the same degree as white women. Black women still suffer worse outcomes and more deaths from <a href="https://doi.org/10.1016/j.ygyno.2017.10.002">gynecologic cancers</a> and have <a href="http://www.bu.edu/articles/2019/racial-disparities-in-maternal-health/">worse health and more deaths</a> affiliated with childbearing, just to name two.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/386199/original/file-20210224-15-1lza41i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="pregnant Black woman sits on hospital bed" src="https://images.theconversation.com/files/386199/original/file-20210224-15-1lza41i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/386199/original/file-20210224-15-1lza41i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/386199/original/file-20210224-15-1lza41i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/386199/original/file-20210224-15-1lza41i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/386199/original/file-20210224-15-1lza41i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/386199/original/file-20210224-15-1lza41i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/386199/original/file-20210224-15-1lza41i.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">Maternal health and mortality statistics are worse for Black women than their white counterparts.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/pregnant-african-american-woman-holding-her-stomach-royalty-free-image/532031183">Jose Luis Pelaez Inc/DigitalVision via Getty Images</a></span>
</figcaption>
</figure>
<p>When tennis star Serena Williams gave birth, she saw firsthand how Black women are disbelieved by the medical establishment. She might have died from postpartum blood clots if she hadn’t advocated for herself <a href="https://thegrio.com/2018/03/10/serena-williams-doctors-arent-listening-so-black-women-are-dying/">in the face of dismissive medical professionals</a>.</p>
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<p>Black people are acutely aware of this history of racism in the medical establishment, and the ways it persists today on both an individual and a collective level. Stereotypes about Black patients, whether the result of explicit or implicit bias, continue to affect the care they receive and their medical outcomes. Again and again, when surveyed, <a href="https://www.kff.org/report-section/kff-the-undefeated-survey-on-race-and-health-main-findings/">Black Americans report that medical providers</a> don’t believe them, won’t prescribe necessary treatments, including pain medication, and blame them for their health problems.</p>
<p>And the association between racism and <a href="https://theconversation.com/racism-at-the-county-level-associated-with-increased-covid-19-cases-and-deaths-150077">increased disease cases and deaths</a> has held true during the COVID-19 pandemic.</p>
<h2>Overcoming these challenges</h2>
<p>Ongoing trust issues around the COVID-19 vaccines are just the latest indication of racial health disparities in the U.S.</p>
<p>Still, there are <a href="https://theconversation.com/racism-at-the-county-level-associated-with-increased-covid-19-cases-and-deaths-150077">ways to begin to close</a> the COVID-19 racial health and mortality gap. <a href="https://www.cidrap.umn.edu/news-perspective/2021/02/experts-seek-allay-covid-vaccine-hesitancy-blacks">Vaccinations for Black people</a> may otherwise continue to lag in proportion to population size.</p>
<p>An important first step is for health care workers and policymakers to <a href="https://www.huffpost.com/entry/surgeon-general-vaccine-distrust-black-americans-medical-racism_n_5fdfceadc5b60d4163435ed8">learn these painful histories and develop strategies</a> informed by an understanding of the systemic racism Black Americans face.</p><img src="https://counter.theconversation.com/content/152368/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Esther Jones 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>Though COVID-19 has killed Black Americans at nearly twice the rate as white Americans, Black people are the least likely racial group to say they’re eager to get the vaccine.Esther Jones, Associate Professor of English, affiliate with Africana Studies and Women's & Gender Studies, Clark UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1535042021-02-07T12:59:17Z2021-02-07T12:59:17ZPosting COVID-19 vaccine selfies on social media can cause anger, frustration<figure><img src="https://images.theconversation.com/files/382560/original/file-20210204-22-npkfr.jpg?ixlib=rb-1.1.0&rect=28%2C0%2C6202%2C4156&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People are celebrating getting the coronavirus vaccine by posting selfies online.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>As doctors across Canada receive COVID-19 vaccines, many are sharing photographs on social media to inspire hope and to encourage others to get vaccinated too. </p>
<p>This has sparked a controversy around “<a href="https://www.theatlantic.com/culture/archive/2021/01/vaccine-photography/617678/">vaccine selfies</a>,” as other doctors say the pictures provoke anxiety, anger and envy. </p>
<p>The <a href="https://www.thestar.com/opinion/contributors/2021/01/11/why-we-are-not-posting-our-vaccine-selfies.html">debate among doctors over how to use social media</a> is merely the tip of the iceberg, with inequalities in Canada’s <a href="https://www.washingtonpost.com/world/the_americas/canada-coronavirus-vaccine-rollout-slow/2021/01/14/80617754-49f3-11eb-a9f4-0e668b9772ba_story.html">slow and irregular vaccine rollout</a> at the root of the frustrations.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/4NpToYb2tLk?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Canada’s vaccine rollout has been frustratingly slow.</span></figcaption>
</figure>
<p>Studies over the past decade have demonstrated links between <a href="https://dx.doi.org/10.1371/journal.pone.0069841">browsing social media</a> and <a href="https://doi.org/10.1521/jscp.2014.33.8.701">depressive symptoms</a>, especially when <a href="https://doi.org/10.1016/j.chb.2014.10.053">online content triggers envy</a>. And during the COVID-19 pandemic, vaccine envy is inevitable, with <a href="https://www.theglobeandmail.com/canada/british-columbia/article-every-drop-is-like-liquid-gold-bc-maximizing-covid-19-vaccine-doses/">vaccines</a> <a href="https://www.cbc.ca/news/canada/saskatchewan/saskatchewan-running-out-of-covid-19-vaccines-1.5879871">being</a> <a href="https://www.cbc.ca/news/canada/edmonton/jason-kenney-covid-19-vaccine-supply-alberta-1.5877385">limited</a> and the <a href="https://www.canada.ca/content/dam/phac-aspc/documents/services/diseases-maladies/coronavirus-disease-covid-19/epidemiological-economic-research-data/update-covid-19-canada-epidemiology-modelling-20210115-en.pdf">pandemic continuing to rapidly grow</a>. </p>
<h2>Social media triggers</h2>
<p>For some health-care workers, social media selfies are an unwelcome trigger.</p>
<p>“Social media is complicated,” says Amelia Yip, a cardiologist in Waterloo, Ont., who recently received her first dose vaccine. “Even within the health-care profession, there are people who should be getting it before others. But the way it’s being rolled out doesn’t always work that way.”</p>
<p>“The way the distribution is happening, it feels like there isn’t a co-ordinated effort. It feels under-appreciative for health-care workers, or even <a href="https://www.cbc.ca/news/canada/toronto/ontario-seniors-want-to-be-vaccinated-sooner-1.5875253">those at risk</a>, not just doctors,” says Yip. </p>
<p>Canada’s vaccine rollout has been <a href="https://www.cbc.ca/news/canada/covid19-vaccine-rollout-plans-canada-1.5836262">highly variable between provinces</a>. In Ontario, for example, almost <a href="https://www.ctvnews.ca/health/coronavirus/coronavirus-vaccine-tracker-how-many-people-in-canada-have-received-shots-1.5247509">19 per cent of vaccinated people have completed both doses, compared to only 1.5 per cent in British Columbia</a>. </p>
<p>And in Québec, where second doses are being <a href="https://www.theglobeandmail.com/canada/article-quebec-further-delaying-second-dose-of-covid-19-vaccines/">postponed significantly until mid-March</a>, no one has yet <a href="https://www.ctvnews.ca/health/coronavirus/coronavirus-vaccine-tracker-how-many-people-in-canada-have-received-shots-1.5247509">received two doses</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/382559/original/file-20210204-22-1xpap8a.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A doctor injects an elderly patient" src="https://images.theconversation.com/files/382559/original/file-20210204-22-1xpap8a.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/382559/original/file-20210204-22-1xpap8a.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/382559/original/file-20210204-22-1xpap8a.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/382559/original/file-20210204-22-1xpap8a.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/382559/original/file-20210204-22-1xpap8a.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/382559/original/file-20210204-22-1xpap8a.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/382559/original/file-20210204-22-1xpap8a.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">Dr. Joss Reimer, left, injects Mabel Aldwinckle with her first dose of the COVID-19 vaccine at Meadowood Manor in Winnipeg, Man., on Jan. 29, 2021.</span>
<span class="attribution"><span class="source">(THE CANADIAN PRESS/John Woods)</span></span>
</figcaption>
</figure>
<p>Yip says there are pockets of people who have been missed in her local rollout, and that at her hospital, cardiologists had to remind authorities that they, too, are involved in critical care. </p>
<p>Meanwhile, says Yip, it’s been doubly frustrating to see vaccine selfies posted by people who don’t work on the frontlines.</p>
<p>“Yesterday, a completely non-medical person who’s an accountant and happens to work at a Toronto hospital got it. When you see someone not even working [with COVID-19 patients] getting it, it feels like the person is jumping the queue.”</p>
<h2>Anger and resignation</h2>
<p>The vaccine rollout in B.C. has featured similar <a href="https://www.cbc.ca/news/canada/british-columbia/b-c-nurses-union-criticizes-covid-19-vaccine-rollout-1.5855692">criticisms</a> and controversies around <a href="https://www.cbc.ca/news/canada/british-columbia/b-c-health-minister-says-review-underway-after-doctors-jump-vaccine-queue-1.5872213">queue-jumping by doctors</a> and <a href="https://globalnews.ca/news/7572603/coronavirus-fraser-health-vaccine-queue/">administrators</a>. </p>
<p>Alan Drummond, an emergency physician in Perth, Ont., where frontline workers are still waiting for word of vaccines, says: </p>
<blockquote>
<p>“You have to take the broader context to understand where some of the disappointment and anger is coming from. For at least 10 months, ER physicians and nurses were dealing with a novel virus that has the potential to be quite deadly. I don’t know anybody in my sphere who shied away from the responsibilities of looking after patients — nobody.”</p>
</blockquote>
<p>Drummond says the initial arrival of vaccines in Canada was met with hope and enthusiasm, and that it was “entirely appropriate” that doctors celebrated on social media as a sign of the beginning of change.</p>
<p>But as selfies continue to get posted online, Drummond says he and his colleagues are beginning to feel resigned and angry.</p>
<p>“The inequities are starting to show…. We need an appropriate queue — we certainly aren’t in it. And [the selfies are] the icing on the cake.”</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CJWz3GbJJ59","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<h2>Impacts of stress</h2>
<p>Stress due to providing care to coronavirus patients has significant consequences. Frontline doctors, nurses and therapists are <a href="https://montreal.ctvnews.ca/quebec-doctors-describe-the-emotional-battle-of-treating-the-province-s-covid-19-patients-1.5261317">burned out</a>. Tragically, 35-year-old doctor Karine Dion <a href="https://globalnews.ca/news/7569318/coronavirus-doctor-karine-dion/">recently died by suicide</a>. Emergency and intensive care doctors have also reported <a href="https://www.thestar.com/news/gta/2021/01/18/the-most-difficult-shift-of-my-career-a-scarborough-er-doctor-describes-work-at-the-hospital-some-call-ontarios-covid-ground-zero.html">feeling overwhelmed</a>. </p>
<p>Sarah Giles, a rural family and emergency doctor in Kenora, Ont., says her community will not be receiving vaccines until April.</p>
<p>“When we look at inequalities, we know that there is a <a href="https://www.theglobeandmail.com/news/national/mortality-rate-gap-widening-between-northern-and-southern-ontario-report/article34730819/">lifespan discrepancy</a> between living in northwest Ontario and in southern Ontario. As my friend said, we’re at the end of the supply for fruits and vegetables and you can tell: We’re at the end for vaccines as well.”</p>
<p>And especially in rural communities, says Giles, every health-care worker is paramount.</p>
<p>“We have human resources issues. If we lose a couple of doctors or nurses, it’s going to be a big problem.”</p>
<p>For Giles, who lives alone, vaccine selfies have been personally anxiety-provoking; she says when she gets vaccinated, she will not post a selfie.</p>
<p>As for Drummond, he has this message for doctors: “By all means celebrate, but celebrate privately. Just don’t do it so publicly when a lot of your colleagues who are dealing with this stuff are dealing with their own anxieties and fears. We get it — we’re happy for you. Just don’t rub salt in our wounds.”</p><img src="https://counter.theconversation.com/content/153504/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ben Huang 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>Vaccine selfies are just the tip of the iceberg of doctor frustration over Canada’s fragmented vaccine rollout.Ben Huang, Global Journalism Fellow, Dalla Lana School of Public Health, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1516702020-12-29T14:19:57Z2020-12-29T14:19:57ZSeat belts and smoking rates show people eventually adopt healthy behaviors – but it can take time we don’t have during a pandemic<figure><img src="https://images.theconversation.com/files/376416/original/file-20201222-15-1l2l98c.jpg?ixlib=rb-1.1.0&rect=7%2C0%2C4683%2C3713&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Once upon a time, buckling up was new behavior.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/young-woman-fastening-seat-belt-news-photo/931844278">Harold M. Lambert/Archive Photos via Getty Images</a></span></figcaption></figure><p>Why do we do things that are bad for us – or not do things that are good for us – even in light of overwhelming evidence? </p>
<p>As someone with a <a href="https://scholar.google.com/scholar?hl=en&as_sdt=0%2C39&q=author%3A%22Juhl+rp%22&btnG=">long career in pharmacy</a>, I have witnessed some pretty dramatic shifts in public health behavior. But I won’t sugarcoat it. It generally takes years – or even decades – of dragging people, kicking and screaming, to finally achieve new and improved societal norms.</p>
<p>This plodding time course seems to be an innate human defect that existed long before the current-day pandemic mask and social distancing conundrums. Historically, people aren’t fond of being told what to do.</p>
<h2>Notable victories</h2>
<p>Attitudes toward smoking have undergone dramatic changes over the past 50 years. Although there has been a gradual decline in smoking, from 42% of the American population in 1965 to the low teens today, there still are <a href="https://www.lung.org/research/trends-in-lung-disease/tobacco-trends-brief/overall-tobacco-trends">a lot of smokers in the U.S.</a> – and premature deaths due to smoking. Even <a href="https://www.doi.org/10.1371/journal.pone.0220168">health care workers fall prey</a> to this unhealthy and highly addictive habit.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/376421/original/file-20201222-17-1a4gzuq.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two 1970s era older male politicians posting a sign that reads 'For your health and safety and the comfort of others, no smoking.'" src="https://images.theconversation.com/files/376421/original/file-20201222-17-1a4gzuq.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/376421/original/file-20201222-17-1a4gzuq.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=476&fit=crop&dpr=1 600w, https://images.theconversation.com/files/376421/original/file-20201222-17-1a4gzuq.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=476&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/376421/original/file-20201222-17-1a4gzuq.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=476&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/376421/original/file-20201222-17-1a4gzuq.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=598&fit=crop&dpr=1 754w, https://images.theconversation.com/files/376421/original/file-20201222-17-1a4gzuq.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=598&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/376421/original/file-20201222-17-1a4gzuq.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=598&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The Colorado Health Department Headquarters begins a ban on smoking in 1972.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/ban-on-smoking-begun-at-state-health-department-news-photo/161903567">David Cupp/Denver Post via Getty Images</a></span>
</figcaption>
</figure>
<p>There was a strongly held view that smoking was a personal decision that do-gooders and the government should keep their noses out of – until the issue was framed differently by studies showing harm caused by secondhand smoke. You are welcome to do what you want to yourself, but it becomes a horse of a different color when it affects others. </p>
<p>Today, public smoking restrictions have become commonplace. But this change in societal behavior didn’t happen overnight or without painful discourse. The journey from the initial 1964 <a href="https://www.hhs.gov/sites/default/files/consequences-smoking-exec-summary.pdf">surgeon general’s report on smoking and health</a> to the 2006 <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576627/">surgeon general’s report on secondhand smoke</a> to today was a fractious one.</p>
<p>Another about-face has been the adoption of seat belts. <a href="https://www.cdc.gov/transportationsafety/seatbeltbrief/index.html">Seat belts save lives.</a> And most people now use them as a result of the <a href="https://www.iihs.org/news/detail/belt-reminders-can-be-just-as-effective-as-interlocks">nagging warning alarm</a>, the marketing of automobile safety, the law and the data. </p>
<p>This change in behavior, however, <a href="https://www.cdc.gov/motorvehiclesafety/calculator/factsheet/seatbelt.html">followed a rocky road</a> over many years. In my earlier days, I can remember more than one occasion when I hopped into a friend’s car, put on my seat belt and was then chastised for having so little faith in my friend’s driving ability.</p>
<p>Seat belts were <a href="https://www.cdc.gov/motorvehiclesafety/calculator/factsheet/seatbelt.html">required to be installed</a> in new cars starting in 1964 and New York enacted the first seat belt use law in 1984. In the U.S., <a href="https://en.wikipedia.org/wiki/Seat_belt_use_rates_in_the_United_States">seat belt use rose</a> from 14% in 1983 to 90% in 2016. </p>
<h2>Continuing challenges</h2>
<p>In the medical arena, much effort has been expended in promoting healthy behaviors – diet, exercise, sleep hygiene, adherence to prescribed drugs and immunizations. Frankly, the success has been mixed. </p>
<p>Studies have suggested <a href="https://www.uspharmacist.com/article/overcoming-barriers-to-statin-adherence">many possible variables</a> associated with not following accepted medical advice: age, gender, race, education, literacy, income, insurance copays, level of physician and pharmacist care – and plain old stubbornness. But there is no single, easily addressable cause of nonadherence to healthy behaviors. </p>
<p>For example, properly prescribed cholesterol-lowering drugs called statins literally add years to patients’ lives <a href="https://www.acc.org/latest-in-cardiology/articles/2016/11/17/09/03/summarizing-the-current-state-and-evidence-on-efficacy-and-safety-of-statin-therapy">by reducing heart attacks and strokes</a>. Even in people with insurance coverage and minimal side effects, <a href="https://www.uspharmacist.com/article/overcoming-barriers-to-statin-adherence">50% of patients discontinue statin therapy</a> within one year of receiving their first prescription. </p>
<p>Vaccines and immunization offer another window into the puzzle of human behavior. <a href="https://www.statista.com/statistics/1040079/life-expectancy-united-states-all-time/">Life expectancy in the U.S. rose</a> from 40 years in 1860 to 70 years in 1960. These gains resulted largely from decreased infant and child mortality due to infectious diseases. A better understanding of infectious diseases along with scientific advances, vaccines and antibacterial drugs were the primary factors for this <a href="https://www.nationalgeographic.com/culture/2019/08/cannot-forget-world-before-vaccines/">profound increase in life expectancy</a>.</p>
<p><iframe id="Ak64w" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/Ak64w/3/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Common sense alone makes the value of vaccines abundantly clear; how many people do you know who are suffering from polio or smallpox? Yet some intelligent, thoughtful friends, family and neighbors are convinced <a href="https://www.cnn.com/2020/10/22/health/anti-vaxxers-old-arguments-covid-19-wellness-partner/index.html">vaccines are not helpful and are even harmful</a>. Some believe wearing a mask is <a href="https://www.nytimes.com/2020/11/18/us/coronavirus-mask-mandate-iowa-reynolds.html">nothing more than a “feel good” placebo</a>. I believe these contrarian beliefs make better press and are therefore more frequently reported than mainstream ones, but clearly there is reason for concern.</p>
<h2>The current crisis</h2>
<p>Historically, changes in societal behavior that benefit public health occur in fits and starts – and never fast enough for the individuals who fall victim before society comes around. </p>
<p>The urgency imposed by the coronavirus has actually resulted in comparatively swift behavioral changes (<a href="https://www.cbsnews.com/news/face-mask-retail-sales-gap-etsy/">masks</a>, <a href="https://news.bloomberglaw.com/environment-and-energy/hand-sanitizer-disinfectant-demands-hit-biblical-proportions">hand-washing</a>, <a href="https://doi.org/10.1377/hlthaff.2020.00608">distancing</a>) in the U.S. – as scientists learned how the coronavirus is spread, how dangerous it can be and which groups are more susceptible. But these behavioral changes were not as complete or as fast as they should – or could – have been when judged by far better outcomes in <a href="https://www.wsj.com/articles/finland-and-norway-avoid-covid-19-lockdowns-but-keep-the-virus-at-bay-11605704407">other countries</a>. </p>
<p>I am discouraged by the battle between the scientific method and political ideology when it comes to public health. Ideology never seems to change and is therefore more comforting to some – while science evolves as new findings debunk old ideas or confirm new ones. It is clear to all who want to listen: controlling the virus and maintaining the economy is not an either/or choice – they are interdependent.</p>
<p>At the same time, I am buoyed that the tide seems to be turning. As a better understanding of treating COVID-19 has emerged and with more than one highly effective vaccine on the horizon, the “<a href="https://www.motherjones.com/2020-elections/2020/10/trump-sticks-by-his-losing-message-fauci-and-the-scientists-are-idiots/">idiot scientists</a>” are gaining ground, both in the lab and at the bedside. Even the most prominent ideologues run to the hospital to get <a href="https://www.nytimes.com/2020/10/02/health/trump-antibody-treatment.html">the best treatments science can offer</a> when the effect of their maskless behavior rears up to bite them. </p>
<p>But as history suggests, the science, no matter how great, is only the beginning of implementation in a divided population. Ultimately, both the citizenry and the economy will benefit from a shot in the arm.</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/151670/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Randy P. Juhl's wife is a retiree of Pfizer Inc., which developed one of the COVID-19 vaccines authorized in the U.S.</span></em></p>Public health recommendations have always been a hard sell. Resistance to new behaviors – like the mask-wearing and social distancing advised during the COVID-19 pandemic – is part of human nature.Randy P. Juhl, Dean Emeritus and Distinguished Service Professor Emeritus of Pharmacy, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1206572019-07-28T12:30:50Z2019-07-28T12:30:50ZWhy parents should fear measles, not the vaccine<figure><img src="https://images.theconversation.com/files/285773/original/file-20190725-136759-1azyh2x.jpg?ixlib=rb-1.1.0&rect=40%2C76%2C2914%2C1998&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Measles is contagious three or four days before a rash appears on the skin, making it highly communicable.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>The oxygen flow was at maximum but it wasn’t enough to keep Aliyah alive. Her measles-damaged lungs failed in the night. </p>
<p>Aliyah was one of hundreds of children with measles that I looked after in a special ward of Kenya’s national hospital in 1972, before the measles vaccine was available. I saw all of the possible complications of measles, many of them life-threatening. They left me with a deep respect for this once-common viral infection of childhood.</p>
<p>As an infection specialist, I celebrated the gradual disappearance of measles cases in Canada following the introduction of the routine measles vaccination in the mid-1970s. Today, most physicians have never seen a case. Parents too are unfamiliar with measles, with some doubting the need to avoid it, even viewing it as a trivial illness. </p>
<p>Given the recent measles <a href="https://doi.org/10.1093/infdis/jis923">outbreaks in Canada</a>, the <a href="https://nationalpost.com/news/world/u-s-measles-outbreak-now-in-30-states-as-it-spreads-to-ohio-and-alaska">United States</a> and <a href="https://www.who.int/immunization/newsroom/measles-data-2019/en/">globally</a>, it is a good idea to remind ourselves what this illness is really like.</p>
<h2>Nausea, vomiting and fever</h2>
<p>Measles is not trivial. It is the most severe of the once-common childhood infections. It is highly contagious and difficult to recognize until the rash appears later in the illness. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1153511372153602050"}"></div></p>
<p>Six decades later, I remember having measles myself as a child: the fever that lasted for days, the headache, shaking chills and drenching sweats. I recall lying on the floor beside my bed, too sick to sit in a chair, while my mother changed the sheets. </p>
<p>This is the normal progress of measles, which causes considerable distress to a sick child and their parents for seven to 10 days, even in the absence of complications. No antiviral drug is available to treat the illness or its complications.</p>
<p>The <a href="https://doi.org/10.1086/377712">infection begins in the respiratory tract</a>, with nasal congestion, sore throat, red eyes and increasing cough. Unlike common colds, measles gets worse over several days, causing increasingly high fever (often to 40 C or 104 F) and putting children in bed with nausea, vomiting, chills and headache. </p>
<p>This pre-rash phase lasts about four days, during which the infected person sheds huge numbers of viruses into their surroundings, accounting for measles being highly contagious. One person with measles can infect 75 to 90 per cent of susceptible members of a household by coughing and sneezing viruses into the air. </p>
<p>Communicability is especially high in group settings such as daycares and school classrooms but can also occur with just brief exposure to an infected person.</p>
<h2>Contagious before symptoms show</h2>
<p>Measles hides its identity. It is often not until the fifth day of illness that the <a href="https://doi.org/10.1086/377712">distinctive rash covers the body</a>, revealing the diagnosis of measles. Children are contagious, however, from three to four days before the rash onset, when symptoms mimic a cold or flu infection. </p>
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<img alt="" src="https://images.theconversation.com/files/285761/original/file-20190725-136749-1m1n76v.jpg?ixlib=rb-1.1.0&rect=0%2C147%2C4742%2C3088&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/285761/original/file-20190725-136749-1m1n76v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/285761/original/file-20190725-136749-1m1n76v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/285761/original/file-20190725-136749-1m1n76v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/285761/original/file-20190725-136749-1m1n76v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/285761/original/file-20190725-136749-1m1n76v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/285761/original/file-20190725-136749-1m1n76v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&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">Measles can lead to pneumonia, brain damage and other complications.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Unlike colds and influenza, measles infection extends beyond the respiratory tract, spreading through the bloodstream to the skin and other organs. The rash of measles results from the <a href="https://doi.org/10.1016/s0140-6736(68)90701-0">child’s immune system</a> “catching up” and attacking viruses in the skin. </p>
<p>Any delay in immune activation, as may occur <a href="https://dx.doi.org/10.1001/jama.1992.03480090085032">with malnutrition or immune disorders</a>, prolongs the virus infection and increases tissue injury. </p>
<p>When the rash appears, this marks the peak of illness and signals the beginning of recovery. The fever will soon subside although the child will still be contagious for several more days, and cough for another one to two weeks. </p>
<h2>Encephalitis and brain damage</h2>
<p>Hospitalization rates for measles are highest for children under five years old — ranging from <a href="https://doi.org/10.2807/1560-7917.ES.2017.22.3.30443">nine per cent</a> to <a href="https://www.cdc.gov/measles/symptoms/complications.html">25 per cent</a> in Western countries.</p>
<p>Complications occur in about one in three young children with measles. </p>
<p>Common complications in the United States <a href="https://www.cdc.gov/measles/symptoms/complications.html">include middle-ear infection (otitis media) in 14 per cent of reported cases, diarrhoea with risk of dehydration in eight per cent and pneumonia in nine per cent</a>, the latter caused by the virus or invading bacteria. </p>
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<p>Brain inflammation or <a href="https://doi.org/10.1093/qjmed/hcu113">encephalitis with convulsions and coma</a> is the most feared complication, occurring in one per 1000 cases. One in three survivors of encephalitis has residual brain damage. A <a href="https://www.cdc.gov/measles/symptoms/complications.html">fatal outcome</a> was reported in two per 1,000 measles cases in the U.S., mainly in <a href="https://dx.doi.org/10.1001/JAMA.1992.03480090085032">children with impaired immunity</a>.</p>
<p>In short, measles is not trivial. It is distressing at best and life-threatening at worst. Parents should fear it. The sensible alternative is to ensure children are fully immunized against measles, given the <a href="http://www.who.int/news-room/fact-sheets/detail/measles">excellent safety record and protection that the measles vaccine offers</a>.</p>
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<p class="fine-print"><em><span>David W Scheifele recently retired as director of the Vaccine Evaluation Center at BC Children’s Hospital. He previously received funding for vaccine studies from several vaccine companies, the Public Health Agency of Canada and the Canadian Immunization Research Network (none in the past 5 years). He is a former chair of the Canadian Association for Immunization Research and Evaluation. </span></em></p>Seven to 10 days in bed with a high fever and rash is the best outcome you can expect if your child catches measles. Brain damage or death is the worst.David W Scheifele, Emeritus Professor of Pediatrics, University of British ColumbiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/810012017-08-24T00:34:42Z2017-08-24T00:34:42ZAnti-vaccination beliefs don’t follow the usual political polarization<figure><img src="https://images.theconversation.com/files/182638/original/file-20170818-7952-1h1mg3d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Signs from a protest in 2015 against a California bill that prohibits parents from using a religious exemption as a reason to not vaccinate their children. The bill became law. </span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Vaccines-California/9bd4e7d8168943c2b23e1ea6e6d0572f/14/0">AP Photo/Rich Pedroncelli</a></span></figcaption></figure><p>When health officials learned that the 2015 measles outbreak was caused by clusters of unvaccinated children, Americans once more wanted to understand why some parents do not vaccinate their children. In our highly polarized culture, media commentators and even academics began to connect opposition to vaccination to either the left or right of politics.</p>
<p>So a question arises: Who is more likely to be opposed to vaccination, liberals or conservatives? As a sociologist who studies infectious disease, I took a look at this. The answer seems to depend on what question you ask. </p>
<p>Because the <a href="http://www.latimes.com/local/california/la-me-measles-full-coverage-sg-storygallery.html">outbreak</a> started in the wealthy, liberal enclave of Marin County, California, and because some of the best-known “anti-vaxxers” are <a href="http://jezebel.com/heres-a-fairly-comprehensive-list-of-anti-vaccination-c-1714760128">Hollywood actors</a>, some right-leaning media outlets connected opposition to vaccination to <a href="http://www.nationalreview.com/article/413297/anti-science-left-ian-tuttle">liberals</a> and related it to other “anti-science” beliefs like fear of <a href="http://www.politico.com/magazine/story/2014/06/democrats-have-a-problem-with-science-too-107270">GMOs</a>, use of alternative medicine, and even <a href="http://thefederalist.com/2015/02/04/five-ways-liberals-ignore-science/">astrology</a>. Other writers have opposed such a <a href="https://www.washingtonpost.com/news/energy-environment/wp/2015/01/26/the-biggest-myth-about-vaccine-deniers-that-theyre-all-a-bunch-of-hippie-liberals/?utm_term=.f8694e8ce1b3">caricature</a> and have argued that opposition to vaccination is actually either <a href="http://www.slate.com/articles/news_and_politics/politics/2015/02/conservatives_and_liberals_hold_anti_science_views_anti_vaxxers_are_a_bipartisan.html">bipartisan</a> or a specifically <a href="http://www.motherjones.com/environment/2014/09/left-science-gmo-vaccines/">conservative</a> problem. Academic research on the topic is also conflicted.</p>
<p>While <a href="https://books.google.com/books?id=Kw-lgaREKGgC&source=gbs_navlinks_s">historians</a> have shown that there is a <a href="https://www.minnpost.com/second-opinion/2015/07/100-plus-year-history-anti-vaccination-movement">long history</a> of opposition to vaccination in America, the contemporary anti-vaccination movement got its major boost in 1998 when <a href="https://en.wikipedia.org/wiki/MMR_vaccine_controversy#1998_The_Lancet_paper">Andrew Wakefield</a> published faulty research in The Lancet that falsely claimed that the mumps, measles and rubella (MMR) vaccine was related to autism.</p>
<p>As to whether liberals or conservatives are now more likely to be opposed to vaccination, some <a href="https://books.google.com/books?id=dJaA7aN6GdAC&source=gbs_navlinks_s">researchers</a> have suggested that, while anti-vaccination beliefs have spread to libertarians on the right, the anti-vaccination movement originates and finds its strongest support in the political left. A later <a href="http://www.realclearscience.com/journal_club/2014/10/20/are_liberals_or_conservatives_more_anti-vaccine_108905.html">article</a> by the same researchers similarly argues that Centers for Disease Control and Prevention (CDC) evidence shows that states that voted for Obama in 2012 have higher rates of nonmedical vaccination exemptions.</p>
<p>Yet, other research suggests that it is in fact conservatives who are more likely to believe that vaccines cause <a href="https://www.washingtonpost.com/news/monkey-cage/wp/2015/03/01/conservatives-are-more-likely-to-believe-that-vaccines-cause-autism/?utm_term=.df5ed1a784d2">autism</a>, that it is liberals who are more likely to endorse <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0158382">pro-vaccination statements</a> and that the more strongly someone identifies with the Republican Party, the more likely he or she is to have a <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2386034">negative opinion</a> of vaccination.</p>
<h2>Some new evidence</h2>
<p>The <a href="http://www.pewinternet.org/2015/01/29/public-and-scientists-views-on-science-and-society/">Pew Research Center</a> has conducted two surveys that asked about vaccination. One survey in early 2015 asked respondents about whether they thought vaccines were safe, and another survey in late 2014 asked respondents about U.S. vaccination policy and whether vaccination for children should be required or a parent’s choice. </p>
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<img alt="" src="https://images.theconversation.com/files/182808/original/file-20170821-4981-1wtrqpf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/182808/original/file-20170821-4981-1wtrqpf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/182808/original/file-20170821-4981-1wtrqpf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/182808/original/file-20170821-4981-1wtrqpf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/182808/original/file-20170821-4981-1wtrqpf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/182808/original/file-20170821-4981-1wtrqpf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/182808/original/file-20170821-4981-1wtrqpf.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">
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<span class="caption">Many people worry about the effects of too many vaccines, but public health officials see them as lifesaving drugs for millions.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hand-holding-syringe-vaccine-616263095?src=bVj_95DT-aNeJI-Lxrl5CQ-1-13">Billion Photos/Shutterstock.com</a></span>
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</figure>
<p>When relating the answers to these questions in the Pew surveys to people’s political views, I find an interesting divergence. The more conservative and also the more liberal someone is, the more likely he or she is to believe that vaccination is unsafe. </p>
<p>Yet only those who are very conservative are more likely to believe that vaccination should be a parent’s choice. This suggests the social dynamics that shape Americans’ personal beliefs about vaccine safety are not the same as the social dynamics that shape their views about whether parents can decide not to vaccinate their children. </p>
<p>To examine this issue, I used a statistical technique called logistic regression that allows you to examine how the probability of a certain outcome will change depending on the characteristics of a survey respondent. I used it to examine whether someone is more or less likely to think that (a) vaccines are unsafe and (b) that vaccination should be a parent’s choice depending on what political beliefs they hold.</p>
<p>I did this while controlling for respondents’ level of education, income, race/ethnicity, age, gender, and parental status. I used the category of “moderates” (what statisticians call a “<a href="http://www.theanalysisfactor.com/strategies-dummy-coding/">reference category</a>”) to compare liberals and conservatives with. Let’s first look at people’s personal beliefs about vaccine safety.</p>
<p>What I found is that the more political someone is, the more likely he or she is to believe that vaccines are unsafe. Those who are “very conservative” are one-and-a-half times more likely to believe this than moderates. </p>
<p>Yet, the same is true for those on the left: compared to moderates, those who are very liberal are also one-and-a-half times more likely to believe vaccines are unsafe. It seems that it does not matter what your politics are, the more partisan, the more likely you believe vaccines are harmful.</p>
<p>When we look at whether people think that vaccination should be mandatory or a parent’s choice, a different story emerges.</p>
<p>Now it is only the very conservative who are more likely to think that it should not be mandatory: they are twice as likely as moderates to think that it should be a parent’s choice. Liberals are now more likely to think vaccination should be required: Compared to moderates, liberals are 43.5 percent less likely to think it should be a parent’s choice and those who are very liberal are 14.2 percent less likely.</p>
<p>What explains this divergence? First we have to realize that there is a difference in the overall number of Americans who believe that vaccinations are unsafe versus the number who believe it should be a parent’s choice. The Pew surveys indicate that 8 percent of the U.S. population think that vaccines are unsafe, while 28.2 percent think it should be a parent’s choice.</p>
<p>This suggests that there are a number of people who believe that vaccines are safe but also believe that vaccinations should be a parent’s choice. Why would someone believe that? It may have more to do with their views of the government than their beliefs about vaccines.</p>
<h2>Maybe it’s not about vaccines, but about who’s in power</h2>
<p>Since President Obama was elected in 2008, those on the right have had a much more <a href="http://www.people-press.org/2015/11/23/beyond-distrust-how-americans-view-their-government/">negative opinion</a> about the federal government. The 2014 Pew survey shows that those who were dissatisfied with the direction of the country in 2014 were 10 percent more likely to believe vaccination should be a parent’s choice than those who were satisfied (33.3 percent compared to 22.7 percent). Who were the most dissatisfied with the direction of the country in 2014? The very conservative (89.1 percent) and the conservative (81.5 percent).</p>
<p>Essentially, it doesn’t matter if you are conservative or liberal; the more political someone is, the more likely he or she is to think that vaccines are unsafe. Yet it is only the very conservative that are more likely to believe that vaccination should be a parent’s choice.</p>
<p>When it comes to political affiliation, it appears that the social forces that shape Americans’ personal beliefs about vaccination safety are not the same as the social forces that shape their views of U.S. vaccination policy. </p>
<p>Beliefs about U.S. vaccination policy and the role of parents’ choice may have more to do with what Americans believe about the proper role of the government and which political party is in power than what they think about vaccines.</p><img src="https://counter.theconversation.com/content/81001/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charles McCoy 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>Opposition to vaccines still prevents many children from getting needed preventative care. Understanding who is opposed, and why, can help, but the answers may surprise you.Charles McCoy, Assistant Professor of Sociology, SUNY PlattsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/815922017-08-23T02:03:29Z2017-08-23T02:03:29ZThe best shot at overcoming vaccination standoffs? Having doctors listen to – not shun – reluctant parents<figure><img src="https://images.theconversation.com/files/182810/original/file-20170821-4956-643qsz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A recent study of medical students and residents found they were reluctant to engage with parents who have vaccination fears. But listening to parents is important. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/little-boy-his-mother-paediatrician-on-443896372?src=CRTssbhfeiGo_fqQxJPtNA-1-45">Olena Yakobchuck/Shutterstock.com</a></span></figcaption></figure><p>Vaccines save between <a href="http://www.who.int/mediacentre/factsheets/fs378/en/">two and three million lives per year</a> by protecting individuals from diseases such as measles, mumps, diphtheria, pertussis, tetanus and others. <a href="http://www.who.int/bulletin/volumes/86/2/07-040089/en/">Clean water</a> is the only other public intervention to save more lives than vaccines. Despite their life-saving benefits, however, parental resistance toward childhood vaccinations is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3906279/">increasing</a>.</p>
<p>In 2017, news came out about a <a href="http://www.healthline.com/health-news/how-easily-could-the-measles-outbreak-in-europe-spread-to-the-us#3">new measles outbreak in Europe</a>. Seventeen unvaccinated children <a href="http://www.bbc.com/news/health-39419976">died as a result of this outbreak</a>. Measles cases have popped up in <a href="http://www.smh.com.au/national/health/sydney-measles-outbreak-six-people-infected-spent-time-in-childrens-hospital-at-westmead-20170405-gve8bp.html">Australia</a>, <a href="http://www.ocregister.com/articles/story-748719-measles-.html">the U.S.</a>, <a href="http://www.telesurtv.net/english/news/Measles-Outbreak-Raise-Concern-in-Canada-Europe-20170405-0007.html">Canada</a> and other countries worldwide. </p>
<p>Health care professionals and public health advocates <a href="https://www.statnews.com/2017/01/31/vaccine-advocates-speak-up/">struggle to create engaging, effective messages</a> to achieve what is called <a href="http://www.telesurtv.net/english/news/Measles-Outbreak-Raise-Concern-in-Canada-Europe-20170405-0007.html">herd immunity</a>. Vaccination works best at controlling disease if enough people (95 percent of the population) are vaccinated, providing protection to those who are vaccinated as well as those vulnerable individuals who are too young, who have weakened immune systems or who have medical reasons for not receiving vaccines.</p>
<p>With others, I recently conducted a study of clinical trainees’ responses to vaccine-hesitant parents. <a href="http://www.sciencedirect.com/science/article/pii/S0738399117302574?via%3Dihub">Results were consistent</a> with <a href="http://pediatrics.aappublications.org/content/early/2016/08/25/peds.2016-2127">national trends</a> suggesting that we need to better support health care professionals and patients through difficult conversations when there are disagreements or concerns about vaccines. As we observe National Immunization Month, now is an especially good time to discuss these important issues.</p>
<h2>Parents need to be respected</h2>
<p>Health care providers <a href="https://www.ncbi.nlm.nih.gov/pubmed/17079529">can influence vaccination rates</a> with the <a href="http://www.sciencedirect.com/science/article/pii/S0264410X13009821">right attitudes and message</a>. However, providers <a href="https://www.ncbi.nlm.nih.gov/pubmed/24315883">do not always have accurate perceptions</a> of parents’ views and concerns about vaccination. Some overestimate parents’ concerns, while others are unsure of how to approach conversations about possible vaccine side effects so that they are not misinterpreted. </p>
<p>Parents might not want to share their concerns out of <a href="http://content.healthaffairs.org/content/31/5/1030.abstract">fear of being labeled “difficult”</a> if they question their providers’ vaccine recommendations. Parents’ fears about expressing vaccine hesitancy may be grounded in reality. </p>
<p>In the <a href="http://www.sciencedirect.com/science/article/pii/S0738399117302574?via%3Dihub">study we conducted</a> among 132 medical students and pediatric residents, we showed clinicians a scenario in which parents were slightly hesitant to vaccinate by saying “I’m just not sure about vaccines. They make me nervous.” Clinical trainees found these parents difficult, frustrating and felt there was little value in having a conversation about vaccination. Many stated they would like to refer these vaccine-hesitant parents to other providers rather than continue to see them in their own practice. </p>
<p>But it might not be a good approach to dismiss parents before engaging in respectful conversations. Having open conversations about vaccination with a trusted physician <a href="https://www.ncbi.nlm.nih.gov/pubmed/27573088">can improve vaccine rates</a>.</p>
<p>Although there is strong evidence that vaccines are safe and that vaccine refusal has dire public health consequences, parents may be making decisions based on their <a href="https://jeffreylbrown.blogspot.com/2015/02/parents-intuition-it-can-harm-as-well.html">natural intuition and feelings</a> about protecting their children. Clinicians should aim to <a href="https://www.ncbi.nlm.nih.gov/pubmed/26195531">understand parents’ values</a> and engage in <a href="http://jamanetwork.com/journals/jama/fullarticle/2633667">genuine, respectful conversations</a>; these processes can help vaccine-hesitant parents feel heard and understood. </p>
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<img alt="" src="https://images.theconversation.com/files/182813/original/file-20170821-4956-q2rmc8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/182813/original/file-20170821-4956-q2rmc8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/182813/original/file-20170821-4956-q2rmc8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/182813/original/file-20170821-4956-q2rmc8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/182813/original/file-20170821-4956-q2rmc8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/182813/original/file-20170821-4956-q2rmc8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/182813/original/file-20170821-4956-q2rmc8.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">
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<span class="caption">Many fears and biases affect parents’ decisions on whether to vaccinate, but one thing is known to ease their concerns: respectful discussions.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/doctor-pediatrician-makes-child-vaccinated-vaccination-361651337?src=-3STmWtWJVcug_IFAMlqDw-1-81">Evgeny Atamanenko/Shutterstock.com</a></span>
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</figure>
<p>Recognizing the <a href="http://jamanetwork.com/journals/jama/fullarticle/2633667">cognitive biases</a> that parents may have can also help providers better connect with their patients. For example, a bias called the <a href="http://www.npr.org/sections/13.7/2015/02/09/384877284/psychological-biases-play-a-part-in-vaccination-decisions">omission bias</a> may lead parents to blame themselves more if a child develops a vaccine-related side effect (even something like a temporary fever) than they would blame themselves if their child develops a vaccine-preventable disease. </p>
<p>Another bias, called <a href="http://www.npr.org/sections/13.7/2015/02/09/384877284/psychological-biases-play-a-part-in-vaccination-decisions">anticipated regret</a>, may lead some parents to expect to feel remorseful if a child develops a vaccine-related side effect, however rare. <a href="https://hbr.org/2015/02/why-debunking-myths-about-vaccines-hasnt-convinced-dubious-parents">Confirmation bias</a> might lead people to believe information that already supports their preexisting beliefs about vaccines, and <a href="http://scienceblogs.com/insolence/2011/05/09/motivated-reasoning-and-the-anti-vaccine/">motivated reasoning</a> might lead them to seek out this supportive information, ignoring information that counters their beliefs.</p>
<h2>Many concerned parents are open to hearing about evidence</h2>
<p>Parents might start with different levels of readiness to vaccinate. <a href="https://bmcpediatr.biomedcentral.com/articles/10.1186/1471-2431-12-154">One literature review</a> found that between 30 to 40 percent of parents accepted vaccines without question; 25-25 percent of parents accepted vaccines, but were slightly anxious about some side effects; 20 to 30 percent were hesitant and wanted to know more about vaccine safety; 2 to 27 percent preferred to delay or alter the vaccine schedule and only 2 percent or less refused vaccines all together. </p>
<p>Engaging parents in discussions about vaccination can make a difference. In particular, clinicians can match messages to parents’ feelings and concerns while addressing both risks and benefits for those who want to hear more about evidence. One study found this can lead <a href="http://pediatrics.aappublications.org/content/early/2016/08/25/peds.2016-2146">one-third to one-half of initially hesitant parents to vaccinate</a>. </p>
<p>If clinicians can connect to parents by identifying a shared goal, parents might be more willing to listen to vaccine recommendations. For example, both parents and clinicians want to keep the child healthy and safe. Starting with statements reflecting that goal can make both people more receptive to listening to each other’s concerns. </p>
<p>Stories and anecdotes that help parents understand the importance of vaccination may also be remembered more than data or statistics. Strategies that focus on <a href="http://www.annfammed.org/content/12/3/270.full">clarifying patients’ values and reasons for vaccine hesitancy</a> can help clinicians and patients partner together when making decisions about vaccination. </p>
<h2>Parents have a role: Critically examining articles they find about vaccines</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/182817/original/file-20170821-4987-2pzbg8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/182817/original/file-20170821-4987-2pzbg8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/182817/original/file-20170821-4987-2pzbg8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/182817/original/file-20170821-4987-2pzbg8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/182817/original/file-20170821-4987-2pzbg8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/182817/original/file-20170821-4987-2pzbg8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/182817/original/file-20170821-4987-2pzbg8.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">
<figcaption>
<span class="caption">Parents should be savvy about sources of information about vaccines, eschewing unsourced material. The Centers for Disease Control and Prevention, on the other hand, has a wealth of information about vaccines that can be trusted.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/fake-news-hoax-conceptyoung-man-using-551220664">panuwat phimpha/Shutterstock.com</a></span>
</figcaption>
</figure>
<p>Communication about health decisions is a <a href="https://www.ncbi.nlm.nih.gov/pubmed/20831668">two-way street</a>. Parents can prepare themselves with <a href="http://www.healthnewsreview.org/blog/">online resources to help them appraise news stories</a>. It is often difficult when looking for information online to tease apart what information is valid and what might be sensationalized. Even some academic journal articles that look like they have been peer-reviewed may skew evidence. These articles are often published in what is called “<a href="https://clinicallibrarian.wordpress.com/2017/01/23/bealls-list-of-predatory-publishers/">predatory journals</a>,” which require substantial fees to publish and are often <a href="http://newatlas.com/predatory-journals-tricked-fake-paper/50594/">not reviewing papers closely</a> for content or data legitimacy. </p>
<p>Parents can also use resources such as the <a href="https://www.cdc.gov/vaccines/index.html">Centers for Disease Control and Prevention</a>, the American Academy of Pediatrics’ <a href="https://www.healthychildren.org/english/safety-prevention/immunizations/Pages/default.aspx">parent information guide</a> and <a href="https://www.healthychildren.org/English/safety-prevention/immunizations/Pages/Vaccine-Studies-Examine-the-Evidence.aspx">online evidence summaries</a>. Some newspapers also report on <a href="https://www.washingtonpost.com/news/to-your-health/wp/2017/04/17/why-its-a-bad-idea-to-space-out-your-childs-vaccination-shots/?utm_term=.3846610891b9">common myths debunked</a> and information researched by the <a href="https://www.washingtonpost.com/news/to-your-health/wp/2017/01/13/the-u-s-already-has-a-vaccine-safety-commission-and-it-works-really-well-experts-say/?utm_term=.a98bf4346e4e">vaccine safety commission</a>. This information can help open the door for conversation with providers if parents still have remaining questions about vaccines. <a href="https://www.cdc.gov/vaccines/vac-gen/common-faqs.htm">Asking questions</a> about side effects and the diseases that vaccines prevent are all questions that providers should be able to answer to help allay fears.</p>
<p>It is clear from our <a href="http://www.sciencedirect.com/science/article/pii/S0738399117302574?via%3Dihub">study of clinical trainees</a> and <a href="http://pediatrics.aappublications.org/content/early/2016/08/25/peds.2016-2127">national trends</a> that we need to better support health care professionals and patients through difficult conversations when there are disagreements or concerns about vaccine evidence. Both providers and patients can play a role in supporting these conversations.</p><img src="https://counter.theconversation.com/content/81592/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mary Politi has consulted for Merck in 2015-2016 and currently receives research funding from Merck, both on topics unrelated to the content of this article.</span></em></p>A recent study suggests that shunning parents who are reluctant to vaccinate their kids isn’t the best strategy. A better strategy might be old-fashioned, but it works.Mary C Politi, Associate Professor of Surgery, Division of Public Health Sciences, Washington University in St. LouisLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/682272016-11-07T02:11:53Z2016-11-07T02:11:53ZExplainer: what are antibodies and why are viruses like dengue worse the second time?<figure><img src="https://images.theconversation.com/files/144513/original/image-20161104-25322-2248hg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For viruses like dengue, being injected with the pathogen as in a vaccine can open the door to secondary infections. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>Our immune system is like a highly trained army. It fends off invading pathogens, usually very effectively. The problem is that sometimes it makes mistakes and attacks us. This can result in <a href="https://theconversation.com/what-are-allergies-and-why-are-we-getting-more-of-them-40318">allergies</a>, <a href="https://theconversation.com/why-its-never-lupus-television-illness-and-the-making-of-a-meme-1198">autoimmune diseases</a> or just <a href="https://theconversation.com/explainer-how-viruses-can-fool-the-immune-system-43707">misfires in the immune system’s attack</a> of invading cells. </p>
<p>But there’s another way the immune system can fail us – by throwing down the welcome mat for viruses on their second invasion.</p>
<h2>What are antibodies?</h2>
<p>Our <a href="https://theconversation.com/explainer-what-is-the-immune-system-19240">immune systems are complex</a> but two components are critical: antibodies and macrophages. Antibodies are produced by the “memory cells” of the immune system so if you are ever challenged by the same infection again, you will be able to recognise it, respond much faster and kill the invaders. </p>
<p>Antibodies are made to attach to certain proteins on the surface of an invading organism, called antigens. By sticking to these antigens, antibodies block the invader’s ability to replicate, and enter cells, thereby rendering the invader useless. </p>
<p>Then the janitor cells of the immune system (macrophages, literally “big eaters”), search around for these “useless invaders” attached to antibodies, engulf them and chop them up for re-use or excretion. </p>
<p>However, some viruses actually get inside macrophages, using the antibodies as a Trojan horse. They pretend to be useless, getting engulfed by the macrophage and then converting the macrophage into a virus-producing machine. This is antibody-dependent enhancement.</p>
<h2>Antibody-dependent enhancement and mosquito-borne viruses</h2>
<p>There are hundreds of thousands of dengue cases across the world each year, making dengue viruses one of the most important mosquito-borne pathogens. There are four types of dengue and while infection with one virus will make you seriously ill, the symptoms can become potentially fatal when infected subsequently with a different strain. </p>
<p>This is because the antibodies made against the first virus type help the second virus to enter cells, resulting in dengue haemorrhagic fever. This is the severe and potentially deadly form of the disease characterised by haemorrhaging (bleeding from the nose or gums or extensive bruising under the skin), severe abdominal pain, vomiting, and fever.</p>
<p>Antibody-dependent enhancement was <a href="http://jem.rupress.org/content/jem/146/1/201.full.pdf">first recognised to occur</a> in humans with dengue in 1977; researchers noticed the disease was more severe in children who received maternal antibodies for dengue or adults who had previously been infected with a different type of dengue (serotype). </p>
<p>Researchers then tested this hypothesis experimentally in monkeys and found the disease to be more severe when the monkeys had been “immunised” with maternal antibodies against dengue.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/144515/original/image-20161104-25343-rlncrl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/144515/original/image-20161104-25343-rlncrl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/144515/original/image-20161104-25343-rlncrl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/144515/original/image-20161104-25343-rlncrl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/144515/original/image-20161104-25343-rlncrl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/144515/original/image-20161104-25343-rlncrl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/144515/original/image-20161104-25343-rlncrl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/144515/original/image-20161104-25343-rlncrl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Zika and dengue can be worse after first exposure.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>This phenomenon has implications for public health, including more serious disease outbreaks and vaccine development.</p>
<p>Could a dengue vaccine make a patient more susceptible to disease, rather than protecting them? This has been a concern for <a href="https://www.ncbi.nlm.nih.gov/pubmed/10954537">other antibody-dependent enhancement viruses</a> such as HIV, Ebola, and Ross River virus. This is why scientists first have to identify protective antibodies when proposing to use <a href="https://theconversation.com/antibody-injections-could-be-stepping-stone-to-hiv-vaccine-58858">antibody injections</a> to safeguard patients from these types of viruses.</p>
<h2>What about Zika?</h2>
<p><a href="https://theconversation.com/explainer-where-did-zika-virus-come-from-and-why-is-it-a-problem-in-brazil-53425">Zika virus</a> is a recently emerging, mosquito-borne virus that has exploded around the globe. It usually causes mild disease characterized by fever, rash and joint pain, if it causes disease at all (<a href="http://www.nejm.org/doi/full/10.1056/NEJMoa0805715#t=articleTop">about 80% of infections</a> cause no symptoms).</p>
<p>Of greater public health concern is that if a pregnant woman is infected with Zika, the virus may lead to her baby being born with a small head – a condition called <a href="https://theconversation.com/proving-that-the-zika-virus-causes-microcephaly-53716">microcephaly</a>.</p>
<p>Zika virus is a flavivirus, similar to dengue. In fact, for people infected with the virus, infection is indistinguishable from dengue using classic antibody tests. This made scientists wonder: could prior infection with Zika cause an antibody-dependent enhancement response following dengue infection or vice versa?</p>
<p><a href="http://www.pnas.org/content/113/28/7852.abstract.html?etoc">Researchers recently tested</a> whether Zika could be capable of eliciting this antibody-dependent enhancement for dengue. The findings revealed dengue antibodies can protect against Zika infection or facilitate the infection, depending on which antigens the antibodies attach to. </p>
<p>Likewise, prior Zika infection can <a href="http://science.sciencemag.org/content/early/2016/07/13/science.aaf8505?utm_campaign=fr_sci_2016-07-14&et_rid=34807079&et_cid=634260">either protect against or worsen</a> dengue infection via antibody-dependent enhancement.</p>
<h2>What does this mean for us?</h2>
<p>It doesn’t change the fact that avoiding mosquito bites is the best way of preventing disease. However, avoiding mosquito bites is easier said than done.</p>
<p>There are implications for these findings regarding the Zika vaccines under development and the future of dengue outbreaks. Developers of a Zika vaccine have to <a href="http://www.nejm.org/doi/full/10.1056/NEJMp1607762#t=article">ensure antibodies developed</a> against the vaccine will not result in antibody-dependent enhancement of dengue in the future. </p>
<p>In a region where dengue is common, such as Brazil, the recent Zika outbreak may result in more severe cases of dengue, <a href="http://science.sciencemag.org/content/early/2016/07/13/science.aaf8505?utm_campaign=fr_sci_2016-07-14&et_rid=34807079&et_cid=634260">including dengue haemorrhagic fever</a>, in the coming years.</p>
<p>Zika may have dominated the public health spotlight this year but in the coming years attention will return to dengue. As traditional mosquito control strategies lose their potency, new technologies will arise. However, the development of an affordable vaccine may be our greatest hope for reducing the burden of dengue and Zika. </p>
<p>Due to the cross-reactivity and antibody-dependent enhancement potential for these two viruses, ensuring Zika and dengue vaccines result in protective antibodies is crucial.</p><img src="https://counter.theconversation.com/content/68227/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emily Johnston Flies receives funding from The Royal Society of South Australia and the University of South Australia. </span></em></p><p class="fine-print"><em><span>Cameron Webb and the Department of Medical Entomology, NSW Health Pathology, have been engaged by a wide range of insect repellent and insecticide manufacturers to provide testing of products and provide expert advice on mosquito biology. Cameron has also received funding from local, state and federal agencies to undertake research into mosquito-borne disease surveillance and management</span></em></p>Our immune system protects us but when it comes to some mosquito-borne disease, it can work against us. What are the implications for the development of a Zika virus vaccine?Emily J Flies, PhD student in Disease Ecology, University of South AustraliaCameron Webb, Clinical Lecturer and Principal Hospital Scientist, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/414082015-05-15T10:12:54Z2015-05-15T10:12:54ZA measles mystery: how could the vaccine prevent deaths from other diseases too?<figure><img src="https://images.theconversation.com/files/81733/original/image-20150514-28615-rvpeff.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Measles immunization campaign poster display at the Eradicate Measles Exhibit in 1972.</span> <span class="attribution"><span class="source">CDC/ Don Lovell via Public Health Image Library</span></span></figcaption></figure><p>If infectious diseases were a monarchy, measles might be king. Not only does measles reign among the most contagious diseases known to man – likely to infect any non-vaccinated individual who stands in the same room as an infected person – measles has long been known to be one of the great killers of children. Before vaccination, measles was responsible <a href="http://www.who.int/mediacentre/factsheets/fs286/en/">for millions of childhood deaths</a>. Today it remains a cause of great illness and death in low-resource countries, killing over <a href="http://dx.doi.org/10.1016/S0140-6736(12)60522-4">140,000 children</a> worldwide every year.</p>
<p>Where measles vaccines have been introduced, childhood deaths often plummet by <a href="http://dx.doi.org/10.1126/science.aaa3662">as much as 50%</a>. Measles is deadly, but before the vaccines were introduced in 1963, the virus did not directly cause half of all childhood disease deaths. In other words, where measles vaccines have been introduced, they were associated with reductions in more childhood disease deaths than were actually caused by the measles.</p>
<p>The reason for these major drops in mortality has been a central mystery surrounding the vaccine for decades. My colleagues and I wanted to take a step toward further unraveling this mystery.</p>
<p>We figure, <a href="http://www.bmj.com/content/311/7003/481?variant=full-text&referer=www.clickfind.com.au">as have others</a>, that there are two ways that the measles vaccine could prevent more deaths than are strictly due to measles virus. </p>
<ol>
<li><p>The vaccine itself could have long-lasting non-specific immune-boosting properties that protect the recipient from other diseases. </p></li>
<li><p>The measles infection could have long-lasting effects that predispose someone to other diseases.</p></li>
</ol>
<p>The first hypothesis has been investigated, but as the World Health Organization (WHO) <a href="http://www.who.int/immunization/sage/meetings/2014/april/en/">recently reported</a>, there is insufficient evidence to explain a purely immune-boosting effect from the vaccine. </p>
<p>On the other hand, recently strong evidence was shown to suggest the latter – that measles infections may induce long-term negative effects on the immune system by deleting immune memory cells, and that these effects may be prevented through vaccination.</p>
<h2>Measles and ‘immune amnesia’</h2>
<p>Measles is a virus, and like all viruses, it hijacks the molecular machinery of the human cells it infects. The virus turns infected cells into self-destructing virus-assembly plants.</p>
<p>Hundreds or thousands of viral progeny are produced in a cell before it explodes, freeing the new viruses to do the same thing in neighboring cells. This is how measles moves through the body, layer by layer, damaging cells of multiple major organ systems. </p>
<p>Measles specifically targets the vast assortment of memory immune cells – these are called memory B and T lymphocytes. They are charged with remembering and targeting all previously encountered diseases. </p>
<p>These memory cells are coated with a molecule called SLAM (short for “signaling lymphocyte-activation molecule”), which normally aids the cells in recognizing and destroying known invaders. SLAM also happens to be a molecule to which the measles virus can readily dock and gain entry. Think of SLAM as a lock, and measles carries a matching key. Thus, by binding to SLAM, measles specifically infects memory cells, sending their numbers crashing down. </p>
<p>A recent study in macaque monkeys has shown that when cell levels built up again a few weeks later, after the infection cleared, <a href="http://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1002885">they didn’t remember</a> the vast array of previously encountered diseases. </p>
<p>Instead the regenerated memory cells were primarily aimed at measles alone. Thus, after having the measles, a person might be left with terrific “immune memory” against measles, but with an “immunologic-amnesia” to the rest of the diseases (or vaccines) he or she had previously encountered.</p>
<p>Assuming these data from macaques represent what happens in humans, then what happens to immune memory? </p>
<p>Does the amnesia eventually wear off and the array of “memories” spontaneously returns, or does the immune memory need to be retrained through new (re-)exposures to disease? And if so, how long might this take? That’s an important question because a person would be at risk of infection from any number of diseases until immune memory returned. And finally, what does this mean in terms of a larger role for measles vaccination?</p>
<h2>How can we figure out how long ‘immune amnesia’ lasts?</h2>
<p>My colleagues (Bryan Grenfell and Jessica Metcalfe at Princeton University and Rik de Swart and Ab Osterhaus at Erasumus University in the Netherlands) and I recently took a first stab at <a href="http://www.sciencemag.org/content/348/6235/694">answering these important questions</a> using population, or epidemiological, data.</p>
<p>We looked at the number of measles cases that occurred every three months during the decades before and after the introduction of the measles vaccines in children in England, Wales, the US and Denmark. We compared these to the number of children who died from all other (non-measles) infectious diseases in the same periods.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/81713/original/image-20150514-28641-5364ge.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/81713/original/image-20150514-28641-5364ge.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/81713/original/image-20150514-28641-5364ge.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=839&fit=crop&dpr=1 600w, https://images.theconversation.com/files/81713/original/image-20150514-28641-5364ge.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=839&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/81713/original/image-20150514-28641-5364ge.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=839&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/81713/original/image-20150514-28641-5364ge.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1054&fit=crop&dpr=1 754w, https://images.theconversation.com/files/81713/original/image-20150514-28641-5364ge.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1054&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/81713/original/image-20150514-28641-5364ge.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1054&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 boy receives a measles vaccination in Atlanta, Georgia in 1962.</span>
<span class="attribution"><span class="source">CDC via Public Health Image Library</span></span>
</figcaption>
</figure>
<p>During the years before the vaccine was introduced, measles was rampant, infecting nearly all children. So we figured that if immune amnesia occurred because of measles, we would be able to detect it as an increase in deaths from non-measles infections following large natural measles epidemics. </p>
<p>But we didn’t just compare the number of measles cases at a given time to the number of non-measles deaths at that same time. We also assessed how long the potential memory loss effects of measles might last – a point that was critical to the formal analysis and findings.</p>
<p>To do that, we created a mathematical model to explore the association between measles cases and non-measles deaths, but with an added assumption: that the effects of a measles infection (the potential immune-amnesia effects) might carry over into later time points. In other words, we added an assumption that the after effects of the infection (increased risk of other diseases) might be felt for months or even years after the time of the infection itself. </p>
<p>The model allowed us to figure out the (theoretical) prevalence of measles immune amnesia in the populations we studied. This means that we could test how well the possible prevalence of measles immune amnesia correlated with the number of non-measles disease deaths. (See the animation for an annotated explanation of what we did.)</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/mznVPBJN4kc?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">In this animation we show how the mathematical model was used to determine how long the immune effects of measles may last for.</span></figcaption>
</figure>
<h2>Immune amnesia may last for over two years</h2>
<p>We found that there were very strong correlations between measles cases and non-measles disease mortality whenever the model was adjusted to assume that the immune effects of measles lasted, on average, 28 months.</p>
<p>This same result, around 28 months of immune amnesia, was found regardless of the country, age group, gender and even the decade, which spanned from the 1940s to 2010 among the various countries.</p>
<p>The association was nearly exactly the same during the decades before and after the measles vaccines were introduced too, showing that the strong associations we noted could not be driven by direct vaccine effects. </p>
<p>We also checked to see if the fluctuations in mortality were due to general improvements in health care. We ran the exact same series of mathematical models substituting the measles data for pertussis (whooping cough), another important vaccine preventable disease that was decreasing over the same time period. In stark contrast to the measles findings, there were no associations between pertussis and non-pertussis childhood deaths.</p>
<p>Ultimately, we found strong evidence that the large reductions in childhood mortality seen following rollout of measles vaccine are likely due to reductions in the number of measles infections (thus avoiding potential measles immune-amnesia effects), and not from potential long-lasting immune-boosting properties of the vaccine itself.</p>
<p>However, our analysis certainly does not rule out other possible non-specific direct immune benefits of the vaccine shot itself, as <a href="http://www.nature.com/ni/journal/v15/n10/abs/ni.2961.html">others have suggested</a>. Rather, it is likely that both mechanisms may work hand in hand. </p>
<h2>Measles is not a benign disease</h2>
<p>Once set in place, we hypothesize that immune-amnesia effects cannot be undone without re-exposures and infections over years. Basically, the memory cells need to “relearn” how to recognize and defend against diseases they had known before, and they can only do this through re-exposure to the pathogen or by re-vaccination. This places the child at risk of disease that he or she used to have some protection against, much like the high risk of infection that babies endure (compared to adults) when first acquiring protective immunity through exposures, infections.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/81747/original/image-20150514-28638-14wc7xw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/81747/original/image-20150514-28638-14wc7xw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/81747/original/image-20150514-28638-14wc7xw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=989&fit=crop&dpr=1 600w, https://images.theconversation.com/files/81747/original/image-20150514-28638-14wc7xw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=989&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/81747/original/image-20150514-28638-14wc7xw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=989&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/81747/original/image-20150514-28638-14wc7xw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1243&fit=crop&dpr=1 754w, https://images.theconversation.com/files/81747/original/image-20150514-28638-14wc7xw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1243&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/81747/original/image-20150514-28638-14wc7xw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1243&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Measles isn’t a benign infection.</span>
<span class="attribution"><a class="source" href="http://wellcomeimages.org/indexplus/result.html?_IXMAXHITS_=1&_IXACTION_=query&_IXFIRST_=25&_IXSR_=qXNTSGDkYsf&_IXSS_=_IXMAXHITS_%3d15%26_IXFPFX_%3dtemplates%252ft%26_IXFIRST_%3d1%26c%3d%2522historical%2bimages%2522%2bOR%2b%2522contemporary%2bimages%2522%2bOR%2b%2522corporate%2bimages%2522%2bOR%2b%2522contemporary%2bclinical%2bimages%2522%26%252asform%3dwellcome%252dimages%26%2524%253dsi%3dtext%26_IXACTION_%3dquery%26i_pre%3d%26IXTO%3d%26t%3d%26_IXINITSR_%3dy%26i_num%3d%26%2524%253dsort%3dsort%2bsortexpr%2bimage_sort%26w%3d%26%2524%253ds%3dmeasles%26IXFROM%3d%26_IXSUBMIT_%3dSubmit%26_IXshc%3dy%26%2524%2b%2528%2528with%2bwi_sfgu%2bis%2bY%2529%2band%2bnot%2b%2528%2522contemporary%2bclinical%2bimages%2522%2bindex%2bwi_collection%2bor%2b%2522corporate%2bimages%2522%2bindex%2bwi_collection%2529%2529%2band%2bnot%2bwith%2bsys_deleted%3d%252e%26_IXrescount%3d36&_IXSPFX_=templates%2ft&_IXFPFX_=templates%2ft">Wellcome Library, London</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>There is a largely held, but incorrect, belief that measles is associated with little severe illness. This is simply not true. The primary infection can have <a href="http://jid.oxfordjournals.org/content/189/Supplement_1/S4.long">devastating effects</a>, including high fevers, rash, lung infections and encephalitis. And our data suggest that measles infection may have serious immunologic effects, leaving children vulnerable to secondary infections, that brew under the surface, possibly for years. These secondary infections are no less harmful, and would not occur if not for a measles infection, perhaps even two or three years earlier.</p>
<p>Measles vaccination is perhaps the best buy there is towards keeping society free of disease. When vaccine skeptics are weighing the scales of perceived (largely unfounded) risks of measles vaccination versus risks of the infection itself, our findings should add a new set of weights showing that vaccines are the best option for both the child and the population at large.</p>
<p>Indeed, there are regions today not lucky enough to have access to vaccines and where parents are reminded daily of the damage caused by vaccine-preventable diseases long forgotten in much of the world. In these regions, parents often line the hospital walls for an opportunity to get their child vaccinated.</p><img src="https://counter.theconversation.com/content/41408/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Mina 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>When the measles vaccine was introduced, it was associated with reductions in more childhood disease deaths than were actually caused by the measles. How does that work?Michael Mina, Postdoctoral researcher at Princeton University and MD/PhD candidate, Emory UniversityLicensed as Creative Commons – attribution, no derivatives.