tag:theconversation.com,2011:/ca-fr/topics/vaccination-rates-for-covid-19-104474/articlesVaccination rates for COVID-19 – La Conversation2022-12-02T13:42:01Ztag:theconversation.com,2011:article/1951552022-12-02T13:42:01Z2022-12-02T13:42:01ZNurses’ attitudes toward COVID-19 vaccination for their children are highly influenced by partisanship, a new study finds<figure><img src="https://images.theconversation.com/files/498352/original/file-20221130-6065-agmvaq.jpg?ixlib=rb-1.1.0&rect=49%2C36%2C8130%2C5408&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">As of Nov. 30, 2022, 62.5% of children and adolescents are unvaccinated against COVID-19.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/nurse-putting-band-aid-on-patients-arm-after-covid-royalty-free-image/1340701756?phrase=nurses%20covid%20vaccines&adppopup=true">South_agency/E+ via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em> </p>
<h2>The big idea</h2>
<p>Children of nurses who identify as Republican are less likely to receive a COVID-19 vaccination compared with children of nurses who identify as Democrat, according to our recently published study in the <a href="https://doi.org/10.1007/s10900-022-01167-4">Journal of Community Health</a>. </p>
<p>We surveyed more than 1,000 nurses in South Dakota in June and July of 2022. Of those, 298 participants reported having children 5 to 17 years old. We asked this group about the vaccination status of their children and found that the children of nurses who identified as Democrats had a 13% higher probability of being vaccinated compared with the offspring of nurses who identified as Republican. </p>
<p>The timing of our survey only allowed us to measure the vaccination intention of parents of children from 6 months to 4 years old, since authorization of COVID-19 vaccines for that age group occurred just days before the survey. Of the 123 nurses who reported having children 6 months to 4 years old, those who identified as Democrats had a 14% higher probability of intending to vaccinate their children compared to self-identified Republicans. </p>
<p>Additionally, we found that those nurses who received a COVID-19 booster dose were more likely to vaccinate their children. On the other hand, gender, education and type of nursing credential had no effect.</p>
<h2>Why it matters</h2>
<p>Since the start of the COVID-19 pandemic, vaccination for children has been a <a href="https://www.vox.com/the-highlight/23438552/covid-vaccine-refusal-hesitancy-politics-polarization-pandemic-mandates">contentious issue</a>. In our study, we found that polarization among nurses split along political party lines in a similar fashion to the general public. </p>
<p>Despite the wide availability of safe and free COVID-19 vaccines for children and adolescents in the U.S., vaccination rates for people under age 18 are lower than for adults. As of Nov. 30, 2022, more than 60% of children <a href="https://www.cdc.gov/vaccines/imz-managers/coverage/covidvaxview/interactive/children.html">remain unvaccinated</a>. </p>
<p>Though children tend to be more resilient to COVID-19, there are still significant risks. The Centers for Diseases Control and Prevention has reported <a href="https://data.cdc.gov/NCHS/Deaths-by-Sex-Ages-0-18-years/xa4b-4pzv">more than 1,500 deaths of children under 18</a> from COVID-19, as of late November 2022. And children are <a href="https://doi.org/10.1038/s41598-022-13495-5">susceptible to “long” COVID</a> symptoms as well.</p>
<p>Nurses – and other health care workers – are at the forefront of efforts to contain COVID-19. They also advise patients who are deciding whether to vaccinate themselves and their families. Our study shows that among nurses, political partisanship appears to influence their attitudes toward vaccinating their own kids.</p>
<p>Public health officials are striving to boost COVID-19 vaccination rates. Yet the politicization of the pandemic continues to hinder these efforts. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/498542/original/file-20221201-16-luueet.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two nurse protesters stand near a street holding up signs arguing against vaccine mandates, with a large group of protesters in the background." src="https://images.theconversation.com/files/498542/original/file-20221201-16-luueet.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/498542/original/file-20221201-16-luueet.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=412&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498542/original/file-20221201-16-luueet.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=412&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498542/original/file-20221201-16-luueet.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=412&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498542/original/file-20221201-16-luueet.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=517&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498542/original/file-20221201-16-luueet.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=517&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498542/original/file-20221201-16-luueet.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=517&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Nurses protesting the Biden administration’s vaccine mandate, which has since been suspended, in Michigan in July 2021.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/protesters-holding-placards-expressing-their-opinion-while-news-photo/1234168497?phrase=nurses">SOPA Images/LightRocket via Getty Images</a></span>
</figcaption>
</figure>
<p>Increasing vaccination rates among children will also protect the <a href="https://www.hhs.gov/immunization/basics/work/protection/index.html">most vulnerable members of society</a>, such as older adults and people with weakened immune systems. Nevertheless, some parents continue to resist vaccinating their children.</p>
<p>Our study shows that parents make COVID-19 vaccination decisions for the entire family. We found that nurses who received a booster dose of a COVID-19 vaccine are more likely to vaccinate their children and adolescents. However, the nurses who haven’t received a booster dose are far less likely to vaccinate their children. </p>
<h2>What other research is being done</h2>
<p>Our findings align with other research carried out by ourselves and others that shows the strong influence of partisan self-identification on COVID-19 attitudes and behaviors. </p>
<p>Other studies we’ve done show that Republicans are less likely than Democrats to <a href="https://doi.org/10.1111/ssqu.13147">receive a COVID-19 vaccination</a> and are less likely to <a href="https://doi.org/10.1177%2F1532673X221118888">support mandatory COVID-19 vaccination</a>. We also found that nurses who identify as Republican are less likely to receive a <a href="https://doi.org/10.1016/j.ajic.2022.11.014">COVID-19 booster dose</a>.</p>
<p>Our study joins a growing body of work that seeks to explore the factors behind COVID-19 vaccine hesitancy among health care workers. Other studies have linked <a href="https://doi.org/10.1001/jamanetworkopen.2021.21931">race and ethnicity</a>, as well as <a href="https://doi.org/10.3390/vaccines9111358">trust</a> in government, physicians and pharmaceutical companies, to the attitudes of health care workers toward COVID-19 vaccination.</p>
<h2>What’s next</h2>
<p>Given the politicization of the pandemic and the erosion of trust in authorities, it’s important that messages encouraging the vaccination of children <a href="https://theconversation.com/covid-19-vaccines-for-children-how-parents-are-influenced-by-misinformation-and-how-they-can-counter-it-173212">come from trusted sources</a>. </p>
<p>Our previous research suggests that <a href="https://doi.org/10.1080/03623319.2022.2049557">religious leaders</a> can help encourage compliance with COVID-19 prevention measures. In the future, we plan to investigate whether endorsements from trusted community leaders could convince parents to vaccinate their children.</p><img src="https://counter.theconversation.com/content/195155/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Nurses who identify as Democrats have a significantly higher likelihood of having their children vaccinated against COVID-19 than those who identify as Republicans.Filip Viskupič, Assistant Professor of Political Science, South Dakota State UniversityDavid Wiltse, Associate Professor of Political Science, South Dakota State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1733242021-12-09T16:53:37Z2021-12-09T16:53:37ZChildren ages 5 to 11 are getting COVID-19 vaccinations: What this might mean for the holidays and the Omicron variant<figure><img src="https://images.theconversation.com/files/436447/original/file-20211208-140109-sdogbt.png?ixlib=rb-1.1.0&rect=0%2C0%2C973%2C785&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Young children are rolling up their sleeves to get vaccinated, protecting themselves against COVID-19 and helping to curb the pandemic.</span> <span class="attribution"><span class="source">(Dasantila Golemi-Kotra)</span>, <span class="license">Author provided</span></span></figcaption></figure><p><a href="https://www.thestar.com/news/canada/2021/11/18/health-canada-is-set-to-approve-the-pfizer-covid-vaccine-for-kids-heres-what-you-need-to-know.html">Public Health Canada</a> approved the use of <a href="https://www.canada.ca/en/health-canada/services/drugs-health-products/covid19-industry/drugs-vaccines-treatments/vaccines/pfizer-biontech.html">Pfizer/BioNTech</a> mRNA vaccine for children ages five to 11 on Nov. 19. The decision was highly anticipated as parents — including one of the authors — have been waiting to protect school-age children in the face of growing SARS-CoV-2 positive cases and spare them from another interruption of the school year. (Children ages five to 11 represent <a href="https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci/recommendations-use-covid-19-vaccines/pfizer-biontech-10-mcg-children-5-11-years-age.html">7.5 per cent</a> of all the cases in Canada, with potentially <a href="https://theconversation.com/im-an-infectious-disease-doctor-yes-im-vaccinating-our-5-year-old-against-covid-19-here-is-why-you-should-too-171001">life-threatening consequences</a>.)</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">
<figcaption>
<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>
</figcaption>
</figure>
<p>As soon as the provincial online booking system became available on Nov. 23, Dasantila booked her daughter for an appointment over the weekend, not wanting her to miss any school days. Then she started planning how to offer comfort on the day of the vaccination: her daughter does not like needles — the sight of a needle on TV or in a magazine or even mentioning one makes her cringe, and she instinctively covers her left arm and says she is in pain.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/if-your-child-is-afraid-of-or-refusing-a-medical-procedure-heres-how-to-help-170923">If your child is afraid of — or refusing — a medical procedure, here’s how to help</a>
</strong>
</em>
</p>
<hr>
<p>The following day, however, she came home and asked whether her vaccination had been booked. When gently informed that it would be on the weekend, she inquired why not sooner? Dasantila was shocked that her little one, who usually had to be coaxed with chocolate to get her shots, was not happy that her vaccination was not booked sooner. Hiding her shock, Dasantila asked why she wanted it sooner, and her daughter said everyone in her class was getting it sooner.</p>
<p>It’s a reminder that children may be stronger than we imagine them to be, and may exceed our expectations. It’s also another reason to thank teachers who have been consistent in their message about the importance of public health measures to protect themselves and others.</p>
<h2>What is the vaccination coverage in Canada?</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/436451/original/file-20211208-25-1us6nae.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A person out-of-frame holds a smartphone camera in the foreground as a girl gets vaccinated" src="https://images.theconversation.com/files/436451/original/file-20211208-25-1us6nae.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/436451/original/file-20211208-25-1us6nae.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=431&fit=crop&dpr=1 600w, https://images.theconversation.com/files/436451/original/file-20211208-25-1us6nae.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=431&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/436451/original/file-20211208-25-1us6nae.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=431&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/436451/original/file-20211208-25-1us6nae.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=542&fit=crop&dpr=1 754w, https://images.theconversation.com/files/436451/original/file-20211208-25-1us6nae.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=542&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/436451/original/file-20211208-25-1us6nae.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=542&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 mother takes a picture of her daughter receiving a COVID-19 vaccine during the second day of vaccination for children aged five to 11 years old in Montréal.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Paul Chiasson</span></span>
</figcaption>
</figure>
<p>The approval of vaccination for children ages five to 11 years comes at a <a href="https://health-infobase.canada.ca/covid-19/epidemiological-summary-covid-19-cases.html">critical point in the pandemic here in Canada</a>. In <a href="https://www.publichealthontario.ca/-/media/documents/ncov/epi/covid-19-vaccine-uptake-ontario-epi-summary.pdf?la=en">Ontario</a>, where we live, cases are <a href="https://globalnews.ca/news/8404305/ontario-covid-cases-november-26-coronavirus/">slowly creeping up</a> (the <a href="https://health-infobase.canada.ca/covid-19/epidemiological-summary-covid-19-cases.html">positivity rate</a> — the percentage of people tested who get a positive result — is fluctuating around three per cent), and <a href="https://www.ontario.ca/page/covid-19-cases-schools#section-1">outbreaks in the province’s elementary schools</a> are at their <a href="https://www.cbc.ca/news/canada/toronto/covid-19-ontario-dec-8-2021-school-outbreaks-rapid-tests-1.6277720">highest level since the pandemic began</a>.</p>
<p>A slow increase in positive cases was expected as people gather more indoors due to the cold weather, more venues opened to full capacities and travel bans were lifted. But we don’t know at what rate this trend will continue, so public health measures and vaccines are the thread we must hold on to. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/needle-fears-can-cause-covid-19-vaccine-hesitancy-but-these-strategies-can-manage-pain-and-fear-165009">Needle fears can cause COVID-19 vaccine hesitancy, but these strategies can manage pain and fear</a>
</strong>
</em>
</p>
<hr>
<p>The participation of five-to-11-year-old children in vaccination programs will make 90 per cent of the population eligible to get vaccinated (this age groups accounts for as many as <a href="https://www.statista.com/statistics/444868/canada-resident-population-by-age-group/">three million</a> children). This level of vaccination can make a substantial difference in “making it or breaking it” for the health-care system in Canada, which has been strained and not at a full capacity when it comes to <a href="https://theconversation.com/collateral-damage-the-unmet-health-care-needs-of-non-covid-19-patients-145934">serving non-COVID-19 patients</a>. </p>
<p>Currently, in Canada, <a href="https://health-infobase.canada.ca/covid-19/vaccination-coverage/">76 per cent of the total population is fully vaccinated</a> (86 per cent of people 12 and older). In Ontario, <a href="https://www.publichealthontario.ca/-/media/documents/ncov/epi/covid-19-vaccine-uptake-ontario-epi-summary.pdf?la=en">77 per cent of total population is fully vaccinated</a> (87 per cent of people 12 and older). Partial vaccination coverage (single dose) among children ages five to 11 is 5.8 per cent in <a href="https://health-infobase.canada.ca/covid-19/vaccination-coverage/">Canada</a> and 22 per cent in <a href="https://covid-19.ontario.ca/data">Ontario</a>.</p>
<h2>Where we are heading?</h2>
<p>A study by the Laboratory for Industrial and Applied Mathematics at York University shows that, with the current Ontario level of full vaccination in the population of 12 and older and in the absence of vaccination for children under 12, the COVID-19 attack ratio (defined as the proportion of infected individuals in the population during an outbreak) among kids <a href="https://doi.org/10.1101/2021.09.25.21263542">under age 12 can reach 18 per cent</a> (the study is not yet peer reviewed).</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/436453/original/file-20211208-136652-fayxzx.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A boy wearing glasses and a mask gets vaccinated by a health-care worker wearing PPE" src="https://images.theconversation.com/files/436453/original/file-20211208-136652-fayxzx.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/436453/original/file-20211208-136652-fayxzx.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=447&fit=crop&dpr=1 600w, https://images.theconversation.com/files/436453/original/file-20211208-136652-fayxzx.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=447&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/436453/original/file-20211208-136652-fayxzx.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=447&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/436453/original/file-20211208-136652-fayxzx.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=562&fit=crop&dpr=1 754w, https://images.theconversation.com/files/436453/original/file-20211208-136652-fayxzx.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=562&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/436453/original/file-20211208-136652-fayxzx.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=562&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 approval of vaccination for children ages five to 11 years comes at a critical point in the pandemic.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Ryan Remiorz</span></span>
</figcaption>
</figure>
<p>This level of infection in this age group can persist even if the social activity of the populations aged 12 and above remains below 75 per cent of the pre-pandemic level. An effective vaccination among kids five to 11 years old, fortunately, can reduce this attack ratio to under 0.2 per cent. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/im-an-infectious-disease-doctor-yes-im-vaccinating-our-5-year-old-against-covid-19-here-is-why-you-should-too-171001">I'm an infectious disease doctor. Yes, I'm vaccinating our 5-year-old against COVID-19. Here is why you should too.</a>
</strong>
</em>
</p>
<hr>
<p>A recent report by the same group, published in the PHAC modelling group <a href="https://nccid.ca/covid-19-phac-modelling-group/">Weekly Report</a> (October Report) shows that the attack ratio among all kids under 12 can be lowered to below two per cent if half of kids in this age group are fully vaccinated, and to 0.17 per cent with a 90 per cent vaccination rate in this age group. A game changer!</p>
<h2>Omicron and the holidays</h2>
<p>The emergence of Omicron, a variant that is considered to be <a href="https://www.macleans.ca/news/omicron-variant-will-likely-be-worse-than-delta-according-to-early-research/">more transmissible than Delta</a>, adds more urgency to getting younger ones vaccinated to curb circulation in the community and protect those that remain vulnerable even after being fully vaccinated (including the booster shots). Numerous studies show that <a href="https://theconversation.com/covid-19-vaccine-faqs-efficacy-immunity-to-illness-vs-infection-yes-theyre-different-new-variants-and-the-likelihood-of-eradication-154569">vaccines protect against severe cases of COVID-19 disease</a>, and reduce infection and transmission. </p>
<p>So as the holidays approach, encourage and support those who remain on the fence when it comes to the vaccines, and continue to embrace public health measures: face masks, physical distancing, limited gatherings and hand hygiene. The holidays may seem a bit brighter this way!</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/173324/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jianhong Wu receives funding from the Natural Sciences and Engineering Research Council of Canada (NSRRC) and from the Canadian Institute of Health Research. NSERC has also joined force with Sanofi Pasteur Canada in funding his Industrial Research Chair program in Vaccine Mathematics, Modelling and Manufacturing.</span></em></p><p class="fine-print"><em><span>Dasantila Golemi-Kotra 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>The participation of five-to-11-year-old children in vaccination programs will make 90 per cent of the population eligible to get vaccinated against COVID-19.Dasantila Golemi-Kotra, Professor, Biology, York University, CanadaJianhong Wu, Professor and Canada Research Chair in Industrial and Applied Mathematics, York University, CanadaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1683802021-09-28T18:11:04Z2021-09-28T18:11:04ZVax and vacation? Why that Pacific island holiday will still mean ‘traveller beware’<figure><img src="https://images.theconversation.com/files/423443/original/file-20210927-19-17mik7n.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4493%2C2991&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Pacific Island countries are betting big on vaccination as a strategy for <a href="https://www.rnz.co.nz/international/pacific-news/447544/samoa-readies-for-new-zealand-travel-bubble">resuming tourism</a> by Christmas and bringing much needed relief for their struggling economies.</p>
<p>For much of the Pacific, tourism has long been the goose that laid the golden egg. But the pandemic has underlined how fragile and temperamental tourism can be. It relies on stable social and economic conditions at both destination and source — the opposite of what has happened since early 2020.</p>
<p>While border openings dependent on vaccination rates might seem hasty, some Pacific leaders see it as the only <a href="https://www.sibconline.com.sb/solair-losses-sbd-11m-due-to-covid-19/?fbclid=IwAR0fomkKaeEXTQI1l0y83rJtYnmUP3GFM1hQeT6kxoo6MnqT9jYFm-c_MPo">viable path</a> forward for economies that have <a href="https://www.pri.org/stories/2021-01-28/pandemic-wiped-out-tourism-pacific-island-nations-can-they-stay-afloat">nosedived</a> because of COVID.</p>
<p>As the South Pacific’s second pandemic summer approaches, the question is how to balance the risk of further outbreaks with a return to tourism and some kind of economic normality.</p>
<h2>Race to vaccinate</h2>
<p>Against a backdrop of hesitancy and misinformation, vaccination rates in some parts of the Pacific are now breaking world records. <a href="https://www.stuff.co.nz/national/health/coronavirus/125748735/covid19-niue-reaches-herd-immunity-with-97pc-of-eligible-population-vaccinated">Niue</a> and the <a href="https://www.stuff.co.nz/world/300390545/cook-islands-vaccinates-96-per-cent-of-eligible-adults">Cook Islands</a> have almost fully vaccinated all eligible citizens this year.</p>
<p>Samoa is also <a href="https://samoaglobalnews.com/samoa-to-lockdown-fr-8am-6pm-for-two-days/?fbclid=IwAR0wJxbEo1nXjoUXYMjLWzJeJJNK9IQrTys4YCkYGZjNmg07C7JRuMrU5G8">ramping up</a> its vaccination programme in the hope of joining the Cooks and Nuie if and when travel resumes within a contained New Zealand-Pacific bubble. </p>
<p>With vaccination also gaining traction in the Solomon Islands, Vanuatu and Fiji, tourism officials are <a href="https://www.rnz.co.nz/international/pacific-news/416595/solomons-looks-to-limited-border-reopening">hopeful</a> a fully vaccinated population will allow them to reopen borders while protecting the health and safety of citizens.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-cuban-medical-training-has-helped-pacific-nations-face-the-pandemic-challenge-167631">How Cuban medical training has helped Pacific nations face the pandemic challenge</a>
</strong>
</em>
</p>
<hr>
<p>But some tourism-dependent states that opened earlier are now struggling. Guam had to <a href="https://www.france24.com/en/live-news/20210903-guam-halts-vacation-and-vax-tours-as-virus-cases-rise">suspend</a> a “vacation and vax” programme – which allowed international visitors to receive a bonus COVID shot in an effort to jump-start tourism – after a Delta surge caused deaths and mass hospitalisations.</p>
<p>With some 278,000 residents, French Polynesia has recorded more than 40,000 COVID cases and over 600 deaths. With just 54% of the population having received their first vaccine dose, tourism is now largely quarantine-free for fully vaccinated visitors. </p>
<p>In Fiji, despite the virus having spread to tourism spots such as the Yasawa islands, Beqa and Kadavu, tourism stakeholders are <a href="https://www.fijitimes.com/do-what-you-can/">optimistic</a> the country (which has begun to ease local restricitions) will re-open its international borders on November 1.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1428885708995923970"}"></div></p>
<h2>Caution versus desperation</h2>
<p>The other side of the coin, of course, is how prepared and willing tourists will be to plan a Pacific holiday — and what conditions are placed on their travel (such as New Zealand’s current quarantine requirement for re-entry).</p>
<p>After opening to quarantine-free travel with New Zealand in May this year, then closing the borders again due to a largely Auckland-based COVID outbreak in August, the Cook Islands has chosen to adopt a <a href="https://www.stuff.co.nz/national/health/coronavirus/126363357/covid19-no-cook-islands-travel-without-vaccine-zero-covid-cases-in-nz-for-14-days">cautious approach</a>.</p>
<p>In future, it will allow inbound travel only for fully vaccinated people and only when there has been zero community transmission in New Zealand. Given the stubbornly long tail of Auckland’s current Delta outbreak, this could mean longer delays.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/pacific-nations-grapple-with-covids-terrible-toll-and-the-desperate-need-for-vaccines-164769">Pacific nations grapple with COVID's terrible toll and the desperate need for vaccines</a>
</strong>
</em>
</p>
<hr>
<p>Similarly, New Zealand has taken a <a href="https://www.nzherald.co.nz/world/covid-19-coronavirus-nz-takes-cautious-approach-to-fijis-plan-to-reopen-border-amid-outbreak-crisis/W7SWIZ4NBKIPT5E4R4SQRGXYJI/">cautious approach</a> with Fiji after <a href="https://www.rnz.co.nz/news/political/448946/covid-19-indonesia-and-fiji-designated-as-very-high-risk-govt">declaring</a> it a high-risk country and limiting travel for the foreseeable future. For its part, Fiji is relying on <a href="https://ourworldindata.org/covid-vaccinations?country=FJI">mass vaccination</a> and compliance with COVID guidelines, including stringent <a href="https://www.stuff.co.nz/world/south-pacific/300353118/covid19-no-jab-no-job-fiji-requires-all-civil-servants-and-private-sector-employers-and-employees-to-get-vaccine-or-dont-turn-up-to-work">enforcement</a> of vaccination for certain workers.</p>
<p>And despite its devastating recent outbreak, Fiji’s government <a href="https://www.rnz.co.nz/national/programmes/checkpoint/audio/2018811895/fiji-prepares-to-reopen-borders-amid-covid-19-pandemic">has claimed</a> it is showing regional leadership in managing tourism recovery. The aim is to offer quarantine-free travel to visitors from “green list” countries (Australia, New Zealand, Japan, Canada, Korea, Singapore and parts of the US), with visitors needing to be fully vaccinated and testing negative for COVID before departure. </p>
<p>But the eagerness to re-open isn’t shared by all, including the country’s opposition leader, Bill Gavoka, who <a href="https://www.scmp.com/lifestyle/travel-leisure/article/3149422/fiji-reopen-borders-tourists-rescue-its-coronavirus-hit">has said</a>: </p>
<blockquote>
<p>We have got to have our priorities right — health first over the economy. I don’t believe Fiji is ready.</p>
</blockquote>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1442590379207839750"}"></div></p>
<h2>Who wants to travel?</h2>
<p>Ultimately, given these many uncertainties, the fate of tourism-dependent Pacific nations will hinge less on government proclamations than on the risk calculations of tourists themselves.</p>
<p>Elsewhere in the world, tourism destinations have tried to reassure travellers while also protecting their own populations. Greece, for example, enacted <a href="https://www.cityam.com/operation-blue-freedom-greece-races-to-vaccinate-islanders-in-bid-to-go-covid-free/">Operation Blue Freedom</a> with the aim of vaccinating all resident adults on specific islands such as Corfu and Crete by the end of July. Subsequent Delta surges have <a href="https://www.reuters.com/world/europe/greek-tourism-faces-tense-summer-patience-2021-07-26/">disrupted</a> re-opening plans, however.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/fijis-other-crisis-away-from-the-covid-emergency-political-dissent-can-still-get-you-arrested-165238">Fiji’s other crisis: away from the COVID emergency, political dissent can still get you arrested</a>
</strong>
</em>
</p>
<hr>
<p>Pacific nations could potentially implement similar policies in selected locations. But it remains to be seen how much vaccine “passports”, currently being touted as a <a href="https://www.nzherald.co.nz/nz/covid-19-delta-outbreak-the-90-project-behaviour-change-experts-21-tips-to-help-nz-get-vaccinated/SKZ2KBPVFMF6LPFPWC5XBOBH7M/">prerequisite</a> for international travel, will be the crucial circuit breaker.</p>
<p>The ability to track and trace visitors is also important, with some countries wanting tight oversight of tourist itineraries, while others hope voluntary use of tracer apps will be enough. </p>
<p>However there are <a href="https://www.fijitimes.com/apps-traces-moves-technology-to-combat-covid-19/">limitations</a> on using such technologies in the Pacific because they rely on people owning and carrying a mobile phone, having sufficient data and GPS permanently enabled. Network coverage is very poor in some places, and phones often cannot provide sufficiently detailed location information to determine virus exposure.</p>
<p>Whatever the measures, Pacific governments have a major challenge on their hands, especially given their weak public health systems. Having gambled hard on tourism being a mainstay of their economies, they must now live in hope that the tourism goose can get back to laying its golden eggs.</p><img src="https://counter.theconversation.com/content/168380/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Regina Scheyvens receives funding from the Royal Society Te Apārangi under a James Cook fellowship.</span></em></p><p class="fine-print"><em><span>Apisalome Movono 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>Desperate for visitors to return, tourism-reliant Pacific nations are racing to re-open borders before Christmas. But will tourists feel safe enough to travel?Apisalome Movono, Senior Lecturer in Development Studies, Massey UniversityRegina Scheyvens, Professor of Development Studies, Massey UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1654572021-08-23T12:04:06Z2021-08-23T12:04:06ZItaly – once overwhelmed by COVID-19 – turns to a health pass and stricter measures to contain virus<figure><img src="https://images.theconversation.com/files/417242/original/file-20210820-13-18zv54x.jpeg?ixlib=rb-1.1.0&rect=0%2C0%2C2796%2C2000&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Italians must now present a form of vaccine passport called a 'Green Pass' to enter many indoor establishments.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/customer-shows-the-green-pass-to-a-staff-member-before-news-photo/1234526930?adppopup=true">Xinhua News Agency via Getty Images</a></span></figcaption></figure><p><em>Cases of COVID-19 are surging around the world, but the course of the pandemic varies widely from country to country. To provide you with a global view as we approach a year and a half since the official declaration of the pandemic, editors from The Conversation around the world commissioned articles looking at specific countries and where they are now in combating the pandemic.</em></p>
<p><em>Here, Sara Belligoni, a public policy scholar now visiting Rome who wrote for us about the <a href="https://theconversation.com/5-reasons-the-coronavirus-hit-italy-so-hard-134636">devastating wave of cases in Italy in early 2020</a>, reports on the country’s increasingly stringent rules to encourage vaccination and bring daily life closer to prepandemic times. You can see the <a href="https://theconversation.com/us/topics/globalcovid-108477">whole series of articles on TheConversation.com</a>.</em></p>
<p></p><hr><p></p>
<p>Italy was the first Western democratic country that faced the COVID-19 crisis. In early 2020, as parts of the country were being <a href="https://www.advisory.com/en/daily-briefing/2020/03/19/italian-hospitals">overwhelmed with coronavirus cases</a>, some media outlets argued that <a href="https://www.nytimes.com/2020/03/21/world/europe/italy-coronavirus-center-lessons.html">the Italian government had taken too long</a> to impose restrictive measures to fight the spread of the coronavirus. </p>
<p>But Italy has learned several lessons since its <a href="https://edition.cnn.com/2020/03/09/europe/coronavirus-italy-lockdown-intl/index.html">first national lockdown on March 9, 2020</a>, and now – a year and a half after that first crushing wave of COVID-19 cases – the country has put in place <a href="https://www.gazzettaufficiale.it/eli/id/2021/07/23/21G00117/sg">measures</a> that in some cases are more stringent than in other countries, including the United States. </p>
<p>With these new protocols in place – notably, a <a href="https://www.laprensalatina.com/italys-covid-19-health-pass-comes-into-force/">health certificate to show vaccination status for certain activities</a> – daily life is moving toward what many people call a new normal. Despite <a href="https://www.dw.com/en/france-italy-see-mass-protests-against-covid-health-pass/a-58794976">some opposition</a>, Italians <a href="https://www.nytimes.com/2021/08/06/world/europe/italy-green-pass-vaccination-covid.html">support these measures</a>, even when they come with a degree of discomfort or extra steps.</p>
<h2>A vaccine passport</h2>
<p>As of Aug. 6, 2021, the government requires individuals to present the <a href="https://www.thelocal.it/20210722/latest-italy-makes-green-pass-mandatory-as-coronavirus-cases-rise/">“Green Pass”</a> – Italy’s extension of the <a href="https://ec.europa.eu/info/live-work-travel-eu/coronavirus-response/safe-covid-19-vaccines-europeans/eu-digital-covid-certificate_en">European Union Digital COVID Certificate</a> – to attend large events, dine indoors, access gyms and more. The Green Pass is essentially a “vaccine passport”: a document, either digital or printed, that confirms its holder has tested negative for the virus in the last 48 hours, been fully vaccinated or recovered from a case of COVID-19.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/417243/original/file-20210820-17-1dcvxpu.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Signs indicating the requirements for a green pass are displayed at the entrance to a museum" src="https://images.theconversation.com/files/417243/original/file-20210820-17-1dcvxpu.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/417243/original/file-20210820-17-1dcvxpu.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/417243/original/file-20210820-17-1dcvxpu.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/417243/original/file-20210820-17-1dcvxpu.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/417243/original/file-20210820-17-1dcvxpu.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/417243/original/file-20210820-17-1dcvxpu.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/417243/original/file-20210820-17-1dcvxpu.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The Italian government’s ‘Green Pass’ proof of vaccination mandate includes popular destinations like museums.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/signs-indicating-the-requirements-for-a-green-pass-are-news-photo/1332633908?adppopup=true">Alessio Coser/Getty Images</a></span>
</figcaption>
</figure>
<p>According to a <a href="https://twitter.com/swg_research/status/1417191759386333227">survey conducted by SWG Research</a>, more than 50% of Italians supports the Green Pass to regulate activities other than traveling. <a href="https://apnews.com/article/lifestyle-health-travel-arts-and-entertainment-coronavirus-pandemic-2a7ce6c789fa0f6475e26c77a0e60cfc">Business owners</a> welcomed the Green Pass as a tool to avoid more restrictive measures – if not even another lockdown in the fall.</p>
<p>With the more contagious delta variant of the coronavirus <a href="https://www.reuters.com/world/europe/covid-19-delta-variant-gains-prevalence-italy-almost-95-health-institute-2021-07-30/">spreading rapidly</a>, the Italian government is <a href="https://www.youtube.com/watch?v=NBmYxnwzDmo">urging more people to get vaccinated</a>, and requiring use of the Green Pass seems to be motivating more people to get the shots. As soon as <a href="https://www.governo.it/it/articolo/comunicato-stampa-del-consiglio-dei-ministri-n-30/17514">Prime Minister Mario Draghi</a> announced the Green Pass requirements on July 22, 2021, several regions <a href="https://www.italy24news.com/local/129661.html">registered record bookings for vaccine appointments</a>, including Abbruzzo, Lazio, Lombardia, Piemonte and Toscana. </p>
<h2>Progress in the vaccination rollout</h2>
<p>Based on what is <a href="https://apnews.com/article/europe-poland-coronavirus-pandemic-coronavirus-vaccine-europe-bc4de12b667ebfb26b11e89e1f8e8b31">reported in the media</a>, the general public considers the Pfizer-BioNTech and Moderna vaccines <a href="https://www.news-medical.net/news/20210802/Study-shows-efficacy-of-Pfizer-BioNTech-and-Moderna-vaccines-against-SARS-CoV-2-delta-variant.aspx">the most effective against the delta variant</a> of the four vaccines approved by the <a href="https://www.ema.europa.eu/en/human-regulatory/overview/public-health-threats/coronavirus-disease-covid-19/treatments-vaccines/covid-19-vaccines">European Medicines Agency</a>. So in the recent surge of vaccination appointments, most people registered to receive the Pfizer or Moderna shots, as in the case of the <a href="https://www.italy24news.com/News/amp/137269">Marche region</a>.</p>
<p>As of Aug. 4, 2021, Italy’s <a href="https://www.nytimes.com/interactive/2021/world/covid-vaccinations-tracker.html">national vaccination rates were higher</a> than those of the United States, with 53% of eligible people fully vaccinated, compared to 50% in the U.S., and 64% having received first shots, versus 58% in the U.S. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/414763/original/file-20210805-25-f7b9ph.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman wearing a purple hospital gown can be seen through a metal fence. A large colorful sign reads 'Centro Vaccinazioni Anti-Covid 19' in green letters" src="https://images.theconversation.com/files/414763/original/file-20210805-25-f7b9ph.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/414763/original/file-20210805-25-f7b9ph.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/414763/original/file-20210805-25-f7b9ph.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/414763/original/file-20210805-25-f7b9ph.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/414763/original/file-20210805-25-f7b9ph.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=565&fit=crop&dpr=1 754w, https://images.theconversation.com/files/414763/original/file-20210805-25-f7b9ph.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=565&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/414763/original/file-20210805-25-f7b9ph.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=565&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Vaccination site, administering the Pfizer vaccine by appointment, in Rome during July 2021.</span>
<span class="attribution"><span class="source">Sara Belligoni</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Italian COVID-19 Emergency Commissioner, General Francesco Paolo Figliuolo, has set a goal of <a href="https://www.wantedinrome.com/news/covid-19-italy-aims-to-vaccinate-80-per-cent-of-population-by-september.html">80% of eligible persons vaccinated by the end of September</a>. According to Giovanni Rezza, the Health Ministry’s Director of Prevention, that would allow the country to <a href="https://www.thelocal.it/20210310/coronavirus-italy-could-be-back-to-normality-in-7-15-months-says-health-official/">get back to “pseudo-normality”</a> within the first months of 2022. </p>
<h2>Color system tracks the pandemic across regions</h2>
<p>With <a href="https://www.agenas.gov.it/covid19/web/index.php#">low percentages</a> of both intensive care and non-critical hospital beds occupied by COVID-19 patients – 3% and 4% respectively as of Aug. 4, 2021 – as well as widely available vaccines, the Italian Ministry of Health has revised how it uses its <a href="https://www.salute.gov.it/portale/nuovocoronavirus/dettaglioContenutiNuovoCoronavirus.jsp?lingua=english&id=5367&area=nuovoCoronavirus&menu=vuoto">color system</a> to set regional public health mandates based on an area’s pandemic situation. </p>
<p>For over a year, colors were assigned – white, yellow, orange or red, in order of emergency level – based on the region’s number of COVID-19 cases. But as of the Prime Minister’s executive order of July 22, the colors are now assigned weekly based on both infection rates and <a href="https://www.ansa.it/english/news/politics/2021/07/22/govt-seeks-agreement-on-green-pass-new-covid-parameters_26fcf823-afa4-47d6-94c3-dc4d9db4bf27.html">hospitalization rates</a> per 100,000 residents. </p>
<p>A region moves into the red zone when the weekly infection rate rises above 150 per 100,000, combined with an intensive care occupancy rate of 30% and an overall hospitalization rate of 40%.</p>
<p>Regional governors strongly support <a href="https://www.ilsole24ore.com/art/come-cambiano-colori-crescono-ricoveri-ma-nessuna-regione-giallo-almeno-fino-ferragosto-AEhvVBb">these latest changes in the color system</a> because they account for not only the total number of infections and hospitalizations, but also the overall severity of the pandemic in the region. </p>
<h2>Masks mandates</h2>
<p>In addition to the Green Pass, <a href="http://www.italia.it/en/useful-info/covid-19-updates-information-for-tourists.html">several requirements remain in place</a>, such as mask wearing and social distancing when indoors, and social distancing even when outdoors. When it is not possible to maintain social distancing outdoors, then masks must be worn. </p>
<p>The only exceptions to the mask mandate are for children under the age of 6, as well as for people with disabilities and their caregivers when wearing a mask would prevent communication or care. </p>
<p>Italy’s seaside destinations, popular with both Italians and tourists, are open this summer – with beach resorts, restaurants and bars observing social distancing and mask mandates as needed or required by the government.</p>
<p>Indoor dining is resuming in Italy, particularly given the reopening of the country to tourists. But during my recent visit, I’ve observed that many people still prefer to eat outdoors – which is actually the typical choice of Italians during the summer, pandemic or no pandemic.</p>
<p>Outdoor mask mandates are now limited to situations where social distancing is not possible, such as during sport events or in line when entering museums. I’ve noticed, however, that many people are choosing to wear masks on the streets as well as indoors, even when not mandated.</p>
<p>The tourism industry has <a href="https://edition.cnn.com/travel/article/italy-travel-covid-19/index.html">eagerly welcomed the government’s</a> reopening of the country to foreign visitors. Travelers entering Italy from some countries, including the United States, are now required to show an official proof of vaccination – such as the EU Digital Certificate or a U.S. Centers for Disease Control and Prevention vaccination card – a negative COVID-19 test or a certificate of recovery from COVID-19 signed by a health care provider.</p>
<h2>Adjusting work life and school</h2>
<p>Offices are still offering employees the <a href="https://temi.camera.it/leg18/temi/gli-interventi-in-materia-di-lavoro-del-decreto-legge-cura-italia.html">option to work remotely, especially at-risk employees</a>. Where employees who are not in an at-risk category are going back to work, they usually have alternate shifts so fewer people are in the office at the same time. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/414765/original/file-20210805-21-ime1tp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A sign requiring a mask and rear door entry on a public bus" src="https://images.theconversation.com/files/414765/original/file-20210805-21-ime1tp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/414765/original/file-20210805-21-ime1tp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/414765/original/file-20210805-21-ime1tp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/414765/original/file-20210805-21-ime1tp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/414765/original/file-20210805-21-ime1tp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=565&fit=crop&dpr=1 754w, https://images.theconversation.com/files/414765/original/file-20210805-21-ime1tp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=565&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/414765/original/file-20210805-21-ime1tp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=565&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Public transportation signs in Rome during July 2021 require people to board the bus from the back door and get off from the middle one – the door closest to the driver is blocked to protect their health and well-being.</span>
<span class="attribution"><span class="source">Sara Bellogini</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Several companies, including international firms with offices in Italy, are taking steps to ensure compliance with <a href="https://home.kpmg/xx/en/home/insights/2020/04/italy-government-and-institution-measures-in-response-to-covid.html">the latest pandemic laws</a>. For example, <a href="https://www.hbs.edu/covid-19-business-impact/insights/leading-through-a-crisis/back-on-track-what-leaders-can-learn-from-ferrari-s-approach-to-the-pandemic">Ferrari</a>, which closed its main factory in Maranello three days before the first national lockdown was imposed, has established a small internal task force to ensure the company follows the government’s rules and recommendations.</p>
<p>The school year officially starts on Sept. 13, 2021, but the government has not yet issued official policies for school reopenings, and it remains unclear what measures will be in place <a href="https://www.thelocal.it/20210705/covid-19-italian-schools-set-to-keep-using-masks-and-distancing-from-september/">during the school year</a>. Factors that could affect this include the pace of vaccination among children and youth aged 12 to 19 years, and how well schools will be able to maintain social distancing – 6 feet between students and teachers, and 3 feet between students – as some schools may not have enough space in their classrooms. </p>
<p>But the system of showing proof of vaccination is being implemented in education as well: Starting in September, teachers, school staff and students at universities <a href="https://www.wantedinrome.com/news/italy-unveils-covid-green-pass-rules-for-schools-universities-and-transport.html">will need to show a Green Pass</a> or get tested regularly. </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/165457/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sara Belligoni is a member of the CONVERGE COVID-19 Working Groups for Public Health and Social Sciences Research: Emergency Management and Policy Analysis in a Pandemic.</span></em></p>After enduring a devastating wave of infections, deaths and lockdowns at the start of the pandemic, Italy is putting in place tougher anti-COVID measures, including a vaccine passport.Sara Belligoni, Ph.D. Candidate in Security Studies, University of Central FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1649502021-07-28T19:57:06Z2021-07-28T19:57:06ZVaccine selfies may seem trivial, but they show people doing their civic duty — and probably encourage others too<figure><img src="https://images.theconversation.com/files/413446/original/file-20210728-13-1hrcagn.jpeg?ixlib=rb-1.1.0&rect=125%2C29%2C4795%2C3245&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Have you been vaccinated yet? And if you have, are you one of a growing number of people who posted a selfie on social media afterwards? At a time when many people distrust government advertising, vaccine selfies — or “vaxxies” — may well be the secret weapon to encourage more people to get the jab.</p>
<p>Suddenly our Facebook, Twitter and Instagram feeds are filling up with selfies of family, friends and even strangers getting their COVID shot. </p>
<p>But vaxxies are more than mere selfies, as they have a unique social function. They are likely helping normalise the vaccine procedure, reducing hesitancy around perceived risks and increasing vaccine trust within social circles.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CQMrXKGDD6V/?utm_source=ig_web_copy_link","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<p>As <a href="https://www.health.gov.au/news/atagi-statement-on-revised-recommendations-on-the-use-of-covid-19-vaccine-astrazeneca-17-june-2021">governments and health officials</a> continue to flip-flop on vaccine age requirements, and <a href="https://www.thelancet.com/journals/landig/article/PIIS2589-7500(20)30227-2/fulltext">anti-vaxxers</a> <a href="https://www.nature.com/articles/s41562-021-01056-1">spread falsehoods</a> through social media and protests, the vaxxie might just be a powerful line of defence against vaccine hesitancy.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/public-protest-or-selfish-ratbaggery-why-free-speech-doesnt-give-you-the-right-to-endanger-other-peoples-health-165079">Public protest or selfish ratbaggery? Why free speech doesn't give you the right to endanger other people's health</a>
</strong>
</em>
</p>
<hr>
<p>As of July 21, more than <a href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/australias-covid-19-vaccine-rollout#total-vaccine-doses">10.6 million COVID vaccine</a> doses had been administered in Australia. As time passes, more and more people are showing their support by posting about their vaccination experience online. </p>
<p>Normally, we see this type of behaviour demonstrating “civic duty” during <a href="https://www.hitc.com/en-gb/2020/11/04/how-to-share-you-voted-on-facebook/">elections</a> or with social movements such as Pride or Black Lives Matter. We’re now seeing similar posts involving vaccination, using a variety of hashtags including #vaxxie, #GetVaccinated, #GetVaccinatedNow, #Vaccination and #jab. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1417502686677774344"}"></div></p>
<h2>In friends we trust</h2>
<p>The vaxxie could be a useful tool in <a href="https://www.sbs.com.au/news/vaccine-tracker-who-has-had-their-covid-19-jab-in-australia?dlb=%5B2021/07/26%5D%20del_newspm_bau&did=DM1468&cid=news:socialshare:twitter">encouraging people to get vaccinated</a>. Over the past decade in particular, there has been an erosion of trust in traditional advertising and a huge surge in social media use. </p>
<p>This means <a href="https://onlinelibrary.wiley.com/doi/10.1002/cb.1800">word-of-mouth recommendations</a> and reviews from people we know (and even people we don’t) are often considered more “authentic” than standard advertising and government messaging.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australias-new-vaccination-campaign-is-another-wasted-opportunity-162756">Australia's new vaccination campaign is another wasted opportunity</a>
</strong>
</em>
</p>
<hr>
<p>Research indicates we look to our friends, family and social groups for guidance during <a href="https://psycnet.apa.org/record/1996-01799-006?doi=1">uncertain</a> times. They provide us with <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1559-1816.2002.tb00236.x">subjective norms</a>: the desire to behave as those who are significant to us think we should. </p>
<p>This results in social pressure to engage in certain behaviours. If our family and friends are posting vaxxies, it’s an implicit nudge for us to get vaccinated too. And as reported <a href="https://www.reuters.com/world/asia-pacific/after-early-covid-19-response-australia-stuck-vaccine-slow-lane-2021-07-01/">vaccine shortages</a> continue and demand grows, seeing vaxxies can also increase our <a href="https://opus.cloud.lib.uts.edu.au/bitstream/10453/147515/2/How%20Influencers%2c%20Celebrities%2c%20and%20FOMO%20Can%20Win%20Over%20Vaccine%20Skeptics%20-%20HBS%20Working%20Knowledge.pdf">fear of missing out</a> (FOMO). </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1417111687463833603"}"></div></p>
<h2>In-groups and out-groups</h2>
<p>In the same way one shows support for social movements on social media, sharing a vaxxie communicates your position on vaccinations — you are either pro-vax or anti-vax. Essentially, you are either with us or against us: a hallmark of classic in-group/out-group behaviour.</p>
<p>The psychology of the in-group/out-group is best illustrated using <a href="https://journals.aom.org/doi/10.5465/amr.1989.4278999">social identity theory</a>. This theory states internal cohesion and loyalty to the in-group exists when the group members maintain a state of almost hostility or assertive opposition toward out-groups — which are often perceived as inferior.</p>
<p>This theory explains <a href="https://www.tandfonline.com/doi/abs/10.3200/SOCP.145.5.531-546?casa_token=tsVXAsELA7kAAAAA:gfcFppojAXYjoS6pngoLf8hffV6aOztDNZ8sCzLxz2FZwSDQVFQli_NTOnerjaHGEW6xPb2B85NZ0g">spectator behaviour at sporting events</a>. As we see more of our friends sharing their vaxxies, we may desire to be a member of the “in-group”. But to be in this group, we need to get a jab (and show evidence with our own vaxxie).</p>
<p>The in-group pressure may be further increased when we see our political leaders or favourite celebrities get involved. <a href="https://abcnews.go.com/US/video/president-elect-joe-biden-covid-19-vaccine-74849672">US President Joe Biden</a>, Dolly Parton and <a href="https://www.thedailybeast.com/sir-ian-mckellen-and-the-art-of-the-perfect-vaccine-selfie">Sir Ian McKellen</a> are just some of the icons whose vaccinations made headlines.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/413247/original/file-20210727-13-3m8v6n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/413247/original/file-20210727-13-3m8v6n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=603&fit=crop&dpr=1 600w, https://images.theconversation.com/files/413247/original/file-20210727-13-3m8v6n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=603&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/413247/original/file-20210727-13-3m8v6n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=603&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/413247/original/file-20210727-13-3m8v6n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=757&fit=crop&dpr=1 754w, https://images.theconversation.com/files/413247/original/file-20210727-13-3m8v6n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=757&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/413247/original/file-20210727-13-3m8v6n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=757&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Dolly Parton posted her own vaxxie.</span>
</figcaption>
</figure>
<h2>Risks of virtue signalling</h2>
<p>One of the main risks in posting a vaxxie is it could alienate others through virtue signalling, which is when a person behaves in a way that highlights their own “good” moral values. People on Facebook will often loudly <a href="https://link.springer.com/article/10.1007/s10551-018-3999-7">proclaim</a> their support for a certain cause because they want to seem caring or “woke”.</p>
<p>But most of us aren’t impressed by those who overtly express their own moral correctness. There’s a fine line between encouraging others to engage in a certain behaviour and coming across as self-righteous. </p>
<p>There may also be an element of <a href="https://www.nytimes.com/2021/01/12/science/crowds-mob-psychology.html">mob mentality</a> at play with vaxxies. Due to excessive pressure from peers, some may find themselves getting vaccinated for emotional (versus rational) reasons. While the pressure to get vaccinated is arguably positive, some individuals may have legitimate concerns which they will suppress in order to conform. </p>
<p>That said, this is not the same as crowd behaviour which is often shrouded in anonymity and involves blindly following others. Vaxxies are personal, identifiable messages and are not anti-social.</p>
<p>Another risk with vaxxies is they may encourage “brand” competition. Vaxxie posters regularly include the hashtag of their vaccine: #pfizer or #astrazeneca. </p>
<p>Given the mixed messaging around AstraZeneca, could a proliferation of Pfizer vaxxies discourage people from seeking out AstraZeneca, at a time when we’re encouraged to take whichever option we can?</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1384685818929811459"}"></div></p>
<p>Despite the risks, however, it’s clear we will need a variety of tools to encourage people to get vaccinated during this crucial phase of the pandemic. Vaxxies likely have an important role to play on this front.</p>
<p>And as long as they don’t seek to overtly shame or alienate others, they could help engender a strong sense of solidarity as more and more people get the jab.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/virtue-signalling-a-slur-meant-to-imply-moral-grandstanding-that-might-not-be-all-bad-145546">'Virtue signalling', a slur meant to imply moral grandstanding that might not be all bad</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/164950/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Are vaxxies just the latest trend in virtue signalling? And even if they are, does that mean they’re not worth it?Louise Grimmer, Senior Lecturer in Marketing, University of TasmaniaGary Mortimer, Professor of Marketing and Consumer Behaviour, Queensland University of TechnologyMartin Grimmer, Professor of Marketing, University of TasmaniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1631692021-07-07T12:36:46Z2021-07-07T12:36:46ZUS Black and Latino communities often have low vaccination rates – but blaming vaccine hesitancy misses the mark<figure><img src="https://images.theconversation.com/files/409523/original/file-20210702-15-1k69t74.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">With many vaccine-eligible people in the U.S. staying away, some vaccine sites have no lines.
</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/sign-displays-the-types-of-covid-19-vaccination-doses-news-photo/1325495649?adppopup=true">Mario Tama/Getty Images</a></span></figcaption></figure><p>By early July 2021, <a href="https://covid.cdc.gov/covid-data-tracker/#vaccinations">nearly two-thirds</a> of all U.S. residents 12 years and older had received at least one dose of a COVID-19 vaccine; 55% were fully vaccinated. But uptake varies drastically by region – and it is <a href="https://covid.cdc.gov/covid-data-tracker/#vaccination-demographic">lower on average among non-white people</a>.</p>
<p>Many blame the <a href="https://covid.cdc.gov/covid-data-tracker/#vaccination-demographic">relatively lower vaccination rates in communities of color</a> on “vaccine hesitancy.” But this label overlooks persistent barriers to access and lumps together the varied reasons people have for refraining from vaccination. It also places all the responsibility for getting vaccinated on individuals. Ultimately, homogenizing peoples’ reasons for not getting vaccinated diverts attention away from <a href="https://www.kff.org/coronavirus-covid-19/issue-brief/implications-of-covid-19-for-social-determinants-of-health/">social factors</a> that research shows play a critical role in health status and outcomes. </p>
<p><a href="https://www.isu.edu/mph/faculty-and-staff/">As medical</a> <a href="https://scholar.google.com/citations?user=3lNCB0IAAAAJ&hl=en">anthropologists</a>, <a href="https://anthropology.ua.edu/people/stephanie-mcclure/">we take</a> a more nuanced view. Working together as lead site investigators for <a href="https://www.communivax.org/local-teams">CommuniVax</a>, a <a href="https://www.communivax.org">national initiative to improve vaccine equity</a>, we and our teams in Alabama, California and Idaho, along with CommuniVax teams elsewhere in the nation, have documented a variety of stances toward vaccination that simply can’t be cast as “hesitant.” </p>
<h2>Limited access hampers vaccination rates</h2>
<p>People of color have long suffered an <a href="https://www.nytimes.com/2020/01/13/upshot/bad-medicine-the-harm-that-comes-from-racism.html">array of health inequities</a>. Accordingly, due to a <a href="https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/index.html">combination of factors</a>, these communities have experienced higher hospitalization due to COVID-19, higher <a href="https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/disparities-illness.html#ref17">disease severity</a> upon admission, higher chances for being placed on breathing support and progression to the intensive care unit, and higher rates of death. </p>
<p>CommuniVax data, including some 200 in-depth interviews within such communities, confirm that overall, those who have directly experienced this kind of <a href="https://theconversation.com/how-californias-covid-19-surge-widens-health-inequalities-for-black-latino-and-low-income-residents-143243">COVID-19-related trauma</a>, are not hesitant. They dearly want vaccinations. For example, in San Diego’s heavily Latino and very hard-hit “South Region,” COVID-19 vaccine uptake is remarkably high – about <a href="https://www.sandiegocounty.gov/content/dam/sdc/hhsa/programs/phs/Epidemiology/COVID-19%20Vaccinations%20Demographics.pdf">84% as of July 6, 2021</a>. </p>
<p>However, vaccine uptake is far from universal in these communities. This is in part due to access issues that go beyond the <a href="https://doi.org/10.1001/jama.2021.1205">well documented challenges</a> of transportation, internet access and skills gaps, and a lack of information on how to get vaccinated. For example, some CommuniVax participants had heard of non-resident white people usurping doses that were meant for communities of color. African American participants, in particular, reported feeling that the <a href="https://www.cnbc.com/2021/03/10/jj-covid-vaccine-distribution-in-poor-black-communities-raises-race-questions.html">Johnson & Johnson vaccines promoted in their communities</a> were the least safe and effective. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/409527/original/file-20210702-21-1oq8we1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="U.S. First Lady Jill Biden gives comfort to a patient at a vaccination clinic" src="https://images.theconversation.com/files/409527/original/file-20210702-21-1oq8we1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/409527/original/file-20210702-21-1oq8we1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409527/original/file-20210702-21-1oq8we1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409527/original/file-20210702-21-1oq8we1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409527/original/file-20210702-21-1oq8we1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409527/original/file-20210702-21-1oq8we1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409527/original/file-20210702-21-1oq8we1.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">The Biden Administration fell short of its Fourth of July target to have at least one shot to 70% of adults.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/first-lady-jill-biden-comforts-a-nervous-patient-at-the-news-photo/1233600284?adppopup=true">Tom Brenner/Pool/AFP via Getty Images</a></span>
</figcaption>
</figure>
<p>Our participant testimony shows that many unvaccinated people are not “vaccine hesitant” but rather “vaccine impeded.” And exclusion can happen not just in a physical sense; <a href="https://www.aafp.org/journals/fpm/blogs/inpractice/entry/countering_vaccine_hesitancy.html">providers’ attitudes towards vaccines matter too</a>. </p>
<p>For instance, Donna, a health care worker in Idaho, said, “I chose not to get it because if I were to get sick, I think I would recover mostly or more rapidly.” This kind of attitude by health care providers <a href="https://doi.org/10.1016/j.vaccine.2016.10.042">can have downstream effects</a>. For example, Donna may not encourage vaccination when on duty or to people she knows; some, just observing her choices, may follow suit. Here, what appears as a community’s hesitancy to vaccinate is instead a reflection of vaccine hesitancy within its health care system.</p>
<p>More directly impeded are community members who, like Angela in Idaho, skipped vaccination because she couldn’t risk having a negative reaction that might require intervention. Although a trip to the doctor is a highly unlikely outcome after a vaccine, it remains a concern for some. “My insurance doesn’t cover as much as it possibly, you know, should,” she noted. And we have encountered many reports of undocumented individuals who fear deportation although, according to <a href="https://www.boundless.com/blog/can-immigrants-get-the-covid-19-vaccine/">current laws</a>, immigration status should not be questioned in relation to the vaccine. </p>
<p>Christina, in San Diego, illustrates another type of practical barrier. She cannot get vaccinated, she said, because she has no one to care for her babies should she fall ill with side effects. Her husband, similarly, can’t take time off from his job – “It doesn’t work that way.” Likewise, Carlos – who made sure that his centenarian father got vaccinated – says he can’t take the vaccine himself due to his dad’s deep dementia: “If I took my vaccine and I got sick, he’d be screwed.” </p>
<h2>Indifference, resilience and ambivalence</h2>
<p>Another segment of unvaccinated people obscured by the “hesitant” label are the “vaccine indifferent.” For various reasons, they <a href="https://doi.org/10.1001/jama.2021.7707">remain relatively untouched</a> by the pandemic: COVID-19 just isn’t on their radar. This might include people who are self-employed or working under the table, people living in rural and remote places, and those whose children are not in the public school system.</p>
<p>Such people thus are not consistently connected to COVID-19-related information. This is particularly true if they forego social or news media and socialize with others who do the same, and if there are significant language barriers. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/409528/original/file-20210702-25-1f0nmfn.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="vaccine recruitment effort by CommuniVax in June" src="https://images.theconversation.com/files/409528/original/file-20210702-25-1f0nmfn.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/409528/original/file-20210702-25-1f0nmfn.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409528/original/file-20210702-25-1f0nmfn.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409528/original/file-20210702-25-1f0nmfn.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409528/original/file-20210702-25-1f0nmfn.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409528/original/file-20210702-25-1f0nmfn.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409528/original/file-20210702-25-1f0nmfn.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">CommuniVax researchers Sarah Song and Grecia Guerrero talk with potential participants outside a grocery store in June.</span>
<span class="attribution"><span class="source">Diego Ceballos/CommuniVax</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>We also learned that, among some of our participants, the initial messaging about <a href="https://www.washingtonpost.com/health/2021/06/21/young-adults-covid-vaccine/">prioritizing high-risk groups backfired</a>, leaving some under 65 and in relatively good health with the impression it wasn’t necessary for them to get the vaccine. Without incentives – travel plans, being accepted to a college or having an employer that mandates vaccination – inertia carries the day.</p>
<p>The indifferent are not against vaccination. Rather, “if it ain’t broke, don’t fix it” and “you do you” tend to typify their views. As Jose from Idaho reported, “I’m not worried because I’ve always taken care of myself.”</p>
<p>We also saw a modified form of indifference in those who believed that the protective steps they already were taking would be enough to keep them COVID-19-free. A janitor said, “I am an essential worker… So from the beginning we took … all the precautions … face masks, taking [social] distance [and using] natural medicines and vitamins for the immune system.” He had, indeed, so far avoided contracting COVID-19.</p>
<p>The view of vaccines as not immediately necessary is magnified among some Latino people by the cultural value placed on the need to endure – “aguantar” in Spanish — to bear up, push through and avoid complaining about daily struggles. This perspective can be seen in many immigrant or impoverished populations, where getting sick or injured <a href="https://www.npr.org/2020/08/26/904045354/our-communities-are-in-crisis-latinos-and-covid-19">can be a precursor</a> to household ruin through job loss and exorbitant, unpayable medical bills. </p>
<p>Yet another dynamic we learned of is what we term “vaccine ambivalence.” Some participants who view COVID-19 as a significant health threat believe the vaccine poses an equivalent risk. We saw this particularly among African Americans in Alabama – not necessarily surprising given that the health care system has not always had <a href="https://doi.org/10.17226/10260">these communities’</a> <a href="https://doi.org/10.1089/heq.2017.0045">best interests</a> at heart. The perceived conundrum leaves people stuck on the fence. Given the <a href="https://doi.org/10.1007/s40615-020-00928-y">legacy of unequal treatment</a> in communities of color, when balancing the “known” of COVID-19 against the unknown of vaccination, their inaction may seem reasonable – especially when coupled with mask-wearing and social distancing.</p>
<h2>Attending to blind spots</h2>
<p>At this point in the pandemic, those with the means and will to get vaccinated have done so. Providing viable <a href="https://doi.org/10.1080/14797585.2021.1886425">counternarratives to misinformation</a> can help bring more people on board. But continuing to focus solely on individual mistrustfulness toward vaccines or so-called hesitancy obscures the other complex reasons people have for being wary of the system and bypassing vaccination. </p>
<p>[<em>Over 100,000 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>Moreover, an overly narrow focus on the vaccine leaves a lot outside the frame. A wider view reveals that the problems leading to inequitable vaccination coverage are the same structural problems that have, historically, prevented people of color from <a href="https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html">having a fair shot</a> at good health and economic outcomes to begin with – problems that even a 100% vaccination rate cannot resolve.</p><img src="https://counter.theconversation.com/content/163169/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>People who haven’t gotten vaccinated for COVID-19 often have complex reasons for their relunctance or may face other barriers. Lumping them all together undercuts the vaccination campaign.Elisa J. Sobo, Professor and Chair of Anthropology, San Diego State UniversityDiana Schow, Visiting Assistant Professor of Community and Public Health; Executive Director, Southeast Idaho Area Health Education Center, Institute of Rural Health, Idaho State University, Idaho State UniversityStephanie McClure, Assistant Professor of Biocultural Medical Anthropology, University of AlabamaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1602282021-05-14T12:37:43Z2021-05-14T12:37:43ZHerd immunity appears unlikely for COVID-19, but CDC says vaccinated people can ditch masks in most settings<figure><img src="https://images.theconversation.com/files/400555/original/file-20210513-24-1oi0y2i.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4266%2C2623&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A woman walks by a sign in New York City amid the coronavirus pandemic on March 30, 2021.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/person-walks-by-a-sign-that-reads-the-vaccine-is-our-best-news-photo/1310072796?adppopup=true">Noam Galai/Getty Images</a></span></figcaption></figure><p><em>When COVID-19 first began spreading, public health and medical experts began talking about the need for the U.S. to reach herd immunity to stop the coronavirus from spreading. Experts have estimated that between 60% and 90% of people in the U.S. would need to be vaccinated for that to happen. Only about <a href="https://www.nytimes.com/interactive/2020/us/covid-19-vaccine-doses.html">35% of the population has been fully vaccinated</a>, and yet the CDC said on May 14, 2021 that <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html">fully vaccinated people can lose their masks in most indoor and outdoor settings</a>.</em> </p>
<p><em>An important question now arises: What happens if we don’t reach herd immunity? Dr. William Petri is a professor of infectious diseases at the University of Virginia who helps lead the global program to achieve herd immunity for polio as the chair of the World Health Organization’s Polio Research Committee. He answers questions here about herd immunity and COVID-19.</em></p>
<h2>What is herd immunity?</h2>
<p>Herd immunity occurs when there are enough immune people in a population that new infections stop. It means that enough people have achieved immunity to disrupt person-to-person transmission in the community, thereby protecting nonimmune people. </p>
<p>Immunity can result from either vaccination or prior infection. Herd immunity may exist globally, as it does with smallpox, or in a country or region. For example, the U.S. <a href="https://doi.org/%2010.1098/rstb.2013.0433">and many other countries</a> have achieved herd immunity for polio and measles, even though global herd immunity does not yet exist.</p>
<h2>Has herd immunity been achieved globally for other infections?</h2>
<p>This has happened only once on a global scale, with <a href="https://www.cdc.gov/smallpox/history/history.html">the eradication of smallpox in 1980</a>. This was after a decadelong worldwide intensive vaccination campaign. </p>
<p>We also are also approaching global herd immunity for polio. When the <a href="https://polioeradication.org">Global Polio Eradication Initiative</a> was formed in 1988 there were 125 countries with endemic polio and over 300,000 children paralyzed annually. Today, after 33 years of immunization campaigns, Afghanistan and Pakistan are the only countries with wild polio virus, with only <a href="https://science.sciencemag.org/content/368/6489/362.abstract">two cases of paralysis due to wild poliovirus this year</a>. So herd immunity can be achieved worldwide, but only through extraordinary efforts with global collaboration.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/RgYvwj_Q2M4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Dr. Anthony Fauci explains herd immunity at a hearing before Congress.</span></figcaption>
</figure>
<h2>It seems as though the goal posts for herd immunity keep changing. Why?</h2>
<p>Experts estimate that between <a href="https://covid19-projections.com/path-to-herd-immunity/">60% and 90% of the U.S. population</a> would need to be immune for there to be herd immunity. This wide range is because there are many moving parts that determine what is needed to achieve herd immunity. </p>
<p>Factors influencing whether the target is 60% or 90% include how well vaccination and prior infection prevent not only illness due to COVID-19, but also infection and transmission to others. Additional considerations include the <a href="https://doi.org/10.1038/d41586-021-00728-2">heightened transmissibility of new variants of SARS-CoV-2</a> and the <a href="https://doi.org/10.1038/d41586-021-00728-2">use of measures to interrupt transmission</a>, including face masks and social distancing. Other important factors include the duration of immunity after vaccination or infection, and environmental factors such as seasonality, population sizes and density and heterogeneity within populations in immunity.</p>
<h2>What is the biggest barrier to herd immunity in the U.S.?</h2>
<p>Two factors could lead to failure to achieve high enough levels of immunity: not every adult receiving the vaccine because of “vaccine hesitancy” and the likely need to vaccinate adolescents and children. The FDA cleared the <a href="https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-pfizer-biontech-covid-19-vaccine-emergency-use">emergency use of the Pfizer-BioNTech COVID-19 vaccine</a> for adolescents 12 to 15 years of age on May 10, 2021, so that could help. But an added barrier is the constant pressure of reintroduction of infection from other countries where vaccination is not as readily available as in the U.S. </p>
<p>Achieving herd immunity to the extent of totally blocking new infections is therefore, while a laudable goal, not easily achievable. I think that for COVID-19 at this time, it will be possible only with the concerted global effort over years, similar to what led to smallpox eradication.</p>
<h2>Why are there ‘vaccine hesitant’ individuals?</h2>
<p>People may be vaccine hesitant for several reasons, including lack of confidence in the vaccine, the inconvenience of receiving the vaccine, or complacency – that is, <a href="https://doi.org/10.1016/j.vaccine.2015.04.036">thinking that if they get COVID-19 it will not be severe</a>. </p>
<p>Lack of confidence includes concerns for vaccine safety or skepticism about the health care providers and public health officials administering them. Complacency reflects a personal decision that vaccination is not a priority for that individual because she or he perceives that the infection is not serious or because of competing priorities for time. Convenience issues include the availability and complexity, such as having to get two doses. </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>
<h2>Since herd immunity will not be reached, what will our lives look like?</h2>
<p>At least into 2022 and likely for much longer, I do not expect there will be herd immunity for COVID-19. What there will be, probably by the end of this summer in the U.S., is a new normalcy. There will be far fewer cases and deaths due to COVID-19, and there will be a removal of social distancing and year-round masking, as evidenced by the CDC’s new guidelines issued May 13, 2021, that <a href="https://www.nytimes.com/2021/05/13/health/cdc-masks-guidance.html">vaccinated people do not have to wear masks in most places</a>. </p>
<p>But there will be a seasonality to coronavirus infections. That means there will be less in the summer and more in the winter. We’ll also see outbreaks in regions and population subgroups that lack adequate immunity, short-lived lockdowns of cities or regions, new and more transmissible variants and a <a href="https://www.cnbc.com/2021/05/11/covid-booster-shots-cdc-director-says-us-planning-just-in-case.html">likely requirement for vaccine booster shots</a>. We cannot let down on the research and development of treatments and new vaccines, as studies show that <a href="https://doi.org/10.1038/d41586-021-00728-2">COVID-19 is here to stay</a>.</p><img src="https://counter.theconversation.com/content/160228/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>William Petri receives research funding from the NIH, the Gates Foundation and Regeneron Inc.</span></em></p>Vaccination rates for COVID-19 have been lower than desired for herd immunity, or when enough people become immune for new infections to stop. What will life look like without it?William Petri, Professor of Medicine, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.