tag:theconversation.com,2011:/ca-fr/topics/vaccine-safety-36676/articlesVaccine safety – La Conversation2022-06-24T11:53:22Ztag:theconversation.com,2011:article/1856662022-06-24T11:53:22Z2022-06-24T11:53:22ZMisinformation will be rampant when it comes to COVID-19 shots for young children – here’s what you can do to counter it<figure><img src="https://images.theconversation.com/files/470619/original/file-20220623-51620-sao1c0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Talking about vaccines with trusted health care providers and with family can help wade through the sea of information – and misinformation. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/pediatrician-with-girl-in-clinic-during-covid-19-royalty-free-image/1318834248?adppopup=true">Morsa Images/DigitalVison via Getty Images</a></span></figcaption></figure><p>When the Centers for Disease Control and Prevention endorsed both the Pfizer-BioNTech and Moderna COVID-19 vaccines for <a href="https://www.cdc.gov/media/releases/2022/s0618-children-vaccine.html">all children ages 6 months to 5 years</a> on June 18, 2022, it opened the door for <a href="https://theconversation.com/at-last-covid-19-shots-for-little-kids-5-essential-reads-185007">nearly 20 million children to get vaccinated</a>.</p>
<p>While this news comes as a relief to many parents who have been anxiously waiting to get their young children vaccinated, a May 2022 survey found that the majority of parents with children under 5 <a href="https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-february-2022/">feel they don’t have enough information</a> about the safety and efficacy of COVID-19 vaccines for this age group. About 40% also said that information from federal health agencies, such as the CDC and the Food and Drug Administration, about vaccines for this age group was confusing.</p>
<p>This is particularly concerning because confusing messaging from public health agencies opens the door for anti-vaccine activities on social media that target vulnerable parents.</p>
<p>We are a team of <a href="https://www.pediatrics.pitt.edu/people/maya-indira-ragavan-md-mph-ms">medical</a> and <a href="https://publichealth.pitt.edu/home/directory/jaime-sidani">public health</a> professionals at the University of Pittsburgh. We have <a href="https://doi.org/10.1016/j.vaccine.2019.03.003">extensive experience</a> researching <a href="https://scholar.google.com/citations?user=-wHMfaIAAAAJ&hl=en">vaccine misinformation on social media</a> and <a href="https://www.pediatrics.pitt.edu/about-us/diversity-equity-and-inclusion/community-and-culture/pittsburgh-community-vaccine;%20https://grants.nih.gov/grants/forms/biosketch.htm">working with community partners</a> to <a href="https://doi.org/10.1016/j.jadohealth.2021.08.021">address vaccine hesitancy</a>, counter misinformation and <a href="https://scholar.google.com/citations?view_op=view_citation&hl=en&user=8RBqepAAAAAJ&cstart=20&pagesize=80&citation_for_view=8RBqepAAAAAJ:TQgYirikUcIC">promote vaccine equity</a>. </p>
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<figcaption><span class="caption">Social media is a ripe breeding ground for vaccine misinformation.</span></figcaption>
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<p>Through this work, we have seen and studied the ways that anti-vaccine activists on social media target vulnerable parents who are trying to navigate the challenges of digesting health information to make appropriate choices for their children.</p>
<h2>Social media and vaccine misinformation</h2>
<p>Anti-vaccine activists are a small but vocal group. According to research conducted by the nonprofit Center for Countering Digital Hate, <a href="https://www.counterhate.com/disinformationdozen">just 12 social media accounts</a> – the “disinformation dozen” – are <a href="https://www.npr.org/2021/05/13/996570855/disinformation-dozen-test-facebooks-twitters-ability-to-curb-vaccine-hoaxes">behind the majority</a> of anti-vaccine posts on Facebook. Studies also show that only <a href="https://doi.org/10.1377/hlthaff.2011.0396">about 2% of parents</a> reject all vaccines for their children. <a href="https://doi.org/10.1542/peds.2020-007609">A larger group</a>, or about 20% of parents, can more accurately be described as vaccine hesitant, which means they are undecided about having their children receive vaccines <a href="https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html">as recommended by the U.S. Centers for Disease and Control and Prevention</a>. </p>
<p>When it comes to COVID-19 shots, as of May 2022 about 20% of parents with children ages 6 months to 5 years said they would <a href="https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-february-2022/">get their child vaccinated right away</a>. Another 25% said they would wait to see how the vaccine is working, and 35% said they would definitely not get their child vaccinated.</p>
<p>It can be difficult for parents to sort through the large amount of information available about COVID-19 vaccines – both true and untrue. In their search for answers, <a href="https://doi.org/10.1016/j.acap.2019.09.009">some parents turn to social media platforms</a>. The problem is, these parents are often targeted by anti-vaccine activists who are better organized and <a href="https://doi.org/10.1038/s41586-020-2281-1">more skilled at tailoring their messages</a> to the <a href="https://doi.org/10.1016/j.vaccine.2019.03.003">varied concerns of people who are vaccine hesitant</a> than are pro-vaccine activists. </p>
<p>Social media, in particular, has been <a href="https://doi.org/10.1016/S1473-3099(20)30565-X">a primary vehicle</a> for the spread of misinformation. Although sometimes misinformation is blatantly false, <a href="https://doi.org/10.1016/j.amepre.2019.03.009">other times it is more like a game of telephone</a>. A kernel of truth gets modified slightly as it is retold, which ends up becoming something untrue. Unfortunately, exposure to COVID-19 misinformation has been shown to <a href="https://doi.org/10.1038/s41562-021-01056-1">reduce people’s intent to get vaccinated</a>.</p>
<h2>Addressing parents’ vaccine concerns</h2>
<p>So how can pediatricians and other health care professionals empower parents to feel confident in the choice to get their children vaccinated for COVID-19? </p>
<p>The answer may lie in working with communities to promote the vaccine as trustworthy instead of simply asking communities to trust it. We are part of the Pittsburgh Community Vaccine Collaborative, which is a community-academic partnership that seeks to ensure equitable access to the COVID-19 vaccines. Through that effort, we have focused on <a href="https://doi.org/10.1177/15248399211029954">building trustworthiness of the vaccines</a> and of the providers and health systems that are offering the vaccines in their communities. </p>
<p><a href="https://www.pewresearch.org/fact-tank/2020/03/13/amid-coronavirus-threat-americans-generally-have-a-high-level-of-trust-in-medical-doctors/">Health care providers are a trusted source of information</a> for COVID-19 vaccine information, but they are not the only sources. <a href="https://doi.org/10.1080/21645515.2017.1394533">Research has found</a> that it is important to lean on the expertise and voices of community partners, community health workers and religious leaders.</p>
<p>Our research suggests that pediatricians and public health professionals <a href="https://doi.org/10.1016/j.jadohealth.2021.08.021">can effectively use social media</a> to promote vaccination and provide families with reputable scientific information to address their questions and concerns. Results of a survey that was <a href="https://doi.org/10.1016/j.acap.2019.09.009">published in Academic Pediatrics</a> found that 96% of parents used social media. Of those, 68% reported using it for health information.</p>
<p>For example, <a href="https://kidspluspgh.com/">a pediatric group</a> we partner with <a href="https://people.com/human-interest/dr-todd-wolynn-takes-on-anti-vaxxers-science-singing-silly/">uses comedy combined with information</a> to combat myths and answer questions about the COVID-19 vaccines. </p>
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<p><a href="https://doi.org/10.1177/00099228211046499">Research shows</a> that parents who report high COVID-19 vaccine intention for themselves also report high COVID-19 vaccine intention for their children. Therefore, talking about vaccines as a family may be helpful in combating misinformation around the COVID-19 vaccine. In addition, parents who have had their children vaccinated can use social media to share their experiences and <a href="https://doi.org/10.1016/j.econlet.2021.109979">make it feel more normal</a> and accepted among their peers.</p>
<p>We have also learned that promoting <a href="https://www.commonsensemedia.org/news-and-media-literacy/what-is-media-literacy-and-why-is-it-important">media literacy</a>, which encourages people to question the media information they come into contact with, can empower parents to sift through the “<a href="https://www.who.int/health-topics/infodemic">infodemic</a>” of COVID-19 vaccine information. </p>
<p>While social media platforms have announced policies of removing vaccine misinformation, <a href="https://doi.org/10.2105/AJPH.2021.306288">research suggests</a> this is not always effective at reducing the influence of such misinformation. Learning how to find the source of a piece of information and thinking about who are the intended targets may help people determine whether the information is true or distorted.</p>
<h2>Next steps</h2>
<p>Addressing COVID-19 vaccine misinformation can feel overwhelming. The <a href="https://www.aap.org/en/">American Academy of Pediatrics</a> has <a href="https://healthychildren.org/English/tips-tools/ask-the-pediatrician/Pages/when-can-children-get-the-COVID-19-vaccine.aspx;%20https://www.healthychildren.org/English/news/Pages/aap-applauds-approval-of-safe-effective-covid-19-vaccines-for-children-ages-6-months-and-older.aspx">helpful information for parents</a> to support making decisions around the COVID-19 vaccine. Parents can also have conversations with their children about media literacy and evaluating information. And they can talk to their children – especially adolescent-age children – about how getting the COVID-19 vaccine can protect them and others. </p>
<p>For questions around COVID-19 vaccines for children of all ages, we recommend you talk with your pediatrician or another health care provider. During that visit, you can also make sure your child is up to date on other vaccines, as <a href="http://dx.doi.org/10.15585/mmwr.mm6919e2">studies have shown</a> that vaccine rates for routine childhood vaccines have decreased during the COVID-19 pandemic.</p>
<p>Increasing COVID-19 vaccine rates for children is important to promote their health and wellness, as well as to move closer to ending the pandemic. </p>
<p><em>This is an updated version of <a href="https://theconversation.com/covid-19-vaccines-for-children-how-parents-are-influenced-by-misinformation-and-how-they-can-counter-it-173212">an article originally published</a> on Dec. 15, 2021.</em></p><img src="https://counter.theconversation.com/content/185666/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jaime Sidani receives funding from the Richard King Mellon Foundation, the American Heart Association, and the National Institutes of Health. </span></em></p><p class="fine-print"><em><span>Beth Hoffman receives funding from the Richard King Mellon Foundation and the National Institutes of Health</span></em></p><p class="fine-print"><em><span>Maya Ragavan currently received funding from the Centers for Disease Control and Prevention. She received funding from a National Center for Advancing Translational Sciences KL2 and an Allegheny County Health Department grant. </span></em></p>With COVID-19 shots finally available for infants and preschoolers, knowing how to combat misinformation on social media and elsewhere could be more important than ever.Jaime Sidani, Assistant Professor of Public Health, University of PittsburghBeth Hoffman, Postdoctoral Associate in Behavioral and Community Health Sciences, University of PittsburghMaya Ragavan, Assistant Professor of Pediatrics, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1841692022-06-02T20:18:18Z2022-06-02T20:18:18ZSocial media spreads rumours about COVID vaccine harms … but it doesn’t always start them<figure><img src="https://images.theconversation.com/files/466593/original/file-20220601-49499-69oasn.jpg?ixlib=rb-1.1.0&rect=417%2C67%2C6053%2C4239&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/Nv-vx3kUR2A">Thought Catalogue/Unsplash</a></span></figcaption></figure><p>For decades, anti-vaccine movements have generated and spread <a href="https://www.sciencedirect.com/science/article/pii/S0264410X11019086?via%3Dihub">rumours that vaccines</a> cause serious health problems. The rollout of COVID vaccines has provided <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251605">new opportunities to spread misinformation</a>.</p>
<p>At the start of the pandemic, people were already <a href="https://theconversation.com/the-9-psychological-barriers-that-lead-to-covid-19-vaccine-hesitancy-and-refusal-168643">worried</a> about the virus and the impact of other public health measures, such as lockdowns, on their physical and social well-being. As COVID vaccines were rolled out, concerns mounted about the small but serious <a href="https://theconversation.com/a-balancing-act-between-benefits-and-risks-making-sense-of-the-latest-vaccine-news-158634">risk of blood clots</a> linked to the AstraZeneca vaccine.</p>
<p>Alongside this, there has been a degree of panic around unsubstantiated rumours of adverse events – extremely rare medical problems after being vaccinated – circulating on social media. </p>
<p>But contrary to the popular belief that social media <em>creates</em> these rumours, <a href="https://www.ssph-journal.org/articles/10.3389/ijph.2022.1604228/full?&utm_source=Email_to_authors_&utm_medium=Email&utm_content=T1_11.5e1_author&utm_campaign=Email_publication&field=&journalName=International_Journal_of_Public_Health&id=1604228">our new research</a> suggests social media generally only <em>aids the spread</em> of these rumours.</p>
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Read more:
<a href="https://theconversation.com/the-9-psychological-barriers-that-lead-to-covid-19-vaccine-hesitancy-and-refusal-168643">The 9 psychological barriers that lead to COVID-19 vaccine hesitancy and refusal</a>
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<h2>What ‘vaccine harms’ are people sharing on social media?</h2>
<p>We have been <a href="https://bmjopen.bmj.com/content/11/6/e049356">studying community attitudes</a> to COVID vaccinations, including the flow of information on social media, the kinds of information being shared, and by whom.</p>
<p>In our <a href="https://www.ssph-journal.org/articles/10.3389/ijph.2022.1604228/full?&utm_source=Email_to_authors_&utm_medium=Email&utm_content=T1_11.5e1_author&utm_campaign=Email_publication&field=&journalName=International_Journal_of_Public_Health&id=1604228">latest study</a>, we tracked emerging concerns about alleged adverse events globally. We used Google Trends and Crowdtangle – a research platform for studying Facebook’s public-facing data. We focused on the most commonly searched and discussed events to track where they were coming from.</p>
<p>We dug into the five most frequently searched adverse events: clotting, fainting, Bell’s palsy, premature death and infertility. </p>
<p><strong>Clotting</strong></p>
<p>Clotting was associated with the AstraZeneca vaccine and the <a href="https://theconversation.com/how-rare-are-blood-clots-after-the-astrazeneca-vaccine-what-should-you-look-out-for-and-how-are-they-treated-161280">rare instances of thrombosis with thrombocytopenia syndrome (TTS)</a>. This led to the vaccine’s suspension or authorities placing age restrictions on its recipients in many countries. </p>
<p>News reporting on clotting was generally reasonable and in line with the threat the condition posed. Because the issue was newsworthy on its own, it did not require sensationalist reporting. Social media spread these reports globally, so the first reports of clotting, emerging from Austria, spread on Facebook pages as far as Ghana, the Philippines and Mexico within eight hours.</p>
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<img alt="A nurse puts a bandaid on a woman's arm after an vaccination." src="https://images.theconversation.com/files/466738/original/file-20220602-22-j83j7i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/466738/original/file-20220602-22-j83j7i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/466738/original/file-20220602-22-j83j7i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/466738/original/file-20220602-22-j83j7i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/466738/original/file-20220602-22-j83j7i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/466738/original/file-20220602-22-j83j7i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/466738/original/file-20220602-22-j83j7i.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">The risk of clots caused concern.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/GZkhG_EvWfY">CDC/Unsplash</a></span>
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<p><strong>Fainting, Bell’s palsy and premature death</strong></p>
<p>There was no scientific basis for the other four rumours we investigated. However, three of them drew specifically from “traditional” (television and newspaper) news reporting on specific incidents. </p>
<p>For example, a Tennessee nurse fainted on television shortly after receiving the Pfizer vaccine. Traditional media reports included the nurse’s own disclosure of a history of fainting and cautioned against attributing it to the vaccine. </p>
<p>Likewise, elderly baseball legend Hank Aaron died from natural causes two weeks after receiving a COVID vaccine on camera. He had hoped to inspire other Black Americans to be vaccinated. </p>
<p>These two incidents were widely reported in traditional media and soon flowed into social media posts attributing them to the vaccine.</p>
<p>The Bell’s palsy rumour came out of news reports in Bangladesh, which were then picked up by a UK outlet, attributing the rare condition to the Pfizer vaccine. </p>
<p><strong>Infertility</strong></p>
<p>The rumours of COVID vaccines causing infertility were the only ones that we could not trace to an original “traditional media” source. Instead, two internet stories misrepresenting the work, and words of scientists were shared widely on social media. Traditional media only picked up the story to report on the misinformation occurring. </p>
<p>We describe this as an example of vaccine sceptics “theory crafting” online. This is when a group of people on the internet use their collective resources to analyse information to develop plausible explanations for events. </p>
<p>In the case of infertility, a willing community misused two scientific sources to construct what they represented as compelling evidence of a cover-up. This theory then led to a persistent internet rumour that COVID vaccines caused fertility problems.</p>
<p>In the other four cases above, we found <a href="https://theconversation.com/media-reports-about-vaccine-hesitancy-could-contribute-to-the-problem-161422">traditional media still played an important role</a> in determining people’s awareness of alleged adverse events. </p>
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<img alt="Pregnant woman holds her dress." src="https://images.theconversation.com/files/466600/original/file-20220601-49109-8b00pd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/466600/original/file-20220601-49109-8b00pd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/466600/original/file-20220601-49109-8b00pd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/466600/original/file-20220601-49109-8b00pd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/466600/original/file-20220601-49109-8b00pd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/466600/original/file-20220601-49109-8b00pd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/466600/original/file-20220601-49109-8b00pd.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">Traditional media reported on vaccine myths about fertility.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/WI-x1wo_Jm4">Ömürden Cengiz/Unsplash</a></span>
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<h2>What did mainstream news outlets do?</h2>
<p>Traditional media outlets were important to those sharing the social media posts, as they treated mainstream media reports as markers of credibility. </p>
<p>Vaccine-sceptical communities used international media sources to build “evidence” for adverse events. They then redistributed this “evidence” among their international networks.</p>
<p>Disreputable outlets chased “<a href="https://theconversation.com/four-reasons-why-listicles-and-clickbait-are-killing-real-journalism-67406">clickbait</a>”, accelerating the spread of misinformation. For instance, when 86-year-old Aaron died, one <a href="https://www.republicworld.com/sports-news/other-sports/hank-aaron-death-mlb-legend-shockingly-passes-away-weeks-after-taking-covid-19-vaccine.html">site</a> led with the headline “Hank Aaron Death: MLB Legend Shockingly Passes Away Weeks After Taking COVID-19 Vaccine”. This headline spread much faster and further on social media than the majority of reports that explained Aaron’s death was not a result of his vaccination. </p>
<p><a href="https://www.ssph-journal.org/articles/10.3389/ijph.2022.1604228/full?&utm_source=Email_to_authors_&utm_medium=Email&utm_content=T1_11.5e1_author&utm_campaign=Email_publication&field=&journalName=International_Journal_of_Public_Health&id=1604228">Inaccurate and sensationalist headlines</a> in mainstream media went on to drive significant searches and shares. The rumours flowed globally, unfettered by national boundaries. </p>
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Read more:
<a href="https://theconversation.com/media-reports-about-vaccine-hesitancy-could-contribute-to-the-problem-161422">Media reports about vaccine hesitancy could contribute to the problem</a>
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<p>Despite most of the rumours we investigated gaining traction because of media reporting, journalists also played an important role in suppressing or debunking illegitimate claims. </p>
<p>The disruption of earlier media models clearly poses a challenge for the accuracy of information shared on the internet. The imperative for news sources to generate clicks can outweigh the imperative to provide accurate and reliable information.</p>
<h2>So what’s the solution?</h2>
<p>We can see no easy answers for resolving the flow of misinformation online. </p>
<p>However, the use of credibility markers for both authors and stories on social media is one possible solution. A system where publicly recognised topic experts can “upvote” and “downvote” news stories to produce a “credibility score” would help readers judge the perceived credibility of particular stories and information.</p>
<p>In the meantime, we recommend scientists and health professionals, where possible, promote their own perspectives when a story about alleged adverse events needs clarifying. Doing so can potentially change the trajectory and spread of a story. </p>
<p>Scientists and health professionals speaking out can’t prevent the stories from being shared within online communities of vaccine-refusers. These people are invested in sharing such information regardless of its veracity. However, professionals can limit the damaging spread of rumours once media outlets begin to report their debunking. </p>
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Read more:
<a href="https://theconversation.com/we-cant-trust-big-tech-or-the-government-to-weed-out-fake-news-but-a-public-led-approach-just-might-work-155955">We can't trust big tech or the government to weed out fake news, but a public-led approach just might work</a>
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<p class="fine-print"><em><span>Katie Attwell receives funding from the Australian Research Council and the WA Department of Health. She is funded by ARC Discovery Early Career Researcher Award DE1901000158. She is a specialist advisor to the Australian Technical Advisory Group on Immunisation (ATAGI) COVID-19. All views presented in this article are her own and not representative of any other organisation.</span></em></p><p class="fine-print"><em><span>Tauel Harper 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>Contrary to the popular belief that social media creates rumours about COVID vaccine harms, new research suggests social media generally only aids the spread of these rumours.Katie Attwell, Associate professor, The University of Western AustraliaTauel Harper, Senior Lecturer, Media and Communication, UWA, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1740322021-12-19T11:14:36Z2021-12-19T11:14:36ZAnswers from COVID experts: How do you talk to family members who aren’t vaccinated? How can the vaccines be safe if they were developed so quickly? Is natural immunity better than being vaccinated?<figure><img src="https://images.theconversation.com/files/438294/original/file-20211218-23072-19asa4x.JPG?ixlib=rb-1.1.0&rect=4%2C4%2C2991%2C1962&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">With the holiday season approaching, people wait to receive a COVID-19 vaccination in Montréal as the pandemic continues in Canada and around the world. </span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Graham Hughes </span></span></figcaption></figure><p><em>The Conversation Canada and McMaster University recently co-hosted a live event on vaccine hesitancy. Editor-in-Chief Scott White spoke with four researchers from McMaster: Medical doctor, educator and researcher Zain Chagla; immunologist Dawn Bowdish; Manali Mukherjee, an assistant professor in the division of respirology at McMaster’s department of medicine; political scientist Clifton van der Linden, who has been conducting ongoing public opinion surveys on COVID-19. Viewers submitted questions to the panel. This is an edited excerpt from the discussion, but you can watch the entire event in the video below.</em></p>
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<p><strong>Scott White</strong>: How many of you have a vaccine hesitant person in your inner circle? What have you tried to say to them to persuade them that vaccines are safe?</p>
<p><strong>Dawn Bowdish</strong>: All the good practices that I use with strangers, I have a hard time implementing with my own family. I think one of the important parts about vaccine hesitancy is it’s not my facts versus your facts and I have all the right facts and you have all the wrong facts, because people who are vaccine hesitant have lots of information, and there’s no metric to say that makes them feel that my information is better than theirs. So I feel like listening to people’s concerns and being really specific and not making judgment calls about what their concerns might be. Because to be honest, the vaccine hesitancy spectrum is huge. So where I have gone wrong with my own family is doing all the things that you shouldn’t do. I talked more than I listened. I threw scientific facts as opposed to listening to people’s stories and concerns. And I appealed to the authority. “I’ve got a PhD. I’ve been working on this for 20 plus years,” and that was a mistake. And so those are the things I would caution people against when you have your own conversations with your vaccine hesitant family members or friends.</p>
<p><strong>Zain Chagla</strong>: We know from things like smoking cessation where the more times that conversation happens in a nonjudgmental and non-confrontational matter, it often ends up with the right outcome at the end of the day. So again, it’s not a conversation to win to the other side and get someone to the pharmacy that afternoon. It’s a conversation to start another conversation and start another conversation and keep going along those lines.</p>
<p><strong>Scott White</strong>: Cliff, you’ve done a lot of work on taking the public pulse on this. What have you learned on trying to convince someone?</p>
<p><strong>Clifton van der Linden</strong>: Certainly, no matter how we model the public opinion data coming in on attitudes towards COVID-19, when it comes to vaccine hesitancy, trust is really the major factor. I think we are in an era where there’s a real sense of anti-intellectualism that’s being cultivated in certain corners of the internet. I think the social media discourse has a huge role to play in the way that trust has eroded as a society. But there are factors in the way that government has conducted itself. There are factors in the bad faith in which certain public actors have conducted themselves. And so there are lots of reasons for mistrust at an institutional level. So I do think that trying to ground conversations with people we love in that framework of trust, knowing that we are concerned about them, that we’re approaching them not because we want to be right but because the consequences of them being wrong are so dire for themselves and for our families and loved ones.</p>
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<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
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<h2>Why are there such strong reactions against vaccines?</h2>
<p><strong>Scott White</strong>: One thing that’s always puzzled me is that there seems to be this really rabid reaction against vaccines, but not other medical procedures like surgery, which is far more invasive, or taking medicine. What is it about vaccines that really seems to cause this hesitancy or resistance?</p>
<p><strong>Dawn Bowdish</strong>: My belief is that it’s partly because it’s a needle and partly because there’s this big mystery about how the immune system works and how it (the vaccine) could be so powerful. The active ingredients in our current vaccines is like 10 micrograms. If you look in your medicine cabinet at your Tylenol, your Advil or whatever, you’ll see that we work in milligrams. But 10 micrograms, a thousand times less, has this incredible powerful effect to be able to create a whole immune response. The amount of stuff that’s in the vaccine is negligible. It’s nothing. But this incredibly powerful immune event, I think is a little bit humbling in some ways.</p>
<p><strong>Clifton van der Linden</strong>: I think that especially in the last five or six years, we have been flooded with discussions of fake news, misinformation, disinformation. I mean, we are told not to trust what we hear from government, depending on who’s running government. The idea that you can trust one day and then not trust the next when there’s a change of party, it leaves people in the state of constant cynicism about the good faith I think particularly of elected officials, but also of government institutions in general. I think there’s a difference in Canada compared to countries like the U.S., where in Canada we do see that the public tends not to trust elected officials, but we still do have a lot of trust in our public health institutions in Canada.</p>
<h2>The safety of vaccines that were developed so quickly</h2>
<p><strong>Scott White</strong>: At <em>The Conversation</em>, we’ve been running <a href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">a series of articles about vaccine confidence and vaccine hesitancy</a> and have been inviting questions from the public. And sort of one of the recurring questions that we get is that people seem to have trouble wrapping their head around the fact that the COVID vaccines have been developed so quickly and that scientists don’t know the long-term effects.</p>
<p><strong>Dawn Bowdish</strong>: The apparent speed was based on decades of fundamental research. I love this as a story because often times as a university academic, the general public thinks we waste time working on things that are fundamentally unimportant. In fact, we did have mRNA based vaccines in the pipeline for many different infections. One of the beauties of the mRNA technology is that it’s fairly easy to alter. Many of the features of vaccination – the dosing intervals, the amount of doses, how we de develop things for kids and for adults and older people – are all based on decades and decades of experience.</p>
<h2>Pregnancy and vaccines</h2>
<p><strong>Scott White</strong>: We get a lot of questions about the potential impact of vaccines on fertility. Zain, from a medical perspective, what are the dangers of not being vaccinated if you are pregnant?</p>
<p><strong>Zain Chagla</strong>: Look, no one is going to deny that most people do get through their infections and don’t die. I think we know this very well, but it doesn’t say that everyone is safe. We do know that elderly people are much more at risk of complications. We know what people with comorbidities are in much more risk of complications. And we have seen young people, who despite looking great on paper, are sitting in our ICUs ventilated, because again, once this virus gets out of control, once the immune system gets super jacked up, it really can cause chaos. And we sometimes don’t know who is that person that it’s going to be chaotic in and not. Pregnant women, I think we’re recognizing much more are in that risk group now. And then we have seen some fairly sick pregnant women. They’re physiologically unwell. They’re obviously carrying a baby. The concerns of having severe COVID not only in the mother, but in the baby, are also a major issue. Unfortunately, we’ve had to deliver babies prematurely for the fact that it would spare the mother their lives more and then make their mother’s oxygenation better.</p>
<p><strong>Dawn Bowdish</strong>: We don’t have a single example of a vaccine leading to long term fertility issues or leading to, I don’t even know what people are envisioning with the context of fertility, but the immune system attacking your ovaries or whatever. And in fact, all those mythologies I think were incredibly clever by the anti-vax group. Because if you’re a parent, what more do you want than grandchildren? And so what is going to trigger your emotional response and your desire to wait and to see more than that threat?</p>
<h2>What is long COVID?</h2>
<p><strong>Scott White</strong>: Manali, you’ve not only researched long COVID, but you’re dealing with it personally. I’m not sure that people fully understand the term and the impact that it can have on your life. So can you tell us about that? And then also speak about the best way to avoid it.</p>
<p><strong>Manali Mukherjee</strong>: A considerable proportion of people who have been infected with COVID-19, irrespective of how severe they were, whether they were in the hospital or whether they recover at home, they continue to have symptoms or actually develop new symptoms long after they have so-called recovered. So the public health gives you that call and tells you, “You know, you have recovered. If you’re feeling fine, go back to work.” But there are a number of people who still feel sick, who have lingering symptoms. These symptoms can range anywhere from chronic fatigue, sense of smell not being there, completely being distorted, having diffused pain, and of course all these can lead to anxiety, palpitations and cognitive impairment. So it’s a constellation of symptoms that’s kind of lingering. And none of these symptoms can be attributed to a clinical diagnosis that they either had before getting COVID. We are trying to look at what might be the reason behind it. I have reasons to believe that it’s deep seated within the immune system. I think that after having COVID, the immune system is still so hyper and it still thinks that the virus is possibly hiding somewhere or there is something still going on and the symptoms are a clinical manifestation of that misunderstanding that the immune system has. So that’s what we are trying to right now unravel and understand and makes sense.</p>
<p><strong>Scott White</strong>: Who’s more susceptible to long COVID? Is it younger people? Older people? Do we know?</p>
<p><strong>Manali Mukherjee</strong>: In my study, I’m seeing people from all age groups, all ethnicities coming in. Even asymptomatic people, people who have the infection, PCR positive test was in asymptomatic. Now they’re having symptoms. So really, we don’t know who’s going to get affected, why they’ll be affected. And worse, we just don’t know when this will stop or whether it will. What worries me right now is we don’t know much right now about the long COVID cases that we have from the original virus, the Wuhan virus to the alpha, beta, delta strains, how long COVID symptoms vary. And now the omicron has come in where we don’t know how it’s really going to be affecting our immune system given that it seems to have a higher transmissibility. And having been said, despite having a milder load, we don’t know how it’s going to really affect those with a longer COVID kind of situation. Will it affect more people with lingering, longer persisting symptoms than actually having a more severe acute infection phase? We don’t know. If you are vaccinated, there is data out there that it kind of reduces your long COVID symptoms. So if you are vaccinated and then still you get omicron, the logic tells me that your immune system might be a better streamlined, the way Dawn said, to handle that infection in a better mode as to not confuse it and make it more rowdier and lead to those lingering long COVID symptoms. So that is again another thing that tells me that vaccination and taking the boosters might actually be in our benefit as a society and community going towards natural immunity or herd immunity.</p>
<h2>Natural immunity vs. vaccine immunity</h2>
<p><strong>Scott White</strong>: There’s been a lot of discussion about herd immunity and on social media, instant experts say natural immunity is better than being vaccinated. Dawn, tell us about herd immunity and natural immunity versus vaccinated – especially as we’re now dealing with the omicron variant.</p>
<p><strong>Dawn Bowdish</strong>: Well, I mean, Manali just gave you an example of natural immunity, right? Long COVID is a natural immune response in some people. I don’t think there’s anything unnatural about a vaccine response. It’s giving your immune system the opportunity to work without distraction, right? So when you get infected with a virus, the virus doesn’t just say, “Oh, whoa. It was me. The immune system’s coming to get me.” It’s destroying tissues. The immune system in many cases is misdirecting and attacking those tissues. So some of the tissue damage we see is mediated by natural immunity, because it gets confused where there’s tissue damage in the context of infections. So natural immunity works sometimes, but vaccine immunity is natural immunity. It’s immunity working without distraction, letting the immune system do its thing without having this virus that’s fighting back and trying to thwart it. The thing about herd immunity is, let’s go back to a time before we had vaccines, antibiotics and doctors. One in three to one in five children died. There were more miscarriages, spontaneous abortions and babies born with severe complications because having an infection during pregnancy is problematic. Sure, if you were one of the lucky ones to survived your first birthday, you might have some level of protection until you got older or until you’ve had some immune compromising event or other illness. So a herd immune system gives a small percentage of the population a little bit of time to be protected from that. But as soon as a new baby’s born, a new pregnancy started, that susceptibility happens all over again. So the idea that we would just let a new virus run rampant in a population and take those risks to the young, the old, the random healthy adults is just cruel from my perspective. Really cruel. The best way for us to reach herd immunity is to get us all vaccinated.</p>
<p><strong>Zain Chagla</strong>: Right now our health-care system is burned to a crisp. We can’t deal with our current caseloads because we have complex patients coming in every day. We have ICU beds that are still allotted for COVID patients and we have health-care workers that are burnt out and have left the profession and are not coming back. So there is a lot of worry in the coming weeks and months as this circulates, that we’re going to see health systems overload. We’re going to see a lot of people test positive regardless of the vaccine status. And we’re going to see a lot of isolation and complications from that. The good news out of all of this though, is boosters do seem to really change the dynamic of vaccines and offer higher level of protection. We’re getting better data by the day that really is suggesting this. And so, I think there is work being done right now across the country, in particular Ontario, to make sure people do have access to a booster shot when their time comes.</p>
<h2>A lack of trust in expertise</h2>
<p><strong>Scott White</strong>: Some people don’t trust government. They don’t trust pharmaceutical companies. And although they may trust their personal doctor, they don’t trust intellectuals and they don’t trust people at universities. Why is that Cliff?</p>
<p><strong>Clifton van der Linden</strong>: We’ve seen a rise in populism throughout western democracies. And along with that rising populism, we’ve seen an unprecedented strain of anti-intellectualism, rejection of science in ways that we have not seen in the post-war era. So I think this is tied up in ideological convictions of partisanship, but really also in polarization. It’s no longer acceptable to have reasonable disagreements. I do think that the structure of public discourse on social media has conditioned us in such a way as to stick to our guns no matter what, to really not be permitted to make mistakes or reverse our judgment even if that means rejecting the decades of scientific research that have been undertaken. And then also looking for signals that substantiate that existing bias that one has.</p>
<h2>Isolation is not a protection strategy</h2>
<p><strong>Scott White</strong>: We had a question sent in to us about someone who’s homeschooled their kids and therefore they believe that that minimizes exposure to others. Again, you hear this from some people. “I don’t get out much” or “I don’t work in an office” or “I work outside, so therefore I don’t really need to be vaccinated.” How would you respond to someone who said something like that?</p>
<p><strong>Zain Chagla</strong>: I have seen people who have tried their best to isolate people that were homebound, but are reliant on certain people to be in their environment for their care that have gotten COVID. So number one, reducing your contacts and staying at home will reduce your risk, but it’s fallible. There are ways that people can get through it. People have to still go to the grocery store, people eventually have to see family, people have to get in public transit, and other ways that people came at exposed. Number two, there is this overlying belief that COVID-19 is somehow going to disappear from the face of this earth. And it’s not, right? This is going to be one of our endemic viruses. It’s not there yet. We’re still seeing epidemic spread, but this is going to be there today, it’s going to be there tomorrow, it’s going to be there the next day. And so, unless you plan on you and your family living a lifestyle where you’re going to be homeschooled and staying at home for the foreseeable decade or two, you’re going to encounter COVID at some point or another. And again, the best thing you can do for your body is have immunity to the virus and have a head start so that when you are encountering this virus, you can deal with it.</p>
<h2>Can minds be changed at this stage?</h2>
<p><strong>Scott White</strong>: Cliff, as someone who’s taking the pulse of the public all the time, do you think that at this stage, almost a year to when the vaccines have been available, is there anything that can be done to convince those who haven’t been vaccinated to actually make that decision now?</p>
<p><strong>Clifton van der Linden</strong>: I think there are some difficult decisions that policy makers have to engage with around this. We’ve seen the efficacy of mandatory vaccinations in certain sectors that has led to people who don’t want to be vaccinated, but nevertheless have made the decision to be vaccinated based on the policies that were put in place. That’s not something that should be done lightly. I think there are reasonable concerns about the government imposing mandatory measures, but there are choices to be made about the collective health of the population. And I will say that what we see in the data of public opinion is that the people who are reluctant to get vaccinated are not a homogenous group. There are different clusters within that group who have different motivations, ideas. They’re basing their decisions on different information and intuition and feelings. And they have different interactions with the public health-care system. But in terms of what we can do, I think it goes back to almost the beginning of the conversation and the really insightful things that my colleagues on this panel have spoken about, which is certainly any frame or any conversation that seeks to patronize or belittle the reasons that people have for not getting vaccinated is probably not going to end up being a successful path to convincing them otherwise. And these are not by and large people who haven’t read anything or who haven’t looked up information in the vaccine or who haven’t taken this very seriously. They do take it seriously. They read a lot about it. But there have been decades of concerted efforts to undermine science when it conflicts with certain interests. Look at the science on climate change for example. This is not something that’s new that has eroded confidence in science in general. We have also consistently underfunded STEM in our public education systems. And that lack of funding has led to an inability to discern authentic information from disinformation and misinformation in the broader public. So it’s almost a perfect storm of institutional and political failings that has led us at this point. I don’t fault individuals by and large. I think we have to think about the system that has led us to the place in which we are now.</p><img src="https://counter.theconversation.com/content/174032/count.gif" alt="The Conversation" width="1" height="1" />
A panel of experts answer questions about vaccines, omicron and other COVID-related issues in a discussion with The Conversation.Scott White, CEO | Editor-in-Chief, The Conversation CanadaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1732122021-12-15T13:29:27Z2021-12-15T13:29:27ZCOVID-19 vaccines for children: How parents are influenced by misinformation, and how they can counter it<figure><img src="https://images.theconversation.com/files/436843/original/file-20211210-68670-uw0s95.jpg?ixlib=rb-1.1.0&rect=43%2C0%2C5699%2C3828&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Health care providers are just one trusted source of information for parents on the safety of COVID-19 vaccines for children.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/doctor-explaining-report-on-tablet-computer-to-royalty-free-image/961221674?adppopup=true"> Cavan Images/Cavan via Getty Images</a></span></figcaption></figure><p>Since <a href="https://www.cdc.gov/media/releases/2021/s1102-PediatricCOVID-19Vaccine.html">COVID-19 vaccines became available</a> for children ages 5 to 11 in early November 2021, many families have been lining up to get their school-age kids vaccinated prior to holiday travel and gatherings.</p>
<p>As of Dec. 14, <a href="https://covid.cdc.gov/covid-data-tracker/#vaccination-demographics-trends">5.6 million U.S. children ages 5 to 11</a> – or about 19% of this age group – have received at least one dose of a COVID-19 vaccine. And 2.9 million, or about 10% of this age group, are fully vaccinated. </p>
<p>However, the <a href="https://www.kff.org/coronavirus-covid-19/press-release/following-an-early-period-of-high-demand-vaccination-for-children-ages-5-11-has-significantly-slowed/">pace has begun to slow</a>. Vaccination rates in this age group <a href="https://www.kff.org/coronavirus-covid-19/issue-brief/an-update-on-vaccine-roll-out-for-5-11-year-olds-in-the-u-s/">vary widely across the country</a>, and the U.S. is still far from reaching a threshold that would help keep COVID-19 infections in check. </p>
<p>We are a team of <a href="https://www.pediatrics.pitt.edu/people/maya-indira-ragavan-md-mph-ms">medical</a> and <a href="https://publichealth.pitt.edu/home/directory/jaime-sidani">public health</a> professionals at the University of Pittsburgh. We have <a href="https://doi.org/10.1016/j.vaccine.2019.03.003">extensive experience</a> researching <a href="https://scholar.google.com/citations?user=-wHMfaIAAAAJ&hl=en">vaccine misinformation on social media</a> and <a href="https://www.pediatrics.pitt.edu/about-us/diversity-equity-and-inclusion/community-and-culture/pittsburgh-community-vaccine">working with community partners</a> to <a href="https://doi.org/10.1016/j.jadohealth.2021.08.021">address vaccine hesitancy</a>, counter misinformation and <a href="https://scholar.google.com/citations?view_op=view_citation&hl=en&user=8RBqepAAAAAJ&cstart=20&pagesize=80&citation_for_view=8RBqepAAAAAJ:TQgYirikUcIC">promote vaccine equity</a>. </p>
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<img alt="Woman with a frustrated expression looking at her smartphone while sitting on couch at home." src="https://images.theconversation.com/files/436845/original/file-20211210-188518-9l4g2x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/436845/original/file-20211210-188518-9l4g2x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/436845/original/file-20211210-188518-9l4g2x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/436845/original/file-20211210-188518-9l4g2x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/436845/original/file-20211210-188518-9l4g2x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/436845/original/file-20211210-188518-9l4g2x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/436845/original/file-20211210-188518-9l4g2x.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">When parents turn to social media to find information about COVID-19 vaccinations for children, they can become easy targets for misinformation spread by anti-vaccine activists.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/frustrated-and-depressed-young-brunette-woman-is-royalty-free-image/1329809753?adppopup=true">Povozniuk/iStock/Getty Images Plus via Getty Images</a></span>
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<p>Through this work, we have seen and studied the ways that anti-vaccine activists on social media target vulnerable parents who are trying to navigate the challenges of digesting health information to make appropriate choices for their children.</p>
<h2>Social media and vaccine misinformation</h2>
<p>Anti-vaccine activists are a small but vocal group. According to research conducted by the non-profit Center for Countering Digital Hate, <a href="https://www.counterhate.com/disinformationdozen">just 12 social media accounts</a> – the “disinformation dozen” – are <a href="https://www.npr.org/2021/05/13/996570855/disinformation-dozen-test-facebooks-twitters-ability-to-curb-vaccine-hoaxes">behind the majority</a> of anti-vaccine posts on Facebook. Studies also show that only <a href="https://doi.org/10.1377/hlthaff.2011.0396">about 2% of parents</a> reject all vaccines for their children. <a href="https://doi.org/10.1542/peds.2020-007609">A larger group</a>, or about 20% of parents, can more accurately be described as vaccine hesitant, which means they are undecided about having their children receive vaccines <a href="https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html">as recommended by the U.S. Centers for Disease and Control and Prevention</a>. </p>
<p><a href="https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-october-2021/">With regard to COVID-19 vaccines specifically</a>, as of October 2021, about one-third of parents with children ages 5 to 11 years said they would get their child vaccinated right away. Another one-third said they would wait to see how the vaccine is working, and the last one-third said they would definitely not get their child vaccinated. </p>
<p>It can be difficult for parents to sort through the large amount of information available about COVID-19 vaccines – both true and untrue. In their search for answers, <a href="https://doi.org/10.1016/j.acap.2019.09.009">some parents turn to social media platforms</a>. The problem is, these parents are often targeted by anti-vaccine activists who are better organized and <a href="https://doi.org/10.1038/s41586-020-2281-1">more skilled at tailoring their messages</a> to the <a href="https://doi.org/10.1016/j.vaccine.2019.03.003">varied concerns of people who are vaccine hesitant</a> in comparison to pro-vaccine activists. </p>
<p>Social media, in particular, has been <a href="https://doi.org/10.1016/S1473-3099(20)30565-X">a primary vehicle</a> for the spread of misinformation. Although sometimes misinformation is blatantly false, <a href="https://doi.org/10.1016/j.amepre.2019.03.009">other times it is more like a game of telephone</a>. A kernel of truth gets modified slightly as it is retold, which ends up becoming something untrue. Unfortunately, exposure to COVID-19 misinformation has been shown to <a href="https://doi.org/10.1038/s41562-021-01056-1">reduce people’s intent to get vaccinated</a>.</p>
<h2>Addressing parents’ vaccine concerns</h2>
<p>So how can pediatricians and other health care professionals empower parents to feel confident in the choice to get their children vaccinated for COVID-19? </p>
<p>The answer may lie in working with communities to promote the vaccine as trustworthy instead of simply asking communities to trust it. We are part of the Pittsburgh Community Vaccine Collaborative, which is a community-academic partnership that seeks to ensure equitable access to the COVID-19 vaccines. Through that effort, we have focused on <a href="https://doi.org/10.1177/15248399211029954">building trustworthiness of the vaccines</a> and of the providers and health systems that are offering the vaccines in their communities. </p>
<p><a href="https://www.pewresearch.org/fact-tank/2020/03/13/amid-coronavirus-threat-americans-generally-have-a-high-level-of-trust-in-medical-doctors/">Health care providers are a trusted source of information</a> for COVID-19 vaccine information, but they are not the only sources. <a href="https://doi.org/10.1080/21645515.2017.1394533">Research has found</a> that it is important to lean on the expertise and voices of community partners, community health workers and religious leaders.</p>
<p>Our research suggests that pediatricians and public health professionals <a href="https://doi.org/10.1016/j.jadohealth.2021.08.021">can effectively use social media</a> to promote vaccination and provide families with reputable scientific information to address their questions and concerns. Results of a survey that was <a href="https://doi.org/10.1016/j.acap.2019.09.009">recently published in Academic Pediatrics</a> found that 96% of parents used social media. Of those, 68% reported using it for health information.</p>
<p>For example, <a href="https://kidspluspgh.com/">a pediatric group</a> we partner with <a href="https://people.com/human-interest/dr-todd-wolynn-takes-on-anti-vaxxers-science-singing-silly/">uses comedy combined with information</a> to combat myths and answer questions about the COVID-19 vaccines. </p>
<iframe src="https://www.tiktok.com/embed/v2/6940691573801749765?lang=en-US" style="border:0;width:100%;min-height:825px;" width="100%" height="400"></iframe>
<p>Social media is also an effective way to reach adolescents who can decide for themselves if they want <a href="https://doi.org/10.1177/00333549211048784">to get a COVID-19 vaccine</a> without their parents’ consent (<a href="https://www.fastcompany.com/90671596/can-teens-get-vaccinated-without-their-parents-consent-it-depends-on-where-they-live">in some cities and states</a>). Adolescents may also be able to influence their parents. </p>
<p><a href="https://doi.org/10.1177/00099228211046499">Research shows</a> that parents who report high COVID-19 vaccine intention for themselves also report high COVID-19 vaccine intention for their children. Therefore, talking about vaccines as a family may be helpful in combating misinformation around the COVID-19 vaccine. In addition, parents who have had their children vaccinated can use social media to share their experiences and <a href="https://doi.org/10.1016/j.econlet.2021.109979">make it feel more normal</a> and accepted among their peers.</p>
<p>We have also learned that promoting <a href="https://www.commonsensemedia.org/news-and-media-literacy/what-is-media-literacy-and-why-is-it-important">media literacy</a>, which encourages people to question the media information they come into contact with, can empower parents to sift through the <a href="https://www.who.int/health-topics/infodemic">“infodemic”</a> of COVID-19 vaccine information. While social media platforms have announced policies of removing vaccine misinformation, <a href="https://doi.org/10.2105/AJPH.2021.306288">research suggests</a> this is not always effective at reducing the influence of such misinformation. Learning how to find the source of a piece of information and thinking about who are the intended targets may help people determine whether the information is true or distorted.</p>
<h2>Next steps</h2>
<p>Addressing COVID-19 vaccine misinformation can feel overwhelming. The <a href="https://www.aap.org/en/">American Academy of Pediatrics</a> has <a href="https://healthychildren.org/English/tips-tools/ask-the-pediatrician/Pages/when-can-children-get-the-COVID-19-vaccine.aspx">helpful information for parents</a> to support making decisions around the COVID-19 vaccine. Parents can also have conversations with their children about media literacy and evaluating information. And they can talk to their children – especially adolescent-age children – about how getting the COVID-19 vaccine can protect them and others. </p>
<p>Increasing COVID-19 vaccine rates for children and young people is important to promote their health and wellness, as well as to move closer to ending the pandemic. </p>
<p>[<em>Too busy to read another daily email?</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-toobusy">Get one of The Conversation’s curated weekly newsletters</a>.]</p><img src="https://counter.theconversation.com/content/173212/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jaime Sidani receives funding from the Richard King Mellon Foundation, the American Heart Association, and the PittCATS Clinical Scholars program, funded by the National Institute on Drug Abuse. </span></em></p><p class="fine-print"><em><span>Beth Hoffman receives funding from The Richard King Mellon Foundation and the National Institutes of Health.</span></em></p><p class="fine-print"><em><span>Maya Ragavan receives funding from the National Institutes of Health (through an institutional KL2) and the Centers for Disease Control and Prevention. </span></em></p>Pediatricians and other health care providers can take some concrete steps toward building trust and counteracting anti-vaccination misinformation.Jaime Sidani, Assistant Professor of Public Health, University of PittsburghBeth Hoffman, Postdoctoral Associate in Behavioral and Community Health Sciences, University of PittsburghMaya Ragavan, Assistant Professor of Pediatrics, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1709112021-11-11T15:41:51Z2021-11-11T15:41:51ZHow cognitive biases and adverse events influence vaccine decisions (maybe even your own)<figure><img src="https://images.theconversation.com/files/430453/original/file-20211105-25-wktftj.jpg?ixlib=rb-1.1.0&rect=1041%2C431%2C3862%2C2110&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Vaccine hesitancy has been a growing challenge for more than a decade. Concerns about vaccine safety and adverse events are the most commonly cited reasons.</span> <span class="attribution"><span class="source">(AP Photo/Rogelio V. Solis) </span></span></figcaption></figure><iframe style="width: 100%; height: 175px; border: none; position: relative; z-index: 1;" allowtransparency="" src="https://narrations.ad-auris.com/widget/the-conversation-canada/how-cognitive-biases-and-adverse-events-influence-vaccine-decisions--maybe-even-your-own-" width="100%" height="400"></iframe>
<p>The <a href="https://www.who.int/immunization/research/forums_and_initiatives/1_RButler_VH_Threat_Child_Health_gvirf16.pdf">World Health Organization</a> recognized vaccine hesitancy as a growing challenge in 2011, and identified it as <a href="https://www.who.int/wer/2011/wer8621.pdf">a new priority topic</a>. This was mostly because of the return of vaccine-preventable diseases like <a href="https://doi.org/10.1038/s41390-019-0354-3">measles in Europe and the United States</a>. </p>
<p>Ten years later, in 2021, we see that vaccine hesitancy has become an even more significant challenge despite all the efforts. The COVID-19 pandemic has brought it to a peak, and all efforts to manage the pandemic depend on the people’s willingness to take the vaccination. However, <a href="https://doi.org/10.3390/vaccines9020160">the numbers are not very promising as some percentage of populations in every country are reluctant to vaccinate</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">
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<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
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<p>Vaccine hesitancy means “<a href="https://doi.org/10.1016/S2352-4642(19)30092-6">delay in acceptance or refusal of vaccines despite availability of vaccination services</a>.” Vaccine-hesitant people cite <a href="https://doi.org/10.1016/j.vaccine.2015.01.068">distrust in vaccine safety and concerns over vaccine adverse events</a> as the most common reasons for reluctance to get vaccinated. </p>
<p>Vaccines are used in healthy people to prevent a disease that might harm them in the future. However, as they are healthy at the time of vaccination, they may worry about the vaccine’s safety.</p>
<p>Our team of business analytics and artificial intelligence researchers at Concordia University, along with a professor of epidemiology at McGill University, has published a paper in the <a href="https://doi.org/10.1186/s12889-021-11745-1"><em>BMC Public Health</em></a> journal that investigated this critical concern from two perspectives. </p>
<p>First, we addressed vaccine safety concerns by analyzing data from vaccine adverse events systems. These are vaccine surveillance systems where adverse events following immunization are reported, monitored and stored in a database. Canada’s system is called the <a href="https://www.canada.ca/en/public-health/services/immunization/canadian-adverse-events-following-immunization-surveillance-system-caefiss.html#_About_the_system">Canadian Adverse Events Following Immunization Surveillance System (CAEFISS)</a>.</p>
<p>Second, we focused on cognitive science and highlighted the critical role of cognitive biases in people’s vaccination decision-making that might lead to vaccine hesitancy.</p>
<h2>Data-driven evidence to address vaccine safety</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/430455/original/file-20211105-19-6xhu5j.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A vaccination centre with Ontario Premier Doug Ford in the background touring the facility and a line of people waiting to greet him in the foreground" src="https://images.theconversation.com/files/430455/original/file-20211105-19-6xhu5j.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/430455/original/file-20211105-19-6xhu5j.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430455/original/file-20211105-19-6xhu5j.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430455/original/file-20211105-19-6xhu5j.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430455/original/file-20211105-19-6xhu5j.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430455/original/file-20211105-19-6xhu5j.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430455/original/file-20211105-19-6xhu5j.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&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 Premier Doug Ford tours a vaccine centre in Windsor, Ont. Distrust in vaccine safety and concerns over vaccine adverse events are the most cited reasons for vaccine hesitancy.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/ Geoff Robins</span></span>
</figcaption>
</figure>
<p>A solution to mitigate distrust in vaccines safety is to <a href="https://doi.org/10.1177/0272989X15607855">provide evidence-based meaningful information about vaccine safety and adverse events</a>. We followed this path and analyzed all the adverse events reported to the <a href="https://vaers.hhs.gov/">U.S. Vaccine Adverse Event Reporting System (VAERS)</a>.</p>
<p>We analyzed almost 294,000 reports over eight years from 2011 to 2018. It equals roughly 115 reports per million people, covering 87 vaccine types. The most frequently reported vaccines were those for chickenpox, influenza, pneumococcal bacteria and human pappilomavirus (HPV).</p>
<p>Each VAERS report (representing one incident) involved an average of three adverse events, the most common being rashes, fever, swelling, pain and headaches. Only 5.5 per cent of the reports were marked as serious, resulting in hospitalization, disability, threats to life or death. The top adverse events in this group also include fever, pain, vomiting, headaches and shortness of breath. </p>
<p>We also analyzed the vaccine adverse events reported to <a href="https://www.canada.ca/en/health-canada/services/drugs-health-products/medeffect-canada/canada-vigilance-program.html">Canada Vigilance</a>. Our findings were consistent with those from the VAERS.</p>
<p>We have provided our results in an <a href="https://public.tableau.com/app/profile/aefi/viz/VAERSAdverseEventFollowingImmuinzationAEFIReports2011-2018/Dashboard1">interactive dashboard</a>. Health-care professionals and others involved in vaccine communication can use this dashboard to provide evidence-based information to the public. Research suggests that <a href="https://doi.org/10.1016/j.vaccine.2016.03.087">summarized data is the best format for communicating vaccine safety information</a>, so using this dashboard in vaccination communication can help mitigate vaccine hesitancy and safety concerns, and increase trust in vaccines.</p>
<h2>The role of cognitive biases in vaccine hesitancy</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/430454/original/file-20211105-17-1g2k9jz.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man in camouflage T-shirt and hat holding an anti-vaccine sign in the foreground, with a group of people in the background" src="https://images.theconversation.com/files/430454/original/file-20211105-17-1g2k9jz.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/430454/original/file-20211105-17-1g2k9jz.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=425&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430454/original/file-20211105-17-1g2k9jz.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=425&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430454/original/file-20211105-17-1g2k9jz.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=425&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430454/original/file-20211105-17-1g2k9jz.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=535&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430454/original/file-20211105-17-1g2k9jz.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=535&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430454/original/file-20211105-17-1g2k9jz.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=535&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An anti-vaccine demonstrator in front of a hospital in Montréal in September 2021.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Paul Chiasson</span></span>
</figcaption>
</figure>
<p>In the second part of our study, after addressing concerns about vaccine adverse events, we examined the role of cognitive biases on vaccine hesitancy. We identified cognitive biases that might affect vaccine communication and decision-making. </p>
<p>As mentioned earlier, vaccines are administrated to healthy people. When people are making decisions about vaccination, they might feel some degrees of risk, ambiguity and uncertainty about the results, which can instigate cognitive biases in the decision-making process. Such cognitive biases might <a href="https://doi.org/10.1016/j.vaccine.2015.03.048">nudge people toward vaccine hesitancy</a>.</p>
<p>For example, contrary to the positive effect of providing people with summarized vaccine safety information that increases vaccine trust, detailed vaccine adverse event reports will decrease trust because of two cognitive biases. </p>
<p>First, when vaccine hesitant people read a detailed report about a vaccine adverse event, it gives them the chance to see what they want to see. It is an example of confirmation bias, which is the <a href="https://doi.org/10.1037/1089-2680.2.2.175">tendency to recall and interpret information that confirms our existing beliefs</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/430452/original/file-20211105-23-1m8sflu.JPG?ixlib=rb-1.1.0&rect=89%2C40%2C2748%2C1859&q=45&auto=format&w=1000&fit=clip"><img alt="An upper arm bearing a heart tattoo and a small round bandage over an injection site" src="https://images.theconversation.com/files/430452/original/file-20211105-23-1m8sflu.JPG?ixlib=rb-1.1.0&rect=89%2C40%2C2748%2C1859&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/430452/original/file-20211105-23-1m8sflu.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430452/original/file-20211105-23-1m8sflu.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430452/original/file-20211105-23-1m8sflu.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430452/original/file-20211105-23-1m8sflu.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430452/original/file-20211105-23-1m8sflu.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430452/original/file-20211105-23-1m8sflu.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">Research suggests that summarized vaccine safety information is the best format for increasing trust in vaccines.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Kayle Neis</span></span>
</figcaption>
</figure>
<p>Second, a detailed adverse event report will also increase the event’s vividness, making it easier to recall the next time there is a decision to be made about taking a vaccine. That is the effect of availability bias, <a href="https://doi.org/10.1016/0010-0285(73)90033-9">the tendency to attribute more weight to factors that are easier to recall</a>.</p>
<p>We identified 15 cognitive biases in the vaccine decision-making process and categorized them into three groups:</p>
<ul>
<li><p><strong>Cognitive biases triggered by processing vaccine-related information</strong> include availability bias, as in the above example, as well as framing effect, base rate neglect, availability bias, anchoring effect and authority bias.</p></li>
<li><p><strong>Cognitive biases triggered in vaccination decision-making</strong> include omission bias, which is when the results of not taking an action are viewed as less damaging than the results of taking action, even when this is not the case. Others include ambiguity aversion, optimism bias, present bias and protected values. </p></li>
<li><p><strong>Cognitive biases triggered by prior beliefs regarding vaccination</strong> include confirmation bias such as the one in the example, as well as belief bias, shared information bias and false consensus effect.</p></li>
</ul>
<p>The <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-11745-1/tables/1">full list of cognitive biases affecting vaccination decision-making and their examples is available here</a>. Public health officials and practitioners can use this list and customize their plans, interventions and other forms of vaccine communication to decrease vaccine hesitancy. </p>
<p>You also can check the list and see if these biases have influenced your own vaccination decisions.</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/170911/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>To help increase trust in vaccines, researchers analyzed data on adverse events to address safety concerns, and then used cognitive science to show how cognitive biases feed vaccine hesitancy.Hossein Azarpanah, PhD Candidate in Business Technology Management, Concordia UniversityLouise Pilote, Professor of Medicine, James McGill Chair, McGill UniversityMohsen Farhadloo, Assistant professor, John Molson School of Business, Concordia UniversityRustam Vahidov, Professor, Dept. of Supply Chain & Business Technology Management, Concordia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1679842021-09-20T20:05:15Z2021-09-20T20:05:15ZNew Zealand has ramped up vaccination rates, but too many people remain concerned about vaccine safety<figure><img src="https://images.theconversation.com/files/422062/original/file-20210920-17-1iwhxm3.jpg?ixlib=rb-1.1.0&rect=40%2C163%2C5422%2C3268&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Fiona Goodall/Getty Images</span></span></figcaption></figure><p>After five weeks in the strictest lockdown, Auckland will move to level 3 restrictions from midnight on Tuesday, for at least two weeks.</p>
<p>Prime Minister Jacinda Ardern said the decision was based on low community spread and an accelerated vaccination rollout. A targeted vaccination campaign will now focus on about 23,000 people in Auckland who are older than 65 but have not yet received their first dose. </p>
<p>GPs and pharmacies are offering vaccinations, walk-in or drive-through vaccination centres have been set up, and <a href="https://www.stuff.co.nz/national/health/coronavirus/126375780/covid19-mr-whippystyle-vaccination-bus-to-roll-in-auckland">mobile vaccination buses</a> are delivering doses throughout Auckland. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1439815081257226248"}"></div></p>
<p>According to the Ministry of Health, 37% of New Zealand’s eligible population are now <a href="https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-data-and-statistics/covid-19-vaccine-data">fully vaccinated</a>, while 72% have received their first dose. But as our new <a href="https://www.researchgate.net/publication/354615019_COVIDHesitancyWorkingPaper">research</a> shows, about 20% choose not to be vaccinated, often because they remain unsure about vaccine safety.</p>
<h2>Barriers to vaccination uptake</h2>
<p>While the vaccine rollout has been criticised for being <a href="https://www.rnz.co.nz/news/political/449840/analysis-sluggish-vaccine-rollout-deserves-an-explanation">sluggish</a>, it picked up pace since the start of the outbreak in August. </p>
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<img alt="This chart shows the number of vaccine doses administered on a given day" src="https://images.theconversation.com/files/422033/original/file-20210920-47336-ecsyfu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/422033/original/file-20210920-47336-ecsyfu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=280&fit=crop&dpr=1 600w, https://images.theconversation.com/files/422033/original/file-20210920-47336-ecsyfu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=280&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/422033/original/file-20210920-47336-ecsyfu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=280&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/422033/original/file-20210920-47336-ecsyfu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=352&fit=crop&dpr=1 754w, https://images.theconversation.com/files/422033/original/file-20210920-47336-ecsyfu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=352&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/422033/original/file-20210920-47336-ecsyfu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=352&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">This chart shows the number of vaccine doses administered on a given day from the COVID-19 immunisation register.</span>
<span class="attribution"><span class="source">Ministry of Health</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p>But a significant number of people continue to say they are not likely to get the vaccine. A recent <a href="https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-vaccines/covid-19-vaccine-strategy-planning-insights/covid-19-vaccine-research-insights">report</a> commissioned by the Ministry of Health shows 71% of those unvaccinated at the time were intending to get vaccinated. In this group, 67% of Māori and 62% of Pacific respondents said they would get vaccinated. </p>
<p>But 20% of unvaccinated people said they were unlikely to have a vaccine, and of those, 11% would “definitely not” get vaccinated. </p>
<p>A similar study in July showed only four in five New Zealanders said they planned on getting vaccinated. </p>
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Read more:
<a href="https://theconversation.com/four-in-five-new-zealanders-plan-to-get-vaccinated-but-many-people-want-more-information-about-vaccine-safety-164322">Four in five New Zealanders plan to get vaccinated, but many people want more information about vaccine safety</a>
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<p>Both studies point to numerous barriers to uptake, such as lack of exposure to the virus, misinformation about vaccination and lack of confidence in the vaccine. The main reasons for being unsure continue to be concerns about long-term effects, safety and waiting to see if others have side effects.</p>
<p>Our <a href="https://www.researchgate.net/publication/354615019_COVIDHesitancyWorkingPaper">work</a>, conducted between June and August 2021, examined two of these barriers: misunderstandings about the vaccine and confidence in the vaccine. </p>
<p>We found 76.2% of our participants identified as physically able to be vaccinated. The remainder (23.8%) identified as physically unable to receive a vaccine due to pre-existing medical conditions or philosophical views. </p>
<p>But of the latter group only 28.9% actually meet the criteria set by groups such as the <a href="https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-vaccines/covid-19-vaccine-health-advice">Ministry of Health</a> or the US Centers for Disease Control and Prevention (<a href="https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Fcovid-19%2Finfo-by-product%2Fclinical-considerations.html">CDC</a>).</p>
<p>The people in this group most often asserted they could not get the jab because they have asthma, want to get pregnant or their doctor or a religious leader told them they shouldn’t. This lack of understanding about who can get the vaccine is a challenge for the vaccination rollout and the government. </p>
<h2>Vaccine confidence is key to uptake</h2>
<p>As the rollout continues and the government pursues its elimination strategy, it must clearly address issues about who can and cannot be vaccinated for medical reasons. </p>
<p>When asked if they would get the COVID-19 vaccine, 70.9% of those who said they are physically or medically unable to do so said they would eventually get it if they had to. </p>
<p>Of those who said they are able to get vaccinated, 76.9% said they would get the jab. Split by political affiliations, 42.5% of National, 66.4% of Labour, 49.5% of Green, 67.5% of Māori Party, 40.6% of “other” political party and 73.7% of non-affiliated voters said they would get vaccinated. </p>
<p>In terms of demographics, 65.2% of Pākehā, 57.7% of Māori, 33.5% of Pasifika and 72.4% of the “other” group (Indian/Asian) said they were likely to get vaccinated. These results for Pākehā, Māori and Pasifika are marginally lower than those reported in the Ministry of Health <a href="https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-vaccines/covid-19-vaccine-strategy-planning-insights/covid-19-vaccine-research-insights">study</a>. </p>
<p>The critical element to understanding the patterns in our research was vaccine confidence. We found significant differences in confidence in COVID-19 vaccines between ethnic groups in New Zealand. Pacific respondents had the lowest levels of confidence, while those who identified as “other” had the highest. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1438278826337849347"}"></div></p>
<p>Māori and Pasifika communities are particularly vulnerable to COVID-19. There is a growing anti-vax movement within some parts of the Pacific community, which Pacific leaders and communities are currently <a href="https://www.tvnz.co.nz/one-news/new-zealand/vaccine-hesitancy-worrying-pasifika-health-providers">addressing</a>. </p>
<p>Recent modelling has shown that unless New Zealand can get its vaccination rate up to 90% and above, the threat of large-scale outbreaks, mass hospitalisations and thousands of deaths is possible once borders reopen.</p>
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Read more:
<a href="https://theconversation.com/at-least-four-in-five-new-zealanders-will-have-to-be-vaccinated-before-border-controls-can-be-fully-relaxed-163486">At least four in five New Zealanders will have to be vaccinated before border controls can be fully relaxed</a>
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<p>To improve our nation’s vaccine rollout, the government should expand messaging on who can and cannot get vaccinated. Further messaging about the safety of the vaccine must continue with Pacific communities. </p>
<p>While the government has discussed the safety of the Pfizer vaccine, it’s clearly not enough. Additional work must be done at the grass-roots level (community centres, churches) to demonstrate the safety and increase confidence in the vaccine.</p><img src="https://counter.theconversation.com/content/167984/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>A survey found almost a quarter of participants thought they could not receive a vaccine because of medical conditions. But only 28.9% of this group actually meet the criteria set by health agencies.Stephen Croucher, Professor and Head of School of Communication, Journalism, and Marketing, Massey UniversityDoug Ashwell, Senior lecturer, Massey UniversityJo Cullinane, Deputy Pro-Vice Chancellor, Massey UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1616672021-06-08T09:23:55Z2021-06-08T09:23:55ZWhat are the side effects of the Pfizer vaccine? An expert explains<p>As of Tuesday this week, all Australian adults aged 40-49 <a href="https://www.health.gov.au/news/covid-19-vaccines-to-be-available-to-everyone-aged-40-years-and-over">are eligible</a> to receive a COVID-19 vaccine. </p>
<p>Some states and territories had already opened up their rollout to under 50s, including <a href="https://www.abc.net.au/news/2021-05-27/vic.-health-minister-says-people-aged-40-49-can-get-vaccine/13361858">Victoria</a>, which invited 40-49-year-olds to come forward from late May in light of the current outbreak. In the <a href="https://www.sbs.com.au/news/anyone-over-the-age-of-16-can-now-get-the-covid-19-vaccine-in-the-northern-territory">Northern Territory</a>, everyone aged over 16 is now eligible, while in <a href="https://thewest.com.au/news/coronavirus/wa-rolls-out-covid-vaccines-for-over-30s-c-3048192">Western Australia</a> adults over 30 will be eligible from Thursday.</p>
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<p>Most Australians under 50 will receive the Pfizer vaccine, which is <a href="https://www.health.gov.au/news/atagi-statement-on-astrazeneca-vaccine-in-response-to-new-vaccine-safety-concerns">the preferred COVID vaccine</a> for people in this age group. This is based on advice from Australia’s Technical Advisory Group on Immunisation around the risk of rare blood clotting disorders following the AstraZeneca vaccine. </p>
<p>To this point, we’ve been quite fixated on the side effects and small risks associated with the AstraZeneca vaccine. But with many Australians now lining up for the Pfizer shot, let’s take a look at what we know about side effects and rare adverse events after this vaccine.</p>
<h2>We’re monitoring the safety of the Pfizer vaccine in real time</h2>
<p>In Australia <a href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/learn-about-covid-19-vaccines/about-the-pfizerbiontech-covid-19-vaccine">the Pfizer vaccine</a> is registered for use in people over 16. Two doses are needed, with a gap of at least three weeks between doses.</p>
<p>This vaccine has now been administered to many millions of people <a href="https://covid.cdc.gov/covid-data-tracker/#vaccinations">around the world</a>. We know a lot about its safety from both clinical trials and safety surveillance programs in the community.</p>
<p><a href="http://www.ausvaxsafety.org.au">AusVaxSafety</a> has been collecting and regularly updating vaccine safety data from Australians who have received a COVID vaccine, either Pfizer or AstraZeneca.</p>
<p>As of May 30, <a href="https://www.ausvaxsafety.org.au/safety-data/covid-19-vaccines">more than 245,000 people</a> had responded to text message or email questionnaires on side effects after their first dose of the Pfizer vaccine, and over 140,000 people had responded after dose two.</p>
<p>Close to two-thirds of people reported no reactions after the first dose, and 40% reported no reactions after the second. </p>
<p>The most common side effects include headache, muscle aches and fatigue, and these are more common after dose two compared to dose one. </p>
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<p>These sorts of side effects are very similar to those reported <a href="https://www.nejm.org/doi/full/10.1056/nejmoa2034577">in clinical trials</a> and what’s been set out in the Pfizer vaccine’s <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2021-PI-01092-1&d=202106081016933">product information</a>. They occur because our immune system <a href="https://www.who.int/news-room/feature-stories/detail/side-effects-of-covid-19-vaccines">is responding</a> to the vaccine.</p>
<p>Side effects will usually present in the first 24-48 hours after vaccination. We know from AusVaxSafety surveillance and <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(21)00224-3/fulltext">safety data from overseas</a> they usually last less than two to three days, and nearly everyone who experiences side effects is back to normal one week after vaccination.</p>
<p>You can manage symptoms such as pain or fever with medicines like paracetamol or ibuprofen. But if your symptoms persist or get worse, you should see your GP. </p>
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Read more:
<a href="https://theconversation.com/were-gathering-data-on-covid-vaccine-side-effects-in-real-time-heres-what-you-can-expect-158945">We're gathering data on COVID vaccine side effects in real time. Here's what you can expect</a>
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<h2>What about allergic reactions?</h2>
<p>There have been <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7002e1.htm#">reports of anaphylaxis</a> after the Pfizer vaccine. Anaphylaxis is an acute allergic reaction where people experience a rash, lip and tongue swelling, trouble breathing and sometimes shock (low blood pressure and fast heart rate).</p>
<p>Overall it’s estimated anaphylaxis occurs in approximately <a href="https://jamanetwork.com/journals/jama/fullarticle/2776557">five people per million</a> doses of the Pfizer vaccine administered. Anaphylaxis nearly always happens in the first 15 minutes to half hour <a href="https://pubmed.ncbi.nlm.nih.gov/29413255/">after vaccination</a>, which is why people are asked to wait in the clinic after receiving a COVID-19 vaccine. </p>
<p>Anaphylaxis is easily treated (reversed) with an injection of adrenaline by nursing and medical staff at the vaccination centres, and people affected generally make a complete recovery.</p>
<p>If you happen to have had an acute allergic reaction after vaccination, it’s important you tell your doctor before getting a second dose of the same vaccine. You may be referred for a specialist allergy consultation.</p>
<h2>Myocarditis and pericarditis</h2>
<p>Recently there have been reports from overseas, including the <a href="https://www.theguardian.com/world/2021/may/23/cdc-studying-reports-of-heart-inflammation-in-young-covid-vaccine-recipients">United States</a> and <a href="https://www.reuters.com/world/middle-east/israel-sees-probable-link-between-pfizer-vaccine-small-number-myocarditis-cases-2021-06-01/">Israel</a>, of myocarditis (heart inflammation) and pericarditis (inflammation of the lining of the heart) following vaccination with the Pfizer vaccine.</p>
<p>The <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/myocarditis.html">US Centres for Disease Control</a> notes these cases have been mostly in younger males (aged 16 years and older), usually appear within several days of vaccination, and are more common after the second dose. </p>
<p>However, no causal link has been formally established. It’s important to note <a href="https://www.nhlbi.nih.gov/health-topics/heart-inflammation">heart inflammation</a> can be caused by many factors. These include infections, particularly from viruses or bacteria; or damage to the heart’s tissue or muscle as a result of autoimmune diseases, medicines, environmental factors, or other triggers, including, rarely, vaccines.</p>
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Read more:
<a href="https://theconversation.com/how-do-we-know-the-covid-vaccine-wont-have-long-term-side-effects-155714">How do we know the COVID vaccine won't have long-term side-effects?</a>
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<p>The COVID-19 subcommittee of the WHO Global Advisory Committee on Vaccine Safety is also reviewing this issue. They have noted that in most of the <a href="https://www.who.int/news/item/26-05-2021-gacvs-myocarditis-reported-with-covid-19-mrna-vaccines">reported cases</a>, the people have recovered.</p>
<p>Australia’s <a href="https://www.tga.gov.au/periodic/covid-19-vaccine-weekly-safety-report-03-06-2021">Therapeutic Goods Administration</a>, meanwhile, is continuing to monitor myocarditis and pericarditis as “adverse events of special interest”.</p>
<p>Rigorous studies where we compare the number of myocarditis cases in vaccinated and unvaccinated populations <a href="https://www.who.int/news/item/26-05-2021-gacvs-myocarditis-reported-with-covid-19-mrna-vaccines">are underway</a> in countries such as Israel, the United Kingdom and the United States to assess whether there is any link between myocarditis and the Pfizer vaccine.</p>
<p>But at this stage, there’s no significant cause for concern.</p>
<h2>The benefits outweigh any risks</h2>
<p>Real-world <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00947-8/fulltext">studies</a> are showing the Pfizer vaccine has clear benefits in reducing deaths and hospitalisations due to COVID-19. </p>
<p>As we’re seeing right now in Victoria, community outbreaks continue to pose a significant risk. Our path out of this pandemic relies on a high uptake of vaccines, and use of the highly effective Pfizer vaccine is key.</p><img src="https://counter.theconversation.com/content/161667/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicholas Wood receives funding from the NHMRC for a career development fellowship. He holds a Churchill Fellowship</span></em></p>Australia is now rolling out the Pfizer vaccine to people aged under 50, with the 40-49 age group newly eligible. Here’s what you can expect.Nicholas Wood, Associate Professor, Discipline of Childhood and Adolescent Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1609232021-05-14T07:52:55Z2021-05-14T07:52:55ZCould the AstraZeneca vaccine cause Guillain-Barré syndrome? We don’t know yet — but there’s minimal cause for concern<p>The Therapeutic Goods Administration (TGA) <a href="https://www.tga.gov.au/periodic/covid-19-vaccine-weekly-safety-report-13-05-2021">yesterday revealed</a> there have been six reports of <a href="https://www.healthline.com/health/guillain-barre-syndrome">Guillain-Barré syndrome</a> in Australia following the AstraZeneca COVID vaccine.</p>
<p>This is an autoimmune disorder, which causes muscle weakness, numbness and tingling. It can be life threatening if it involves the respiratory muscles.</p>
<p>But at this stage, there isn’t cause for serious concern. The six reports are out of <a href="https://www.tga.gov.au/periodic/covid-19-vaccine-weekly-safety-report-13-05-2021">1.8 million doses</a> of the AstraZeneca vaccine administered in Australia so far. This means the syndrome has affected about one in 300,000, which is less than the rate at which it occurs in the population normally; in adults, we see about 2–3 cases per 100,000 people every year. </p>
<p>Neither the TGA nor any other country have confirmed there’s a link between the AstraZeneca vaccine and Guillain-Barré syndrome. So these cases may have occurred by chance. At the same time, it is possible there’s a connection.</p>
<h2>What is Guillain-Barré syndrome?</h2>
<p>Guillain-Barré syndrome occurs when the immune system attacks healthy nerve cells. In <a href="https://www.mayoclinic.org/diseases-conditions/guillain-barre-syndrome/symptoms-causes">about two-thirds of cases</a>, it follows a viral or bacterial infection.</p>
<p>The most common infection linked to the syndrome is the bacteria <em><a href="https://www.cdc.gov/campylobacter/guillain-barre.html#:%7E:text=About%20two%2Dthirds%20of%20people,common%20risk%20factors%20for%20GBS.">Campylobacter jejuni</a></em>, which infects the gastrointestinal tract and commonly causes diarrhoea.</p>
<p>We’ve also seen it occur after infection with viruses such as <a href="https://theconversation.com/explainer-what-is-guillain-barre-syndrome-and-is-it-caused-by-the-zika-virus-53884">Zika virus</a> and the human immunodeficiency virus (<a href="https://www.healthline.com/health/guillain-barre-syndrome#causes">HIV</a>). It has been linked to <a href="https://theconversation.com/rare-neurological-disorder-guillain-barre-syndrome-linked-to-covid-19-141511">COVID-19 too</a>, but we don’t have much data on this yet.</p>
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<img alt="" src="https://images.theconversation.com/files/400713/original/file-20210514-19-ni9z8n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/400713/original/file-20210514-19-ni9z8n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/400713/original/file-20210514-19-ni9z8n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/400713/original/file-20210514-19-ni9z8n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/400713/original/file-20210514-19-ni9z8n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/400713/original/file-20210514-19-ni9z8n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/400713/original/file-20210514-19-ni9z8n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">In people with Guillain-Barré syndrome, the immune system attacks healthy nerve cells.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/demyelination-neuron-damage-myelin-sheath-seen-1972301618">Shutterstock</a></span>
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<p>The reason for the link between Guillain-Barré syndrome and infections is complex, but essentially scientists believe it’s caused by something called “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266166/">molecular mimicry</a>”. </p>
<p>This occurs when the structures on the surface of pathogens resemble (or mimic) structures on your cells. For Guillain-Barré syndrome, this relates to sugar structures (glycans) on the myelin sheath (the insulating covering on neurons that enables them to transmit nerve impulses). </p>
<p>For people with Guillain-Barré syndrome, these sugar structures on their nerve cells appear similar to sugar-containing molecules on the surface of some bacteria or viruses. As a result, antibodies generated to target the infection also attack nerve cells (autoantibodies), destroying the myelin sheath nerves need to conduct signals. This stops muscles from working properly.</p>
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Read more:
<a href="https://theconversation.com/explainer-what-is-guillain-barre-syndrome-and-is-it-caused-by-the-zika-virus-53884">Explainer: what is Guillain-Barré syndrome and is it caused by the Zika virus?</a>
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<p>The syndrome can affect different muscles, meaning the weakness can be felt in different places. For example, it might affect speech, breathing or bladder control. </p>
<p>It can be treated with antibodies from healthy donors (immunoglobulin therapy) which inhibits the autoantibodies causing damage. Another option is to filter the autoantibodies out of the blood (plasma exchange). In time, most people will recover with treatment; the condition is very rarely fatal. </p>
<p>The syndrome is more common in people <a href="https://www.webmd.com/brain/what-is-guillain-barre">50 and older</a>, which is a concern as this is the age group receiving the AstraZeneca vaccine in Australia. But it’s still vanishingly rare, and this risk — if indeed there is a link — doesn’t come close to outweighing the benefit of the vaccine for this age group. </p>
<h2>So, how could Guillain-Barré syndrome be linked with the AstraZeneca vaccine?</h2>
<p>Along with the TGA, the <a href="https://www.reuters.com/article/brief-ema-says-assessing-reports-of-guil/brief-ema-says-assessing-reports-of-guillain-barre-syndrome-with-astrazenecas-covid-19-vaccine-idUSFWN2MU167">European Medicines Agency</a> is reportedly assessing reports of Guillain-Barré syndrome in a small number of people who <a href="https://casereports.bmj.com/content/14/4/e242956">have received</a> the AstraZeneca vaccine. </p>
<p>There is a possible explanation — though it’s important to stress that in the absence of empirical evidence, this is currently only speculation. The adenovirus — that’s the viral vector used in the AstraZeneca vaccine — like many viruses, contains proteins linked to sugar structures (glycoproteins). </p>
<p>So one potential mechanism is that some of the antibodies generated against the vector following vaccination recognise these glycoproteins and cross-react with sugar structures on nerve cells. This is similar to the process I described above in terms of how Guillain-Barré syndrome could be linked to infection.</p>
<p>Notably, the blood clots linked to the AstraZeneca vaccine are also thought to be <a href="https://www.sciencemag.org/news/2021/05/what-s-future-vaccines-linked-rare-clotting-disorders-science-breaks-down-latest">an autoimmune driven illness</a>. This has opened up the possibility autoimmune reactions can be triggered by the AstraZeneca vaccine. </p>
<p>Still, the numbers of either event are very low and currently the data is lacking to definitively show that these adverse events are being caused by autoimmunity induced by the adenovirus vector. We need more research.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-do-we-actually-investigate-rare-covid-19-vaccine-side-effects-160000">How do we actually investigate rare COVID-19 vaccine side-effects?</a>
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<p>In very rare cases, we’ve seen Guillain-Barré syndrome in the days and weeks after <a href="https://www.cdc.gov/vaccinesafety/concerns/guillain-barre-syndrome.html">flu vaccination</a>.</p>
<p>As the flu vaccine is different from year to year, this only happens sometimes. But when scientists have observed an increased risk, it’s been only 1–2 additional cases per million flu vaccines. You’d be at greater risk of contracting Guillain-Barré syndrome after getting the flu than after getting the flu shot. </p>
<p>The same is very likely to be true of COVID.</p>
<h2>What now?</h2>
<p>The TGA has called Guillain-Barré syndrome an “<a href="https://www.tga.gov.au/periodic/covid-19-vaccine-weekly-safety-report-13-05-2021">adverse event of special interest</a>”. This means it’s still not clear if there’s a causal relationship. From here, the TGA will continue to monitor the situation and collate the data as it comes in, until it can get a clearer picture.</p>
<p>But there’s no need to panic, or to feel discouraged from receiving the AstraZeneca vaccine; this remains an important part of Australia’s vaccination strategy. </p>
<p>For those over 50, you’re still <a href="https://www.sciencemag.org/news/2021/05/what-s-future-vaccines-linked-rare-clotting-disorders-science-breaks-down-latest">at much greater risk</a> of any adverse outcomes — Guillain-Barré syndrome, blood clots or otherwise — if you contract COVID-19, than from the vaccine.</p>
<p>The risk of COVID remains significant and for those eligible, the AstraZeneca vaccine remains a sensible option to protect yourself and the wider community.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/rare-neurological-disorder-guillain-barre-syndrome-linked-to-covid-19-141511">Rare neurological disorder, Guillain-Barre Syndrome, linked to COVID-19</a>
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</em>
</p>
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<img src="https://counter.theconversation.com/content/160923/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nathan Bartlett 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 TGA has reported a handful of cases of the autoimmune disorder Guillain-Barré syndrome following the AstraZeneca vaccine.Nathan Bartlett, Associate Professor, School of Biomedical Sciences and Pharmacy, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1606022021-05-10T02:42:28Z2021-05-10T02:42:28ZI have asthma, diabetes or another illness — can I get my COVID vaccine yet?<figure><img src="https://images.theconversation.com/files/399612/original/file-20210510-21-4epm7m.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5812%2C3871&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-asian-woman-using-blue-asthma-1716465901">Shutterstock</a></span></figcaption></figure><p>Australia is <a href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/getting-vaccinated-for-covid-19/when-will-i-get-a-covid-19-vaccine">currently</a> in <a href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/getting-vaccinated-for-covid-19/when-will-i-get-a-covid-19-vaccine">Phase 1a and Phase 1b</a> of the COVID vaccine rollout but as a GP, I have had many questions from patients unsure if they’re in those categories or not.</p>
<p>One way to find out is to use the Australian government’s eligibility checker <a href="https://www.health.gov.au/resources/apps-and-tools/covid-19-vaccine-eligibility-checker">here</a>, or ask your GP. </p>
<p><a href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/getting-vaccinated-for-covid-19/when-will-i-get-a-covid-19-vaccine">Phase 1a</a> includes quarantine and border workers, frontline health care workers, aged care and disability care staff/residents. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/vaccinating-the-highest-risk-groups-first-was-the-plan-but-people-with-disability-are-being-left-behind-159439">Vaccinating the highest-risk groups first was the plan. But people with disability are being left behind</a>
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</em>
</p>
<hr>
<p><a href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/getting-vaccinated-for-covid-19/when-will-i-get-a-covid-19-vaccine">Phase 1b</a> includes many more categories of people, including</p>
<ul>
<li>healthcare workers currently employed and not included in Phase 1a</li>
<li>household contacts of quarantine and border workers</li>
<li>critical and high risk workers (including defence, police, fire, emergency services and meat processing)</li>
<li>people aged 70 years and over</li>
<li>Aboriginal and Torres Strait Islander people aged 50 years and over </li>
<li>adults with an underlying medical condition or significant disability.</li>
</ul>
<p>Many people are unsure if their condition qualifies as an underlying medical condition or significant disability. There is a useful factsheet on Phase 1b on the federal health department website <a href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/phase-1b">here</a>. </p>
<p>Here’s what you need to know.</p>
<h2>What if I have asthma?</h2>
<p>Only severe asthma counts. If you have mild or moderate asthma, you do <em>not</em> qualify under Phase 1b. The rate of severe asthma in Australia is <a href="https://www.nationalasthma.org.au/living-with-asthma/resources/health-professionals/charts/severe-asthma-checklist">under 4%</a>, so most people who have asthma do not have “severe asthma” and so the vast majority don’t qualify under 1b.</p>
<p>If you take a high dose preventer (inhaled corticosteroid) every day and still need to use your reliever puffer (ventolin/salbutamol) more than twice a week, then that is counted as <a href="https://asthma.org.au/about-asthma/severe-asthma/what-is-severe-asthma/">severe</a>. </p>
<p>It may also be counted as severe if you cannot reduce your preventer dose without having an asthma attack — even if you currently have the right mix of medications to keep your asthma under control. </p>
<p>If you have other chronic lung diseases like chronic obstructive pulmonary disease, cystic fibrosis or interstitial lung disease, then you are eligible for a vaccine under Phase 1b.</p>
<h2>What about diabetes?</h2>
<p>Yes, diabetes is counted as a severe underlying medical condition under Phase 1b. It doesn’t matter if it is Type 1 or Type 2 diabetes — you are eligible for a jab.</p>
<figure class="align-center ">
<img alt="Person with diabetes using a lancet pen" src="https://images.theconversation.com/files/399613/original/file-20210510-23-xb9ge2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/399613/original/file-20210510-23-xb9ge2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/399613/original/file-20210510-23-xb9ge2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/399613/original/file-20210510-23-xb9ge2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/399613/original/file-20210510-23-xb9ge2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/399613/original/file-20210510-23-xb9ge2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/399613/original/file-20210510-23-xb9ge2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Everyone with diabetes, type 1 or 2, is currently eligible for a COVID vaccine in Australia under phase 1B.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-taking-blood-sample-lancet-pen-716756734">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Does obesity count?</h2>
<p>Yes. Anyone with a BMI over 40 is eligible. Obesity predisposes you to a range of chronic health problems so it is considered serious enough to qualify.</p>
<h2>What about heart disease?</h2>
<p>It depends. If you’ve had ischaemic heart disease, valvular heart disease, cardiomyopathies and pulmonary hypertension, then you qualify under Phase 1b. It would need to be, for example, a documented heart attack or enlarged heart or clear damage to the valves. If in doubt, ask your GP.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/399624/original/file-20210510-13-ib61uk.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Specified underlying medical conditions for Phase 1b." src="https://images.theconversation.com/files/399624/original/file-20210510-13-ib61uk.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/399624/original/file-20210510-13-ib61uk.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1295&fit=crop&dpr=1 600w, https://images.theconversation.com/files/399624/original/file-20210510-13-ib61uk.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1295&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/399624/original/file-20210510-13-ib61uk.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1295&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/399624/original/file-20210510-13-ib61uk.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1627&fit=crop&dpr=1 754w, https://images.theconversation.com/files/399624/original/file-20210510-13-ib61uk.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1627&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/399624/original/file-20210510-13-ib61uk.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1627&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Specified underlying medical conditions for Phase 1b.</span>
<span class="attribution"><a class="source" href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/phase-1b#specified-underlying-medical-conditions">Created using data from Australian Department of Health.</a></span>
</figcaption>
</figure>
<h2>Does high blood pressure count?</h2>
<p>Yes, it does if it is difficult to control; so if you are on two or more medications then you are eligible under Phase 1b.</p>
<h2>I have cancer or have had it in the past, can I get the jab yet?</h2>
<p>It depends, but the answer may well be yes. For example, if you had breast cancer in the last five years you would be eligible. Check the list <a href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/phase-1b#adults-with-a-specified-underlying-medical-condition">here</a>.</p>
<h2>What about chronic inflammatory conditions?</h2>
<p>Some people with chronic inflammatory conditions requiring medical treatments are eligible, including systemic lupus erythematosus, rheumatoid arthritis, Crohn’s disease, and ulcerative colitis. </p>
<p>Usually these diseases need treatment with disease modifying anti-rheumatic drugs (DMARDs), immune-suppressive or immunomodulatory therapies.</p>
<p>Osetoarthritis doesn’t count.</p>
<p>This category is generally <em>not</em> inclusive of people living with osteoarthritis, fibromyalgia, myalgic encephalomyelitis/chronic fatigue syndrome or similar non-immunocompromising inflammatory conditions.</p>
<h2>Is kidney disease included?</h2>
<p>Yes, but only if you have kidney impairment with an eGFR of <44ml/min. Ask your GP if you are not sure. Mild to moderate chronic kidney disease doesn’t count.</p>
<h2>What about migraine?</h2>
<p>Probably not. The chronic neurological conditions category includes stroke, dementia, multiple sclerosis, motor neurone disease, Parkinson’s disease, cerebral palsy. It’s generally not inclusive of migraine or cluster headaches.</p>
<h2>What if I am a carer?</h2>
<p>You might well qualify. Check the details <a href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/phase-1b#specified-underlying-medical-conditions">here</a> but many carers of people with serious medical conditions or disability will qualify. I have had many people bringing in someone they care for to be vaccinated, not realising they are also able to get the a shot under this phase of the rollout.</p>
<p>However, family members of people with disability who are not carers aren’t yet eligible. Carers of adults <em>not</em> eligible under Phases 1a or 1b are also not yet able to get the jab.</p>
<h2>What’s next?</h2>
<p><a href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/getting-vaccinated-for-covid-19/when-will-i-get-a-covid-19-vaccine">Phase 2a</a> of the rollout is coming soon. That includes:</p>
<ul>
<li>people aged 50 years and over </li>
<li>Aboriginal and Torres Strait Islander people aged 16-49 years</li>
<li>other critical and high risk workers</li>
</ul>
<p>After that comes <a href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/getting-vaccinated-for-covid-19/when-will-i-get-a-covid-19-vaccine">Phase 2b</a>, which is where people aged 16-49 years can be vaccinated. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/were-gathering-data-on-covid-vaccine-side-effects-in-real-time-heres-what-you-can-expect-158945">We're gathering data on COVID vaccine side effects in real time. Here's what you can expect</a>
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</em>
</p>
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<img src="https://counter.theconversation.com/content/160602/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Natasha Yates is affiliated with RACGP.
</span></em></p>Many people are unsure if their condition qualifies as an underlying medical condition. They may not realise they’re already eligible for the COVID vaccine.Natasha Yates, Assistant Professor, General Practice, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1600002021-05-06T04:52:19Z2021-05-06T04:52:19ZHow do we actually investigate rare COVID-19 vaccine side-effects?<figure><img src="https://images.theconversation.com/files/399109/original/file-20210506-14-wffzox.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/smiling-young-woman-tshirt-showing-plaster-1954104319">from www.shutterstock.com</a></span></figcaption></figure><p>Investigations <a href="https://www.abc.net.au/news/2021-04-29/nsw-two-men-die-after-receiving-covid-19-vaccination/100103076">are under way</a> to determine whether the deaths of two people in New South Wales who developed blood clots are linked to the AstraZeneca vaccine.</p>
<p>We’ve also heard today that <a href="https://www.tga.gov.au/periodic/covid-19-vaccine-weekly-safety-report-06-05-2021">11 Australians</a> have so far developed blood clots (thrombosis with thrombocytopenia syndrome) linked with the vaccine.</p>
<p>But what are these investigations? And who decides whether events like these are actually linked to COVID-19 vaccines, or something else?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/im-over-50-and-can-now-get-my-covid-vaccine-is-the-astrazeneca-vaccine-safe-does-it-work-what-else-do-i-need-to-know-159814">I'm over 50 and can now get my COVID vaccine. Is the AstraZeneca vaccine safe? Does it work? What else do I need to know?</a>
</strong>
</em>
</p>
<hr>
<h2>What triggers the process?</h2>
<p>There is a lot of interest in the safety of COVID-19 vaccines. So the public and health-care workers are “highly tuned in” to reporting suspected side-effects. </p>
<p>Anyone can <a href="https://www.tga.gov.au/covid-19-vaccine-safety-monitoring-and-reporting">report these</a> to Australia’s drug regulator, the Therapeutic Goods Administration (TGA). Alternatively, people who have been vaccinated can do so when prompted with a survey via the <a href="https://www.ausvaxsafety.org.au/">AusVaxSafety</a> system.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1369167449086554116"}"></div></p>
<p>This is a good thing as it means we are likely to pick up any serious or unusual events. Every report is valuable and contributes to our safety monitoring. However, just because an event happened after a vaccine does not mean the vaccine <em>caused</em> it.</p>
<p>A serious event could be caused by an underlying medical condition, a medication the person was taking at the time, or some other factor unrelated to the vaccine. </p>
<p>For example, before COVID-19 and vaccines against it, dozens of people across Australia developed blood clots, in their <a href="https://www.racgp.org.au/download/documents/AFP/2010/July/201007ho.pdf">legs, lungs</a>, <a href="https://www.ahajournals.org/doi/pdf/10.1161/strokeaha.116.013617">brain</a> and other parts of the body, every day, often without warning or clear cause. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-vaccines-have-been-developed-in-record-time-but-how-will-we-know-theyre-safe-153888">COVID vaccines have been developed in record time. But how will we know they're safe?</a>
</strong>
</em>
</p>
<hr>
<h2>What happens next?</h2>
<p>When a person has a suspected vaccine side-effect it is usually <a href="https://www.tga.gov.au/reporting-adverse-events">reported</a> to the state or territory health department; some reports go directly to the TGA. </p>
<p>Most reactions reported after vaccination are mild to moderate. <a href="https://www.ausvaxsafety.org.au/safety-data/covid-19-vaccines">AusVaxSafety surveys</a> in more than 365,000 people in Australia confirm what we saw in vaccine trials. Up to two-thirds of people experience symptoms such as fever, muscle aches, joint pains and headache within the first one or two days after vaccination, which go away without treatment. This is the immune system responding to the vaccine.</p>
<h2>What if it’s serious?</h2>
<p>If the person dies or had a serious event needing hospitalisation within the days to weeks after vaccination — like the clotting cases you will have heard about, or there was an unusual unexpected event — there are further investigations. </p>
<p>Health department and TGA staff gather as much information as possible about the person, including their medical history, risk factors, any medications they are on, details and timing of the vaccine, hospitalisation records, any laboratory test results and whether they have recovered or have any ongoing issues. This will involve liaising with the person’s GP, specialists and the hospital.</p>
<p>Many states and territories then convene an <a href="https://www.health.nsw.gov.au/Infectious/covid-19/vaccine/Pages/clinicians.aspx">expert panel</a> of doctors to discuss a serious case. These panels often include the treating doctor, discuss the case in detail and may advise extra tests that may help them understand the event. </p>
<p>A full clinical dossier is then provided to the TGA, which then further reviews the case and decides whether a group of independent expert advisors, known as a “vaccine safety investigation group” or VSIG, is needed to review the case in detail and assess if the vaccine caused it.</p>
<p>The VSIG <a href="https://www.tga.gov.au/alert/astrazeneca-chadox1-s-covid-19-vaccine-2">often includes</a> independent medical experts in vaccine safety, infectious diseases, haematology, public health and vaccine confidence, other medical specialists, and a consumer representative.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/398804/original/file-20210505-19-1pn14lh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Socially distanced meeting, with videocall" src="https://images.theconversation.com/files/398804/original/file-20210505-19-1pn14lh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/398804/original/file-20210505-19-1pn14lh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/398804/original/file-20210505-19-1pn14lh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/398804/original/file-20210505-19-1pn14lh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/398804/original/file-20210505-19-1pn14lh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/398804/original/file-20210505-19-1pn14lh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/398804/original/file-20210505-19-1pn14lh.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">An independent panel of advisers meet to review the case in detail and to report to the TGA.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/online-video-conference-social-distancing-webinar-1818069497">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>The group reviews the clinical details of the event. It then uses an <a href="https://www.who.int/vaccine_safety/publications/CausalityAssessmentAEFI_EN.pdf?ua=1">internationally accepted method</a> to rate the level of certainty of a link between the serious event and the vaccine.</p>
<p>First, the group determines if there is enough clinical information to come to a decision, and if not, will request further information from the state/territory health department and may need to reconvene when that information is available.</p>
<p>The group then determines if the case is classified as:</p>
<ul>
<li><p>caused by the immunisation process (such as errors in vaccine technique) or the vaccine itself (the official terminology is “consistent causal association to immunisation”)</p></li>
<li><p>uncertain if the vaccine or immunisation process caused the event (“indeterminate”)</p></li>
<li><p>a coincidence (“inconsistent causal association to immunisation”). This could when because an underlying condition or something other than vaccine was the cause.</p></li>
</ul>
<p>The TGA then <a href="https://www.tga.gov.au/alert/astrazeneca-chadox1-s-covid-19-vaccine-3">publishes</a> the results of this independent assessment on its website. This is accompanied by a summary of the case(s) and extra clinical advice for doctors. The TGA also feeds the results back to the state/territory health department and treating doctor.</p>
<p>This information will also be included in <a href="https://www.tga.gov.au/communicating-covid-19-safety-information">weekly updates</a> published on the TGA website and is reviewed by other key advisory groups, including the <a href="https://www.health.gov.au/committees-and-groups/australian-technical-advisory-group-on-immunisation-atagi">Australian Technical Advisory Group on Immunisation</a> and the government, who monitor the progress of immunisation programs, including for COVID-19. </p>
<h2>Here’s the context</h2>
<p>While such serious vaccine-related events <a href="https://www.abc.net.au/news/2021-04-29/nsw-two-men-die-after-receiving-covid-19-vaccination/100103076">grab the headlines</a>, it’s important to remember they are <a href="https://theconversation.com/what-is-thrombocytopenia-the-rare-blood-condition-possibly-linked-to-the-astrazeneca-vaccine-158522">rare</a>. Most side-effects are mild-to-moderate and short-lived. On the other hand, the <a href="https://www.health.gov.au/resources/publications/covid-19-vaccination-weighing-up-the-potential-benefits-against-risk-of-harm-from-covid-19-vaccine-astrazeneca">benefits of COVID-19 vaccination</a> in ending the pandemic are enormous. </p>
<p>When concerning events occur after vaccination, it’s important to know Australia has strong systems to properly investigate them, look at any possible link and communicate the results to the public.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/a-balancing-act-between-benefits-and-risks-making-sense-of-the-latest-vaccine-news-158634">A balancing act between benefits and risks: making sense of the latest vaccine news</a>
</strong>
</em>
</p>
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<img src="https://counter.theconversation.com/content/160000/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicholas Wood receives funding from the NHMRC for a Career Development Fellowship. He holds a Churchill Fellowship.</span></em></p><p class="fine-print"><em><span>Kristine Macartney is the Director of the National Centre for Immunisation Research and Surveillance (NCIRS). NCIRS receives funding from the Australian and state governments, the WHO, the Gavi Vaccine Alliance and the NHMRC. She is a member of numerous vaccine advisory groups, including ATAGI, ACV, and an independent expert on the WHO Global Advisory Committee on Vaccine Safety.</span></em></p>A serious event such as a blood clot could be caused by an underlying medical condition, a medication the person was taking at the time, or some other factor unrelated to the vaccine.Nicholas Wood, Associate Professor, Discipline of Childhood and Adolescent Health, University of SydneyKristine Macartney, Professor, Discipline of Paediatrics and Child Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1579902021-04-15T18:47:02Z2021-04-15T18:47:02ZCOVID vaccine weekly: safety concerns and reactions in the west dent confidence worldwide<p>COVID-19 vaccination has hit arguably its biggest hurdle so far. The rollout of two vaccines – AstraZeneca’s and Johnson & Johnson’s – has been paused, restricted or completely stopped in a number of countries as regulators and governments respond to signs that they may be linked to rare abnormal blood clots in a small number of recipients.</p>
<p>The European Medicines Agency has noted that the link between the blood clots and the AstraZeneca vaccine is probable but unproven. But it is up to individual member states to decide how they wish to use the vaccine. The effect is that some European countries have introduced strict limits, allowing the jab to be given only to older age groups who are at significant risk from the virus, <a href="https://theconversation.com/astrazeneca-vaccine-what-now-for-rollout-in-the-uk-and-europe-158515">writes</a> Anthony Cox, Reader in Clinical Pharmacy and Drug Safety at the University of Birmingham. </p>
<p>Denmark <a href="https://www.telegraph.co.uk/news/2021/04/14/denmark-permanently-stops-using-astrazeneca-vaccine/">has even chosen</a> to withdraw the product completely, and Norway’s public health institute has said it <a href="https://www.euronews.com/2021/04/15/norway-should-stop-using-the-astrazeneca-vaccine-says-country-s-public-health-institute">should do the same</a>. However, in Britain the response has been more measured. The UK’s Joint Committee on Vaccination and Immunisation has recommended that under-30s should be offered an alternative vaccine — Pfizer and Moderna shots are now both being administered in the country — but that otherwise its use should continue as for all other groups it benefits outweigh the risks.</p>
<p>In the US, the same safety signal of a rare, unwanted type of blood clotting has been reported more frequently than normally would be expected among people who have taken the Johnson & Johnson vaccine. As a result, the vaccine’s rollout <a href="https://theconversation.com/johnson-and-johnson-vaccine-suspension-a-doctor-explains-what-this-means-for-you-158923">has been paused</a> in the US while officials, like their European counterparts, try to uncover whether there is a link.</p>
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<img alt="" src="https://images.theconversation.com/files/320716/original/file-20200316-18073-ruhw8b.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/320716/original/file-20200316-18073-ruhw8b.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/320716/original/file-20200316-18073-ruhw8b.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/320716/original/file-20200316-18073-ruhw8b.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/320716/original/file-20200316-18073-ruhw8b.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/320716/original/file-20200316-18073-ruhw8b.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/320716/original/file-20200316-18073-ruhw8b.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>
</figcaption>
</figure>
<p><em><strong>This is our weekly round-up of expert information about the <a href="https://theconversation.com/uk/topics/covid-vaccines-96571">COVID-19 vaccines</a>.</strong> <br>
The Conversation, a not-for-profit group, works with a wide range of academics across its global network to produce evidence-based analysis and insights. Get more regular updates from trusted experts by <a href="https://theconversation.com/uk/newsletters/the-daily-2">subscribing to our free newsletter</a> .</em></p>
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<p>The decisions of these western nations’ regulators are having a knock-on effect elsewhere. The withholding of AstraZeneca and Johnson & Johnson vaccines in Europe and the US <a href="https://www.nytimes.com/2021/04/14/world/europe/western-vaccines-africa-hesitancy.html">has dented</a> both official and public confidence in these jabs, in some instances in countries where there are currently no alternatives. </p>
<p>South Africa, having stopped using the AstraZeneca vaccine because of concerns that it may be less effective against the country’s dominant variant of coronavirus, has now also paused giving the Johnson & Johnson vaccine. In other African countries still offering the AstraZeneca jab, public fear is mounting and doses are going unused. Considering how efforts to deliver vaccines to lower-income countries are <a href="https://theconversation.com/the-best-hope-for-fairly-distributing-covid-19-vaccines-globally-is-at-risk-of-failing-heres-how-to-save-it-158779">already faltering</a>, declining faith in the few doses that have been provided is worrying – this compounds the issue that coverage in low- and middle-income countries was <a href="https://theconversation.com/covid-19-vaccines-how-and-when-will-lower-income-countries-get-access-152718">already likely to be low</a> for the foreseeable future.</p>
<figure class="align-center ">
<img alt="A blood clot inside a vein" src="https://images.theconversation.com/files/395340/original/file-20210415-23-jgoh36.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/395340/original/file-20210415-23-jgoh36.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/395340/original/file-20210415-23-jgoh36.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/395340/original/file-20210415-23-jgoh36.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/395340/original/file-20210415-23-jgoh36.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/395340/original/file-20210415-23-jgoh36.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/395340/original/file-20210415-23-jgoh36.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">
<figcaption>
<span class="caption">In the UK, blood clots associated with the AstraZeneca vaccine appear to be affecting around 1 in every 250,000 people.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/3d-rendered-medically-accurate-illustration-blood-1081586696">SciePro/Shutterstock</a></span>
</figcaption>
</figure>
<p>The specific type of blood clotting reported with these vaccines is quite rare. It’s called cerebral venous sinus thrombosis, <a href="https://theconversation.com/blood-clot-risks-comparing-the-astrazeneca-vaccine-and-the-contraceptive-pill-158652">explains</a> Adam Taylor, Director of the Clinical Anatomy Learning Centre at Lancaster University, and is accompanied by a lack of platelets in the blood – what’s known as <a href="https://theconversation.com/what-is-thrombocytopenia-the-rare-blood-condition-possibly-linked-to-the-astrazeneca-vaccine-158522">thrombocytopenia</a>. The rarity of this type of clotting suggests that the same thing might be going wrong in recipients of both vaccines, which has led people to look at their similarities. </p>
<p>One theory, which Kylie Quinn of RMIT in Australia <a href="https://theconversation.com/is-it-the-adenovirus-vaccine-technology-used-by-astrazeneca-and-johnson-and-johnson-causing-blood-clots-theres-no-evidence-yet-158944">outlines</a>, is that the clotting may be related to the vaccines’ design. Both stimulate an immune response by getting the body to make copies of the coronavirus’s spike protein, and they do this by delivering some of the coronavirus’s genetic material into the body using a different, harmless adenovirus as a carrier. There’s no evidence yet, but it could be that this adenovirus-based system is triggering an adverse immune response that affects the blood in a small minority of people. </p>
<p>Meanwhile, a second blood-related disorder – capillary leak syndrome – also may be surfacing more frequently than it would usually among people who have taken the AstraZeneca vaccine. However, drawing a link between this condition and the vaccine may be even harder than with the blood clotting, as so little is known about it, <a href="https://theconversation.com/what-is-capillary-leak-syndrome-and-is-it-linked-to-the-astrazeneca-vaccine-158812">writes</a> Peter Abel, Senior Lecturer in Haematology, Immunolgy, Genetics and Evolution at the University of Central Lancashire. There’s also no evidence so far that it and the blood clotting issues are linked.</p>
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<p><em>Get the latest news and advice on <a href="https://theconversation.com/uk/covid-19">COVID-19</a>, direct from the experts in your inbox. Join hundreds of thousands who trust experts by <strong><a href="https://theconversation.com/uk/newsletters/the-daily-2">subscribing to our newsletter</a></strong>.</em></p><img src="https://counter.theconversation.com/content/157990/count.gif" alt="The Conversation" width="1" height="1" />
Both the AstraZeneca and Johnson & Johnson vaccines are now being investigated for links to rare blood disorders.Rob Reddick, Commissioning Editor, COVID-19Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1588122021-04-14T13:46:11Z2021-04-14T13:46:11ZWhat is capillary leak syndrome and is it linked to the AstraZeneca vaccine?<figure><img src="https://images.theconversation.com/files/395041/original/file-20210414-13-y5ib5v.jpg?ixlib=rb-1.1.0&rect=263%2C30%2C3433%2C1949&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Capillaries are the body's smallest blood vessels, and allow oxygen, nutrients and waste products to be delivered and removed from tissues.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/system-many-small-capillaries-branch-out-1748988446">hareluya/Shutterstock</a></span></figcaption></figure><p>Following the <a href="https://www.ema.europa.eu/en/news/astrazenecas-covid-19-vaccine-ema-finds-possible-link-very-rare-cases-unusual-blood-clots-low-blood">announcement</a> of a possible link between the AstraZeneca vaccine and rare blood clots, the European Medicines Agency (EMA) is now investigating whether the vaccine is linked to a second very rare blood disorder: systemic capillary leak syndrome (SCLS). </p>
<p>To date, <a href="https://www.ema.europa.eu/en/news/meeting-highlights-pharmacovigilance-risk-assessment-committee-prac-6-9-april-2021">five cases</a> of SCLS in recently vaccinated people have been reported to the EMA. The regulator’s Pharmacovigilance Risk Assessment Committee is now working to see if a causal link with the AstraZeneca vaccine can be established – as it did following reports of blood clots – and whether new safety guidelines for the vaccine are needed.</p>
<p>This investigation is a response to what the EMA calls a “safety signal”. These are unusual events that have been flagged up as possible side-effects of a given medicine, but which need researching in-depth for this to be confirmed. </p>
<p>As the <a href="https://www.ema.europa.eu/en/human-regulatory/post-authorisation/pharmacovigilance/signal-management">EMA notes</a>, receiving safety signals doesn’t itself prove that a medicine causes the adverse events being reported – illness or other medicines could also be the cause. This is why every case needs to be thoroughly investigated, and we should avoid jumping to conclusions. </p>
<p>However, with tens of millions of vaccines having been given, it’s very difficult to tease out whether such rare events can be attributed to the vaccine or are appearing as part of the normal course of events in a population.</p>
<h2>A mysterious condition</h2>
<p>We also don’t know a lot about SCLS in the first place. There have been <a href="https://rarediseases.org/rare-diseases/systemic-capillary-leak-syndrome/">fewer than 500 cases reported</a> since it was first described by researchers in 1960 (it is also known as Clarkson’s disease, after one of these scientists). </p>
<p>In this disorder, the blood plasma, the yellowish liquid part of the blood, leaks out from the smallest blood vessels, the capillaries, into the surrounding tissues, potentially causing great damage. It can lead to organ failure and death if untreated.</p>
<p>Sufferers have irregular episodes that are different in their intensity depending on the individual. This means that making a diagnosis can be difficult. Sufferers may also feel tired and have <a href="https://www.nhs.uk/conditions/oedema/">water retention</a> (also known as oedema, where fluid builds up in the body), both of which are relatively common – particularly in the elderly – and may be caused by many things. This can delay people reporting such symptoms to their GP. </p>
<figure class="align-center ">
<img alt="A patient with water retention (oedema) in one of their hands" src="https://images.theconversation.com/files/395043/original/file-20210414-21-s6llzm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/395043/original/file-20210414-21-s6llzm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=510&fit=crop&dpr=1 600w, https://images.theconversation.com/files/395043/original/file-20210414-21-s6llzm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=510&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/395043/original/file-20210414-21-s6llzm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=510&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/395043/original/file-20210414-21-s6llzm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=640&fit=crop&dpr=1 754w, https://images.theconversation.com/files/395043/original/file-20210414-21-s6llzm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=640&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/395043/original/file-20210414-21-s6llzm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=640&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Water retention can cause parts of the body to swell as fluid builds up.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/comparison-normal-right-hand-left-swollen-1395702005">Zay Nyi Nyi/Shutterstock</a></span>
</figcaption>
</figure>
<p>Unsurprisingly, SCLS can be misdiagnosed. Its symptoms are similar to those seen in sepsis, which also <a href="https://pubmed.ncbi.nlm.nih.gov/12803259/">causes the capillaries to leak</a>. SCLS also <a href="https://rarediseases.info.nih.gov/diseases/1084/systemic-capillary-leak-syndrome">causes</a> low blood pressure, low levels of albumin (a protein found in the blood plasma) and a high red blood cell concentration – all signs of other, more common disorders. </p>
<p>Together, these factors may have led to cases of the condition being missed in the past, which in turn may have hampered efforts to understand it better. It’s also plausible that they might make it harder for people to spot instances of SCLS now. However, this may be counterbalanced by the fact that people are now <a href="https://www.theguardian.com/society/2021/apr/09/ae-swamped-with-patients-seeking-help-for-mild-covid-jab-side-effects">highly alert</a> to the possibility of vaccine side-effects, and so may be more vigilant in picking them up – a recognised phenomenon known as “<a href="https://journals.sagepub.com/doi/abs/10.1177/0018578719882323">notoriety bias</a>”.</p>
<p>There’s also a common feature of SCLS that could be useful for identification: the production of an abnormal immune protein, known as M protein. This <a href="https://www.jacionline.org/article/S0091-6749(16)32460-5/pdf">occurs in up to 85%</a> of patients who are diagnosed with the condition. However, the production of M protein also occurs in some types of blood cancer, such as <a href="https://www.cancer.net/cancer-types/multiple-myeloma/stages">myeloma</a>, a much more common disease among the elderly (who have predominantly taken the vaccine).</p>
<h2>What do we know about its causes?</h2>
<p>Studies show that during SCLS there seem to be changes in the <a href="https://pubmed.ncbi.nlm.nih.gov/11591575/">integrity of blood vessel walls</a>, accompanied by a disordered immune response. It’s possible therefore that the immune system is directly affecting the blood vessels; we know from another condition – <a href="https://www.nhs.uk/conditions/vasculitis/">vasculitis</a> – that an autoimmune reaction to the blood vessels can happen.</p>
<p>Patients who have been diagnosed with SCLS tend to be <a href="https://rarediseases.org/rare-diseases/systemic-capillary-leak-syndrome/">carefully given fluids</a> to manage their symptoms, and some patients have improved after <a href="https://www.amjmed.com/article/S0002-9343(17)30602-2/pdf">being given intravenous immunoglobulin</a> (the protein from which antibodies are made). This seems to prevent further episodes, highlighting the immune system’s likely role in the disease. But the specific causes of SCLS are <a href="https://rarediseases.info.nih.gov/diseases/1084/systemic-capillary-leak-syndrome">unknown</a>.</p>
<p>The EMA will be looking closely at whether a possible mechanism is the AstraZeneca vaccine causing the immune system to attack blood vessels. A single similar incidence of this was <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4690641/">reported in 2015</a>, when a dialysis patient developed SCLS after an influenza vaccine. Although researchers were unable to link this occurrence of SCLS to the vaccine, they nevertheless reported it to the Netherlands Pharmacovigilance Centre as a possible side-effect.</p>
<p>Another question for the EMA is whether this rare blood disorder can be linked to the <a href="https://theconversation.com/blood-clot-risks-comparing-the-astrazeneca-vaccine-and-the-contraceptive-pill-158652">other recently reported safety signal</a>: blood clots with low platelet counts. While it may be tempting to link the two conditions with each other and the vaccine rollout, there’s no evidence yet to suggest they are connected. Even if both disorders are proven to be linked to the vaccine, they could still be completely unconnected. </p>
<p>It’s important to remember that there have been very few cases of this syndrome reported so far. If the regulators do establish that there’s a causal relationship between SCLS and the vaccine, the benefits of taking it still need to be weighed correctly against the risks, with this being reflected in any future guidance and communications.</p><img src="https://counter.theconversation.com/content/158812/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Abel 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>European regulators are investigating a possible link between the vaccine and a second rare blood disorder.Peter Abel, Senior Lecturer in Haematology, Immunolgy, Genetics and Evolution, University of Central LancashireLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1587632021-04-12T05:30:34Z2021-04-12T05:30:34ZNew AstraZeneca advice is a safer path, but it’s damaged vaccine confidence. The government must urgently restore it<p>The federal government’s <a href="https://www.health.gov.au/news/atagi-statement-on-astrazeneca-vaccine-in-response-to-new-vaccine-safety-concerns">recommendation</a> last week that the Pfizer COVID-19 vaccine is now the preferred vaccine for <a href="https://theconversation.com/new-setback-for-vaccine-rollout-with-astrazeneca-not-advised-for-people-under-50-158661">adults under 50</a> has shaken public confidence in the COVID-19 vaccine rollout.</p>
<p>The Australian Technical Advisory Group on Immunisation (ATAGI) advised the AstraZeneca vaccine, previously planned as Australia’s main vaccine, will no longer be the preferred vaccine for adults <a href="https://www.health.gov.au/news/atagi-statement-on-astrazeneca-vaccine-in-response-to-new-vaccine-safety-concerns">under 50</a>. It came after an extensive review of data from the United Kingdom and Europe which <a href="https://www.ema.europa.eu/en/news/astrazenecas-covid-19-vaccine-ema-finds-possible-link-very-rare-cases-unusual-blood-clots-low-blood">found an association</a> between a <a href="https://theconversation.com/what-is-thrombocytopenia-the-rare-blood-condition-possibly-linked-to-the-astrazeneca-vaccine-158522">very rare type of blood clot</a> and the AstraZeneca vaccine.</p>
<p>Public confusion has already resulted in <a href="https://www.theage.com.au/national/patients-call-off-their-shots-as-some-gps-pull-out-of-vaccine-program-20210409-p57hsh.html">mass cancellations</a> of vaccine appointments at GP clinics, by adults both over and under 50.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1380370724490186753"}"></div></p>
<p>It’s important to remember the Australian government can afford to choose a safer path because we are not in the midst of a large COVID-19 outbreak.</p>
<p>But a decrease in vaccine confidence may be an unintended consequence of this path.</p>
<p>Now, the federal government must urgently restore public confidence in the vaccine rollout. It needs to quickly reassure adults aged over 50 the AstraZeneca vaccine is safe.</p>
<p>It’s essential the government gets this right. Concerns about one vaccine can damage public trust in other vaccines. </p>
<h2>Why has a safer approach decreased confidence?</h2>
<p>Vaccine confidence can be fickle. There are many recent examples of established vaccine programs that have been undermined by unrelated <a href="https://doi.org/10.1136/bmj.l739">events</a> or <a href="https://doi.org/10.1016/S1473-3099(20)30053-0">errors</a>. This has led to mass disease outbreak and preventable death. For example, in the Philippines, a new measles outbreak that infected <a href="https://reliefweb.int/report/philippines/philippines-measles-outbreak-operation-update-re-emergence-vaccine-preventable">47,871</a> people in 2019 and killed 632, mostly children, was fuelled by a drop in measles vaccination spurred by concerns about a dengue fever vaccine.</p>
<p>Vaccine program resilience is an even bigger ask during a new vaccine rollout where rare effects are expected once the vaccine is given to hundreds of millions of people. </p>
<p>Research from the Australian National University published last week <a href="https://www.theaustralian.com.au/breaking-news/young-women-most-reluctant-group-to-get-covid19-jab/news-story/c5ec369f81f8e70cf79aeafe222cb1b0">found</a> young women are the most likely to avoid vaccination. Women who did not approve of the government’s handling of recent sexual harassment scandals were less likely to accept a COVID vaccine. This demonstrates the importance of trust, and shows a lack of trust in one area of the government’s remit can spill into other areas. </p>
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<p>Because the risk of catching COVID-19 is currently so low in Australia, many people are feeling less interested in being vaccinated.</p>
<p><a href="https://doi.org/10.1016/S1473-3099(20)30724-6">One Australian study</a>, published in September last year, found fewer people were willing to accept a COVID-19 vaccine compared to a <a href="https://doi.org/10.1016/S1473-3099(20)30559-4">similar study</a> done two months earlier. This decrease was evident following a decreased number of new COVID-19 cases in Australia in the time between these two studies. People can change their intention to be vaccinated when they fear the effects from the vaccine more than the disease.</p>
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<p>On top of all of this, some members of the community are still concerned COVID-19 vaccines were developed too quickly and without appropriate checks and balances — even though this isn’t true.</p>
<p>Changing recommendations during a vaccine program rollout can compound these concerns.</p>
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Read more:
<a href="https://theconversation.com/less-than-a-year-to-develop-a-covid-vaccine-heres-why-you-shouldnt-be-alarmed-150414">Less than a year to develop a COVID vaccine – here's why you shouldn't be alarmed</a>
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<h2>How can confidence be restored?</h2>
<p>While the federal government was quick to accept the recommendation from ATAGI, the confusion has added to the rollout chaos. Public confidence has been damaged, and further <a href="https://www.bbc.com/news/world-australia-56684833">vaccine delays are imminent</a> across the board, including for younger health and aged-care workers. </p>
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Read more:
<a href="https://theconversation.com/4-ways-australias-covid-vaccine-rollout-has-been-bungled-158225">4 ways Australia's COVID vaccine rollout has been bungled</a>
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<p>Vaccine program resilience is essential to survive the bumps along the way and the government has not invested enough in understanding public sentiment and developing plain language information resources. </p>
<p>The challenge for public health and the federal government now is to address the understandable concerns and prevent them from contaminating the broader public dialog on COVID-19 vaccination.</p>
<p>With high numbers of Australians needing to be vaccinated to prevent further COVID-19 outbreaks, there’s very little room for vaccine rejection.</p>
<p>The government urgently needs to use clear messaging for all communities and health professionals. This includes communities with <a href="https://theconversation.com/how-can-governments-communicate-with-multicultural-australians-about-covid-vaccines-its-not-as-simple-as-having-a-poster-in-their-language-156097">diverse cultural and language requirements</a> </p>
<p>These efforts will greatly benefit from multidisciplinary teams of infectious disease, vaccine, social science and communication experts.</p>
<h2>We need a compensation scheme</h2>
<p>During Australia’s COVID-19 vaccine rollout, so far one man in his 40s has <a href="https://www.abc.net.au/news/2021-04-02/man-who-received-astrazeneca-coronavirus-vaccine-has-blood-clots/100046540">developed blood clots</a> following vaccination with the AstraZeneca vaccine. There’s a <a href="https://www.health.gov.au/news/atagi-statement-on-astrazeneca-vaccine-in-response-to-new-vaccine-safety-concerns">25% death rate</a> following a vaccine-related clot according to ATAGI. Four to six clots <a href="https://www.health.gov.au/news/atagi-statement-on-astrazeneca-vaccine-in-response-to-new-vaccine-safety-concerns">are expected</a> per million doses of AstraZeneca vaccine (first dose) and while this reaction is exceedingly rare, it is severe. </p>
<p>This also highlights the importance of a no-fault vaccine injury compensation <a href="https://theconversation.com/bad-reactions-to-the-covid-vaccine-will-be-rare-but-australians-deserve-a-proper-compensation-scheme-150288">scheme</a>.</p>
<p>Such a scheme recognises that if the government promotes whole of community vaccination for collective good, then it also accepts the ethical and financial burden for the few people who will sustain a serious injury. The federal government should implement one as a matter of priority.</p>
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Read more:
<a href="https://theconversation.com/bad-reactions-to-the-covid-vaccine-will-be-rare-but-australians-deserve-a-proper-compensation-scheme-150288">Bad reactions to the COVID vaccine will be rare, but Australians deserve a proper compensation scheme</a>
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<img src="https://counter.theconversation.com/content/158763/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jane E Frawley 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 challenge now is to address the understandable concerns and prevent them from contaminating the broader public dialogue on COVID-19 vaccination.Jane E Frawley, NHMRC Research Fellow, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1586112021-04-08T07:34:06Z2021-04-08T07:34:06ZAstraZeneca’s blood clot risk is incredibly small. Australia shouldn’t follow the UK’s lead of offering under 30s another vaccine<p>Authorities in the United Kingdom overnight <a href="https://www.abc.net.au/news/2021-04-08/astrazeneca-covid-vaccine-not-given-to-under-30-uk-blood-clots/100054824">recommended</a> people under 30 be offered an alternative COVID vaccine to the AstraZeneca/Oxford shot. </p>
<p>The recommendation came after the European Medicines Agency (EMA) <a href="https://www.ema.europa.eu/en/news/astrazenecas-covid-19-vaccine-ema-finds-possible-link-very-rare-cases-unusual-blood-clots-low-blood">found</a> a “possible link” between the vaccine and blood clots. The EMA <a href="https://www.bbc.com/news/world-europe-56665150">also said</a> blood clots should be listed as a “very rare” side effect of the vaccine.</p>
<p>It’s important to note there’s still no conclusive evidence the vaccine is <em>causing</em> the clots, as so few have been reported. However, evidence there is a link is increasing, which has prompted more focused monitoring. </p>
<p>The benefits of getting a COVID vaccine still far outweigh the risks. I would still be encouraging everyone to be vaccinated with the AstraZeneca vaccine.</p>
<p>Prime Minister Scott Morrison <a href="https://www.theage.com.au/politics/federal/australian-government-reviewing-latest-uk-europe-astrazeneca-vaccine-advice-20210408-p57he0.html">said this morning</a> “there’s nothing to suggest at this stage that there would be any change” to Australia’s current rollout strategy. The Therapeutic Goods Administration and the Australian Technical Advisory Group on Immunisation are <a href="https://www.abc.net.au/news/2021-04-08/australia-government-urgently-look-astrazeneca-covid-vaccine/100054896">currently reviewing</a> the data and latest advice from Europe and the UK.</p>
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<h2>What’s causing these clots?</h2>
<p>Blood clotting events linked to vaccination are <a href="https://www.thanz.org.au/documents/item/577">being called</a> “vaccine-induced prothrombotic immune thrombocytopenia” (VIPIT).</p>
<p>In these rare instances, clots are forming in a patient’s blood, and <a href="https://www.abc.net.au/news/2021-04-08/covid19-vaccine-blood-clotting-az-explainer/100055638">not just in veins but in arteries</a> and other rare locations like the <a href="https://www.theaustralian.com.au/nation/coronavirus-latest-about-astrazeneca-vaccine-and-blood-clot-risk/news-story/8fec82bcb59afc1c710e1a9b1be0abe7">brain and abdomen</a>. This is also paired with <a href="https://www.smh.com.au/national/what-we-know-so-far-about-blood-clots-linked-to-astrazeneca-vaccine-20210408-p57hg6.html">low platelet counts</a> (cells needed for the blood to clot).</p>
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Read more:
<a href="https://theconversation.com/what-is-thrombocytopenia-the-rare-blood-condition-possibly-linked-to-the-astrazeneca-vaccine-158522">What is thrombocytopenia, the rare blood condition possibly linked to the AstraZeneca vaccine?</a>
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<p>It appears, in these instances, the body’s response to the vaccine is triggering an “off target” immune response that is attacking platelets. <a href="https://www.researchsquare.com/article/rs-362354/v1">Limited data</a> that is yet to be peer reviewed suggests antibodies targeting platelets cause them to become activated and trigger clotting. This autoimmune response also targets the platelets for destruction, reducing their level in the blood. So platelets are either tied up in clots or are eliminated. Both processes contribute to “thrombocytopenia” (low blood platelet count).</p>
<p>Like infections, vaccines trigger an immune response, so when receiving any shot that stimulates a robust immune response there’s a small but real risk your immune system will generate “off target” effects. In these rare instances, these effects can lead to autoimmunity, which is an immune response that attacks your own cells.</p>
<h2>All vaccines and medications come with small risks</h2>
<p>The numbers of clots reported after the AstraZeneca are very small, so we don’t exactly know how common they are. But they <a href="https://www.smh.com.au/national/here-s-what-we-know-about-astrazeneca-and-that-rare-blood-clotting-disorder-20210405-p57gl5.html">appear to occur</a> at a rate between one in 25,000 and one in 500,000.</p>
<p>The UK’s vaccine advisory board <a href="https://www.abc.net.au/news/2021-04-08/astrazeneca-vaccine-linked-to-rare-blood-clots-ema/100054774">said</a> there were 79 cases of blood clotting issues among more than 20 million people given the AstraZeneca vaccine. That’s a chance of about 0.0004%, or one in 250,000.</p>
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<p>Researchers haven’t yet identified any specific risk factors so far for the development of blood clots following COVID vaccination. We need to understand as quickly as possible what these are if indeed a causal link is established.</p>
<p><a href="https://www.reuters.com/article/us-health-coronavirus-astrazeneca-vaccin-idUSKBN2BT1ER">Some have suggested</a> there could be a link with women taking the contraceptive pill having a higher risk of blood clots after receiving the AstraZeneca vaccine. But there’s no evidence for this at all. As far as I know, information on whether women receiving the vaccine are taking the contraceptive pill isn’t captured. Perhaps it’s something to consider going forward.</p>
<p>Young people don’t appear to be at particularly higher risk of blood clots linked to the vaccine. The publicised cases of blood clots have occurred in <a href="https://www.afr.com/policy/health-and-education/scientists-name-clotting-syndrome-associated-with-astrazeneca-vaccine-20210406-p57guv">mostly women under 60 years of age</a>.</p>
<h2>Australia shouldn’t follow the UK’s new recommendation</h2>
<p>One reason the UK is able to advise younger people to receive other vaccines is because it has other vaccine options, including the Pfizer and Moderna shots. Offering the under 30s an alternative vaccine isn’t really going to hinder the rollout, which is going very well in the UK.</p>
<p>But this isn’t the case in Australia. The AstraZeneca shot is the only one we have guaranteed supply of, given CSL is producing it in Melbourne.</p>
<p>It’s important to remember the AstraZeneca vaccine is a very safe and effective vaccine. It’s also easier to store and distribute than the Pfizer vaccine.</p>
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<h2>The priority is vaccinating as many people as possible and quickly</h2>
<p>It’s important to note we’re in uncharted territory. This is the first time in modern history we’ve been in a situation where we’ve needed to roll out a vaccine to deal with a pandemic.</p>
<p>We’re also using new vaccine technologies that we’ve had to expedite to try and get on top of this virus as soon as possible. These new technologies, including AstraZeneca’s, have never been tested at this immense scale until now.</p>
<p>There are a lot of unknowns, but certainly the scale in which were doing this means we’re going to see very rare adverse events linked to these vaccines.</p>
<p>At this stage the priority is still to vaccinate as many people as possible, as quickly as possible.</p>
<p>My primary concern is ongoing high levels of transmission across the world. The more cases there are, and longer we delay vaccinating people, the higher the likelihood is of new variants of the virus emerging. </p>
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Read more:
<a href="https://theconversation.com/uk-south-african-brazilian-a-virologist-explains-each-covid-variant-and-what-they-mean-for-the-pandemic-154547">UK, South African, Brazilian: a virologist explains each COVID variant and what they mean for the pandemic</a>
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<p>Even though we have very low COVID-19 case numbers in Australia currently, we’ve seen regular outbreaks <a href="https://theconversation.com/perth-is-the-latest-city-to-suffer-a-covid-quarantine-breach-why-does-this-keep-happening-154375">stemming from hotel quarantine</a>. We can’t predict what’s going to happen in the future. The longer the virus is waiting at our doorstep, the greater the risk we’ll have another outbreak and end up in lockdown and much worse — and nobody wants that.</p><img src="https://counter.theconversation.com/content/158611/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nathan Bartlett 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>All vaccines and medications come with risks. But the risks of delaying vaccination are far higher.Nathan Bartlett, Associate Professor, School of Biomedical Sciences and Pharmacy, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1583002021-04-01T20:07:11Z2021-04-01T20:07:11ZWhy Johnson & Johnson throwing out 15 million COVID-19 vaccine doses shouldn’t scare you<figure><img src="https://images.theconversation.com/files/393200/original/file-20210401-21-1aa4vgp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Vaccine production staff demonstrate operations at a facility in Germany.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakGermanyVaccineManufacturing/5d45624961da484aaf748f5e5e0859db/photo">AP Photo/Michael Probst</a></span></figcaption></figure><p>Human errors at a manufacturing plant forced Johnson & Johnson to throw out <a href="https://www.politico.com/news/2021/03/31/johnson-johnson-vaccine-15-million-ruined-478776">15 million doses</a> of its COVID-19 vaccine – enough to vaccinate 7% of the U.S. adult population. </p>
<p>The New York Times, which first reported the loss on March 31, 2021, called it “<a href="https://www.nytimes.com/2021/03/31/world/johnson-and-johnson-vaccine-mixup.html?smtyp=cur&smid=tw-nytimes">a major embarrassment</a>” for the vaccine-maker and its subcontractor, Emergent BioSolutions.</p>
<p>But while errors with an impact of that magnitude sound shocking, they’re also a reminder that the U.S. vaccine manufacturing process has strict quality control measures designed to catch these problems before they reach the public.</p>
<p>Vaccine manufacturing is complex, with many potential points for errors. As an expert in <a href="https://scholar.google.com/citations?user=cpd3_bYAAAAJ&hl=en">health care operations</a> and the <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3797192">COVID-19 vaccine rollout</a>, I closely follow vaccine manufacturing and approval processes. The multiple layers of quality checks by the producer and external inspectors throughout the process are essential to protect public health.</p>
<h2>Checking the vaccines, and checking them again</h2>
<p>After authorizing a vaccine, the U.S. Food and Drug Administration must <a href="https://www.historyofvaccines.org/content/articles/vaccine-development-testing-and-regulation">approve and regularly inspect</a> each vaccine manufacturing facility. </p>
<p>Before each batch of vaccines is released by the FDA, it undergoes rigorous and extensive testing to ensure vaccine safety. In the case of COVID-19 vaccines, manufacturers are required to submit the results of each quality control test for each batch of vaccines <a href="https://www.fda.gov/media/144412/download">48 hours</a> prior to its distribution. This stringent quality control process has led to what the FDA describes as the <a href="https://www.fda.gov/files/vaccines,%20blood%20&%20biologics/published/Ensuring-the-Safety-of-Vaccines-in-the-United-States.pdf">safest vaccine supply</a> in U.S. history.</p>
<p>The quality control process is also how <a href="https://www.jnj.com/johnson-johnson-statement-on-u-s-covid-19-vaccine-manufacturing">Johnson & Johnson discovered</a> defects within the batch of 15 million doses at the Emergent BioSolutions facility. </p>
<p>The Baltimore plant was one of several <a href="https://www.hhs.gov/about/news/2020/06/01/hhs-adds-628-million-contract-emergent-biosolutions-secure-manufacturing-capacity-operation-warp-speed.html">contracted by the federal government</a> in 2020 to help vaccine-makers ramp up production. The facility was still awaiting authorization from the FDA to deliver the vaccines for U.S. use when the problems were discovered. As standard practice, Johnson & Johnson said it had <a href="https://www.jnj.com/johnson-johnson-statement-on-u-s-covid-19-vaccine-manufacturing">specialists at the facility</a> to check safety and quality. The Washington Post reported that workers at the facility in late February <a href="https://www.washingtonpost.com/business/2021/03/31/vaccine-johnson-johnson-emergent/">mixed up</a> the ingredients for the AstraZeneca and Johnson & Johnson vaccines both being produced there, throwing the entire batch into question. The FDA had <a href="https://apnews.com/article/virus-vaccine-johnson-and-johnson-emergent-biosolutions-d9edd171f8013e17c0be8b13a6db7fed">previously flagged quality control concerns</a> at Emergent’s Baltimore plant related to its testing of a potential treatment for anthrax, according to the records obtained by the Associated Press. </p>
<p>All vaccine manufacturing plants – domestic and international – require authorization from the FDA before they can supply vaccines to the U.S. population. The Johnson & Johnson vaccines currently used in the U.S. were manufactured in Johnson & Johnson’s own <a href="https://www.cbsnews.com/news/quality-control-issues-force-johnson-johnson-to-scrap-doses-of-covid-19-vaccine/">facility in the Netherlands</a>. </p>
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<img alt="A worker looks closely at a series of packaged syringes" src="https://images.theconversation.com/files/393202/original/file-20210401-23-1oxoflc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/393202/original/file-20210401-23-1oxoflc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/393202/original/file-20210401-23-1oxoflc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/393202/original/file-20210401-23-1oxoflc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/393202/original/file-20210401-23-1oxoflc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/393202/original/file-20210401-23-1oxoflc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/393202/original/file-20210401-23-1oxoflc.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">Quality control for the COVID-19 vaccines includes checking the vials, syringes and every other part of the vaccine process.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/in-this-photograph-taken-on-september-2-a-worker-checks-news-photo/1228416934">Sajjad Hussain/AFP via Getty Images</a></span>
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<p>The U.S. government’s Operation Warp Speed has also been involved in quality control. At one point, it deployed <a href="https://www.gao.gov/assets/gao-21-319.pdf">16 Department of Defense personnel</a> to two manufacturing sites to fill gaps in the quality control workforce so production could continue.</p>
<p>After vaccines have been distributed, the Centers for Disease Control and Prevention continues to <a href="http://dx.doi.org/10.15585/mmwr.mm7008e3">monitor for any problems in patients</a>.</p>
<p>[<em>Get the best of The Conversation, every weekend.</em> <a href="https://theconversation.com/us/newsletters/weekly-highlights-61?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=weeklybest">Sign up for our weekly newsletter</a>.]</p>
<h2>How much time goes into quality checks?</h2>
<p>The U.S. learned years ago how crucial quality control checks and independent verification are for vaccine safety. In 1955, the <a href="https://theconversation.com/the-great-polio-vaccine-mess-and-the-lessons-it-holds-about-federal-coordination-for-todays-covid-19-vaccination-effort-152806">polio vaccine rollout</a> led to <a href="https://www.statnews.com/2020/12/07/covid-19-vaccine-safety-lessons-paul-meier-polio/">40,000 vaccine-induced polio infections</a>.</p>
<p>Flu vaccine-maker <a href="https://www.sanofi.com/en/your-health/flu-vaccine-a-race-against-the-clock">Sanofi says it now spends about 70%</a> of its production time on quality checks, and its vaccines are checked again by health officials once they’re shipped from the facility.</p>
<p>The new mRNA technology used by COVID-19 vaccine-makers Moderna and Pfizer is somewhat <a href="http://doi.org/10.1208/s12249-020-01744-7">less challenging</a> because it doesn’t involve live virus, as traditional flu vaccines do. Pfizer says it spends <a href="https://www.usatoday.com/in-depth/news/health/2021/02/07/how-covid-vaccine-made-step-step-journey-pfizer-dose/4371693001/">more than half</a> of its production time on assuring the quality of each batch. </p>
<h2>Manufacturing improvements are also crucial</h2>
<p>Manufacturing process improvement is just as important as thorough quality testing, because errors do happen.</p>
<p>In 2020, <a href="https://apnews.com/article/international-news-oxford-coronavirus-pandemic-883e783962dc562a99864b4b63de9897">AstraZeneca</a> revealed that a manufacturing error led to one-and-a-half – instead of two – doses of its vaccine being given to nearly 3,000 study patients. That error clouded its study results and <a href="https://www.newyorker.com/news/daily-comment/why-there-is-so-much-confusion-about-the-astrazeneca-vaccine">delayed</a> the U.S. approval process by months.</p>
<p>The Biden administration has asked Johnson & Johnson to <a href="https://www.politico.com/news/2021/03/31/johnson-johnson-vaccine-15-million-ruined-478776">step up</a> its supervision of Emergent’s production process. </p>
<p>The incident shows that the industry has work to do to minimize manufacturing errors. Yet, I would argue that the public has every reason to remain confident in the rigorous quality control process that prevents bad vaccines from circulating and ensures vaccine safety.</p><img src="https://counter.theconversation.com/content/158300/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tinglong Dai 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>Vaccine manufacturing is complex, with lots of potential points for errors. But it also has extensive quality control checks and approvals.Tinglong Dai, Associate Professor of Operations Management & Business Analytics, Johns Hopkins Carey Business School, Johns Hopkins University School of NursingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1571982021-03-16T12:09:36Z2021-03-16T12:09:36ZHow do mRNA vaccines work – and why do you need a second dose? 5 essential reads<figure><img src="https://images.theconversation.com/files/389685/original/file-20210315-21-6lsrd2.jpg?ixlib=rb-1.1.0&rect=188%2C179%2C5775%2C4014&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">New mRNA vaccines use genes from the coronavirus to produce immunity.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/covid-19-vaccine-royalty-free-image/1287361510"> Andriy Onufriyenko/Moment via Getty Images</a></span></figcaption></figure><p><a href="https://www.nytimes.com/interactive/2021/world/covid-vaccinations-tracker.html">Tens of millions of people</a> across the U.S. have received a coronavirus vaccine. So far, the <a href="https://abc7chicago.com/covid-vaccine-moderna-pfizer-coronavirus-how-many-people-in-the-us-have-been-vaccinated-who-is-eligible-for/10380767/">majority of doses have been either the Moderna or Pfizer vaccine</a>, both of which use mRNA to generate an immune response. These gene-based vaccines have been in the works for decades, but this is the first time they have been used widely in people.</p>
<p>MRNA vaccines are proving to be <a href="https://www.statnews.com/2021/02/02/comparing-the-covid-19-vaccines-developed-by-pfizer-moderna-and-johnson-johnson/">more effective than anyone had hoped</a>, but as with any new medical advancement, people have a lot of questions. How do they work? Are they safe? Do I really need two shots? Why do they need to be kept so cold? And will this be the vaccine technology of the future? Below, we highlight five articles from The Conversation that will help answer your questions about mRNA vaccines.</p>
<h2>1. A vaccine revolution</h2>
<p>“DNA and mRNA vaccines <a href="https://theconversation.com/3-medical-innovations-fueled-by-covid-19-that-will-outlast-the-pandemic-156464">offer huge advantages over traditional types of vaccines</a>, since they use only genetic code from a pathogen – rather than the entire virus or bacteria,” writes <a href="https://scholar.google.com/citations?hl=en&user=eNprtJEAAAAJ">Deborah Fuller, a microbiologist</a> at the University of Washington who has been working on gene-based vaccines for decades.</p>
<p>The Moderna and Pfizer vaccines are proof that mRNA vaccines are ready for prime time – and far surpass their predecessors. “The hopes that gene-based vaccines could one day provide a vaccine for malaria or HIV, cure cancer, replace less effective traditional vaccines or be ready to stop the next pandemic before it gets started are no longer far-fetched,” explains Fuller.</p>
<h2>2. How does an mRNA vaccine work?</h2>
<p>These vaccines are not only effective, they work in a fundamentally different way from traditional vaccines, explains <a href="https://scholar.google.com/citations?hl=en&user=F8vQ9xIAAAAJ">Sanjay Mishra</a>, a staff scientist at the Vanderbilt University Medical Center. </p>
<p>Traditional vaccines use an entire dead virus – or just a piece of one – to generate immunity. “But an <a href="https://theconversation.com/how-mrna-vaccines-from-pfizer-and-moderna-work-why-theyre-a-breakthrough-and-why-they-need-to-be-kept-so-cold-150238">mRNA vaccine is different</a>,” writes Mishra, “because rather than having the viral protein injected, a person receives genetic material – mRNA – that encodes the viral protein. When these genetic instructions are injected into the upper arm, the muscle cells translate them to make the viral protein directly in the body.”</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/389686/original/file-20210315-21-jqmjnt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A drawing of the coronavirus." src="https://images.theconversation.com/files/389686/original/file-20210315-21-jqmjnt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/389686/original/file-20210315-21-jqmjnt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/389686/original/file-20210315-21-jqmjnt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/389686/original/file-20210315-21-jqmjnt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/389686/original/file-20210315-21-jqmjnt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=423&fit=crop&dpr=1 754w, https://images.theconversation.com/files/389686/original/file-20210315-21-jqmjnt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=423&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/389686/original/file-20210315-21-jqmjnt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=423&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Just as the pandemic hit, mRNA vaccine research had reached a tipping point.</span>
<span class="attribution"><a class="source" href="https://phil.cdc.gov/Details.aspx?pid=23312">CDC/Alissa Eckert, MSMI; Dan Higgins, MAMS</a></span>
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<h2>3. Quick to market, but still safe</h2>
<p>“Safety is the first and foremost goal for a vaccine,” says <a href="https://scholar.google.com/citations?hl=en&user=6yMIM1MAAAAJ">William Petri</a>, a Professor of Medicine at the University of Virginia. A lot of people have expressed safety concerns based on how fast these vaccines were developed, approved and distributed. </p>
<p>According to Petri, the vaccines still went through every normal step – they just did them simultaneously.</p>
<blockquote>
<p>“In my opinion, <a href="https://theconversation.com/covid-19-vaccines-were-developed-in-record-time-but-are-these-game-changers-safe-150249">safety is not compromised by the speed of vaccine development</a> and emergency use authorization. The reason that vaccines may be approved so quickly is that the large clinical trials to assess vaccine efficacy and safety are happening at the same time as the large-scale manufacturing preparation, funded by the federal government’s Operation Warp Speed program.”</p>
</blockquote>
<h2>4. Why it’s important to get your second shot</h2>
<p>You got your first vaccine shot. But with shortages and supply problems, getting the second dose might be becoming a hassle. Does it really matter? Yes, explains William Petri in another article. </p>
<p>“The first dose primes the immune system and introduces the body to the germ of interest. This allows the immune system to prepare its defense. The second dose, or booster, provides the opportunity for the immune system to ramp up the quality and quantity of the antibodies used to fight the virus.”</p>
<p>Immunity is a complex process, and “if the booster isn’t given within the appropriate window, lower quantities of antibodies will be produced that <a href="https://theconversation.com/why-it-takes-2-shots-to-make-mrna-vaccines-do-their-antibody-creating-best-and-what-the-data-shows-on-delaying-the-booster-dose-153956">may not provide as powerful protection from the virus</a>,” writes Petri. So go get your second shot if you can, even if you have to get it a bit later than expected.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/389687/original/file-20210315-15-5cwqys.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A person getting the coronavirus vaccine." src="https://images.theconversation.com/files/389687/original/file-20210315-15-5cwqys.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/389687/original/file-20210315-15-5cwqys.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/389687/original/file-20210315-15-5cwqys.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/389687/original/file-20210315-15-5cwqys.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/389687/original/file-20210315-15-5cwqys.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/389687/original/file-20210315-15-5cwqys.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/389687/original/file-20210315-15-5cwqys.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">Both doses are important for full immunity.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakPfizerVaccineMichigan/4956f368c5ce455795c5891b82a7b5b8/photo?Query=vaccine%20shot%20covid&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=1632&currentItemNo=12">AP Photo/Paul Sancya</a></span>
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<h2>5. Subzero storage makes distribution a challenge</h2>
<p>For all of their amazing attributes, mRNA vaccines do have at least one weakness: “If they get too warm or too cold they spoil. And, just like fish, a spoiled vaccine must be thrown away,” explains <a href="https://scholar.google.com/citations?user=ecFsBp0AAAAJ&hl=en&oi=ao">Anna Nagurney</a>, Professor of Operations Management at the University of Massachusetts, Amherst, who studies medical supply chains. </p>
<p>The mRNA molecule is very fragile, so vaccines need to be kept at extremely cold, very specific temperatures – a challenge for distribution. “The answer is something called <a href="https://theconversation.com/keeping-coronavirus-vaccines-at-subzero-temperatures-during-distribution-will-be-hard-but-likely-key-to-ending-pandemic-146071">the vaccine cold chain</a> – a supply chain that can keep vaccines in tightly controlled temperatures from the moment they are made to the moment that they are administered to a person,” explains Nagurney. This cold supply chain is critical to getting vaccines where they need to go, and without it, no matter how good the vaccines are, they can’t make much of a difference.</p>
<p><em>Editor’s note: This story is a roundup of articles from The Conversation’s archives.</em></p><img src="https://counter.theconversation.com/content/157198/count.gif" alt="The Conversation" width="1" height="1" />
So far, most vaccines in the US are mRNA vaccines. These represent a new technology and are likely to take over the vaccine world. But how do they work? What are their weaknesses? Five experts explain.Daniel Merino, Associate Breaking News Editor and Co-Host of The Conversation Weekly PodcastLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1538572021-03-02T13:21:32Z2021-03-02T13:21:32ZWhat’s in a name for a vaccine campaign? Maybe the end of the pandemic<figure><img src="https://images.theconversation.com/files/386774/original/file-20210226-17-eg3yep.jpg?ixlib=rb-1.1.0&rect=14%2C0%2C4792%2C2997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An unidentified doctor talks with a boy who holds a lollipop reward after participating in a measles vaccine research program in Upper Darby, Pennsylvania, in 1963. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/an-unidentified-medical-professional-talks-with-a-boy-who-news-photo/1271741549?adppopup=true">NASA/PhotoQuest/Getty Images</a></span></figcaption></figure><p><a href="https://www.nytimes.com/interactive/2020/us/covid-19-vaccine-doses.html">Nearly 50 million people</a> in the U.S. had received at least one dose of the coronavirus vaccine by March 1, and millions of others have spent hours online trying to get an appointment. But soon, the demand could fall because of vaccine hesitancy. </p>
<p>How is the government going to get people on board? From my research, I have found that an important part of a successful vaccine campaign is in the name.</p>
<p>As a <a href="https://scholar.google.com/citations?user=KeAdSmgAAAAJ&hl=en">health communication scholar</a> who studies the history of epidemics, I have been interested in the naming and public delivery of the COVID-19 government response. In many ways, this moment parallels crises of the past, as people in previous epidemics and pandemics also struggled to find ways to protect themselves against deadly disease.</p>
<figure class="align-center ">
<img alt="Dr. Fauci in front of an American flag." src="https://images.theconversation.com/files/386783/original/file-20210226-13-9k3sya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/386783/original/file-20210226-13-9k3sya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/386783/original/file-20210226-13-9k3sya.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/386783/original/file-20210226-13-9k3sya.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/386783/original/file-20210226-13-9k3sya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/386783/original/file-20210226-13-9k3sya.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/386783/original/file-20210226-13-9k3sya.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Dr. Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases, speaking about Zika in January 2016.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/dr-anthony-fauci-director-of-the-national-institute-of-news-photo/507412658?adppopup=true">Win McNamee/Getty Images</a></span>
</figcaption>
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<h2>Abandoning the ‘Operation Warp Speed’ name</h2>
<p>In the week leading up to the 2021 presidential inauguration, the Biden transition team announced that the White House’s national COVID-19 vaccine plan <a href="https://www.npr.org/sections/coronavirus-live-updates/2021/01/15/957261530/biden-administration-will-rename-operation-warp-speed-citing-trump-failures">would no longer be called “Operation Warp Speed</a>,” the name coined by Biden’s predecessor, Donald Trump. </p>
<p>On Jan. 21, 2021, the Biden administration released its 200-page COVID-19 plan, “<a href="https://www.whitehouse.gov/wp-content/uploads/2021/01/National-Strategy-for-the-COVID-19-Response-and-Pandemic-Preparedness.pdf">The National Strategy for the COVID-19 Response and Pandemic Preparedness</a>.” The change in names not only broadened the focus to include additional safety measures to curb transmission during the distribution process. It also signified a profound shift in the administration’s approach and consideration of the pandemic itself. </p>
<p>Dr. Anthony Fauci and other public health experts <a href="https://www.forbes.com/sites/andrewsolender/2020/09/08/fauci-worries-operation-warp-speed-fuels-perception-vaccine-is-being-rushed/?sh=2b568ff921dc">criticized the “Operation Warp Speed” name</a>, arguing that it falsely conveyed a lack of scientific rigor and adherence to safety protocol in the vaccine approval process. </p>
<p>In a <a href="https://www.usatoday.com/story/news/health/2020/05/15/coronavirus-operation-warp-speed-could-deliver-vaccine-years-end-trump/5199969002/">May 15, 2020, press conference</a>, Trump explained the campaign name, stating, “It’s called ‘Operation Warp Speed.’ That means big, and it means fast. A massive scientific, industrial and logistical endeavor unlike anything our country has seen since the <a href="https://www.britannica.com/event/Manhattan-Project">Manhattan Project</a>.”</p>
<p>Fauci and others believed that the name “Operation Warp Speed” could have undermined public trust in any COVID-19 vaccine to be developed, feeding into theories and misconceptions of the anti-vaccine movement. It also marked a historical deviation in the identification of vaccine campaigns for the general public. The names we Americans use broadly today, inoculation and vaccination, emerged as the names for very specific immunization procedures against a specific disease, smallpox. </p>
<h2>Smallpox: A big controversy</h2>
<p>In the past, immunization terms stemmed from the induced immunological protection against smallpox. During the Boston smallpox epidemic of 1721, for example, Puritan minister <a href="https://www.newworldencyclopedia.org/entry/Cotton_Mather">Cotton Mather</a> and Colonial physician <a href="https://www.britannica.com/biography/Zabdiel-Boylston">Dr. Zabdiel Boylston</a> introduced the practice of inoculation in hopes of protecting the town. <a href="https://www.historyofvaccines.org/content/blog/onesimus-smallpox-boston-cotton-mather">Onesimus</a>, an enslaved man who was in bondage to Mather, had told Mather of the practice and how he had been inoculated as a child in Africa. The practice involved intentionally infecting people with smallpox in hopes of reducing its severity. </p>
<p>People fiercely discussed this controversial approach in public discourse, even spurring James Franklin, older brother of Benjamin, to create the <a href="https://www.jstor.org/stable/25055558">New England Courant</a> as an outlet to oppose its practice. Many articles in The Courant, Boston Gazette and the Boston News-Letter, along with pamphlets, argued for and against the practice of inoculation. This cemented the term in 18th-century vocabulary, along with its alternative name, “variolation.”</p>
<p>This practice, and growing public familiarity with it, set the stage for acceptance of the first vaccine, which would change the course of disease. In 1798, English physician <a href="https://doi.org/10.1080/08998280.2005.11928028">Dr. Edward Jenner</a> proposed that inducing a mild cowpox infection could protect against smallpox – which he called a “vaccine,” from vaccinia, meaning cowpox. </p>
<figure class="align-center ">
<img alt="Cars lined up at an outdoor vaccination site." src="https://images.theconversation.com/files/386784/original/file-20210226-13-7nd4cp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/386784/original/file-20210226-13-7nd4cp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/386784/original/file-20210226-13-7nd4cp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/386784/original/file-20210226-13-7nd4cp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/386784/original/file-20210226-13-7nd4cp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/386784/original/file-20210226-13-7nd4cp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/386784/original/file-20210226-13-7nd4cp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Millions of people already have been vaccinated.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/people-drive-their-cars-to-medical-tents-at-a-mass-covid-19-news-photo/1230878462?adppopup=true">Michael Ciaglo/Getty Images</a></span>
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<h2>Say its name</h2>
<p>Immunization campaigns for approved and established vaccines have often gone unnamed, simply listing the disease name, location and date, like the <a href="https://www.newspapers.com/clip/69098399/typhoid-vaccine-campaign-the-dispatch/">1916 typhoid vaccine campaign</a> in North Carolina’s Catawba County, northwest of Charlotte, North Carolina. Even sponsored vaccine programs have not necessarily taken on the name of the supporting corporation. In 1926, the Metropolitan Life Insurance Co. donated US$15,000 toward the eradication of diphtheria in New York. Despite this contribution, the campaign went unnamed. </p>
<p>In the trial and development stage, vaccines were not typically named, even in the press. News articles referred to the “anti-disease” vaccine – that is, “anti-smallpox,” “anti-typhoid,” “anti-tetanus” – sometimes including the lead scientist’s last name, as with the <a href="https://www.newspapers.com/image/?clipping_id=69084986&fcfToken=eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJmcmVlLXZpZXctaWQiOjE4NDA5NDAyLCJpYXQiOjE2MTIxOTM5ODAsImV4cCI6MTYxMjI4MDM4MH0.5VGsAzoDoaI7FTcOoz5y-H82Nnx4Re3zejt_Nc19_50">Enders measles vaccine</a>. For example, although polio vaccine trials in 1954 labeled the recruited child participants “polio pioneers,” the vaccine itself was called the <a href="https://www.newspapers.com/clip/71973862/70000-in-1955-need-help-from-march-of/">“anti-polio”</a> or Salk vaccine. </p>
<h2>Nicknaming vaccines can be a problem</h2>
<p>When vaccine campaigns have been named, catchy or abstract names can be problematic, especially in the experimental stages. The 1950s gamma globulin trials prompted confusion with the nickname “Operation Lollipop,” which referred to the “<a href="https://www.newspapers.com/image/?clipping_id=69088610&fcfToken=eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJmcmVlLXZpZXctaWQiOjYxODQyMDY1NiwiaWF0IjoxNjEyMTk2OTgyLCJleHAiOjE2MTIyODMzODJ9.0jKMZwQ71SxLmmfwhZizpUbMYJp7u2epGSNgDB_Tr0Y">all-day sucker</a>” given to children after the injection. Some people misunderstood, believing that scientists had delivered the actual polio virus in the candy to participants, prompting clarification that the name “<a href="https://www.newspapers.com/clip/69088520/question-and-answer-on-polio/">had nothing to do with the experiment itself</a>.”</p>
<figure class="align-left ">
<img alt="Star Wars characters C3PO and R2-D2 in a poster promoting immunization." src="https://images.theconversation.com/files/387082/original/file-20210301-20-189rg2q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/387082/original/file-20210301-20-189rg2q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=941&fit=crop&dpr=1 600w, https://images.theconversation.com/files/387082/original/file-20210301-20-189rg2q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=941&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/387082/original/file-20210301-20-189rg2q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=941&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/387082/original/file-20210301-20-189rg2q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1183&fit=crop&dpr=1 754w, https://images.theconversation.com/files/387082/original/file-20210301-20-189rg2q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1183&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/387082/original/file-20210301-20-189rg2q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1183&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A Star Wars poster from 1977 encouraged immunization.</span>
<span class="attribution"><a class="source" href="http://resource.nlm.nih.gov/101437666">Centers for Disease Control and Prevention</a></span>
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</figure>
<p>More often, campaigns and slogans have been used in catch-up immunization drives after already widely distributed vaccines, as in the polio vaccine “<a href="https://www.cdc.gov/museum/history/wellbee.html">Wellbee</a>,” Utah’s 1967 “<a href="https://www.newspapers.com/clip/69098737/muzzle-measles-this-saturday-southern/">Muzzle Measles</a>,” the 1977 Star Wars “Parents of Earth” message or the <a href="https://www.huffpost.com/entry/dr-seuss-birthday-immunization-_n_6784814">1997 Dr. Seuss Immunization Awareness Campaign</a>. These programs highlighted the importance of existing vaccines, rather than introducing new ones. </p>
<p><a href="https://www.bloomberg.com/news/articles/2021-01-15/biden-team-is-retiring-warp-speed-name-from-vaccination-push">As public health officials have noted</a>, the title “Operation Warp Speed,” combined with the lack of a strategic COVID-19 response plan under the Trump administration, took away from the strict adherence to safety protocols that vaccine producers and the Food and Drug Administration have followed. In a <a href="https://news.gallup.com/poll/328415/readiness-covid-vaccine-steadies.aspx">Gallup Panel survey from Dec. 15, 2020, to Jan. 3, 2021</a>, 65% of participants said they would get the vaccine, with divisions in age, race, education and party affiliation. The name “Operation Warp Speed” paired with coronavirus misinformation, <a href="https://www.nytimes.com/2020/09/30/us/politics/trump-coronavirus-misinformation.html">much of it directly from Trump</a>, likely contributed to the lack of trust in the vaccines before they were even developed. </p>
<p>At least 75% to 80% of the population needs to become immunized – <a href="https://news.harvard.edu/gazette/story/2020/12/anthony-fauci-offers-a-timeline-for-ending-covid-19-pandemic/">the number needed for herd immunity</a> – to end of the pandemic, according to Fauci. Thus, I believe it will be important to develop a trustworthy campaign and a name that bolsters confidence.</p>
<p>The Biden administration is not starting from scratch. I believe that the Biden administration’s adoption of a new direct name for its response plan is the first step toward pandemic recovery. Building confidence across various groups and communities will be critical for herd immunity to be achieved. The new campaign name, then, initiated what needs to be a straightforward, factual approach, integral to widespread COVID-19 immunization.</p><img src="https://counter.theconversation.com/content/153857/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katherine A. Foss does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Vaccination has been controversial from its beginning. Gaining people’s trust in vaccines has been crucial. An important part of that is a strong communications plan.Katherine A. Foss, Professor of Media Studies, Middle Tennessee State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1557142021-02-23T19:11:30Z2021-02-23T19:11:30ZHow do we know the COVID vaccine won’t have long-term side-effects?<figure><img src="https://images.theconversation.com/files/385476/original/file-20210222-13-7imnr3.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C5991%2C3979&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>As Australia’s COVID-19 vaccine rollout begins this week, many people still have questions about the <a href="https://www.abc.net.au/news/health/2021-01-27/covid-vaccine-safety-questions/13089036">safety of COVID-19 vaccines</a>, both in the short and long term.</p>
<p>As vaccine experts, we hear these concerns all the time, and it’s normal to have questions about a vaccine.</p>
<p>The good news is that scientists have already been testing COVID-19 vaccines for months. For starters, serious side-effects are very, very rare. And, together with what we know about previous vaccines, if side-effects are going to occur, they usually happen within a few months after getting a vaccine. This is why international medical regulators, including Australia’s Therapeutic Goods Administration (TGA), require the first few months of safety data before approving new vaccines. This, plus information coming from vaccine recipients in the northern hemisphere, gives us confidence that COVID-19 vaccines are safe.</p>
<p>In fact, most side-effects occur within the first one or two days. And most of these are minor, such as pain at the injection site, fatigue or fever — which are signs your immune system is building a response against the thing you’ve been vaccinated against.</p>
<h2>What do we know about long-term side effects?</h2>
<p>Since December, <a href="https://ourworldindata.org/covid-vaccinations">more than 200 million people</a> have received at least one dose of a COVID-19 vaccine worldwide — more than the total number of people who have been infected with the virus (<a href="https://www.worldometers.info/coronavirus/">112 million</a>).</p>
<p>Given the sheer number of vaccines administered to date, common, uncommon and rare side-effects would have been detected by now. What’s more, we’ve been testing these vaccines in clinical trials since mid-2020, and both the Pfizer and AstraZeneca vaccines have shown excellent safety results.</p>
<p>This gives us confidence the vaccines that’ll be used around Australia are safe.</p>
<p>We’ve also seen some people raise concerns online about mRNA vaccines, such as the Pfizer-BioNTech vaccine, being a <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/mrna.html">“new” technology</a>. mRNA (or “messenger” RNA) is found in all living cells. <a href="https://www.gavi.org/vaccineswork/will-mrna-vaccine-alter-my-dna">mRNA is a message</a> that tells cells how to make proteins that trigger the immune response inside the body. That immune response is what protects against infection if an individual is exposed to the virus. mRNA is not the same as DNA (your genes), and it cannot combine with our DNA to change our genetic code. <a href="https://www.forbes.com/sites/victoriaforster/2021/01/11/covid-19-vaccines-cant-alter-your-dna-heres-why/?sh=cfed61224911">mRNA vaccines do not affect or interact with DNA</a> in any way. So we can be assured there’ll be no long-term DNA-altering effects from these vaccines.</p>
<p>What’s more, checking the safety of the vaccines doesn’t just stop after they’ve been registered for use. Once a vaccine has been introduced, <a href="https://www.immune.org.nz/vaccines/vaccine-safety/safety-monitoring">ongoing monitoring</a> of its safety is a crucial part of the vaccine development process. </p>
<p>Australia has a <a href="https://theconversation.com/covid-vaccines-have-been-developed-in-record-time-but-how-will-we-know-theyre-safe-153888">robust system for this ongoing monitoring</a>. The system was established to detect any unexpected side-effects from vaccines (if they occur) and ensure they’re investigated promptly. This type of monitoring is standard practise in Australia for vaccines. The data about COVID-19 vaccination collected in these surveillance systems will be published weekly on the <a href="https://www.tga.gov.au/communicating-covid-19-safety-information">TGA website</a>. This should reassure Australians that if there’s a new serious side-effect, we will know about it, communicate it, and act on it quickly.</p>
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Read more:
<a href="https://theconversation.com/covid-vaccines-have-been-developed-in-record-time-but-how-will-we-know-theyre-safe-153888">COVID vaccines have been developed in record time. But how will we know they're safe?</a>
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<p><a href="https://www.cdc.gov/vaccinesafety/concerns/concerns-history.html">Withdrawal of vaccines</a> after introduction to the general population is a very rare event.
In the United States, a rotavirus vaccine called <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4843a5.htm">Rotashield</a> led to a small increase in the number of small intestinal blockages. This prompted its withdrawal in the late 1990s. In Australia, an <a href="https://www.tga.gov.au/alert/seasonal-flu-vaccine-investigation-febrile-reactions-young-children-following-2010-seasonal-trivalent-influenza-vaccination">increased risk of febrile seizures</a> in young children following a specific influenza vaccine was identified in 2010. It was subsequently withdrawn from use in that age group, and we now vaccinate with a different, <a href="https://www.ausvaxsafety.org.au/safety-data/influenza-vaccine">safer flu vaccine</a>. This vaccine is <a href="https://immunisationhandbook.health.gov.au/vaccine-preventable-diseases/influenza-flu">no longer available in Australia</a>, and has been subsequently reformulated. </p>
<p>Both of these side-effects were observed within weeks of vaccination.</p>
<p>We now have improved monitoring systems in Australia to detect such serious side-effects <a href="https://bmjopen.bmj.com/content/10/2/e031851">even sooner</a>, in the general population after clinical trials, than we did a decade ago.</p>
<h2>But what about short-term side-effects?</h2>
<p><strong>Pfizer-BioNTech COVID-19 vaccine</strong></p>
<p>The expected side-effects of the Pfizer vaccine have been reported from <a href="https://www.nejm.org/doi/pdf/10.1056/NEJMoa2034577?articleTools=true">trials</a> involving roughly 43,000 participants aged 16 years and older from the US, Argentina, Brazil and South Africa. Half of the participants received the Pfizer vaccine and half received a placebo. And as part of COVID-19 vaccine rollouts around the world, <a href="https://ourworldindata.org/covid-vaccinations">millions of people</a> have already been given this vaccine since December, meaning we have safety data now from both clinical trials and two months of “real world” vaccination. </p>
<p>For those receiving this vaccine in the large clinical trials which <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-conclude-phase-3-study-covid-19-vaccine">started in July 2020</a>, <a href="https://www.fda.gov/media/144246/download">about 80%</a> have reported pain at the injection site. Other common side-effects included fatigue, headache, muscle pain, chills, joint pain and fever.</p>
<p>These were most often reported one or two days after the day of vaccination, and typically only lasted about one day. While some vaccine recipients may need a day off work due to some of these side-effects, this does not indicate the vaccine is unsafe. </p>
<p>In trials, no difference was seen in the rate of severe side-effects between the Pfizer vaccine and placebo. Early in the US program, <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7002e1.htm">21 cases of anaphylaxis</a> were reported. It’s <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7002e1.htm">estimated</a> anaphylaxis occurs at a rate of 11 in every one million recipients (0.0011%) of the Pfizer COVID-19 vaccine. Most occurred within 15 minutes, and all patients recovered. This is why it’s a good idea though to remain at the vaccine clinic for up to <a href="https://immunisationhandbook.health.gov.au/vaccination-procedures/after-vaccination">15 minutes</a> after vaccination so that treatment and care can be provided if necessary. </p>
<p>A <a href="https://www.tga.gov.au/media-release/investigation-reveals-no-specific-risk-covid-19-vaccinations-elderly-patients">further concern was raised in January</a>, after the death of 30 very frail elderly patients in Norway after receiving the Pfizer-BioNTech COVID-19 vaccine. But <a href="https://www.ema.europa.eu/en/documents/covid-19-vaccine-safety-update/covid-19-vaccine-safety-update-comirnaty-january-2021_en.pdf">investigation by the European regulator</a> concluded these weren’t related to the vaccine, but rather to underlying conditions present before vaccination. </p>
<p><strong>Oxford-AstraZeneca COVID-19 vaccine</strong></p>
<p>This vaccine has been tested in ongoing trials with around 55,000 participants from the <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32661-1/fulltext">United Kingdom, Brazil, South Africa</a> and <a href="https://clinicaltrials.gov/ct2/show/NCT04516746">the US</a>. About half received the Oxford-AstraZeneca vaccine and half a placebo. <a href="https://www.gov.uk/government/publications/coronavirus-covid-19-vaccine-adverse-reactions/coronavirus-vaccine-summary-of-yellow-card-reporting#annex-1-vaccine-analysis-print">Millions of doses</a> have been already been administered among the general population, particularly in the UK.</p>
<p>Data from four <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32661-1/fulltext">clinical trials</a> which commenced in April 2020 in the UK, Brazil and South Africa, show the most common side-effects were pain at the injection site, fatigue, headache and muscle pain. Similar to the Pfizer vaccine, there was no difference in the rate of reported severe side-effects for the vaccine compared with the placebo.</p>
<p>Just 0.7% of <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32661-1/fulltext">participants</a> (79 people) from the four clinical trials who received the Oxford-AstraZeneca vaccine reported a serious side-effect after receiving at least one dose, compared with 0.8% (89 people) of those in the placebo group. <a href="https://www.gov.uk/government/publications/coronavirus-covid-19-vaccine-adverse-reactions/coronavirus-vaccine-summary-of-yellow-card-reporting#annex-1-vaccine-analysis-print">No additional safety concerns</a> have been identified since the vaccination program began in the UK.</p>
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<strong>
Read more:
<a href="https://theconversation.com/should-i-get-a-covid-vaccine-while-im-pregnant-or-breastfeeding-is-it-safe-for-me-and-my-baby-153309">Should I get a COVID vaccine while I'm pregnant or breastfeeding? Is it safe for me and my baby?</a>
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<h2>If recommended a COVID-19 vaccine, take it</h2>
<p>With countries continuing to monitor those who have received vaccines, we should be reassured there are no major safety concerns detected for serious side-effects so far. With millions of people vaccinated already, our confidence about the safety of COVID-19 vaccines is very high.</p>
<p>In Australia, and internationally, we have robust systems in place to continually monitor vaccine safety, ensuring Australians can be safely afforded the protection that COVID-19 vaccines are designed to provide.</p><img src="https://counter.theconversation.com/content/155714/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chris Blyth receives funding from the National Health and Medical Research Council. He is affiliated with the Australasian Society of Infectious Diseases, and is a member of government advisory committees including Australian Technical Advisory Group on Immunisation and COVID-19 Vaccines and Treatment for Australia - Science and Industry Technical Advisory Group.</span></em></p><p class="fine-print"><em><span>Margie Danchin receives funding from the National Health and Medical Research Council, WHO and Commonwealth and State government. She is a member of the Australian Technical Advisory Group on Immunisation COVID-19 Vaccine working group on vaccine safety, confidence and evaluation and chair of the Collaboration on Social Science and Immunisation (COSSI). </span></em></p><p class="fine-print"><em><span>Nicholas Wood receives funding from the NHMRC for a Career Development Fellowship</span></em></p><p class="fine-print"><em><span>Lucy Deng and Samantha Carlson 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>Years of vaccine research tells us that, if side effects are going to occur, they normally occur within the first months after getting a vaccine.Samantha Carlson, Post Doctoral Research Officer, Telethon Kids InstituteChristopher Blyth, Paediatrician, Infectious Diseases Physician and Clinical Microbiologist, Telethon Kids Institute, The University of Western AustraliaLucy Deng, Paediatrician, National Centre for Immunisation Research and Surveillance; Clinical Lecturer, Children's Hospital Westmead Clinical School, University of SydneyMargie Danchin, Associate Professor, University of Melbourne, Murdoch Children's Research InstituteNicholas Wood, Associate Professor, Discipline of Childhood and Adolescent Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1550502021-02-15T18:51:46Z2021-02-15T18:51:46ZWhy telling stories could be a more powerful way of convincing some people to take a COVID vaccine than just the facts<p>Scientists don’t know exactly what percentage of the population will need to get a COVID vaccine to achieve <a href="https://www.sciencedirect.com/science/article/pii/S1074761320301709">herd immunity</a>. Some diseases, <a href="https://go.gale.com/ps/anonymous?id=GALE%7CA596089803&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=10788956&p=AONE&sw=w">such as whooping cough</a>, need very high <a href="https://www.who.int/bulletin/volumes/86/2/07-040089/en/">rates of vaccination</a> between <a href="https://www.sciencedirect.com/science/article/pii/S0264410X20313633">90-95%</a>.</p>
<p>The rise of new, <a href="https://theconversation.com/uk-south-african-brazilian-a-virologist-explains-each-covid-variant-and-what-they-mean-for-the-pandemic-154547">more infectious coronavirus variants</a> might mean even <a href="https://iview.abc.net.au/show/national-press-club-address/series/0/video/NC2111C002S00">more people may need to be vaccinated</a> against COVID than we initially thought.</p>
<p>One question therefore becomes crucial: how will governments convince enough people to get vaccinated to achieve <a href="https://www.thelancet.com/article/S0140-6736(20)32318-7/fulltext">herd immunity</a>?</p>
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Read more:
<a href="https://theconversation.com/herd-immunity-is-the-end-game-for-the-pandemic-but-the-astrazeneca-vaccine-wont-get-us-there-155115">Herd immunity is the end game for the pandemic, but the AstraZeneca vaccine won’t get us there</a>
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<p>One method might be to use emotional storytelling to sway people who aren’t convinced by fact-based logical messaging.</p>
<h2>Appeals to logic or emotive stories?</h2>
<p>Many people will say yes to being vaccinated. <a href="https://www.nature.com/articles/s41591-020-1124-9">One international survey</a>, published in October last year, found an average of 71.5% of participants (from 19 countries) would be likely to accept a COVID vaccine.</p>
<p>But some people who would normally be pro-vaccination might have concerns about the speed of the approvals of these vaccines.</p>
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<em>
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Read more:
<a href="https://theconversation.com/covid-vaccines-have-been-developed-in-record-time-but-how-will-we-know-theyre-safe-153888">COVID vaccines have been developed in record time. But how will we know they're safe?</a>
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<p>To deal with such fears, the Australian government has crafted public health messages that appeal to logic using facts, figures and explanations about how the process has been done safely.</p>
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<figcaption><span class="caption">The federal government has begun its COVID vaccine advertising campaign. So far, it features experts explaining the process in a cool and calm tone.</span></figcaption>
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Read more:
<a href="https://theconversation.com/the-government-is-spending-almost-a-24m-to-convince-us-to-accept-a-covid-vaccine-but-will-its-new-campaign-actually-work-154062">The government is spending almost A$24m to convince us to accept a COVID vaccine. But will its new campaign actually work?</a>
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<p>However, other people, particularly those who are unlikely to get vaccinated, may not necessarily respond well to these messages.</p>
<p><a href="https://journals.sagepub.com/doi/10.1177/1090198117739673">Evidence suggests</a> vaccine-hesitant groups are less likely to respond to factual information particularly from “pro-vaccine” sources.</p>
<p>But they may respond more to personal stories about the effects of the virus. In <a href="https://www.cambridge.org/core/journals/children-australia/article/abs/narrative-acculturation-and-ritual-themes-from-a-socioecological-study-of-australian-defence-force-families-experiencing-parental-deployment/11358F65CB70E9336EE595999BDE8F41">my area of research</a>, we call these stories “<a href="https://www.cambridge.org/core/journals/children-australia/article/abs/harnessing-the-power-of-cultural-health-narratives-when-working-with-parents-of-young-children/F5E7843F523E669269574EE8B44B076A">cultural health narratives</a>”.</p>
<p>Within the <a href="https://www.sciencedirect.com/science/article/pii/S0033350620305242">anti-vax movement</a>, these narratives are often powerful stories of people negatively affected by vaccinations, or what they believe are vaccine-related side effects. These emotional accounts are very powerful because <a href="https://books.google.com.au/books?hl=en&lr=&id=Gd3lT5yP3ZQC&oi=fnd&pg=PP2&dq=gottschall+the+storytelling+animal&ots=V8h0UzXG2p&sig=ZBpPNU1ughQA2Fhh1FT5Ca3Y9GA&redir_esc=y#v=onepage&q=gottschall%20the%20storytelling%20animal&f=false">we’re attracted to narratives</a> and we live our lives through them.</p>
<p>We tell stories about our lives to ourselves, our friends and families through conversations, photo diaries and social media. We consume other people’s stories through novels, news, movies and so on.</p>
<p>What’s more, some countries have done very well <a href="https://www.abc.net.au/news/2021-01-30/seven-countries-with-better-coronavirus-response-than-australia/13102988">controlling the virus</a> using low-technology health measures, such as hand washing, social distancing, border shutdowns and quarantining.</p>
<p>This might sound like a digression, but stay with me — the downside for these countries is that most people in the population don’t know anyone who has had COVID nor lost anyone to the disease. This might mean they are less likely to see the need to be vaccinated.</p>
<p>This also means there’s a lack of personal COVID health stories within those countries, including Australia. <a href="https://www.ledonline.it/index.php/LCM-Journal/article/view/1800">Anti-vax messages</a> often use emotional stories for their own ends, and their messages can fill these gaps if governments don’t report their own real health stories. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1216877334105489411"}"></div></p>
<h2>How could governments use storytelling?</h2>
<p>When we hear a story, we often lower our guard and tend to start responding emotionally to the characters. <a href="https://www.cambridge.org/core/journals/children-australia/article/abs/narrative-acculturation-and-ritual-themes-from-a-socioecological-study-of-australian-defence-force-families-experiencing-parental-deployment/11358F65CB70E9336EE595999BDE8F41">Parents</a>, educators and religious leaders have long used this as a way of teaching. </p>
<p>Governments could use storytelling to potentially improve COVID vaccination rates particularly among those who are unlikely to get the jab.</p>
<p>Governments could add emotional <a href="https://www.tandfonline.com/doi/full/10.1080/07359683.2019.1575061">health stories</a> to their vaccination messages.</p>
<p>These narratives could show the negative effects of the virus on people’s lives, and/or they can be used to show the positive effects of vaccinations to help avoid disease.</p>
<p>These could be targeted towards those that might be more likely to be <a href="https://journals.sagepub.com/doi/full/10.1177/0017896917725360">influenced by stories</a>, using traditional and social media platforms.</p>
<p>These true, personal video accounts could include:</p>
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<li><p>people who have had the virus, recovered but have <a href="https://www.abc.net.au/news/2020-12-23/long-term-effects-of-covid-study-in-medical-journal/13007498">long-term health problems</a></p></li>
<li><p>people who have lost relatives, <a href="https://www.abc.net.au/news/2020-07-22/daughter-stuck-in-covid-hotel-quarantine-cannot-comfort-mother/12480750">and were isolated from them</a></p></li>
<li><p><a href="https://www.cnbc.com/video/2020/09/28/coronavirus-health-workers-front-lines-1-million-deaths.html">health workers</a> who have worked in places where the virus is out of control.</p></li>
</ul>
<h2>Do health stories work?</h2>
<p>Emotional and personal health narratives <a href="https://ijoc.org/index.php/ijoc/article/view/8383">can be</a> <a href="https://journals.sagepub.com/doi/10.1177/1359105316656243">a powerful way</a> of communicating <a href="https://rcommunicationr.org/index.php/rcr/article/download/24/81">health messaging</a>, and the benefits of vaccination. </p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S0264410X06005470#!">One study</a>, conducted by Professor Julie Leask and colleagues, showed 37 parents both anti-vaxxer health stories and medical pro-vaccination stories.</p>
<p>The pro-vaccination stories included footage of children with measles and whooping cough. Every focus group recalled the footage, with some parents labelling it “shocking” and “devastating”. The authors noted that parents, when voicing support of vaccination, leaned on stories in the decision process — not just facts.</p>
<p>The authors concluded that “stories about people affected by vaccine-preventable diseases need to re-enter the public discourse”.</p>
<p><a href="https://doi.org/10.1080/10810730.2017.1341568">Another study</a> highlighted the positive effects of first-person narratives on young people to help them avoid Type 2 diabetes. In this study, personal narratives told by people who had the disease were most effective in persuading the participants to change their lifestyle to avoid Type 2 diabetes.</p>
<h2>Social media will be challenging</h2>
<p>People get information about vaccination from health workers, relatives, friends, and social and traditional media. </p>
<p><a href="https://www.thelancet.com/journals/landig/article/PIIS2589-7500(19)30136-0/fulltext">Social media platforms</a> can be problematic because if someone clicks an article with vaccine misinformation, more articles with even more misleading ideas are likely to appear in their news feeds. The opposite also occurs; if someone clicks on pro-vaccination information, more pro-vaccination information is fed to them. This can lead to <a href="https://www.youtube.com/watch?v=uaaC57tcci0">polarisation</a> within the community.</p>
<p>Dealing with misleading health messages about COVID vaccines will be very important for governments, and it’ll be vital for them to stay in front of <a href="https://www.thelancet.com/journals/landig/article/PIIS2589-7500(20)30227-2/fulltext">anti-vax COVID messaging</a>. Factual information will be essential, but true, personal <a href="https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2015.1373">health stories</a> are another tool to convince particular groups.</p>
<p>It seems the federal government is <a href="https://www.australia.gov.au/covid19vaccines">not yet specifically targeting these groups</a>, but may need to in the race for <a href="https://www.who.int/news-room/q-a-detail/herd-immunity-lockdowns-and-covid-19">COVID herd immunity</a>.</p><img src="https://counter.theconversation.com/content/155050/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marg Rogers 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>How will governments convince enough people to get vaccinated to achieve herd immunity?Marg Rogers, Lecturer, Early Childhood Education, University of New EnglandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1528562021-02-10T20:57:50Z2021-02-10T20:57:50Z5 factors that could dictate the success or failure of the COVID-19 vaccine rollout<figure><img src="https://images.theconversation.com/files/382964/original/file-20210208-17-in1iqm.jpg?ixlib=rb-1.1.0&rect=55%2C0%2C3299%2C2228&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Tamara Dus, director of University Health Network Safety Services, administers a Pfizer-BioNTech COVID-19 vaccine in Toronto. </span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Frank Gunn</span></span></figcaption></figure><p>As a viral immunologist who develops immunization strategies to prevent infectious diseases and treat cancers, I would like to highlight outstanding questions about the emergency use of vaccines against <a href="https://www.canada.ca/en/public-health/services/laboratory-biosafety-biosecurity/biosafety-directives-advisories-notifications/novel-coronavirus-january-27.html">SARS-CoV-2</a>, the coronavirus that causes <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it">COVID-19</a>.</p>
<p>These vaccines have raised hopes that the pandemic is <a href="https://www.bbc.com/news/health-54949799">nearing an end</a>. Hopefully this is true, but here are some potential sticking points.</p>
<h2>1. Long-term safety profile of COVID-19 vaccines</h2>
<p>Because COVID-19 vaccines have received regulatory approval in record-shattering time, these vaccines are being distributed with uniquely short safety profiles: only months’ worth of data are available. </p>
<p>Short-term safety of approved COVID-19 vaccines <a href="http://doi.org/10.1056/NEJMoa2035389">looks</a> <a href="http://doi.org/10.1056/NEJMoa2034577">good</a>. However, induction of <a href="https://www.mayoclinic.org/diseases-conditions/anaphylaxis/symptoms-causes/syc-20351468#:%7E:text=Anaphylaxis%20causes%20your%20immune%20system,rash%3B%20and%20nausea%20and%20vomiting.">anaphylactic reactions</a> in <a href="https://www.cbc.ca/news/canada/hamilton/covid-19-vaccine-allergic-reaction-1.5856827#:%7E:text=Canada-,Hamilton%20PSW%20says%20allergic%20reaction%20to%20COVID%2D19%20vaccine%20led,get%20a%20COVID%2D19%20vaccine.">some vaccine recipients</a> hasn’t helped the optics for those with <a href="https://www.ecdc.europa.eu/en/immunisation-vaccines/vaccine-hesitancy">vaccine hesitancy</a>. But these cases are rare and usually associated with pre-existing severe allergies. </p>
<p><a href="https://www.cfn-nce.ca/frailty-matters/what-is-frailty/">Twenty-three frail elderly</a> individuals in Norway <a href="https://doi.org/10.1136/bmj.n149">died shortly after receiving the Pfizer vaccine</a>. It is difficult to ascertain the reason for these deaths and they may have had nothing to do with the vaccine. It has put pressure on physicians in that country to try to determine which members of this demographic at high risk for COVID-19 mortality should and should not be vaccinated. </p>
<p>If too many unpredicted severe long-term side-effects were to accrue over time, this could be cause for withdrawal of approval for a vaccine.</p>
<h2>2. Duration of immunity of COVID-19 vaccines</h2>
<p><a href="https://www.sciencemag.org/news/2019/04/how-long-do-vaccines-last-surprising-answers-may-help-protect-people-longer">Duration of immunity</a> refers to how long a person is protected after being vaccinated. For previous vaccines, we could have reasonable confidence that immunity would last at least a few years prior to public rollouts. COVID-19 vaccines only have a few months’ worth of <a href="http://doi.org/10.1056/NEJMc2032195">data on duration of immunity</a>. </p>
<p>If <a href="https://science.sciencemag.org/content/364/6437/224.full">immunity declines</a> before “<a href="https://www.jhsph.edu/covid-19/articles/achieving-herd-immunity-with-covid19.html">herd immunity</a>” is achieved, previously vaccinated individuals will become susceptible to infection again and the rollout could fail.</p>
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<img alt="A person wearing a hooded coat and a face masks walks past a sign pointing to the entrance of COVID-19 vaccination clinic." src="https://images.theconversation.com/files/382965/original/file-20210208-13-rla7q4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/382965/original/file-20210208-13-rla7q4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=449&fit=crop&dpr=1 600w, https://images.theconversation.com/files/382965/original/file-20210208-13-rla7q4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=449&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/382965/original/file-20210208-13-rla7q4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=449&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/382965/original/file-20210208-13-rla7q4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=565&fit=crop&dpr=1 754w, https://images.theconversation.com/files/382965/original/file-20210208-13-rla7q4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=565&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/382965/original/file-20210208-13-rla7q4.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">
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<span class="caption">A man walks past the COVID-19 vaccination site at Maimonides long-term care facility in Montréal.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Ryan Remiorz</span></span>
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</figure>
<h2>3. Effectiveness of COVID-19 vaccines</h2>
<p>There were public declarations of greater than 90 per cent effectiveness for the <a href="https://investors.modernatx.com/news-releases/news-release-details/moderna-announces-primary-efficacy-analysis-phase-3-cove-study">Moderna</a> and <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-announce-vaccine-candidate-against">Pfizer</a> vaccines. Unfortunately, Pfizer did not publicly disclose the fact that there were large numbers of suspected, but unconfirmed cases of COVID-19 that were excluded from their calculation of efficacy. This was revealed in a <a href="https://www.fda.gov/media/144245/download">summary report</a> issued by the United States Food and Drug Administration (FDA).</p>
<p>Re-analysis of the data with this new information accounted for was performed by the associate editor of the <em>British Medical Journal</em>, who reported his non-peer-reviewed findings in the journal’s opinion column. His estimate suggests the true effectiveness of the vaccine might be as low as <a href="https://blogs.bmj.com/bmj/2021/01/04/peter-doshi-pfizer-and-modernas-95-effective-vaccines-we-need-more-details-and-the-raw-data/">19 to 29 per cent</a>. This can’t be confirmed or refuted until raw data not included in the FDA report are released. </p>
<p>The effectiveness reported for Sinovac Biotech’s currently unapproved vaccine <a href="https://edition.cnn.com/world/live-news/coronavirus-pandemic-vaccine-updates-01-08-21/h_ab72abc621a3b254838b7897a7a3c32b">dropped from 78 per cent</a> early in a clinical trial being run in Brazil to <a href="https://www.cnn.com/2021/01/13/asia/sinovac-covid-vaccine-efficacy-intl-hnk/index.html">50.38</a> per cent in the late stages of the trial. The cut-off for approval of COVID-19 vaccines has been set at <a href="https://www.nbcnews.com/health/health-news/fda-s-cutoff-covid-19-vaccine-effectiveness-50-percent-what-n1245506">50 per cent effectiveness</a>. If efficacy during public rollouts ends up being less than “advertised,” COVID-19 vaccines will under-perform relative to expectations.</p>
<h2>4. Risk of variants that can evade vaccine-induced immunity</h2>
<p><a href="https://www.who.int/csr/don/21-december-2020-sars-cov2-variant-united-kingdom/en/">Several</a> <a href="https://www.the-scientist.com/news-opinion/south-african-sars-cov-2-variant-alarms-scientists-68317">novel</a> <a href="https://www.who.int/csr/don/03-december-2020-mink-associated-sars-cov2-denmark/en/#:%7E:text=On%205%20November%2C%20the%20Danish,from%20August%20to%20September%202020.">variants</a> of SARS-CoV-2 have been identified recently. Coronaviruses copy their genetic material in a way that inherently <a href="https://media.nature.com/original/magazine-assets/d41586-020-02544-6/d41586-020-02544-6.pdf">induces random mutations</a>. If these mutations promote survival of the virus in vaccinated people, it could spell disaster for the current immunization strategy.</p>
<p>Although the risk of mutations that can evade vaccine-induced immunity cannot be accurately quantified, the way COVID-19 vaccines are being rolled out will likely increase the potential for this to occur for at least two reasons. First, the current vaccines confer narrowly focused immunity that targets a single <a href="https://doi.org/10.1038/s41467-020-15562-9">viral spike protein</a>. That means SARS-CoV-2 only needs to mutate one protein to evade vaccine-induced immunity. In contrast, it would be more difficult for the virus if it had to mutate several proteins to become immune-evasive.</p>
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Read more:
<a href="https://theconversation.com/the-mink-link-how-covid-19-mutations-in-animals-affect-human-health-and-vaccine-effectiveness-149947">The mink link: How COVID-19 mutations in animals affect human health and vaccine effectiveness</a>
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<p>Secondly, the <a href="https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/prevention-risks/covid-19-vaccine-treatment/vaccine-rollout.html#a4">vaccination program</a> is being rolled out in piece-meal fashion. This slow expansion of narrowly focused immunity among people who are surrounded by others who are not immune provides the time and contact with a “reservoir population” that a virus would need to generate random variants that can probe their potential to infect vaccinated people. </p>
<p>If a variant emerges that has altered its spike protein enough to bypass vaccine-induced immunity, the vaccine rollout could fail. If this happens, vaccines may need to be re-engineered to express a novel version of the spike protein, preferably with other proteins added to broaden immunity.</p>
<p>Importantly, acquisition of natural immunity, which targets multiple components of the virus, may reduce the risk of re-infection with variants that can bypass spike protein-specific immunity.</p>
<h2>5. Untested COVID-19 vaccine regimens</h2>
<p>Due to logistical challenges of rolling out two-shot vaccines and with the goal of maximizing how many and how quickly people can be vaccinated, <a href="https://www.healio.com/news/primary-care/20210106/could-a-singledose-vaccine-strategy-be-more-beneficial-in-covid19">single-dose</a> regimens, combining <a href="https://www.krem.com/article/news/verify/verify-covid-19-vaccine-mixing/293-89be6a9e-196c-414c-affa-dea94915963f">vaccines from different manufacturers</a>, and regimens that alter the <a href="https://doi.org/10.1136/bmj.n18">intervals between doses</a> are all being considered.</p>
<p>Note that the efficacy of Pfizer’s and Moderna’s vaccines only holds true beginning one to two weeks after the second shot, and using the recommended interval and dose. The performance of vaccines cannot be guaranteed if administered differently than the way in which they obtained regulatory approval. Indeed, results of a single-dose regimen with the Pfizer vaccine in Israel were <a href="https://www.theguardian.com/world/2021/jan/22/israeli-covid-chiefs-remarks-on-vaccine-inaccurate-say-officials">reported as disappointing</a>, although this is being debated.</p>
<p>The overall magnitude and/or quality of immune responses could be compromised by lengthening the interval between the two doses. Deviations in protocols <a href="https://www.fda.gov/news-events/press-announcements/fda-statement-following-authorized-dosing-schedules-covid-19-vaccines">should not be tolerated</a> unless backed up by clinical trial data.</p>
<h2>Herd immunity without rollout success?</h2>
<figure class="align-center ">
<img alt="A woman in a face mask with her hands in the air in celebration." src="https://images.theconversation.com/files/382967/original/file-20210208-21-1ujjv68.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/382967/original/file-20210208-21-1ujjv68.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/382967/original/file-20210208-21-1ujjv68.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/382967/original/file-20210208-21-1ujjv68.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/382967/original/file-20210208-21-1ujjv68.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/382967/original/file-20210208-21-1ujjv68.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/382967/original/file-20210208-21-1ujjv68.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">Registered nurse Sherry Plett celebrates after receiving a COVID-19 vaccine shot in the COVID-19 vaccination clinic at the Winnipeg Health Sciences Centre, Dec. 16, 2020.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/John Woods</span></span>
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</figure>
<p>Can herd immunity still be achieved if COVID-19 vaccines underperform? Probably! Mounting evidence suggests most people that have been infected with SARS-CoV-2 have <a href="https://doi.org/10.1101/2020.12.18.20248336">naturally acquired immunity</a> that can <a href="http://doi.org/10.1126/science.abf4063">protect them from re-infection</a>. In fact, we have much longer duration data for naturally acquired immunity than for vaccine-induced immunity against SARS-CoV-2. </p>
<p>There is even evidence that pre-existing immunity against other coronaviruses, including those that merely cause colds, can <a href="http://doi.org/10.1126/science.abd3871">cross-protect</a> some people against SARS-CoV-2. This is not surprising because this is what our immune system is designed to do. All these people will contribute to the acquisition of herd immunity. </p>
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<a href="https://theconversation.com/can-antibody-tests-tell-us-who-is-immune-to-covid-19-138240">Can antibody tests tell us who is immune to COVID-19?</a>
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<p>At the beginning of the pandemic most governments decided against using naturally acquired immunity as a primary way to achieve herd immunity to allow hospitals time to deal with severe illnesses. However, one year into the pandemic a huge unanswered question is: how close/far are we from natural herd immunity? </p>
<p>In Canada, we have done a poor job of tracking this. A starting point would be extensive antibody testing. If someone has antibodies in their blood against SARS-CoV-2, then they were infected at some point. If this had been combined with the direct detection of SARS-CoV-2 being done at testing centres, we could have had a massive data set in-hand.</p>
<p>Natural immunity acquired by an ever-growing number of people means fewer people require vaccination to reach herd immunity. As a bonus, natural immunity also equates to broader immunity; these people should be less susceptible to re-infection if an immuno-evasive SARS-CoV-2 variant emerges. </p>
<p><a href="https://www.statcan.gc.ca/eng/survey/household/5339/brochure">Statistics Canada</a> is initiating a large-scale study to conduct antibody testing on randomly selected Canadians. A smaller study by a <a href="https://www.utoronto.ca/news/u-t-epidemiologist-leads-study-tracking-covid-19-immunity-10000-canadians">researcher at the University of Toronto</a> was started in June 2020. Data from these studies could be used to estimate how much natural immunity exists in the general population. However, looking only for circulating antibodies against SARS-CoV-2 will likely underestimate immunity. These will often disappear, but the memory B cells that produce them <a href="https://doi.org/10.1101/2020.11.15.383323">are usually long-lasting</a> and can <a href="https://doi.org/10.1038/s41577-020-00436-4">confer protection</a>.</p><img src="https://counter.theconversation.com/content/152856/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Byram Bridle received funding from the Canadian Institutes of Health Research, the Natural Sciences and Engineering Research Council of Canada, the Canada Foundation for Innovation, and Ontario COVID-19 Rapid Research Funding.</span></em></p>The arrival of COVID-19 vaccines has raised hope for an end to the pandemic. Hopefully that’s true, but there are variables. Here are some factors that could affect the success of the vaccine rollout.Byram W. Bridle, Associate Professor of Viral Immunology, Department of Pathobiology, University of GuelphLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1527452021-01-13T13:25:29Z2021-01-13T13:25:29ZAmericans have unrealistic expectations for a COVID-19 vaccine<figure><img src="https://images.theconversation.com/files/378374/original/file-20210112-15-wm8pez.jpg?ixlib=rb-1.1.0&rect=25%2C6%2C4168%2C2772&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If too many Americans refuse to take the COVID-19 vaccine, achieving population immunity will be difficult.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/moderna-covid-19-vaccine-vial-is-seen-on-the-first-day-that-news-photo/1230350415?adppopup=true">Paul Hennessy/NurPhoto via Getty Images</a></span></figcaption></figure><p>Many Americans appear to be experiencing <a href="https://www.forbes.com/sites/coronavirusfrontlines/2020/11/03/why-we-should-resist-over-optimism-about-covid-19-vaccines/?sh=2bdd1f4b6ae6">cautious</a> <a href="https://www.cbsnews.com/news/covid-19-vaccine-pfizer-doses-extra-hospital-workers/">optimism</a> about the role that vaccines could play in ending the pandemic. But recent public opinion research suggests that <a href="https://www.kff.org/coronavirus-covid-19/report/kff-covid-19-vaccine-monitor-december-2020/">29%</a> to <a href="https://news.gallup.com/poll/327425/willingness-covid-vaccine-ticks.aspx">37%</a> of Americans plan to refuse a COVID-19 vaccine.</p>
<p>According to <a href="https://doi.org/10.1016/j.jinf.2020.03.027">some</a> <a href="https://www.statnews.com/2020/12/17/calculating-our-way-to-herd-immunity/">epidemiological</a> <a href="https://khn.org/news/article/trumps-wrong-15-herd-immunity-is-not-on-par-with-strength-of-a-vaccine/">estimates</a>, as many as three-fourths of Americans must become immune to COVID-19 – either by recovering from the disease or by getting vaccinated – to halt the virus’s <a href="https://www.cbsnews.com/news/covid-vaccine-fauci-what-to-know/">spread</a>. As a <a href="https://scholar.google.com/citations?user=v6UjvxIAAAAJ&hl=en&oi=sra">scholar</a> who studies vaccine hesitancy, I ask how Americans’ vaccine-related expectations might influence their willingness to vaccinate. What attributes do Americans expect a COVID-19 vaccine to have, and will they be less likely to get vaccinated if the vaccine they have the opportunity to take defies some of their preferences?</p>
<p>In a new <a href="https://doi.org/10.1016/j.socscimed.2020.113642">peer-reviewed study</a>, I found that the vaccine Americans most prefer may not reflect the choices we actually have. Americans are most likely to intend to vaccinate when a vaccine is made in the U.S., administered in a single dose, over 90% effective and carrying a less than 1 in 100 chance of experiencing minor side effects, and has spent just over a year in development. </p>
<p>However, even under these ideal conditions, the likelihood that the average respondent in the study would choose to vaccinate is just 68%. This implies that many Americans may refuse vaccination, even when a vaccine satisfies their expectations.</p>
<figure class="align-center ">
<img alt="President-elect Biden receives his COVID-19 vaccination shot." src="https://images.theconversation.com/files/378117/original/file-20210111-17-dpiv0r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/378117/original/file-20210111-17-dpiv0r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/378117/original/file-20210111-17-dpiv0r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/378117/original/file-20210111-17-dpiv0r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/378117/original/file-20210111-17-dpiv0r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/378117/original/file-20210111-17-dpiv0r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/378117/original/file-20210111-17-dpiv0r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">President-elect Biden publicly receives his second round of the vaccine on Jan. 11 in Newark, Delaware.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/president-elect-joe-biden-receives-the-second-dose-of-a-news-photo/1295839050?adppopup=true">Alex Wong via Getty Images</a></span>
</figcaption>
</figure>
<h2>Why do some Americans plan to refuse a COVID-19 vaccine?</h2>
<p>Since <a href="https://www.nytimes.com/2020/12/11/health/pfizer-vaccine-authorized.html">Pfizer</a> and <a href="https://www.nytimes.com/2020/12/18/health/covid-vaccine-fda-moderna.html">Moderna</a> vaccines gained emergency use authorization, front-line health care workers and other vulnerable groups have <a href="https://www.bbc.com/news/world-us-canada-55305720">started</a> to receive the vaccine.</p>
<p>Public opinion <a href="https://theconversation.com/a-majority-of-vaccine-skeptics-plan-to-refuse-a-covid-19-vaccine-a-study-suggests-and-that-could-be-a-big-problem-137559">research</a>, however, has documented substantial COVID-19 vaccine hesitancy. While intentions to <a href="https://news.gallup.com/poll/325208/americans-willing-covid-vaccine.aspx">vaccinate</a> <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/">have</a> <a href="https://www.kff.org/coronavirus-covid-19/report/kff-covid-19-vaccine-monitor-december-2020/">rebounded</a> in <a href="https://news.gallup.com/poll/327425/willingness-covid-vaccine-ticks.aspx">recent weeks</a> following a substantial <a href="https://www.pewresearch.org/science/2020/09/17/u-s-public-now-divided-over-whether-to-get-covid-19-vaccine/">drop-off</a> <a href="https://news.gallup.com/poll/317018/one-three-americans-not-covid-vaccine.aspx">this past summer</a>, some recent estimates suggest that <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/">more than a third</a> of Americans plan to forgo vaccination. Refusal rates that high could jeopardize our ability to achieve population immunity, and thereby prolong the pandemic.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/378436/original/file-20210112-19-1auvqdo.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/378436/original/file-20210112-19-1auvqdo.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/378436/original/file-20210112-19-1auvqdo.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=818&fit=crop&dpr=1 600w, https://images.theconversation.com/files/378436/original/file-20210112-19-1auvqdo.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=818&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/378436/original/file-20210112-19-1auvqdo.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=818&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/378436/original/file-20210112-19-1auvqdo.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1027&fit=crop&dpr=1 754w, https://images.theconversation.com/files/378436/original/file-20210112-19-1auvqdo.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1027&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/378436/original/file-20210112-19-1auvqdo.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1027&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Consequently, many researchers have tried to figure out why some Americans are more likely to refuse a vaccine than others. Both <a href="https://doi.org/10.1016/j.socscimed.2020.113638">academic</a> and <a href="https://www.kff.org/coronavirus-covid-19/report/kff-covid-19-vaccine-monitor-december-2020/">public opinion</a> research finds that women, compared with men, and Black Americans, compared with white Americans, are significantly more likely to intend to refuse vaccination.</p>
<p>Vaccine refusal is <a href="https://www.nytimes.com/2020/12/18/us/politics/trump-vaccine-skeptics.html">also</a> <a href="https://www.nytimes.com/2020/12/13/us/politics/coronavirus-vaccine-education-campaign.html">politically</a> <a href="https://www.washingtonpost.com/politics/2020/12/22/how-political-leaders-could-persuade-more-americans-get-covid-19-vaccination/">contentious</a>. Refusal tends to <a href="https://www.electionanalysis.ws/us/president2020/section-1-policy-and-political-context/president-trump-promised-a-covid-vaccine-by-election-day-that-politicized-vaccination-intentions/">reflect disagreements</a> with the way <a href="https://www.washingtonpost.com/politics/2020/12/22/how-political-leaders-could-persuade-more-americans-get-covid-19-vaccination/">politicians</a> talk about vaccine-related issues.</p>
<p>Fewer studies, however, have asked about whether or not the properties of vaccines themselves might influence vaccination intentions.</p>
<figure class="align-center ">
<img alt="A woman receives a COVID-19 shot." src="https://images.theconversation.com/files/378118/original/file-20210111-17-nmismi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/378118/original/file-20210111-17-nmismi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/378118/original/file-20210111-17-nmismi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/378118/original/file-20210111-17-nmismi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/378118/original/file-20210111-17-nmismi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/378118/original/file-20210111-17-nmismi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/378118/original/file-20210111-17-nmismi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Surveys suggest up to 40% of Americans may refuse to receive the COVID-19 vaccine.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/doctor-and-senior-adult-african-descent-patient-royalty-free-image/1289992743?adppopup=true">fstop123 via Getty Images</a></span>
</figcaption>
</figure>
<h2>Do Americans prefer some COVID-19 vaccines to others?</h2>
<p>My <a href="https://doi.org/10.1016/j.socscimed.2020.113642">new peer-reviewed study</a>, based on a representative online survey of U.S. adults, offers some answers. I asked 990 U.S. adults to each rate how likely they would be, on a scale of 1 to 10, to pursue vaccination for vaccines with randomly chosen attribute combinations. </p>
<p>Respondents rated their intentions to vaccinate for hypothetical vaccines that varied in their countries of origin (U.S., U.K., China, or Russia), effectiveness (50%, 70%, or 90% effective at preventing infection); dosage requirements (one vs. two doses); antigen type (mRNA vs. an attenuated virus); the amount of time spent in development (nine, 12 or 15 months); and the chances of experiencing such minor side effects as soreness at the injection site, chills or fever (1 in 100, 1 in 10, or 1 in 2).</p>
<p>This procedure, known as a <a href="https://www.qualtrics.com/experience-management/research/types-of-conjoint/">conjoint experimental design</a>, asked respondents to compare six hypothetical vaccines with randomly generated attribute combinations. I estimated the effect of each attribute on vaccination intentions using statistical techniques that allowed me to control for the influence of all other attributes.</p>
<h2>A mismatch between expectations and reality</h2>
<p>The results present both encouraging and discouraging implications for COVID-19 vaccine uptake. I found it encouraging that Americans are no more or less likely to intend to vaccinate based on the type of antigen used to create a COVID-19 vaccine.</p>
<p>Respondents also showed only a slight preference for vaccines that were in development more than a year and those administered in just a single dose, leading to about a 2% increase in intentions, in both cases. This, too, is good news, as both the Pfizer and Moderna vaccines must be administered in two doses. They also received emergency use authorization approval in under one calendar year.</p>
<p>The less encouraging news, however, is that Americans are much less likely to intend to vaccinate when vaccine candidates are developed outside the U.S. Intention to vaccinate dropped by 21% for a vaccine developed in China, 18% for one developed in Russia, and 6% in the U.K. This is potentially problematic, as <a href="https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html">some leading</a> vaccine candidates, such as AstraZeneca’s vaccine, are produced outside of the U.S.</p>
<p>Respondents also want a low risk of experiencing minor side effects. They said they prefer vaccines that produce a less than 1 in 100 chance of experiencing such side effects as fever and chills to those that produce a 1 in 2 chance. This, too, may be problematic. <a href="https://www.vox.com/22158238/covid-19-vaccine-side-effects-explained">More than half</a> of participants in Pfizer’s clinical trials experienced some level of fatigue after getting vaccinated, and more than a third experienced chills.</p>
<p>Finally, Americans prefer vaccines that are at least 90% effective to those that are 70% (about a 5% decrease in intentions to vaccinate) or 50% effective (an 11% decrease). Both <a href="https://www.statnews.com/2020/12/19/a-side-by-side-comparison-of-the-pfizer-biontech-and-moderna-vaccines/">Pfizer and Moderna’s vaccines</a> have proved over 90% effective in late-stage clinical trials. However, these expectations may be at odds with the effectiveness of some vaccines, such as AstraZeneca’s, that may achieve <a href="https://www.bbc.com/news/health-55302595">closer to 70% effectiveness</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1348293766063525890"}"></div></p>
<p>I was most concerned to find that, even when a vaccine satisfies Americans’ expectations, the likelihood that the average respondent in the study would choose to vaccinate is just 68%. This means that high refusal rates could jeopardize achieving population immunity even under ideal conditions, and may be even higher in reality. </p>
<h2>Why expectations matter</h2>
<p>The correspondence between Americans’ preferred vaccine attributes and those of the vaccines we have the chance to receive could prove critical in determining how many Americans opt to vaccinate.</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 new science newsletter</a>.</em>]</p>
<p>Consequently, I believe that this research suggests that public demand for different vaccines earning federal approval may vary. This means that health experts may need to plan for Americans to be more likely to vaccinate if offered some vaccines compared with others. Public opinion researchers should also measure vaccination intentions for specific vaccines, in addition to vaccination attitudes more generally.</p>
<p>Finally, I think these results present an important challenge for health communication. Vaccines garnering federal approval are likely to contain a mix of attributes that Americans find both favorable and unfavorable. While it is important that health communicators are forthright about characteristics that some might deem unfavorable, placing a comparatively stronger emphasis on characteristics viewed favorably could encourage Americans to vaccinate.</p><img src="https://counter.theconversation.com/content/152745/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matt Motta 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>Two in five Americans say they don’t want a COVID-19 vaccine, which is a problem. Finding out what Americans do want from a vaccine might help.Matt Motta, Assistant Professor of Political Science, Oklahoma State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1519582020-12-16T15:46:35Z2020-12-16T15:46:35ZCan COVID-19 vaccinations be mandated? Short answer: Yes<figure><img src="https://images.theconversation.com/files/375250/original/file-20201215-17-1yiipur.jpg?ixlib=rb-1.1.0&rect=0%2C26%2C3319%2C2382&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Francesca Passer, a registered pharmacist technician, carefully fills a syringe with the Pfizer-BioNTech COVID-19 mRNA vaccine at a vaccine clinic during the COVID-19 pandemic in Toronto on Dec. 15, 2020. </span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span></figcaption></figure><p>The process of vaccinating <a href="https://www.ctvnews.ca/health/coronavirus/canada-s-mass-covid-19-vaccination-rollout-expands-1.5231839">Canadians against COVID-19 has begun</a>. With the rise in <a href="https://doi.org/10.1016/S2352-4642(19)30092-6">vaccine hesitancy</a>, and many refusing even to wear masks, people are wondering whether COVID-19 vaccination could be mandatory.</p>
<p>It could, in particular contexts. One is the workplace, through employer policies. Another is through legislation. However, neither possibility is simple or straightforward.</p>
<h2>Workplace policies</h2>
<p>Employers have many reasons to consider mandatory vaccination. One reason is their legal duty to take “<a href="https://www.ccohs.ca/oshanswers/legisl/responsi.html">every reasonable precaution</a>” to create a safe working environment.</p>
<p>While that duty compels some pandemic-related directives, there is <a href="https://www.thestar.com/business/2020/12/10/can-your-employer-force-you-to-take-the-covid-19-vaccine.html">disagreement about whether a vaccination policy</a> is among them. Either way, any subsequent policy would be subject to certain considerations.</p>
<p>The main consideration would likely be human rights legislation, which protects employees against discrimination on specified grounds. A mandatory vaccination policy has implications for those for whom a <a href="https://www.bbc.com/news/health-55244122">medical condition</a> or religious belief makes vaccination untenable.</p>
<p>While there is no absolute right to accommodation, employers have a significant duty to make efforts to find an accommodation that is reasonable in the circumstances. A demonstrated medical need or sincere religious belief will not necessarily trump a workplace policy. Rather, employers must accommodate to the point of “undue hardship.”</p>
<p>What constitutes undue hardship depends on the facts, as does what form a reasonable accommodation could take. If an employee with a valid claim can work from home (an increasingly plausible prospect), a refusal to allow this as an accommodation could violate human rights law. In other cases, a mask might be deemed sufficient accommodation. </p>
<figure class="align-center ">
<img alt="A man wearing a mask sits in front of his laptop." src="https://images.theconversation.com/files/374867/original/file-20201214-17-13g9w26.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/374867/original/file-20201214-17-13g9w26.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/374867/original/file-20201214-17-13g9w26.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/374867/original/file-20201214-17-13g9w26.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/374867/original/file-20201214-17-13g9w26.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/374867/original/file-20201214-17-13g9w26.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/374867/original/file-20201214-17-13g9w26.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Asking an employee who won’t be vaccinated to wear a mask while at work could be considered a ‘reasonable accommodation.’</span>
<span class="attribution"><span class="source">(Piqsels)</span></span>
</figcaption>
</figure>
<p>Legal concerns aside, accommodation, specifically for those with a medical need, just makes sense. That’s because one argument for widespread vaccination is to achieve <a href="https://www.who.int/news-room/q-a-detail/herd-immunity-lockdowns-and-covid-19#:%7E:text=%27Herd%20immunity%27%2C,exposing%20them%20to%20it.">herd immunity</a>, that can protect those who aren’t vaccinated.</p>
<p>Importantly, applicable human rights law doesn’t recognize all grounds upon which one might refuse vaccination, so the bigger question regards so-called “conscientious” refusal, such as concerns about vaccine safety and/or efficacy. Because such grounds are unprotected by the relevant human rights legislation, they likely won’t find much traction.</p>
<h2>Management rights in unionized workplaces</h2>
<p>In unionized workplaces, employer policies are subject to further considerations — namely collective agreement language, and a <a href="http://usw5890.com/wp-content/uploads/2013/11/The-KVP-Award-on-Company-Rules.pdf">reasonableness test</a>. There are many things that may render a policy unreasonable, such as whether the intrusion into employee privacy by collecting personal health information is outweighed by the benefit of doing so. </p>
<p>A mandatory COVID-19 testing policy for employees of a retirement home <a href="https://www.torkinmanes.com/docs/default-source/default-document-library/caressant-care-nursing-homes.pdf?sfvrsn=e82e5ad5_0">was recently upheld</a> on the basis that the intrusion into privacy was justified, despite the fact that other safety measures were already in place and no outbreak had yet occurred. </p>
<p>In arriving at this conclusion, the arbitrator noted that testing was invasive and imperfect but the consequences of an outbreak were more dire.</p>
<figure class="align-center ">
<img alt="A nurse wearing a mask vaccinates another woman." src="https://images.theconversation.com/files/375249/original/file-20201215-17-1cxjgri.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3917%2C2609&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/375249/original/file-20201215-17-1cxjgri.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/375249/original/file-20201215-17-1cxjgri.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/375249/original/file-20201215-17-1cxjgri.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/375249/original/file-20201215-17-1cxjgri.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/375249/original/file-20201215-17-1cxjgri.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/375249/original/file-20201215-17-1cxjgri.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">Nurse Venus Lucero administers the first Pfizer-BioNTech COVID-19 vaccine at the Ottawa Hospital to Jo-Anne Miner at a vaccination clinic on Dec. 15, 2020.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Adrian Wyld</span></span>
</figcaption>
</figure>
<p>By contrast, arbitrators have previously been divided about employer policies concerning seasonal flu vaccination, with some arbitrators finding them to be reasonable, <a href="https://www.sdc.gov.on.ca/sites/mol/drs/gaa/Arbitration%20Awards%20Library/832767%20-%202015-09-08.pdf">while others have disagreed</a>. Again, decisions are fact-dependent. The fact that COVID-19 is a much deadlier virus than seasonal flu, and that current vaccines are <a href="https://hartfordhealthcare.org/about-us/news-press/news-detail?articleId=29570&publicid=461">much more effective,</a> matters.</p>
<p>Collective agreement language, too, is relevant. In cases where workplace vaccination policies have not been upheld, language in the agreement permitting vaccine refusal was a factor. </p>
<h2>Laws could require vaccination</h2>
<p>Mandating vaccination through laws is another possibility. Previously, attempts to do so have mostly, <a href="https://tspace.library.utoronto.ca/bitstream/1807/68441/1/Ogbogu_Ubaka_L_201411_SJD_thesis.pdf">but not only</a>, been concerned with admission to schools.</p>
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Read more:
<a href="https://theconversation.com/most-of-us-support-mandatory-vaccines-for-schoolkids-but-is-it-good-policy-114580">Most of us support mandatory vaccines for schoolkids, but is it good policy?</a>
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<p>Existing school-entry vaccination laws, however, allow parents to easily obtain exemptions. Vaccination, in fact, is not actually mandatory for school admissions. The most recent attempt to limit these exemptions to cases of medical need was narrowly defeated <a href="https://www.lakelandtoday.ca/national-news/new-brunswick-legislators-defeat-controversial-mandatory-vaccination-bill-2445338">earlier this year</a> in New Brunswick.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/375274/original/file-20201216-23-353gha.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A blonde boy cries as he gets vaccinated." src="https://images.theconversation.com/files/375274/original/file-20201216-23-353gha.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/375274/original/file-20201216-23-353gha.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=505&fit=crop&dpr=1 600w, https://images.theconversation.com/files/375274/original/file-20201216-23-353gha.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=505&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/375274/original/file-20201216-23-353gha.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=505&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/375274/original/file-20201216-23-353gha.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=635&fit=crop&dpr=1 754w, https://images.theconversation.com/files/375274/original/file-20201216-23-353gha.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=635&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/375274/original/file-20201216-23-353gha.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=635&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 four-year-old boy cries as he gets his H1N1 flu shot in Montréal in November 2009.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Ryan Remiorz</span></span>
</figcaption>
</figure>
<p>Lacking the political will to mandate vaccines, however, is not the same as lacking authority to do so should political winds shift.</p>
<p>Ontario’s health minister recently stated that people will receive <a href="https://toronto.ctvnews.ca/ontarians-could-face-restrictions-if-they-refuse-to-get-covid-19-vaccine-health-minister-says-1.5222009?fbclid=IwAR2c788HdBQhzFfrlxf_avBtdAvhWReWvHLkRX1D2FTWFGe9s03TRRDq6w0">proof of COVID-19 vaccination</a>, anticipating situations that will require documentation — including travel. Notably, in August, Transport Canada issued a directive requiring <a href="https://www.cbc.ca/news/canada/calgary/mask-air-travel-canada-covid-19-1.5681510">proof of medical exemption</a> before boarding a plane without a mask. Implicit in this directive is that non-medical reasons for mask refusal are unacceptable. </p>
<p>Any similar law allowing only medically based exemptions from vaccination (for travel or school entry, for example) would certainly be challenged in court under Canada’s Charter of Rights and Freedoms. A recent Charter challenge to Newfoundland and Labrador’s travel restrictions <a href="https://www.cbc.ca/news/canada/newfoundland-labrador/travel-ban-appeal-decision-1.5767641">was unsuccessful</a>, but other challenges to various <a href="https://www.jccf.ca/wp-content/uploads/2020/12/2020-12-07-Originating-Application_Redacted.pdf">lockdown measures are underway</a>.</p>
<p>Unlike provincial human rights laws, the Charter protects matters of “conscience.” But that doesn’t mean a mandatory vaccination law is doomed to fail if challenged.</p>
<p>A well-crafted law could be defended as proportional, all things considered. The Charter itself allows for a “<a href="https://www.justice.gc.ca/eng/csj-sjc/rfc-dlc/ccrf-ccdl/check/art1.html">balance between the rights of the individual and the interests of society</a>.” Pandemic considerations could tilt that balance in favour of deference to government decision-making. </p>
<h2>Persuasion or mandates?</h2>
<p>People have a legal right to <a href="https://www.cmpa-acpm.ca/en/advice-publications/handbooks/consent-a-guide-for-canadian-physicians">refuse medical treatment</a>. But this right is not necessarily violated by denial of access to communal spaces due to that refusal. </p>
<p>With that said, the pandemic, far from being the crisis that has us all pulling in the same direction, has <a href="https://leaderpost.com/news/saskatchewan/freedom-rally-to-converge-on-sask-leg-despite-public-health-order">heightened societal rifts</a>. </p>
<p>In that context, the <a href="https://blogs.bmj.com/medical-ethics/2020/04/28/a-lesson-from-covid-19-persuasion-can-be-a-more-powerful-tool-than-mandates-in-improving-vaccine-uptake/">ongoing debate</a> over whether mandates or persuasion is a better vehicle for increasing vaccination rates is taking on an increased urgency.</p><img src="https://counter.theconversation.com/content/151958/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alison Braley-Rattai 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>Employers could require their workers to get vaccinated against COVID-19 via both workplace policies and existing laws. Neither option, however, is simple or straightforward.Alison Braley-Rattai, Assistant Professor, Labour Law, Brock UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1509672020-12-01T15:22:05Z2020-12-01T15:22:05ZCOVID-19 vaccine trials in Africa: what’s promising, and what’s problematic<figure><img src="https://images.theconversation.com/files/371752/original/file-20201127-19-7ifqee.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Scientists are working around the clock to develop and test vaccines against SARS-CoV-2, the causative agent of COVID-19. Experts agree that widespread use of safe and effective vaccines will rapidly contain <a href="https://www.nationalgeographic.com/science/2020/04/why-coronavirus-vaccine-could-take-way-longer-than-a-year/">the COVID-19 pandemic</a>, preventing transmission and disease. </p>
<p>A key step in the process of any vaccine development is clinical testing, which involves assigning a vaccine or a placebo to human subjects, then evaluating the health effects over a period of time. This testing helps to demonstrate safety in diverse human populations living in different settings, and to determine vaccine efficacy – the ability to prevent infection and disease.</p>
<p>Globally, COVID-19 vaccine <a href="https://www.who.int/news/item/24-08-2020-172-countries-and-multiple-candidate-vaccines-engaged-in-covid-19-vaccine-global-access-facility">trials</a> are being conducted in all continents, representing all diverse human populations in the world. In Africa, <a href="https://www.arabnews.com/node/1744091/middle-east">Egypt</a> and <a href="https://theconversation.com/pasha-79-why-south-africas-role-in-covid-19-vaccine-trials-is-important-145472">South Africa</a> are participating in these trials. Many other countries are also preparing to participate.</p>
<p>To date there are 260 COVID-19 vaccine candidates at different stages of development. Sixty of these are undergoing clinical testing (human trials) in different phases. This includes phase III trials – the point at which scientists aim to determine how well a vaccine protects (efficacy) trial participants from infection or severe COVID-19 symptoms. </p>
<p>November 2020 has been a celebratory month. Preliminary phase III data of three different COVID-19 vaccine candidates showed impressively high efficacy ranging from 70% to 95%. All three – <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-announce-vaccine-candidate-against">Pfizer/BioNTech</a>, <a href="https://www.modernatx.com/modernas-work-potential-vaccine-against-covid-19">Moderna mRNA-1273</a> and <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31604-4/fulltext">Oxford ChAdOx1-S</a> vaccines – are in the late stage of phase III clinical trials. Pfizer/BioNTech and Oxford ChAdOx1-S are being tested in Africa too. After investigations of an initial safety concern in phase III trial, the Oxford ChAdOx1-S vaccine testing <a href="https://www.bmj.com/content/370/bmj.m3525">has proceeded well</a>.</p>
<p>The groundbreaking developments offer hope and optimism. But there are still major obstacles ahead, particularly for developing countries. Chief among these are the fact that at least one of the vaccines showing promise needs to be kept at extremely low temperatures prior to use. This will be a difficult ask for most African countries.</p>
<p>In addition, there are concerns about access to the vaccines once manufacturing starts. Among the key concerns is the availability of sufficient vaccine doses to meet the high demand. And then there’s the question of affordability. Resources will be urgently needed to procure and distribute COVID-19 vaccines at a rapid pace. </p>
<p>A great deal of focus is being placed on the <a href="https://www.gavi.org/covax-facility">COVAX Facility, a GAVI co-led</a> global risk sharing plan. This is overseeing the pooling of procurement and equitable distribution of eventual COVID-19 vaccines.</p>
<h2>The promise</h2>
<p>There are three vaccines at phase III stage with a similar choice of an antigen – the SARS-CoV-2 spike protein. But they work differently in the way they teach the immune system to protect our bodies from COVID-19.</p>
<p>Pfizer/BioNTech is a mRNA vaccine. Such vaccines work by instructing the human cells to make a small part of the virus surface protein and induce the appropriate type of immune response that is thought to confer protection. In this case, it is an immune response to the SARS-CoV-2 spike protein. This protein plays a key role in enabling coronaviruses to infect human cells and replicate. </p>
<p>In some infected people, COVID-19 disease develops, whereas others remain asymptomatic, without any signs or symptoms of the disease. Preliminary data show no major safety concerns are associated with a two-dose administration of the vaccine. This mRNA-based COVID-19 vaccine induces T-cell and strong neutralising antibody immune responses. Both T-cell and antibody immune responses are thought to be critical in protecting against COVID-19. A similar mRNA vaccine, made by Moderna, has shown comparable results.</p>
<p>Efficacy of 95% has been reported for the Pfizer/BioNTech (mRNA) vaccine, far exceeding the expectations. This type of vaccine can be rapidly manufactured and scaled to capacity to meet the high demand for millions of doses. If licensed, it will be the first mRNA vaccine approved for human use by the regulatory authorities. </p>
<p>Oxford ChAdOx1-S is a non-replicating viral vector vaccine. The viral vector, or backbone, used in this vaccine is based on the chimpanzee adenovirus (ChAd). The choice of this type of vector is to circumvent common pre-existing immunity to human adenoviruses (HAdV) that would blunt the ability of such a vaccine to engage the human immune system. </p>
<p>Already, scientists have experience with clinical testing (safety and immunological profiles) of the ChAd <a href="https://academic.oup.com/cid/article/70/10/2073/5537685">viral vectored vaccines</a>.</p>
<p>The Oxford ChAdOx1-S works by using a replication-deficient adenovirus vector to conveniently deliver the spike protein to immune cells or tissues, thereby inducing the desired immune response against SARS-CoV-2. The vaccine-induced immunity comprises of T-cell and strong neutralising (infection-blocking) antibody immune responses. </p>
<p>Novavax NVX-CoV2373 is a protein subunit vaccine. Subunit vaccines work by presenting a specific antigen that stimulates the immune system to mount a response. Importantly, these types of vaccines require combination with adjuvants (a compound that enhances an immune response), as the antigens alone are not enough to induce optimal and long-term immunity. </p>
<p>The antigen (spike protein) in NVX-CoV2373 vaccine is made and purified from cell culture, then formulated – along with Novavax’s saponin-based Matrix-M adjuvant – to a nanoparticle. There is vast clinical experience of this type of vaccine platform in terms of safety and immunogenicity, such as the seasonal influenza vaccine. </p>
<p>Preliminary data shows NVX-CoV2373 vaccine-induced immunity comprises T-cell and strong neutralising antibody immune responses. It is likely this two-dose schedule vaccine candidate will show high efficacy. </p>
<h2>The problems</h2>
<p>A big challenge for the Pfizer/BioNTec vaccine is the cold chain requirements. It needs to be transported and stored at unusually low temperatures (-70°C, on dry ice) prior to use. Immunisation programmes – particularly those on the continent – don’t have the vaccine supply and cold chain infrastructures that can optimally handle this vaccine. This is especially true at the level-one healthcare facilities where immunisations routinely take place. </p>
<p>This means that significant investments will have to be made prior to rollout to communities in remote areas. This could cause massive delays in the use of the vaccine, especially in low- and middle-income countries. The good news is that innovative approaches, such as design and development of appropriate transport containers, <a href="https://www.mecotec.net/en/first-mobile-hybrid-container-solution-for-covid-19-vaccines/">may address these challenges</a>. </p>
<p>The other two vaccines can be handled within the current immunisation cold chain infrastructure that keeps temperature at a range of 2°C to 8°C prior to use.</p>
<p>Another potential challenge is that the use of any of these vaccines by national immunisation programmes will need to be informed by high quality and timely evidence that takes local context into consideration. This means national policy makers must urgently and meticulously consider the merits and demerits of each of the vaccines prior to deciding which one to use.</p>
<p>On cost and access, a great deal of effort is being put into the COVAX Facility. This seems to be Africa’s only insurance policy against being the last in the queue.</p><img src="https://counter.theconversation.com/content/150967/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Benjamin Kagina receives funding from the Wellcome Trust and from Bill and Melinda Gates Foundation. Benjamin has also received educational grants from Sanofi Pasteur, Pfizer, GSK and Merck.</span></em></p>There are three promising COVID-19 trials.Benjamin Kagina, Senior Research Officer, Vaccines For Africa Initiative, Faculty of Health Sciences, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1501292020-11-24T13:08:23Z2020-11-24T13:08:23ZCoronavirus vaccines: health experts identify ways to build public trust<figure><img src="https://images.theconversation.com/files/370409/original/file-20201119-24-xhdci2.jpg?ixlib=rb-1.1.0&rect=5%2C0%2C3489%2C2335&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The drug maker company Pfizer says its COVID-19 vaccine is 95% effective with no serious side effects.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/woman-walks-in-front-of-pfizer-headquarters-on-november-18-news-photo/1286417492?adppopup=true">Eduardo Munoz Alvarez/VIEW press/Corbis News via Getty Images</a></span></figcaption></figure><p>The pharmaceutical companies Pfizer and BioNtech announced Nov. 20, 2020, that they will <a href="https://www.cnn.com/2020/11/18/health/biontech-vaccine-ugur-sahin-intl/index.html">seek emergency use authorization from the Food and Drug Administration</a> for a vaccine to prevent COVID-19. On Nov. 16, <a href="https://www.nytimes.com/live/2020/moderna-covid-19-vaccine">Moderna announced</a> that a vaccine it has been working on has been shown to be close to 95% effective.</p>
<p>But no vaccine will be nearly that effective in reality if people refuse to take it. And recent polls suggest that <a href="https://news.gallup.com/poll/325208/americans-willing-covid-vaccine.aspx?utm_source=nextdraft&utm_medium=email">about 40%</a> of Americans won’t take a COVID-19 vaccine when it becomes available. Those numbers are even higher among <a href="https://news.gallup.com/poll/325208/americans-willing-covid-vaccine.aspx?utm_source=nextdraft&utm_medium=email">nonwhite Americans</a>.</p>
<p>The factors that lead people to make choices to take vaccines are nuanced. People’s choices are affected <a href="https://theconversation.com/why-scientists-and-public-health-officials-need-to-address-vaccine-mistrust-instead-of-dismissing-it-146955">by how they see the world</a>, their perceptions of the choices people like them will make, whom they trust, their perceptions of risk, consistency of message and convenience of actually getting the vaccine. </p>
<figure class="align-center ">
<img alt="Recent polls say nearly half of Americans won't take the COVID-19 vaccine." src="https://images.theconversation.com/files/370413/original/file-20201119-21-c4fvri.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/370413/original/file-20201119-21-c4fvri.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/370413/original/file-20201119-21-c4fvri.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/370413/original/file-20201119-21-c4fvri.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/370413/original/file-20201119-21-c4fvri.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/370413/original/file-20201119-21-c4fvri.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/370413/original/file-20201119-21-c4fvri.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Polls suggest millions of Americans won’t take the COVID-19 vaccine.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/anti-vaccine-activists-protest-and-hold-signs-in-front-of-news-photo/1228270828?adppopup=true">Scott Eisen via Getty Images</a></span>
</figcaption>
</figure>
<p>In a world with unlimited supplies of vaccine and budget to support outreach, public officials could craft highly specific campaigns for each community and identity in the world. The vaccine would be simultaneously available to everyone, and our personal doctors would administer it and assure us of its efficacy.</p>
<p>That world doesn’t exist.</p>
<p>Melissa Fleming, the United Nations undersecretary general for global communications, recently launched the <a href="https://shareverified.com/en">Verified initiative</a> to combat misinformation about COVID-19. Verified engaged the Center for Public Interest Communications at the University of Florida. Our team of scholars, strategists and storytellers works with organizations around the world to apply social, behavioral and cognitive science to drive lasting social change. We were asked to identify research-based messages that might overcome vaccine hesitancy. Verified released our <a href="https://covid19vaccinescommunicationprinciples.org/">guide Thursday</a>.</p>
<p>We quickly identified the leading scholars in this space, and 16 social and behavioral psychologists, medical anthropologists, behavioral economists, neuroscientists and political communications scholars joined us for a series of conversations over five days. We asked questions like: What makes people resilient against misinformation? What drives vaccine hesitancy? Which frames will be most effective? What kinds of message strategies have been effective with specific communities? And finally, what are some of the best ways to make taking the vaccine a social norm?</p>
<figure class="align-center ">
<img alt="Even in cases where there's opposition, there are ways to increase acceptance for the COVID-19 vaccine." src="https://images.theconversation.com/files/370418/original/file-20201119-24-ecuvzs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/370418/original/file-20201119-24-ecuvzs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/370418/original/file-20201119-24-ecuvzs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/370418/original/file-20201119-24-ecuvzs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/370418/original/file-20201119-24-ecuvzs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/370418/original/file-20201119-24-ecuvzs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/370418/original/file-20201119-24-ecuvzs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Although many Americans say they will refuse the COVID-19 vaccine, there are ways to increase acceptance.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/anti-vaccine-activists-hold-up-signs-during-a-protest-in-news-photo/1228271048?adppopup=true">Scott Eisen via Getty Images</a></span>
</figcaption>
</figure>
<p>Eight principles emerged from those conversations that we believe can increase trust, acceptance and demand for vaccination. We have shared these principles with the leaders across the U.N. as part of their global efforts to reduce vaccine hesitancy and overcome misinformation related to COVID-19. </p>
<ol>
<li><p>Work within worldviews, identities and moral values. Each of us has a unique set of identities, worldviews and moral values that influence our choices and behaviors, and even what we believe to be true. It’s worthwhile to understand what others <a href="https://shotofprevention.com/2017/12/05/research-suggests-vaccine-hesitancy-often-tied-to-concerns-about-individual-liberty-and-purity/">see as right and wrong and to connect with what’s most important to them</a>. Find the common ground between what you hope to achieve and what matters to them. For example, taking a vaccine, then, would become <a href="https://www.theguardian.com/world/2020/nov/07/could-a-covid-vaccine-bring-back-normality">a way to return to activities and behaviors</a> that matter most to them.</p></li>
<li><p>Use timing to the best advantage. It’s far easier to build trust when you’re the first to articulate a message. People are most likely to trust – and stick to – <a href="https://www.bbc.com/future/article/20181114-could-this-game-be-a-vaccine-against-fake-news">the version of information they hear first</a>. It’s equally important, however, that they <a href="https://www.centerforhealthsecurity.org/our-work/pubs_archive/pubs-pdfs/2020/200709-The-Publics-Role-in-COVID-19-Vaccination.pdf">hear that same message multiple times from an array of sources</a>. </p></li>
<li><p>Use the right messengers for the audience. People act when they trust the messenger, the message and their motivations. Trusted messengers <a href="https://www.centerforhealthsecurity.org/our-work/pubs_archive/pubs-pdfs/2020/200709-The-Publics-Role-in-COVID-19-Vaccination.pdf">vary greatly from community to community</a>, but there are some broad lessons you can apply. Ideally, the messenger is someone with deep expertise: a doctor, a scientist or a public health practitioner. But trusted messengers are also those in our “in-groups,” people we see as being like us and who share our values. As behavioral economist David Fetherstonhaugh put it, “I couldn’t stress enough the importance of a message coming from within an in-group — someone that’s automatically on the inside. It’s almost like such messages even bypass deliberate cognition because they are coming from a trusted source: ‘They’re my family, or it’s my pastor, or it’s my party leader.’ So the source of a message, in-group vs. out-group, is extraordinarily important for how a message is received.”</p></li>
<li><p>Make the <a href="https://theconversation.com/why-scientists-and-public-health-officials-need-to-address-vaccine-mistrust-instead-of-dismissing-it-146955">content concrete</a>, supply a narrative and provide value. If messages aren’t concrete and don’t include stories, our powerful sense-making brains will fill the abstraction with stories and ideas that make sense to us. One particular space to build that narrative is around vaccine trials. Instead of saying “we’re in stage 3,” name the number of people who have participated in successful trials and share stories of individuals who participated in those trials. </p></li>
<li><p>Recognize that communities have <a href="https://www.statnews.com/2020/08/14/covid-19-clinical-trials-are-are-failing-to-enroll-diverse-populations-despite-awareness-efforts/">different relationships with vaccination</a>. In some societies, people may be fearful of vaccines, but have a strong trust in authority. In others, mandatory vaccinations have created distrust of government authorities. In others, <a href="https://doi.org/10.1016/j.socscimed.2018.12.020">decades of mistreatment and exploitation</a> have resulted in a <a href="https://www.scientificamerican.com/article/why-so-many-americans-are-skeptical-of-a-coronavirus-vaccine/">profound lack of trust in new medical treatments</a>. Different societies also have different relationships with authority. In societies where people trust authority, they’re more likely to accept direction even if they don’t support it. </p></li>
<li><p>Reinforce positive behaviors. We are deeply affected by the behavior and choices of people in our networks – <a href="https://tech.winningbrain.com.ng/2020/11/09/is-social-media-ready-for-a-covid-19-vaccine/">even people we may not have met</a>. So to change behavior, you have to shift people’s perceptions of what normal behavior looks like. Examining vaccine hesitancy through the lens of social norms offers two opportunities to make a difference. The first is activating trusted influencers within social networks and people’s perceptions of what others are doing. The second is in shifting the communications norms among those communicating on behalf of the vaccine.</p></li>
<li><p>Evoke the right emotions. It’s tempting to activate emotions like fear or shame to get people to take a vaccine, but it’s unlikely to work. Fear immobilizes people, and shame is likely to achieve the wrong reaction. Look to more constructive emotions like awe, hope and parental love to get people to act.</p></li>
<li><p>Be explicit and transparent about motivations. Our perceptions of the motivations of the messenger matters. Our motivations in seeking information are equally important. We’re less likely to trust a vaccine if we question the motives of the people advocating for us to take it. </p></li>
</ol>
<p>There is, of course, a weakness in this tool, which is that it’s based on research conducted on hesitancy around other vaccines. We don’t know about COVID-19, because we don’t yet have the vaccine. But even with these obvious limitations, science-informed messages are the best tools we have. </p>
<p>[<em>Research into coronavirus and other news from science</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-research">Subscribe to The Conversation’s new science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/150129/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This project was supported by the United Nations Verified initiative, an effort to combat misinformation. </span></em></p>The United Nations recently asked a group of experts across the world to recommend ways to persuade people to take a COVID-19 vaccine. Here is a summary of their suggestions.Ann Christiano, Director, Center for Public Interest Communications, University of FloridaJack J. Barry, Postdoctoral research associate, University of FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1495222020-11-05T05:56:22Z2020-11-05T05:56:22ZWhat do we know about the Novavax and Pfizer COVID vaccines that Australia just signed up for?<figure><img src="https://images.theconversation.com/files/367599/original/file-20201104-23-1xy5a9j.jpg?ixlib=rb-1.1.0&rect=1%2C1%2C1024%2C530&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/development-creation-covid19-vaccine-design-by-1782359774">Shutterstock</a></span></figcaption></figure><p>The federal government’s <a href="https://www.abc.net.au/news/2020-11-04/two-new-coronavirus-vaccine-deals-50-million-doses-government/12849572">announcement</a> of agreements to supply vaccines from Novavax and Pfizer/BioNTech <a href="https://www.pm.gov.au/media/australia-secures-further-50-million-doses-covid-19-vaccine">potentially increases</a> the pool of COVID-19 vaccines Australians will be able to access.</p>
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<p>These two vaccines are in addition to supply arrangements for vaccines from Oxford University/AstraZeneca and the University of Queensland/CSL, <a href="https://theconversation.com/putting-our-money-on-two-covid-vaccines-is-better-than-one-why-australias-latest-vaccine-deal-makes-sense-145693">announced in September</a>. Australia will also have access to vaccines via the World Health Organisation-backed <a href="https://theconversation.com/australias-just-signed-up-for-a-shot-at-9-covid-19-vaccines-heres-what-to-expect-146750">COVAX initiative</a>.</p>
<p>However, these arrangements depend on whether the vaccines are shown to be safe and effective in clinical trials, which are still ongoing. So what do we know about the two vaccines in this latest deal?</p>
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Read more:
<a href="https://theconversation.com/scott-morrison-to-announce-two-new-covid-vaccine-deals-149458">Scott Morrison to announce two new COVID vaccine deals</a>
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<h2>What do we know about the Novavax vaccine?</h2>
<p>The Novavax vaccine, NVX-CoV2373, contains <a href="https://ir.novavax.com/news-releases/news-release-details/novavax-present-covid-19-vaccine-data-world-vaccine-congress">purified pieces</a> of the spike protein of SARS-CoV-2, the virus that causes COVID-19. </p>
<p>These proteins are administered with an adjuvant, a molecule that enhances the immune response. The idea is that when this vaccine is administered, the body recognises its contents as “foreign” and mounts a protective immune response.</p>
<p>Early clinical trials were performed <a href="https://www.nejm.org/doi/10.1056/NEJMoa2026920?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">in Australia</a>. In the phase 1 clinical trials, the vaccine was generally well-tolerated and produced <a href="https://www.nejm.org/doi/10.1056/NEJMoa2026920?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">strong antibody responses</a>, stronger than what we see in patients recovering from COVID-19.</p>
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Read more:
<a href="https://theconversation.com/from-adenoviruses-to-rna-the-pros-and-cons-of-different-covid-vaccine-technologies-145454">From adenoviruses to RNA: the pros and cons of different COVID vaccine technologies</a>
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<p>In September, Novavax launched a phase 3 clinical trial <a href="https://www.clinicaltrialsregister.eu/ctr-search/trial/2020-004123-16/GB">in the United Kingdom</a>. Further large-scale clinical trials are planned for other countries in late 2020 and early 2021. </p>
<p>If the Novavax vaccine is successful <a href="https://www.health.gov.au/resources/publications/coronavirus-covid-19-information-about-the-novavax-vaccine-for-covid-19">40 million doses</a> are expected to be available in Australia during 2021, with the option to buy a further 10 million. </p>
<h2>What do we know about the Pfizer vaccine?</h2>
<p>The vaccine developed by Pfizer, BNT162b2, is based on the genetic material mRNA (or messenger ribonucleic acid). Such mRNA vaccines carry a piece of genetic material that codes for viral proteins, or parts of them. Once inside your cells, the mRNA instructs your cells’ protein factories to make copies of these viral proteins. These then stimulate your immune system to mount a protective immune response.</p>
<p>Pfizer’s BNT162b2 vaccine <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-choose-lead-mrna-vaccine-candidate-0">codes for</a> the virus’ full-length spike protein.</p>
<p>In <a href="https://clinicaltrials.gov/ct2/show/NCT04380701">early clinical trials</a>, the vaccine was generally safe with no serious side-effects. The vaccine also produced a <a href="https://pubmed.ncbi.nlm.nih.gov/33053279/">robust immune response</a> after two doses.</p>
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<a href="https://images.theconversation.com/files/367656/original/file-20201105-24-155ysu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Illustration of single-stranded RNA" src="https://images.theconversation.com/files/367656/original/file-20201105-24-155ysu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/367656/original/file-20201105-24-155ysu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/367656/original/file-20201105-24-155ysu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/367656/original/file-20201105-24-155ysu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/367656/original/file-20201105-24-155ysu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/367656/original/file-20201105-24-155ysu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/367656/original/file-20201105-24-155ysu.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>
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<span class="caption">Vaccines based on RNA use your cells’ protein factories to make viral protein, which stimulates your immune system.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/single-strand-ribonucleic-acid-rna-research-1094792225">Shutterstock</a></span>
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<p>When older adults (65-85 years of age) were vaccinated, they produced a <a href="https://pubmed.ncbi.nlm.nih.gov/33053279/">greater neutralising antibody response</a> than seen in patients who contracted SARS-CoV-2 naturally.</p>
<p>Interestingly, BNT162b2 is one of the first COVID-19 vaccines to be tested <a href="https://www.pfizer.com/science/coronavirus/vaccine">in adolescents</a> (12-18 years of age).</p>
<p><a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-choose-lead-mrna-vaccine-candidate-0">In July</a>, Pfizer announced the launch of large-scale phase 2/3 trials. Trials are under way in <a href="https://www.health.gov.au/sites/default/files/documents/2020/11/coronavirus-covid-19-information-about-the-pfizer-biontech-vaccine-for-covid-19.pdf">several countries</a>, including the United States, Germany, Argentina, Brazil and South Africa, involving 44,000 participants. </p>
<p>One of the challenges facing this vaccine is distribution, as it needs to be stored below -70°C. This is costly and makes transportation difficult, particularly in developing regions. </p>
<p>If BNT162b2 is successful, <a href="https://www.pm.gov.au/media/australia-secures-further-50-million-doses-covid-19-vaccine">10 million doses</a> <a href="https://www.health.gov.au/sites/default/files/documents/2020/11/coronavirus-covid-19-information-about-the-pfizer-biontech-vaccine-for-covid-19.pdf">will be available</a> in Australia from early 2021.</p>
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<strong>
Read more:
<a href="https://theconversation.com/australias-just-signed-up-for-a-shot-at-9-covid-19-vaccines-heres-what-to-expect-146750">Australia's just signed up for a shot at 9 COVID-19 vaccines. Here's what to expect</a>
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<h2>What happens next?</h2>
<p>Both vaccines, if successful in clinical trials, will be manufactured outside Australia. </p>
<p>This will <a href="https://theconversation.com/australia-may-miss-out-on-several-covid-vaccines-if-it-cant-make-mrna-ones-locally-148996">allay fears</a> Australia might miss out on mRNA vaccines as the country does not have the technology and capacity to make these vaccines itself.</p>
<p>A successful COVID-19 vaccine will also need to navigate the rigorous assessment and approval processes of the Therapeutic Goods Administration for use in Australia.</p>
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Read more:
<a href="https://theconversation.com/australia-may-miss-out-on-several-covid-vaccines-if-it-cant-make-mrna-ones-locally-148996">Australia may miss out on several COVID vaccines if it can't make mRNA ones locally</a>
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<h2>Hedging our bets</h2>
<p>It is unlikely all COVID-19 vaccines currently in development will be successful. We have already seen COVID-19 vaccine trials <a href="https://theconversation.com/the-oxford-vaccine-trial-has-been-paused-but-this-is-no-reason-to-panic-145882">temporarily halted</a> due to safety issues. And not all vaccines will provide a consistent level of immunity. Some vaccines may only provide immunity for limited periods of time and require a booster shot.</p>
<p>By investing in numerous front-running candidates, the Australian government’s strategy of not putting all its eggs in one basket is a wise one. </p>
<p>Investing in a range of vaccine technologies also has benefits, should more than one vaccine become available. This is because different vaccine technologies may be more effective or safe in different populations. This increases the likelihood all sections of society — young and old, with or without existing medical complications — could be targeted.</p><img src="https://counter.theconversation.com/content/149522/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Taylor receives funding from The National Health and Medical Research Council of Australia, the National Foundation for Medical Research and Innovation and the New South Wales Department of Primary Industries. </span></em></p>Two more COVID-19 vaccines may now be on the cards for Australia, should they pass clinical trials. But, as with earlier vaccine deals, there are no guarantees.Adam Taylor, Early Career Research Leader, Emerging Viruses, Inflammation and Therapeutics Group, Menzies Health Institute Queensland, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.