tag:theconversation.com,2011:/es/topics/naci-104340/articlesNACI – The Conversation2021-11-01T16:26:59Ztag:theconversation.com,2011:article/1698202021-11-01T16:26:59Z2021-11-01T16:26:59ZEthical decisions: Weighing risks and benefits of approving COVID-19 vaccination in children ages 5-11<figure><img src="https://images.theconversation.com/files/429411/original/file-20211029-23-1u7vp0d.jpg?ixlib=rb-1.1.0&rect=257%2C74%2C4082%2C2809&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ethics are important to vaccination decisions because while science can clarify some of the costs and benefits, it cannot tell us which costs and benefits matter most to us.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Frank Gunn </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/ethical-decisions--weighing-risks-and-benefits-of-approving-covid-19-vaccination-in-children-ages-5-11" width="100%" height="400"></iframe>
<p>The U.S. Food and Drug Administration has approved <a href="https://www.cbc.ca/news/world/fda-approves-pfizer-children-1.6229798">Pfizer’s COVID-19 vaccine for use in children ages five to 11</a>. Pfizer’s <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-announce-positive-topline-results">clinical trial results</a> indicate the vaccine is safe and effective in this age group. </p>
<p>This is an important development. <a href="https://globalnews.ca/news/8250271/covid-19-bc-modelling-data-children/">COVID-19 infections</a> <a href="https://www.cbc.ca/news/canada/calgary/covid-alberta-kids-1.6208827">are on the rise</a> <a href="https://www.cbc.ca/news/canada/saskatchewan/covid-19-saskatchewan-october-9-1.6206509">in children</a> <a href="https://www.thestar.com/politics/provincial/2021/09/28/ontarios-new-covid-19-cases-could-drop-to-200-a-day-or-rise-to-5000-latest-modelling-projects.html">across</a> <a href="https://www.cbc.ca/news/canada/new-brunswick/new-brunswick-school-covid-19-1.6202893">Canada</a>.</p>
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<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
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<p>It is now up to <a href="https://www.cbc.ca/news/health/pfizer-seeks-kids-covid-vaccine-approval-health-canada-1.6215547">Health Canada</a> to consider the data and to decide whether to authorize this COVID-19 vaccine for children. Once it is authorized in Canada, the <a href="https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci.html">National Advisory Committee on Immunization</a> (NACI) will have to decide whether to recommend vaccination for all children in this age group. </p>
<p>This raises the question of how this decision ought to be made.</p>
<h2>Making an ethical decision</h2>
<p>As a moral philosopher who has <a href="http://blog.practicalethics.ox.ac.uk/2021/08/we-should-vaccinate-children-in-high-income-countries-against-covid-19-too/">collaboratively researched</a> <a href="https://doi.org/10.1136/bmj.n1687">ethical issues relating to the vaccination of children</a>, I believe it is important to answer this question, for two reasons. </p>
<p>First, whatever the decision, the principles on which it is based — and should be based — must be clear and transparent. </p>
<p>Second, surprisingly little attention has been paid to this issue in Canada, despite the decision to vaccinate children being a matter <a href="https://www.politico.eu/article/coronavirus-vaccine-children-ethics-science/">of science and ethics</a>. Science can clarify some of the costs and benefits of vaccination, but it cannot tell us which costs and benefits matter and when a cost-benefit ratio is favourable.</p>
<p>Fortunately, there is no need to generate a decision-making procedure from scratch. The procedure used by the <a href="https://www.gov.uk/government/groups/joint-committee-on-vaccination-and-immunisation">United Kingdom’s Joint Committee on Vaccination and Immunisation</a> (JCVI) in deciding whether to vaccinate healthy children aged 12-15 in the U.K. can provide important lessons about what not to do.</p>
<h2>Risks and benefits</h2>
<p>The most important factor is whether the benefits of vaccination outweigh its risks, and the degree to which the benefits outweigh the risks. In weighing these, the JCVI relied on what it called the “health perspective.” </p>
<p>Reasoning from this perspective, the JCVI held (in a <a href="https://www.gov.uk/government/publications/covid-19-vaccination-of-children-and-young-people-aged-12-to-17-years-jcvi-statement/jvci-statement-on-covid-19-vaccination-of-children-and-young-people-aged-12-to-17-years-15-july-2021">series</a> of <a href="https://www.gov.uk/government/publications/jcvi-statement-august-2021-covid-19-vaccination-of-children-and-young-people-aged-12-to-17-years/jcvi-statement-on-covid-19-vaccination-of-children-and-young-people-aged-12-to-17-years-4-august-2021">public</a> <a href="https://www.gov.uk/government/publications/jcvi-statement-september-2021-covid-19-vaccination-of-children-aged-12-to-15-years/jcvi-statement-on-covid-19-vaccination-of-children-aged-12-to-15-years-3-september-2021">statements</a>) that the chief benefits of vaccination against COVID-19 were the prevention of death, hospitalization, intensive care unit (ICU) admissions and pediatric inflammatory multisystem syndrome (PIMS) or multisystem inflammatory syndrome (MIS-C). </p>
<p>The chief harms of vaccination were myocarditis, or inflammation of the heart, and pericarditis, inflammation of the thin sack surrounding the heart, though it said these were rare and “typically self-limiting and resolved within a short time.”</p>
<p>The JCVI argued that the benefits of vaccination in this age group are only “marginally greater” than the harms and that therefore vaccination would not be offered to all members of this group.</p>
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<a href="https://images.theconversation.com/files/429412/original/file-20211029-25-1xe05b5.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A boy wearing a face mask getting an injection" src="https://images.theconversation.com/files/429412/original/file-20211029-25-1xe05b5.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/429412/original/file-20211029-25-1xe05b5.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/429412/original/file-20211029-25-1xe05b5.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/429412/original/file-20211029-25-1xe05b5.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/429412/original/file-20211029-25-1xe05b5.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/429412/original/file-20211029-25-1xe05b5.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/429412/original/file-20211029-25-1xe05b5.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Twelve-year-old Sam Hallett got his shot at the Aboriginal Health and Wellness Centre in Winnipeg shortly after Health Canada approved COVID-19 vaccination in his age group in May.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Winnipeg Free Press-Mike Deal</span></span>
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<p><a href="https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci/recommendations-use-covid-19-vaccines/mrna-adolescents.html">NACI disagreed</a>, but did not outline the ethical principles it relied on in recommending vaccination for children ages 12-17.</p>
<p>JCVI’s decision not to offer all children vaccination against COVID-19 was flawed in numerous respects. (It was later <a href="https://www.gov.uk/government/publications/universal-vaccination-of-children-and-young-people-aged-12-to-15-years-against-covid-19/universal-vaccination-of-children-and-young-people-aged-12-to-15-years-against-covid-19">overruled by the chief medical officers of the U.K.’s four nations</a>.) NACI will do well to avoid these mistakes in making its decision about vaccinating children ages five to 11.</p>
<p>The Independent Scientific Advisory Group for Emergencies (Independent SAGE, a group of British scientists offering independent scientific advice on the prevention of COVID-19) <a href="https://www.independentsage.org/wp-content/uploads/2021/10/Independent-SAGE-JCVI-statement_transparency_final.pdf">has raised a number of concerns about the JCVI’s decision-making process</a>. </p>
<p>One concern is the way in which the JCVI calculated the benefits of vaccination, basing these calculations on risk to the population of all children of death, hospitalization, ICU admission and so on from COVID-19 infection, rather than the risks of these to children with a confirmed infection of COVID-19.</p>
<p>Another concern Independent SAGE raised was that the JCVI did not state which vaccine it considered when it examined the risks, a relevant concern <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/heart-inflammation-rates-higher-after-moderna-covid-19-shot-than-pfizer-vaccine-2021-10-01/">since heart inflammation rates appear to be higher after the Moderna vaccine than after the Pfizer</a> vaccine.</p>
<h2>Direct and indirect benefits</h2>
<p>Some of JVCI’s other mistakes related to value judgments, relying on the health perspective to make its decision. However, the JCVI was not consistent on what this included. </p>
<p>As noted, the JCVI mentioned the prevention of death, hospitalization, ICU admission and PIMS or MIS-C. These are not the only health benefits of vaccination against COVID-19. Some direct and indirect health benefits of vaccination were not clearly included.</p>
<p>The direct benefits include the prevention of <a href="https://www.who.int/publications/i/item/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1">long COVID</a> — a condition affecting anywhere <a href="https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(21)00198-X/fulltext">from two</a> <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/english-study-finds-long-covid-affects-up-1-7-children-months-after-infection-2021-09-01/">to 14</a> per cent of children infected with COVID-19 — and potential neurological and cognitive deficits caused by COVID-19 infection. </p>
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<a href="https://images.theconversation.com/files/429418/original/file-20211029-21-1rwklhi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A group of adolescents near a schoolyard play structure" src="https://images.theconversation.com/files/429418/original/file-20211029-21-1rwklhi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/429418/original/file-20211029-21-1rwklhi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=422&fit=crop&dpr=1 600w, https://images.theconversation.com/files/429418/original/file-20211029-21-1rwklhi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=422&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/429418/original/file-20211029-21-1rwklhi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=422&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/429418/original/file-20211029-21-1rwklhi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=530&fit=crop&dpr=1 754w, https://images.theconversation.com/files/429418/original/file-20211029-21-1rwklhi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=530&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/429418/original/file-20211029-21-1rwklhi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=530&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">Families and youth aged 12 and older line up for a COVID-19 vaccine at a Toronto school in May.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span>
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<p>Preventing the <a href="https://doi.org/10.1136/bmj.n2052">negative mental and physical health effects</a> associated with school closures, limits on sporting and other such activities and physical distancing requirements are among the indirect benefits (though these were rightly noted by NACI in its recommendation to vaccinate adolescents). These health effects are important when deciding whether to vaccinate.</p>
<p>These are the known risks and benefits. However, the JCVI’s refusal to recommend vaccination to all children aged 12-15 was due to the uncertainties “regarding the magnitude of the potential harms” of vaccination, including myocarditis. </p>
<p>Although it gave considerable weight to unknown harms or uncertainties of vaccination, the JVCI did not consider potential unknown benefits of vaccination, or uncertainties about benefits. There was no reason to rule these out. Uncertainties about benefits seem to be of as much importance in thinking about the risk benefit profile of COVID-19 vaccination as uncertainties about risks. These, again, matter greatly to this decision.</p>
<p>The JCVI made another ethical error when it said the harms of vaccination should be given greater weight (relatively speaking) than the benefits. </p>
<p>There is no good reason to place a higher relative value on harms compared to benefits. Harms caused by vaccines are not worse than harms caused by COVID-19. It does not appear to be true that the rare and typically mild pericarditis or the myocarditis caused by vaccination is any worse than the pericarditis or the myocarditis caused (at <a href="https://www.newscientist.com/article/mg25133462-800-myocarditis-is-more-common-after-covid-19-infection-than-vaccination/">greater</a> <a href="https://www.nytimes.com/2021/10/06/health/covid-vaccine-children-dose.html?smid=tw-share">frequency</a>) by COVID-19 infection. This is not in line with other treatments considered for children, for which harms are not typically weighed more heavily than benefits.</p>
<h2>The well-being perspective</h2>
<p>It was a mistake for JCVI to make the decision about vaccination against COVID-19 in children purely on the basis of the health perspective. Health is important. But it is not the only value in the lives of children. Health is a priority because without it many other important benefits — enjoying friends, connecting with relatives, absorbing oneself in homework or music lessons — become much more difficult, if not impossible.</p>
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<a href="https://images.theconversation.com/files/429417/original/file-20211029-27-7g7pj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A 12-year-old girl wearing a face mask with a sticker reading 'I got vaccinated'" src="https://images.theconversation.com/files/429417/original/file-20211029-27-7g7pj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/429417/original/file-20211029-27-7g7pj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/429417/original/file-20211029-27-7g7pj5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/429417/original/file-20211029-27-7g7pj5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/429417/original/file-20211029-27-7g7pj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=565&fit=crop&dpr=1 754w, https://images.theconversation.com/files/429417/original/file-20211029-27-7g7pj5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=565&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/429417/original/file-20211029-27-7g7pj5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=565&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Sound ethics and sound science show that vaccinating children is, all things considered, beneficial.</span>
<span class="attribution"><span class="source">(AP Photo/Angie Wang)</span></span>
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<p>The JCVI mentioned the beneficial effects of vaccination on education. But it did not factor these benefits into the decision relating to vaccinating children against COVID-19. </p>
<p>Educational and other benefits afforded to children by vaccination matter greatly and must be factored into this decision. Moving beyond the health perspective into the well-being perspective encompasses a larger range of benefits and protections from vaccination, including safe and stable learning environments, time with extended family, sport, music performances and the many other things that make life happy and meaningful for children.</p>
<p>When making the decision whether to vaccinate children aged five to 11 against COVID-19, regulators in Canada must rely on both sound science and sound ethics. They must in particular consider all the health and well-being impacts of vaccination more generally; they must consider the uncertain harms and benefits of vaccination; and they must treat benefits and harms symmetrically.</p>
<p>Doing so will show that vaccinating children is, all things considered, beneficial.</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/169820/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anthony Skelton 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>When making the decision whether to vaccinate children aged five to 11 against COVID-19, regulators in Canada must rely on sound ethics as well as sound science.Anthony Skelton, Associate Professor of Philosophy and Core Member of the Rotman Institute of Philosophy, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1603942021-05-12T17:18:41Z2021-05-12T17:18:41ZConfusing AstraZeneca warfare messaging: Destroy the COVID-19 enemy fast, but wait<figure><img src="https://images.theconversation.com/files/400025/original/file-20210511-13-3tffry.jpg?ixlib=rb-1.1.0&rect=0%2C540%2C4200%2C2093&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Vanquishing the enemy? People stand in a quick moving line up at a mass vaccination centre during the COVID-19 pandemic in Mississauga, Ont., on May 10, 2021. </span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span></figcaption></figure><p>Comparing vaccines to weapons emphasizes the importance of acting quickly in the “war” against COVID-19. But there are other consequences of employing warfare metaphors to communicate a sense of urgency. </p>
<p>We often employ metaphors to help explain complex, unfamiliar phenomena. Metaphors allow us to compare something unknown and abstract to something familiar and concrete. Metaphors are pervasive and can underscore our basic <a href="https://doi.org/10.1002/mar.20210">understanding of concepts</a> — that is, we understand and explain our experiences by conceiving of one thing in terms of another.</p>
<p>For example, we understand and experience time as if it were a finite resource: time is money, we do not want to waste time, and we are always trying to save time. </p>
<p>Medicine is frequently understood and experienced <a href="https://doi.org/10.1016/j.socscimed.2013.01.020">in terms of war</a>. Health-care professionals tend to be the main protagonists regarding medicine as war and medical technologies are viewed as weapons in the fight against disease and illness. </p>
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<img alt="A battleground painting called the Phantom Horseman by Sir John Gilbert" src="https://images.theconversation.com/files/400027/original/file-20210511-24-89tcpl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/400027/original/file-20210511-24-89tcpl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=342&fit=crop&dpr=1 600w, https://images.theconversation.com/files/400027/original/file-20210511-24-89tcpl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=342&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/400027/original/file-20210511-24-89tcpl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=342&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/400027/original/file-20210511-24-89tcpl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=430&fit=crop&dpr=1 754w, https://images.theconversation.com/files/400027/original/file-20210511-24-89tcpl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=430&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/400027/original/file-20210511-24-89tcpl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=430&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 medical profession often positions itself as going to war against diseases.</span>
<span class="attribution"><span class="source">Birmingham Museums Trust</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<h2>Compelling action?</h2>
<p>We know that military or warfare metaphors can compel action — they make the need to act very salient — and yet these metaphors can have <a href="https://doi.org/10.1177%2F1470593118796697">unintended consequences</a>.</p>
<p>In <a href="https://doi.org/10.1016/j.socscimed.2013.01.020">my research</a>, I have found that prescription drug advertisements frequently portray illness as an enemy. Personification of an unknown illness through the attribution of sinister, human characteristics may help us cope by providing a reason for our suffering.</p>
<p>We talk about <a href="https://www.washingtonpost.com/nation/2020/12/14/first-covid-vaccines-new-york/">vaccines</a> and <a href="https://www.thestar.com/politics/political-opinion/2021/03/15/vaccine-passports-could-be-an-effective-weapon-against-covid-19.html">vaccine passports</a> as powerful weapons in the <a href="https://www.theglobeandmail.com/opinion/article-we-are-at-war-with-covid-19-we-need-to-fight-it-like-a-war/">war against COVID-19</a>. These messages prompt us to personify the virus and to conceive of it as an enemy who is threatening our well-being. </p>
<p>The science of COVID-19 is still emerging, making it difficult for anyone to fully understand the virus. Viewing it as our enemy makes the abstract concrete and provides a reason for senseless deaths. </p>
<p>When politicians talk about <a href="https://www.reuters.com/article/us-health-coronavirus-macron-restriction/we-are-at-war-france-imposes-lockdown-to-combat-virus-idUSKBN2133G5">waging war against COVID-19</a>, they are communicating the importance of doing everything in our power to defeat the virus. When we hear the statement “the war against COVID,” we know we aren’t literally engaging in warfare with a virus. But we tap into our understanding of what it means to be at war against an enemy, and we transfer that knowledge to the situation we are facing with COVID-19. </p>
<figure class="align-center ">
<img alt="Sophie Grégoire Trudeau gets her AstraZeneca vaccination as Justin Trudeau looks on." src="https://images.theconversation.com/files/400029/original/file-20210511-24-hykyag.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/400029/original/file-20210511-24-hykyag.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/400029/original/file-20210511-24-hykyag.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/400029/original/file-20210511-24-hykyag.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/400029/original/file-20210511-24-hykyag.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/400029/original/file-20210511-24-hykyag.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/400029/original/file-20210511-24-hykyag.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">Prime Minister Justin Trudeau looks on as a pharmacist administers the COVID-19 AstraZeneca vaccine to Sophie Grégoire Trudeau in Ottawa.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Adrian Wyld</span></span>
</figcaption>
</figure>
<p>Warfare metaphors are useful at compelling people to act — they draw on our understanding of needing to do everything we can to defeat an enemy threat. Our understanding of warfare, however, does not end at taking action. It also includes the understanding that there are winners and losers in war. </p>
<h2>Contradictory messaging</h2>
<p>We’ve been exposed to conflicting messages surrounding our choice of weapon to battle COVID-19. The <a href="https://twitter.com/JustinTrudeau/status/1383491639377686532?s=20">best vaccine is the first vaccine you are offered</a>, we’ve been told repeatedly by Prime Minister Justin Trudeau and countless others, but <a href="https://www.winnipegfreepress.com/arts-and-life/life/health/naci-chair-says-advice-not-meant-to-give-astrazeneca-recipients-vaccine-remorse-574363972.html">wait if you can</a> because the actual best vaccine might be the one with the fewest side effects, <a href="https://www.ctvnews.ca/health/coronavirus/naci-chair-says-advice-not-meant-to-give-astrazeneca-recipients-vaccine-remorse-1.5417053">according to the National Advisory Committee on Immunization (NACI)</a>. Or don’t get the AstraZeneca vaccine at all, <a href="https://www.cbc.ca/news/canada/toronto/ontario-update-astrazeneca-vaccine-1.6022545">says Ontario’s chief medical officer of health.</a></p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1383491639377686532"}"></div></p>
<p>We are being told to simultaneously move swiftly and <a href="https://www.canada.ca/content/dam/phac-aspc/documents/services/immunization/national-advisory-committee-on-immunization-naci/recommendations-use-covid-19-vaccines/recommendations-use-covid-19-vaccines-en.pdf">to make thoughtful, reasoned choices</a>. These messages are bound to confuse and frustrate. </p>
<p>If I wait to get an <a href="https://www.canada.ca/en/health-canada/services/drugs-health-products/covid19-industry/drugs-vaccines-treatments/vaccines/type-mrna.html">mRNA vaccine</a> (<a href="https://www.canada.ca/en/health-canada/services/drugs-health-products/covid19-industry/drugs-vaccines-treatments/vaccines/pfizer-biontech.html">Pfizer-BioNTech</a> or <a href="https://www.canada.ca/en/health-canada/services/drugs-health-products/covid19-industry/drugs-vaccines-treatments/vaccines/moderna.html">Moderna</a>), am I letting down my country because I am not acting swiftly to defeat the enemy virus? </p>
<p>If I take the first vaccine offered to me and it is a <a href="https://www.canada.ca/en/health-canada/services/drugs-health-products/covid19-industry/drugs-vaccines-treatments/vaccines/type-viral-vector.html">viral vector vaccine</a> (<a href="https://www.canada.ca/en/health-canada/services/drugs-health-products/covid19-industry/drugs-vaccines-treatments/vaccines/astrazeneca.html">AstraZeneca</a> or <a href="https://www.canada.ca/en/health-canada/services/drugs-health-products/covid19-industry/drugs-vaccines-treatments/vaccines/janssen.html">Janssen/Johnson & Johnson</a>), am I being reckless with my health?</p>
<h2>Overly nervous about side-effects</h2>
<p>Complicating these conflicting messages is the risk of <a href="https://doi.org/10.1509%2Fjmkg.74.4.031">over-estimatating the likelihood</a> of rare side effects of prescription drugs. <a href="https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci.html">NACI is recommending</a> we make thoughtful, rational choices about which vaccine to get by weighing the risks and benefits, and yet research has shown that many of us have difficulty assessing the likelihood that a rare side effect will actually occur. </p>
<p>People frequently <a href="https://doi.org/10.1002/(SICI)1099-0771(200001/03)13:1%3C1::AID-BDM333%3E3.0.CO;2-S">rely on their feelings</a> when making risk-benefit judgments. The so-called <a href="https://doi.org/10.3389/fpsyg.2020.00970">affect heuristic</a> has been found to occur across a wide range of situations, meaning we overestimate risks and underestimate benefits when experiencing negative emotions. In addition, Canadians report feeling <a href="https://www.mentalhealthcommission.ca/sites/default/files/2020-05/nanos_covid_may_2020.pdf">greater levels of stress</a> since the onset of the pandemic. Together, these make rational risk-benefit judgments increasingly difficult.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-behavioural-science-can-help-us-understand-human-behaviour-during-a-pandemic-143028">How behavioural science can help us understand human behaviour during a pandemic</a>
</strong>
</em>
</p>
<hr>
<p>Depicting the virus as an enemy force presents people with a vivid, negative image of an otherwise abstract concept. </p>
<p>While employing warfare metaphors spurs people to action, it also creates expectations that we’ll triumph over the enemy virus. What if <a href="https://www.nature.com/articles/d41586-021-00396-2">we don’t eradicate COVID-19</a>, but are faced with the situation of living with the virus for many years to come? Will we have lost the war? </p>
<p>Politicians and public health officials should be mindful of the metaphors in their messages as they are fundamental to how we perceive the world around us — and can profoundly confuse us when it comes to vaccination.</p><img src="https://counter.theconversation.com/content/160394/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marjorie Delbaere receives funding from Social Sciences and Humanities Research Council.</span></em></p>Public officials are telling us simultaneously to move swiftly on vaccination and also to make thoughtful, reasoned choices about which vaccine we get. These messages are confusing and frustrating.Marjorie Delbaere, Associate Professor of Marketing and Associate Dean, University of SaskatchewanLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1603402021-05-12T06:11:15Z2021-05-12T06:11:15ZPublic health officials are failing to communicate effectively about AstraZeneca<figure><img src="https://images.theconversation.com/files/400106/original/file-20210511-16-7se2r7.jpg?ixlib=rb-1.1.0&rect=0%2C949%2C4200%2C1961&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People line up at a mass vaccination centre during the COVID-19 pandemic in Mississauga, Ont.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span></figcaption></figure><p>It’s a frightening and perplexing time for Canadians who have either been vaccinated against COVID-19 or are trying to determine what vaccine to get.</p>
<p>On May 3, the National Advisory Committee on Immunization (NACI) updated its <a href="https://www.canada.ca/content/dam/phac-aspc/documents/services/immunization/national-advisory-committee-on-immunization-naci/recommendations-use-covid-19-vaccines/summary-updated-statement-may-3-2021/NACI-summary-janssen-en.pdf">COVID-19 vaccine statement</a> and recommended that <a href="https://www.cbc.ca/radio/asithappens/as-it-happens-tuesday-edition-1.6013354/naci-advice-to-wait-for-preferred-vaccine-sends-bad-message-to-essential-workers-doctor-1.6013526">Canadians less likely to contract COVID-19 may want to wait for a Pfizer or Moderna vaccine</a> instead of AstraZeneca (AZ). </p>
<p>Days later, <a href="https://www.cbc.ca/news/canada/toronto/ontario-update-astrazeneca-vaccine-1.6022545">Ontario said it would not administer AZ</a>
as a first dose due to the risk of rare blood clots. </p>
<p>Although the NACI update did not contradict its earlier guidance when it recommended <a href="https://www.cbc.ca/news/health/astrazeneca-covid-19-vaccine-over-30-naci-1.6000052">expanding the use of the AZ vaccine to all Canadians over the age of 30</a>, people were understandably left with the impression that viral vector vaccines — including AZ and Janssen/Johnson & Johnson — are less safe and effective than their mRNA counterparts. Combined with Ontario’s move, that impression will undoubtedly intensify.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-19-vaccine-faqs-efficacy-immunity-to-illness-vs-infection-yes-theyre-different-new-variants-and-the-likelihood-of-eradication-154569">COVID-19 vaccine FAQs: Efficacy, immunity to illness vs. infection (yes, they’re different), new variants and the likelihood of eradication</a>
</strong>
</em>
</p>
<hr>
<p>NACI’s advice of “waiting for preferred vaccines if you can” provoked an immediate backlash both in the virtual House of Commons and on social media. </p>
<p>When questioned by Michelle Rempel Garner, the Conservative health critic, on whether Health Canada still recommends “taking the first vaccine you’re offered,” Health Minister Patty Hajdu dodged the question by suggesting that “<a href="https://www.macleans.ca/politics/one-day-in-ottawa-and-a-catastrophe-of-vaccine-messaging">people should consult their health-care professional to decide which vaccine is right for them</a>.” </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/400102/original/file-20210511-15-12pjm7n.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Patty Hajdu gets her vaccine." src="https://images.theconversation.com/files/400102/original/file-20210511-15-12pjm7n.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/400102/original/file-20210511-15-12pjm7n.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/400102/original/file-20210511-15-12pjm7n.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/400102/original/file-20210511-15-12pjm7n.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/400102/original/file-20210511-15-12pjm7n.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/400102/original/file-20210511-15-12pjm7n.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/400102/original/file-20210511-15-12pjm7n.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">Federal Health Minister Patty Hajdu is seen after receiving her first dose of COVID-19 vaccine in Thunder Bay, Ont., on April 23.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/David Jackson</span></span>
</figcaption>
</figure>
<p>On <a href="https://globalnews.ca/news/7831937/covid-naci-preferred-vaccine-choice">social media</a>, other health experts expressed their frustration that NACI’s message may fuel vaccine hesitancy, while some recipients of AZ were startled to learn, after being advised weeks earlier to get the vaccine, that it’s second-rate or possibly dangerous.</p>
<p>David Williams, Ontario’s chief medical of health, has also faced a social media backlash.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1392223909496426498"}"></div></p>
<p>There’s no doubt NACI, Health Canada and now Ontario’s top public health official have run into a serious communication problem. </p>
<p>Let’s delve into crisis management and communication theories to elaborate on what’s gone wrong in NACI’s vaccine messaging, and what lessons can be learned to improve future communications. </p>
<h2>Communicating uncertainty</h2>
<p>How messages are framed has a significant impact on the public. For instance, it has been found that media discourses <a href="https://doi.org/10.1016/j.socscimed.2020.113572">emphasizing the connection between COVID-19 and China, and deeming the pandemic a threat caused by foreigners,</a> have been a major contributor to the notable increase in racist and xenophobic attitudes during the pandemic.</p>
<p>News can be conveyed via a variety of communication strategies, and story-telling is arguably the most powerful one. British media scholar Philip Seargeant argues in <a href="https://www.bloomsbury.com/us/the-art-of-political-storytelling-9781350107380/">his analysis of the rise of conspiracy theories and post-truth politics</a> that stories framing “corrupt states controlled by ruthless elites” fuel the prevailing anti-establishment sentiments found in both right-wing populist movements and disinformation online. </p>
<figure class="align-center ">
<img alt="People wait after being vaccinated at the Woodbine Racetrack with images of horses behind them." src="https://images.theconversation.com/files/400104/original/file-20210511-19-1bxizkt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/400104/original/file-20210511-19-1bxizkt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=419&fit=crop&dpr=1 600w, https://images.theconversation.com/files/400104/original/file-20210511-19-1bxizkt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=419&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/400104/original/file-20210511-19-1bxizkt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=419&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/400104/original/file-20210511-19-1bxizkt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=527&fit=crop&dpr=1 754w, https://images.theconversation.com/files/400104/original/file-20210511-19-1bxizkt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=527&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/400104/original/file-20210511-19-1bxizkt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=527&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">People wait after being vaccinated at a COVID-19 vaccine clinic at Woodbine Racetrack in Toronto.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span>
</figcaption>
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<p>A vivid story can easily capture public attention away from abstract charts and figures because it plays on our emotions.</p>
<p>What initially triggered recent public anxiety and confusion about COVID-19 vaccinations was NACI’s statement that “<a href="https://www.canada.ca/content/dam/phac-aspc/documents/services/immunization/national-advisory-committee-on-immunization-naci/recommendations-use-covid-19-vaccines/summary-updated-statement-may-3-2021/NACI-summary-janssen-en.pdf">it continues to preferentially recommend authorized mRNA COVID-19 vaccines due to the excellent protection they provide and the absence of safety signals of concern</a>.” The word <em>preferentially</em> inevitably provoked readers to think a comparison to other vaccines was being made. </p>
<h2>Making a bad situation worse</h2>
<p>Then on May 4, NACI’s chair, Dr. Caroline Quach-Thanh, appeared on CTV’s Power Play in an apparent attempt to clarify confusion and ease public anger. <a href="https://www.macleans.ca/politics/one-day-in-ottawa-and-a-catastrophe-of-vaccine-messaging/">Yet the hypothetical story she presented further worsened the situation</a>. </p>
<p>When explaining why NACI advocated for an “informed consent” regarding which vaccine to take, Quach-Thanh commented:</p>
<blockquote>
<p>“If, for instance, my sister was to get the AstraZeneca vaccine and die of a thrombosis when I know that it could have been prevented and that she’s not in a high-risk area, I’m not sure I could live with it.”</p>
</blockquote>
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<figcaption><span class="caption">Dr. Caroline Quach-Thanh appears on CTV News.</span></figcaption>
</figure>
<p>As soon as a hypothetical story of this nature lodges in people’s minds, scientific information about the extreme rarity of vaccine-induced blood clots becomes less relevant for people wondering whether they should opt for AstraZeneca. Getting the vaccine, after all, has been framed as a “risk-taking” behaviour by a top public health official.</p>
<p>There are two additional problems in advocating that people should make their own risk assessments. First, people tend to <a href="https://doi.org/10.1111/j.1539-6924.2006.00773.x">under-estimate the risk of contracting COVID-19</a>, especially in the absence of relevant knowledge.</p>
<p>With so many uncertainties associated with the community spread of COVID-19, it’s inherently difficult for the general public to figure out whether the infection risk in the areas they live is high enough to warrant an immediate AZ shot. </p>
<p>Second, an individual cost-benefit analysis encourages a personal calculation: If I feel comfortable that I have a low risk of contracting COVID-19, then I can wait for my preferred vaccine. This contradicts early vaccine communication efforts in which getting vaccinated was portrayed as an act of responsibility that could protect family members, neighbours, front-line workers and colleagues.</p>
<h2>A unique crisis</h2>
<p>None of this is meant to discredit NACI’s critical contributions to public health. The COVID-19 pandemic has surpassed all previous public health crises in terms of its scope, duration and severity, creating enormous challenges to public health communicators on a daily basis. </p>
<p>The ongoing situation also defies the conventional wisdom about crisis communication in many ways. <a href="https://doi.org/10.1016/S0363-8111(01)00072-8">Traditionally, crisis management and communications instruction</a> involves training students to handle tasks arising from a potential crisis and to prepare for it, and to provide daily updates both during the crisis and in its aftermath.</p>
<p>When conflicting messages appear in news media, the spokespeople for organizations often adopt <a href="https://www.marshallstrategy.com/think-big-understanding-the-value-of-strategic-ambiguity/">strategic ambiguity</a> to grapple with uncertainty while maintaining a public image of transparency and openness. </p>
<p>This playbook has been rewritten by the outbreak of COVID-19. The pandemic’s abrupt, evolving and global nature has transformed it into what’s known as a syndemic in which unexpected communication crises can be triggered by even a single word — in this case, “preferentially.”</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-coronavirus-doesnt-exist-in-isolation-it-feeds-on-other-diseases-crises-135664">The coronavirus doesn't exist in isolation — it feeds on other diseases, crises</a>
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<p>Meanwhile, with almost all public conversations taking place online, it’s almost impossible for a public institution to single-handedly control the mainstream narrative. Any ambiguity can lead to outright misinformation. </p>
<p>Ultimately, the NACI and other COVID-19 messaging controversies highlight the importance of closely co-ordinating communication among different stakeholders. That will ensure any possible conflicting messages can be negotiated and presented in a far less confusing and damaging manner to the public.</p><img src="https://counter.theconversation.com/content/160340/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sibo Chen 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>Canadian public health organizations have run into a serious communication problem about the AstraZeneca vaccine. Crisis management and communication theories explain what’s gone wrong.Sibo Chen, Assistant Professor, School of Professional Communication, Toronto Metropolitan UniversityLicensed as Creative Commons – attribution, no derivatives.