tag:theconversation.com,2011:/global/topics/vaccination-campaigns-35139/articlesVaccination campaigns – The Conversation2023-04-27T12:31:56Ztag:theconversation.com,2011:article/1905182023-04-27T12:31:56Z2023-04-27T12:31:56Z‘Got polio?’ messaging underscores a vaccine campaign’s success but creates false sense of security as memories of the disease fade in US<figure><img src="https://images.theconversation.com/files/523213/original/file-20230427-22-64ll1p.jpg?ixlib=rb-1.1.0&rect=55%2C130%2C3285%2C2434&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For much of the 20th century, Americans were used to seeing people bearing the signs of past polio infection.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/boy-helps-his-brother-a-polio-victim-confined-to-a-news-photo/526756448">Genevieve Naylor/Corbis via Getty Images</a></span></figcaption></figure><p>“<a href="https://twitter.com/sofia_vignolo/status/1129501200716636160">Got Polio? Me neither. Thanks, Science.</a>”</p>
<p>Messages like this are used in memes, posters, T-shirts and even some billboards to promote routine vaccinations. As this catchy statement reminds people of once-feared diseases of the past, it – perhaps unintentionally – conveys the message that polio has been relegated to the history books.</p>
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<a href="https://images.theconversation.com/files/520043/original/file-20230410-5132-hx8ppo.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Leonardo DiCaprio meme 'Remember that time you got polio? Nope? Me neither? Thanks Science!'" src="https://images.theconversation.com/files/520043/original/file-20230410-5132-hx8ppo.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/520043/original/file-20230410-5132-hx8ppo.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520043/original/file-20230410-5132-hx8ppo.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520043/original/file-20230410-5132-hx8ppo.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520043/original/file-20230410-5132-hx8ppo.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520043/original/file-20230410-5132-hx8ppo.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520043/original/file-20230410-5132-hx8ppo.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">This pro-science message uses a popular ‘cheers’ meme format.</span>
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<p>Phrasing that aims to encourage immunizations by highlighting their accomplishments implies that some diseases are no longer a threat.</p>
<p>Few people today know much about polio. In 2022, only one-third of surveyed adults in the U.S. were <a href="https://www.annenbergpublicpolicycenter.org/what-u-s-adults-know-and-believe-about-polio-and-the-bivalent-covid-booster/">aware that polio has no cure</a>. Moreover, a 2020 poll had found that <a href="https://news.gallup.com/poll/276929/fewer-continue-vaccines-important.aspx">84% of adults viewed vaccinating children as important</a>, a 10% decline from 2001. The COVID-19 pandemic amplified anti-vaccination messaging, while also <a href="https://doi.org/10.1002/hsr2.516">delaying routine immunization</a>.</p>
<p>Vaccine-preventable diseases are far from eradicated. Measles outbreaks in unvaccinated or under-vaccinated American communities have begun resurfacing in the past few years, despite a <a href="https://www.cdc.gov/measles/elimination.html">2000 declaration</a> that the virus had been eliminated in the U.S. <a href="https://wonder.cdc.gov/nndss/static/2019/annual/2019-table2l.html">Pertussis cases have been on the rise</a>, with more than 18,000 cases reported in 2019. And in July 2022, polio reappeared in an unvaccinated New York man – the first U.S. diagnosis since 1979. This case helped return attention to polio, causing at least some young adults to <a href="https://www.nytimes.com/2022/08/17/health/polio-vaccine-history-millennials.html">wonder about their own vaccination status</a>.</p>
<p>A shift in focus to <a href="https://polioeradication.org">immunization in developing countries</a> has further lulled Americans into a false sense of security. While global approaches have been effective and are certainly needed, as the author of “<a href="https://www.umasspress.com/9781625345288/constructing-the-outbreak/">Constructing the Outbreak: Epidemics in Media and Collective Memory</a>,” I suggest that the celebratory messaging is no longer as effective as it once was and runs the risk of making it seem as if polio only lives in history books.</p>
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<a href="https://images.theconversation.com/files/523214/original/file-20230427-560-ekoj1v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="semicircle of patients in iron lungs use mirrors to watch a TV" src="https://images.theconversation.com/files/523214/original/file-20230427-560-ekoj1v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/523214/original/file-20230427-560-ekoj1v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=463&fit=crop&dpr=1 600w, https://images.theconversation.com/files/523214/original/file-20230427-560-ekoj1v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=463&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/523214/original/file-20230427-560-ekoj1v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=463&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/523214/original/file-20230427-560-ekoj1v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=582&fit=crop&dpr=1 754w, https://images.theconversation.com/files/523214/original/file-20230427-560-ekoj1v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=582&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/523214/original/file-20230427-560-ekoj1v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=582&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Polio patients at Baltimore’s Children’s Hospital watched television from inside the iron lungs that breathed for them.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/iron-lung-victims-get-television-set-baltimore-md-iron-lung-news-photo/515427562">Bettmann via Getty Images</a></span>
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<h2>Campaigning against a devastating disease</h2>
<p>Before vaccines, polio – called infantile paralysis or poliomyelitis – was the most feared childhood disease in the U.S. Frequently affecting elementary school kids, the disease sometimes presented like a cold or flu – fever, sore throat and headache. In other cases, limb or spinal pain and numbness first indicated that something was wrong. Paralysis of legs, arms, neck, diaphragm or a combination could occur and, depending on the area affected, render patients unable to walk, lift their arms, or breathe outside of an iron lung.</p>
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<a href="https://images.theconversation.com/files/520095/original/file-20230410-3779-u51y6h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="magazine add with images of kids with polio asks for donations" src="https://images.theconversation.com/files/520095/original/file-20230410-3779-u51y6h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/520095/original/file-20230410-3779-u51y6h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=780&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520095/original/file-20230410-3779-u51y6h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=780&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520095/original/file-20230410-3779-u51y6h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=780&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520095/original/file-20230410-3779-u51y6h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=980&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520095/original/file-20230410-3779-u51y6h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=980&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520095/original/file-20230410-3779-u51y6h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=980&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Full page ads like this one from 1953 solicited funds to help polio patients.</span>
<span class="attribution"><span class="source">March of Dimes</span></span>
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<p>Only time could <a href="https://doi.org/10.1136%2Fbmj.1.4602.465">reveal whether the paralysis was permanent</a> or would recede, sometimes to return decades later as <a href="https://www.ninds.nih.gov/health-information/disorders/post-polio-syndrome">Post-Polio Syndrome</a>. Enough people were infected in outbreaks in the 1930s, 1940s and early 1950s that the effects of paralytic polio were quite visible in everyday life in the form of braces, crutches, slings and other mobility devices.</p>
<p>Thanks to the National Foundation for Infantile Paralysis, beating polio became a national priority. The NFIP grew out of President Franklin Delano Roosevelt’s Warm Springs Foundation. <a href="https://theconversation.com/what-fdrs-polio-crusade-teaches-us-about-presidential-leadership-amid-crisis-137215">Roosevelt himself had been partially paralyzed</a> by polio, and the NFIP provided funds for public education, research and survivors’ rehabilitation.</p>
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<a href="https://images.theconversation.com/files/523215/original/file-20230427-986-uvz7nc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Eleanor Roosevelt smiles with a young boy holding a 'Mothers March on Polio' scroll" src="https://images.theconversation.com/files/523215/original/file-20230427-986-uvz7nc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/523215/original/file-20230427-986-uvz7nc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=760&fit=crop&dpr=1 600w, https://images.theconversation.com/files/523215/original/file-20230427-986-uvz7nc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=760&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/523215/original/file-20230427-986-uvz7nc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=760&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/523215/original/file-20230427-986-uvz7nc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=955&fit=crop&dpr=1 754w, https://images.theconversation.com/files/523215/original/file-20230427-986-uvz7nc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=955&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/523215/original/file-20230427-986-uvz7nc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=955&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Eleanor Roosevelt helped inaugurate the Mothers’ March on Polio to raise money to fight the disease.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/the-mothers-march-on-polio-was-inaugurated-december-10-1953-news-photo/535083978">Bettmann/CORBIS via Getty Images</a></span>
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<p>Its campaigns were prolific and diverse, combining interpersonal and mass communication strategies.</p>
<p>From FDR “Birthday Ball” celebrations to parades and elementary school fundraising competitions, various groups raised money. <a href="https://www.umasspress.com/9781625345288/constructing-the-outbreak/">High schoolers performed polio-themed plays</a>, putting the disease itself on trial in “The People vs. Polio.” People passed around collection boxes at movie theaters and other public gatherings.</p>
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<a href="https://images.theconversation.com/files/520093/original/file-20230410-18-dbduj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="text of three 'I will not' and 'I will' points" src="https://images.theconversation.com/files/520093/original/file-20230410-18-dbduj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/520093/original/file-20230410-18-dbduj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1569&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520093/original/file-20230410-18-dbduj8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1569&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520093/original/file-20230410-18-dbduj8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1569&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520093/original/file-20230410-18-dbduj8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1972&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520093/original/file-20230410-18-dbduj8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1972&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520093/original/file-20230410-18-dbduj8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1972&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">An ad placed in Vogue in 1952 laid out the ‘Polio Pledge.’</span>
<span class="attribution"><span class="source">National Foundation for Infantile Paralysis</span></span>
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<p>Campaigns used every medium. Brochures and short films raised awareness of the threat of polio, emphasizing the need for funding to support patient rehabilitation and scientific research. The National Foundation for Infantile Paralysis generated scores of radio scripts and hired Frank Sinatra, Elvis Presley and other famous voices to read them. <a href="https://youtu.be/fOkJAIPkxRA">Judy Garland, Mickey Rooney</a>, <a href="https://www.youtube.com/watch?v=BOXw-Px-X-8&t=4s">Lucille Ball</a> and other Hollywood stars also joined the fight. Comic strips and cartoons featuring Mickey Mouse and Donald Duck rallied for March of Dimes funds to help polio patients.</p>
<p>Starting in 1946, the NFIP featured children with crutches and braces who had survived polio as “<a href="https://www.marchofdimes.org/about/news/memoriam-donald-anderson-first-poster-child-1940-2014">poster children</a>” asking for funds to help them walk again. News stories covered outbreaks and polio epidemics, detailing the devastation of the disease on individuals, families and communities, while advising families how to reduce risk through the “Polio Pledge for Parents,” which provided a <a href="https://nyshistoricnewspapers.org/lccn/sn83031653/1952-07-17/ed-1/seq-4/">list of do’s and don'ts</a> during summer months.</p>
<h2>From public enemy No. 1 to success story</h2>
<p>The work of the National Foundation for Infantile Paralysis yielded unprecedented and continuous success, providing hospitals with equipment during epidemics and supporting the development of vaccines. Following the largest vaccine trial in history, on April 12, 1955, the Poliomyelitis Vaccine Evaluation Center announced that Jonas Salk’s vaccine was <a href="https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.45.5_Pt_1.575">80%-90% effective</a> against paralytic polio and officially <a href="https://theconversation.com/the-great-polio-vaccine-mess-and-the-lessons-it-holds-about-federal-coordination-for-todays-covid-19-vaccination-effort-152806">ready for general use</a>.</p>
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<a href="https://images.theconversation.com/files/523216/original/file-20230427-27-uurxai.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="families in line outside a school with a sign 'Entrance for polio shots' in 1955" src="https://images.theconversation.com/files/523216/original/file-20230427-27-uurxai.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/523216/original/file-20230427-27-uurxai.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=449&fit=crop&dpr=1 600w, https://images.theconversation.com/files/523216/original/file-20230427-27-uurxai.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=449&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/523216/original/file-20230427-27-uurxai.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=449&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/523216/original/file-20230427-27-uurxai.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=565&fit=crop&dpr=1 754w, https://images.theconversation.com/files/523216/original/file-20230427-27-uurxai.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=565&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/523216/original/file-20230427-27-uurxai.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=565&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Once a vaccine was available, people lined up to protect themselves and their families from the virus.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/san-diego-california-first-and-second-graders-at-the-kit-news-photo/514704620">Bettmann via Getty Images</a></span>
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<p>Over the next decade, the NFIP shifted its focus to widespread immunization, again using both mass media and local campaigns. With Salk’s vaccine, and then Albert Sabin’s, polio cases fell quickly, from the peak of 57,879 cases in 1952 to <a href="https://doi.org/10.2307/4593032">only 72 cases in 1965</a>, with the <a href="https://www.cdc.gov/polio/what-is-polio/polio-us.html">last naturally occurring U.S. case in 1979</a>.</p>
<p>The repeated declaration of what polio vaccines could and were accomplishing was <a href="https://www.npr.org/sections/health-shots/2021/05/03/988756973/cant-help-falling-in-love-with-a-vaccine-how-polio-campaign-beat-vaccine-hesitan">strategically effective</a> in persuading more people to get their shots. The American public of the 1960s and 1970s had lived through repeated polio epidemics and knew both the fear of contracting the disease and its visible aftereffects. As of 2021, <a href="https://immunizationdata.who.int/pages/coverage/POL.html?CODE=USA&ANTIGEN=POL3&YEAR=">92.7% of Americans</a> were fully protected by the vaccine, though these rates have been in decline since 2010 and <a href="https://www.cdc.gov/vaccines/imz-managers/coverage/schoolvaxview/data-reports/index.html">fluctuate by region</a>.</p>
<p>Public health rhetoric that <a href="https://doi.org/10.1016/j.vaccine.2011.10.005">focused on this vaccine success story</a> worked around the world in the late 1980s and 1990s. Gradually, though, the perceived threat in the U.S. of polio and other vaccine-preventable diseases dissipated over generations as vaccinations largely eliminated the risk. Most people in developed countries <a href="https://www.fda.gov/consumers/consumer-updates/vaccines-protect-children-harmful-infectious-diseases">lack firsthand experiences</a> of just how terrifying these diseases are, having never experienced polio, diphtheria, measles or pertussis, or lost family members to them.</p>
<p>At the same time that polio has been largely forgotten in the U.S., <a href="https://theconversation.com/covid-19-misinformation-scientists-create-a-psychological-vaccine-to-protect-against-fake-news-153024">anti-vaccination messages have been spreading disinformation</a> that distorts the risk of vaccines, ignoring the realities of the diseases they immunize against.</p>
<p>Rhetoric from polio vaccine campaigns in the 1950s and 1960s emphasized the risks of not getting immunized – acute illness, life-changing pain and paralysis or even death. In the 21st century U.S., immunization campaigns no longer emphasize these risks, and it’s easy to forget the potentially deadly repercussions of skipping vaccines.</p>
<p>I believe pervasive public health messaging can counter anti-vaccination disinformation. A reminder for the American public about this still dangerous disease can help ensure that “Got Polio?” does not become a serious question.</p><img src="https://counter.theconversation.com/content/190518/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katherine A. Foss does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Polio vaccines have been a massive public health victory in the US. But purely celebratory messaging overlooks the ongoing threat if vaccination rates fall.Katherine A. Foss, Professor of Media Studies, Middle Tennessee State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1799292022-04-05T12:29:36Z2022-04-05T12:29:36ZThe 1 in 10 U.S. doctors with reservations about vaccines could be undermining the fight against COVID-19<figure><img src="https://images.theconversation.com/files/456203/original/file-20220404-19-l6si62.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2380%2C1252&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">While the vast majority of primary care providers have higher confidence in vaccines than the general public, some do not.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/diverse-doctors-during-vaccination-in-hospital-royalty-free-image/1292690417">Evgeniy Shkolenko/iStock via Getty Images Plus</a></span></figcaption></figure><p><a href="https://library.cqpress.com/cqresearcher/document.php?id=cqresrre2021030500">American attitudes</a> toward scientific expertise have become <a href="https://doi.org/10.1177%2F1532673X17719507">increasingly contentious</a> in recent years. But many people across the political spectrum still place high levels of <a href="https://www.npr.org/2020/12/30/951095644/even-if-its-bonkers-poll-finds-many-believe-qanon-and-other-conspiracy-theories">trust in their personal physicians</a>. Correspondingly, both <a href="https://www.usatoday.com/story/opinion/2021/03/23/how-primary-care-doctors-can-help-reduce-covid-vaccine-hesitancy-column/4796449001/">popular media</a> and <a href="https://www.cdc.gov/vaccines/covid-19/hcp/engaging-patients.html">public health officials</a> have encouraged physicians to serve as <a href="https://www.ama-assn.org/press-center/press-releases/ama-survey-shows-over-96-doctors-fully-vaccinated-against-covid-19">strong advocates</a> for COVID-19 vaccination.</p>
<p>At the same time, however, there have been several cases of doctors expressing skepticism about vaccines in the media. Though the American Medical Association found that <a href="https://www.ama-assn.org/press-center/press-releases/ama-survey-shows-over-96-doctors-fully-vaccinated-against-covid-19">96% of physicians</a> reported being fully vaccinated against COVID-19 in June 2021, some <a href="https://www.cnn.com/2021/10/19/us/doctors-covid-vaccine-misinformation-invs/index.html">high-profile</a> <a href="https://time.com/6099700/covid-doctors-misinformation/">physicians</a> have spread misinformation about vaccine safety. Some patients have also reported that their personal physicians <a href="https://www.theatlantic.com/politics/archive/2021/09/doctors-tell-patients-not-vaccinated-covid-19/620024/">discouraged them</a> from getting vaccinated on both medical and non-medical grounds.</p>
<p>One conservative group of doctors called the <a href="https://www.theatlantic.com/health/archive/2020/02/aaps-make-health-care-great-again/607015/">American Association of Physicians and Surgeons</a>, which counts Republican Senator and ophthalmologist <a href="https://www.courier-journal.com/story/news/politics/gerth/2015/02/04/rand-paul-in-association-of-american-physicians-and-surgeons/22857153/">Rand Paul</a> among its members, offers several examples of how some physicians actively promote vaccine skepticism.</p>
<p>Following the 2015 Disneyland measles outbreak, AAPS shared a <a href="https://tucson.com/news/science/health-med-fit/tucson-group-fueling-national-vaccine-fears/article_8bee1d28-75c0-59dd-b40f-15058df6cdf5.html">press release</a> falsely linking the measles, mumps and rubella vaccine to autism in children, a claim based on <a href="https://doi.org/10.1136/bmj.c696">fraudulent research</a> that the scientific community has <a href="https://doi.org/10.1016/j.vaccine.2014.04.085">widely discredited</a>. The group has also taken legal action to encourage <a href="https://aapsonline.org/aaps-files-an-amicus-brief-in-support-of-parental-rights-on-minor-consent-law-for-covid-vaccination/">parental noncompliance</a> with childhood vaccine mandates, <a href="https://www.vice.com/en/article/n7nqm7/mysterious-medical-organizations-are-calling-for-an-end-to-covid-vaccines">using</a> <a href="https://theconversation.com/unverified-reports-of-vaccine-side-effects-in-vaers-arent-the-smoking-guns-portrayed-by-right-wing-media-outlets-they-can-offer-insight-into-vaccine-hesitancy-166401">misinterpreted data</a> to suggest that COVID-19 vaccines are uniquely dangerous compared to other vaccines.</p>
<p>While groups like AAPS do not represent the views of most physicians, these examples raise an important question: Just how prevalent is physician vaccine hesitancy, and why might some physicians hold negative views toward vaccines? </p>
<p>As <a href="https://scholar.google.com/citations?user=v6UjvxIAAAAJ&hl=en">political science</a> and <a href="https://scholar.google.com/citations?user=o-RnPqUAAAAJ&hl=en">health policy</a> researchers studying vaccine hesitancy, we wanted to answer this question. Our <a href="https://doi.org/10.1016/j.vaccine.2022.03.025">recent study</a> found that the <a href="https://theconversation.com/why-the-next-major-hurdle-to-ending-the-pandemic-will-be-about-persuading-people-to-get-vaccinated-153847">same factors</a> thought to encourage hesitancy in the general public – like having right-leaning political views – might also motivate physician opposition to vaccination. </p>
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<h2>Physician vaccine confidence is a mixed bag</h2>
<p>In May 2021, we asked 625 primary care physicians nationwide about their general attitudes toward vaccines and whether they believed vaccines are safe, effective and important. We also asked PCPs how much confidence they had in the safety of the Moderna, Pfizer-BioNTech and Johnson & Johnson COVID-19 vaccines, which were each authorized for emergency use in the U.S. at the time. Respondents answered these questions on a scale ranging from “strongly agree” to “strongly disagree.” </p>
<p>We also surveyed potential factors that could influence physician attitudes toward vaccines. These included political ideology, previous infection with COVID-19, religiosity and standard demographics like gender, race, ethnicity and income.</p>
<p>On the surface, our results provide some reassuring news for using physicians as leading vaccine promoters. We found that only 5.2% of PCPs were unvaccinated against COVID at the time of our survey, echoing the findings of the <a href="https://www.ama-assn.org/press-center/press-releases/ama-survey-shows-over-96-doctors-fully-vaccinated-against-covid-19">American Medical Association’s June 2021 survey</a>. In addition, our results suggest that PCPs’ views toward vaccines are overwhelmingly positive – 88% of physicians agreed or strongly agreed that vaccines in general are safe. Likewise, 90% of physicians agreed that vaccines are effective, and 89% agreed that vaccines are important. When we compared our PCP responses to responses from the general public on the same questions, we found that PCPs are 19% more likely to strongly agree that vaccines are safe and 16% more likely to strongly agree they’re effective.</p>
<p>Digging deeper into the data, however, reveals some troubling trends. Even if most physicians are well-positioned to serve as vaccination advocates, our results still suggest that 10.1% of PCPs do not agree that vaccines in general are safe. Similarly, 9.3% do not agree that all vaccines are effective, and 8.3% do not agree that they are important.</p>
<p>PCP political leanings and previous health experiences may help explain why some hold negative views toward vaccination. We found that politically conservative PCPs and those who previously contracted COVID-19 were 19% less likely to believe that vaccines in general are safe and effective.</p>
<p>We found similar results when examining confidence in the three COVID-19 vaccines available in the U.S. at the time, a little over six months after the <a href="https://www.fda.gov/news-events/press-announcements/fda-takes-key-action-fight-against-covid-19-issuing-emergency-use-authorization-first-covid-19">first vaccine was authorized</a>. Approximately 90% of PCPs were either “very confident” or “confident” in the safety of the Pfizer-BioNTech and Moderna vaccines. Still, 9.5% and 8.7% lacked confidence in the safety of the Moderna and Pfizer-BioNTech vaccines, respectively. Only 68% of physicians expressed confidence in the Johnson & Johnson vaccine, likely due to <a href="https://www.yalemedicine.org/news/covid-19-vaccine-comparison">reports of its relatively lesser effectiveness</a> at the time.</p>
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<a href="https://images.theconversation.com/files/456205/original/file-20220404-13680-53lfso.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Health care provider administering vaccine to another health care provider" src="https://images.theconversation.com/files/456205/original/file-20220404-13680-53lfso.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/456205/original/file-20220404-13680-53lfso.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/456205/original/file-20220404-13680-53lfso.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/456205/original/file-20220404-13680-53lfso.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/456205/original/file-20220404-13680-53lfso.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/456205/original/file-20220404-13680-53lfso.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/456205/original/file-20220404-13680-53lfso.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">According to an American Medical Association survey, 96% of physicians were fully vaccinated against COVID-19 in June 2021.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/female-nurse-being-vaccinated-by-a-coworker-royalty-free-image/1302703902">Juanmonino/E+ via Getty Images</a></span>
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<h2>Why this matters</h2>
<p>Our research finds that physician vaccine hesitancy is more prevalent than vaccination campaigns may have assumed. Vaccine hesitancy among physicians is also likely motivated by the same factors that encourage hesitancy in the general public. This potentially poses a problem for vaccination efforts that rely on physicians to promote vaccine uptake.</p>
<p>[<em>Over 150,000 readers rely on The Conversation’s newsletters to understand the world.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-150ksignup">Sign up today</a>.]</p>
<p>Nevertheless, our work offers room for potential optimism and ways to improve vaccine confidence in this group.</p>
<p><a href="https://doi.org/10.1177%2F1532673X211022639">Partisanship</a>, for example, plays an important role in <a href="https://doi.org/10.2105/AJPH.2020.305828">shaping vaccine hesitancy</a>. Consequently, tactics shown to improve vaccine attitudes in the general public – such as <a href="https://doi.org/10.1073/pnas.2106559118">highlighting GOP politicians</a> with more positive views toward vaccination – could potentially increase support for vaccination among physicians as well. In our view, studying ways to encourage vaccine enthusiasm among PCPs could help “move the needle” on vaccine uptake in the U.S.</p><img src="https://counter.theconversation.com/content/179929/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many COVID-19 vaccination campaigns encourage doctors to serve as a trusted source of vaccine information. But certain vaccine-hesitant providers may stymie these efforts.Matt Motta, Assistant Professor of Political Science, Oklahoma State UniversityTimothy Callaghan, Assistant Professor of Health Policy and Managment, School of Public Health, Texas A&M UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1622402021-06-16T05:32:29Z2021-06-16T05:32:29ZDiverse spokespeople and humour: how the government’s next ad campaign could boost COVID vaccine uptake<figure><img src="https://images.theconversation.com/files/406628/original/file-20210616-13-nvtasx.jpg?ixlib=rb-1.1.0&rect=12%2C0%2C8231%2C6192&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/man-sitting-on-sofa-changing-channel-579243235">Shutterstock</a></span></figcaption></figure><p>The federal government <a href="https://www.smh.com.au/politics/federal/those-ads-won-t-work-on-anyone-new-tack-to-motivate-younger-people-to-get-the-jab-20210528-p57w44.html">recently indicated</a> it will launch a new COVID-19 vaccine advertising campaign in July, targeting younger Australians under 40.</p>
<p>To date, federal vaccine promotion efforts have not been particularly engaging, perhaps due to an over-reliance on <a href="https://www.abc.net.au/news/2021-06-03/federal-government-mckinsey-covid-vaccine-strategy-advice/100185786?utm_campaign=news-article-share-control&utm_content=twitter&utm_medium=content_shared&utm_source=abc_news_web">consulting firms</a> over vaccine social science <a href="https://www.thesaturdaypaper.com.au/news/health/2021/02/13/experts-raise-concerns-about-vaccine-messaging/161313480011092#hrd">researchers</a>. But news of a revitalised campaign is welcome, and could offer a chance to change course. </p>
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<p>In our recent Victorian <a href="https://www.mcri.edu.au/research/themes/infection-and-immunity/vaccine-uptake">COVID-19 Vaccine Preparedness Study</a>, we looked at the vaccine-related intentions, concerns and information needs of people prioritised in phases 1a and 1b of the rollout. </p>
<p>The results are yet to be published in a peer-reviewed journal. But drawing on our findings, as well as peer-reviewed research in this area, here’s what we want to see in any upcoming COVID vaccination campaign.</p>
<h2>1. Diverse spokespeople</h2>
<p>The diversity of Australia should be reflected in the spokespeople delivering messages around COVID vaccination, through both broad and tailored campaigns. Research shows we’re more likely to trust people who <a href="https://doi.org/10.1098/rspb.2002.2034">look like us</a>, which means we need spokespeople from different ethnic backgrounds, of different ages, and with different body shapes.</p>
<p>While it was encouraging to see Channel 9 using its platform to promote COVID-19 vaccination, their cast was rightly criticised for being <a href="https://www.sbs.com.au/nitv/article/2021/06/01/look-all-porcelain-covid-vaccination-ad-criticised-featuring-all-white-cast-1">entirely white</a>. They were also all able-bodied and generally homogenous.</p>
<p>Our research also found members of the public wanted to hear about the COVID-19 vaccines <a href="https://www.mcri.edu.au/research/themes/infection-and-immunity/vaccine-uptake">from real people</a> — not politicians. They wanted to hear how people like them made the decision to be vaccinated, what it was like getting the vaccine and what the side effects were afterwards. </p>
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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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<h2>2. Humour and emotion</h2>
<p>It seems like the COVID-19 vaccine advertisements that have been shared most widely in Australia are actually from other countries, like the <a href="https://www.youtube.com/watch?v=8kHYUq0_0YQ">United Kingdom</a>, <a href="https://www.youtube.com/watch?v=Cf2T3YgyaHA">Singapore</a>, <a href="https://www.youtube.com/watch?v=TcIQATtAkS0">New Zealand</a> and <a href="https://twitter.com/olivierveran/status/1402506086767333377">France</a>.</p>
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<p>This is a shame, but it’s not surprising, when you compare these funny, entertaining messages with the relatively dry <a href="https://www.youtube.com/watch?v=HY2S9N9MEJU">Australian ads</a>. The Singapore ad is colourful, musical and a little bit bonkers. But amid the silliness, it still manages to highlight key messages like “don’t wait and see” and “low cases isn’t no cases”. </p>
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<p>The more engaging the messaging is, the more widely it will be shared. And we need information about the vaccine rollout to reach as many people as possible.</p>
<h2>3. Avoid scare tactics</h2>
<p>Some people have been <a href="https://www.afr.com/politics/federal/eu-to-allow-fully-vaccinated-travellers-20210520-p57tfm">calling</a> for fear-based campaigns to scare people into vaccinating. This kind of campaign might include, for example, footage of people with severe COVID or scary statistics about COVID-related deaths or serious illness in Australia or overseas.</p>
<p>However, fear-based messages to promote vaccines can actually <a href="https://pediatrics.aappublications.org/content/133/4/e835">backfire</a>, increasing fear of vaccine side effects. Fear <a href="https://www.abc.net.au/news/2021-05-23/what-can-we-learn-from-hiv-aids-campaign-for-covid/13352356">campaigns</a> can also stigmatise people who have concerns, questions, or simply face challenges accessing vaccines. This makes it harder to bridge the gap with those who are hesitant. </p>
<p>Fear messaging can also make people angry and <a href="https://theconversation.com/why-using-fear-to-promote-covid-19-vaccination-and-mask-wearing-could-backfire-153865">erode trust</a> in the messengers. Trust in the public health system is crucial to support vaccine uptake — and we can’t afford to damage this as it’s very hard to build and easy to lose.</p>
<h2>What else do we need?</h2>
<p>Barriers to vaccine uptake for any group are likely to be a mix of acceptance and access factors. So while a diverse, engaging communication campaign is clearly needed, this should be implemented alongside other evidence-based strategies to bolster vaccine acceptance and uptake. </p>
<p><strong>Nudges</strong></p>
<p>Behavioural “nudges” are simple ways to encourage vaccination. A recent <a href="https://www.pnas.org/content/118/20/e2101165118">study</a> from the United States found the most effective nudge to increase influenza vaccine uptake was a text message sent to people before a regular GP appointment, indicating a flu vaccine was reserved and waiting for them.</p>
<p>The Therapeutic Goods Administration has recently clarified people in Australia could also be offered <a href="https://www.tga.gov.au/communicating-about-covid-19-vaccines">incentives</a> to vaccinate. In other countries, incentives have included anything from <a href="https://www.nejm.org/doi/full/10.1056/NEJMp2107719">a free beer</a> to a lottery ticket.</p>
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<strong>
Read more:
<a href="https://theconversation.com/incentives-could-boost-vaccine-uptake-in-australia-but-we-need-different-approaches-for-different-groups-161363">Incentives could boost vaccine uptake in Australia. But we need different approaches for different groups</a>
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<p><strong>Community engagement</strong> </p>
<p>Outreach and face-to-face engagement may be more effective than TV or social media campaigns for many groups, particularly culturally and linguistically diverse populations. </p>
<p>Training community, faith and industry leaders to become <a href="https://theconversation.com/from-faith-leaders-to-office-workers-5-ways-we-can-all-be-covid-vaccine-champions-160454">vaccine champions</a> enables communication messages to reach more people in a targeted, culturally appropriate way. People want to discuss concerns with their community leaders and communities, where there is the greatest trust.</p>
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<img alt="A young woman shows a bandaid on her upper arm." src="https://images.theconversation.com/files/406647/original/file-20210616-19-1nfljzr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/406647/original/file-20210616-19-1nfljzr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/406647/original/file-20210616-19-1nfljzr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/406647/original/file-20210616-19-1nfljzr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/406647/original/file-20210616-19-1nfljzr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/406647/original/file-20210616-19-1nfljzr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/406647/original/file-20210616-19-1nfljzr.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">Participants in our study wanted to receive information about vaccines from ‘real’ people.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/vaccination-immunization-flu-prevention-concept-getting-1990636178">Shutterstock</a></span>
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<p><strong>Support for health-care workers</strong></p>
<p>GPs, nurses and pharmacists are at the coalface of the vaccine rollout, discussing COVID-19 vaccines with people every day. Health-care workers in <a href="https://www.mcri.edu.au/research/themes/infection-and-immunity/vaccine-uptake">our study</a> said they wanted resources like decision aids and pictorial representations of risk and benefits to support personalised discussions with people with varying levels of health literacy.</p>
<p>It’s also time we considered Medicare item numbers for GPs separate to vaccine administration, to support the <a href="https://www1.racgp.org.au/newsgp/professional/vaccine-rollout-funding-reform-headlines-racgp-adv">additional time spent addressing hesitancy</a>. </p>
<p><strong>Improved accessibility</strong></p>
<p>Improving access to COVID-19 vaccines is crucial to increase uptake. In addition to securing adequate vaccine supply and clearly communicating where and when vaccines are available, the booking systems need to be simplified and streamlined. In Victoria, the phone booking system <a href="https://www.theguardian.com/australia-news/2021/may/27/victorias-hotline-for-booking-covid-vaccines-crashes-after-being-inundated-with-calls">crashed</a> as soon as the government announced people aged 40-49 were eligible. </p>
<p><strong>Data</strong></p>
<p>Finally, we need better <a href="https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/new-reporting-requirements-on-workforce-covid-19-vaccination-to-protect-older-australians-in-aged-care">data</a> about vaccine uptake, concerns and barriers faced by different groups. This will allow us to better target communication and other strategies. </p>
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<em>
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Read more:
<a href="https://theconversation.com/yeh-nah-maybe-when-it-comes-to-accepting-the-covid-vaccine-its-australias-fence-sitters-we-should-pay-attention-to-154554">Yeh, nah, maybe. When it comes to accepting the COVID vaccine, it's Australia's fence-sitters we should pay attention to</a>
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<img src="https://counter.theconversation.com/content/162240/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jessica Kaufman receives funding from the Victorian Department of Health (C9824) and the National Health and Medical Research Foundation (Vaccine Barriers Assessment Tool, GNT1164200). She is a member of the Collaboration on Social Science and Immunisation (COSSI) network.</span></em></p>The federal government is due to launch a new advertising campaign for COVID-19 vaccines in July. This is a chance to offer something more engaging than what we’ve seen to date.Jessica Kaufman, Research Fellow, Vaccine Uptake Group, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1584162021-04-07T08:17:12Z2021-04-07T08:17:12ZAustralia urgently needs mass COVID vaccination hubs. But we need more vaccines first<p>Australia’s COVID-19 vaccine rollout has been <a href="https://theconversation.com/4-ways-australias-covid-vaccine-rollout-has-been-bungled-158225">much maligned recently</a>, as it’s become clear we’re way behind schedule.</p>
<p>So far Australia’s average daily rate since the rollout began in late February is <a href="https://twitter.com/MarylouiseMcla1/status/1379045097803718658">around 22,000 doses a day</a> according to my calculations. To achieve herd immunity, I calculate <a href="https://twitter.com/MarylouiseMcla1/status/1357107437686300674">we’ll need to vaccinate 85% of the population</a>, using a combination of the Pfizer and AstraZeneca vaccines. To achieve this by the end of March 2022, I calculate we need to vaccinate at least 133,000 people a day until December 31, and then around 79,000 a day in the first three months of 2022.</p>
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<p>One way to achieve this would be to stop relying on small GP and respiratory clinics and urgently move towards using mass vaccination hubs.</p>
<p>However, we don’t yet have enough of the AstraZeneca vaccine to service large vaccination hubs. This I think is one reason why Australian authorities have not yet planned to use them.</p>
<h2>What are mass vaccination sites?</h2>
<p>Mass vaccination means vaccination on a large scale in a short time. Locations for mass vaccination would include stadiums and sportsgrounds, schools, parks, places of worship, and shopping centres.</p>
<p>This is what’s being done in countries like <a href="https://www.nejm.org/doi/full/10.1056/NEJMp2102535">Israel</a>, the <a href="https://www.abc.net.au/news/2021-02-15/retired-nurse-after-48-years-stayed-to-help-with-vaccine-uk-roll/13146128">United Kingdom</a> and the <a href="https://www.abc.net.au/news/2021-04-06/australia-mass-covid-vaccinations-stadiums/100050228">United States</a>.</p>
<p>According to <a href="https://ourworldindata.org/covid-vaccinations">the latest data</a>, Israel has given at least one dose to 60% of its population; that figure is 46% in the UK and 32% in the US.</p>
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Read more:
<a href="https://theconversation.com/vital-signs-israel-shows-how-to-do-vaccinations-right-its-a-race-and-were-behind-157242">Vital Signs: Israel shows how to do vaccinations right. It's a race, and we're behind</a>
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<p>In Australia we’ve given about <a href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines">850,000 COVID vaccine doses</a>, which is roughly <a href="https://www.google.com/url?q=https://www.abs.gov.au/statistics/people/population/national-state-and-territory-population/latest-release&sa=D&source=hangouts&ust=1617866844097000&usg=AFQjCNEHgpzeFyghZWpKCsUFom4yIb1yVA">4% of the adult population</a>.</p>
<p>As Australia moves into phase 1B of the rollout and beyond, the federal government’s plan has been to rely solely on GP, respiratory clinics and eventually community pharmacies. This plan presumes we’re all middle class and have the ability to access a local GP during work hours or early evenings. But many people who are unemployed, disadvantaged, working multiple part-time jobs, disaffected or can’t get away from work might not be able or willing to visit a GP clinic in their neighbourhood.</p>
<p>Instead, many might be more comfortable going to a mass site. For the placement of mass vaccination facilities to improve uptake of the vaccine, authorities should consult demographers who can identify the location of vaccination hubs to be most effective in attracting the most people.</p>
<h2>We can’t rely on small GP clinics alone</h2>
<p>Relying on small GP and respiratory clinics means the rollout is progressing very slowly. Local clinics might vaccinate around 50 people per day, depending on the size of their clinic. They also need to ensure physical distancing that allows space for people to wait for 15 minutes after their vaccination while they are monitored for any side effects.</p>
<p>GPs also need to continue to see patients with various health and well-being needs they should not ignore, even in a pandemic.</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>Federal Deputy Chief Medical Officer Michael Kidd <a href="https://www.abc.net.au/news/2021-04-06/australia-mass-covid-vaccinations-stadiums/100050228">said</a> mass hubs were “not off the agenda”. And today, the NSW government <a href="https://www.abc.net.au/news/2021-04-07/nsw-government-to-set-up-mass-covid-vaccination-hub-in-homebush/100052546">announced</a> it will be setting up a mass COVID vaccination hub in Homebush, in Sydney’s inner west. </p>
<p>This is a good start but we need many more mass vaccination sites before we can get close to reaching the daily target.</p>
<p>So far there isn’t a formal plan detailing how the federal or state governments will introduce mass vaccination hubs in the COVID vaccine rollout.</p>
<h2>Vaccine supply is the crucial issue</h2>
<p>Vaccination is a huge logistical challenge amid a global pandemic and there’s an element of authorities learning to build the ship while it’s sailing.</p>
<p>Australian governments may also not yet be able to supply sufficient vaccines for mass vaccination hubs. </p>
<p>The federal government has repeatedly said Melbourne-based biotech company CSL will be producing <a href="https://www.abc.net.au/news/2021-04-07/scott-morrison-brendan-murphy-covid-vaccine-delay-supply/100052430">one million doses of the AstraZeneca vaccine a week</a>. It’s yet to reach that target, and it’s not yet clear exactly when it will. </p>
<p>But let’s look at that target and presume CSL reaches it soon. One million doses divided by seven days a week equals about 142,000 doses a day. This is only just on the cusp of being sufficient to reach our daily vaccination target. But it doesn’t take into account other delays that might occur such as problems with distribution, loss of stock, logistical hurdles, and bottlenecks at vaccination clinics.</p>
<p>In outbreak management you plan for the worst-case scenario. So when setting goals you should plan forward and look backwards to identify weaknesses in the plan, such as not receiving enough vaccine and logistical issues. You must also allow a buffer if things go “pear shaped”. </p>
<p>The fact we’re already behind the federal government’s initial target of vaccinating all Australian adults by the end of October this year suggests its plans were idealistic. It’s difficult to make further assessments without full transparency around vaccine supply and distribution.</p>
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<p>There have been issues with Europe blocking and slowing supply. Planning appropriately for the rollout would have included considerations for delays for approval and batch testing. It begs the questions of why <a href="https://www.news.com.au/national/politics/where-australias-25m-missing-covid19-vaccine-doses-are/news-story/9a4b89bbd922f727b6c9e16cfd1f5485">2.5 million doses</a> of the AstraZeneca vaccine are currently waiting for batch testing.</p>
<p>Authorities should be fully transparent about issues relating to vaccine supply, batch testing and distribution, so the public can feel fully informed and engaged in the vaccine rollout.</p>
<p>Great examples of transparency in vaccine rollouts can be seen in <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">New Zealand</a> and <a href="https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/prevention-risks/covid-19-vaccine-treatment/vaccine-rollout.html">Canada</a>. NZ includes <a href="https://www.medsafe.govt.nz/COVID-19/vaccine-report-overview.asp">weekly adverse reaction reports</a> where people can read about vaccine side effects. Greater transparency like this can reduce anxiety, hesitancy and conspiracy theories.</p>
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Read more:
<a href="https://theconversation.com/as-australias-covid-vaccine-rollout-splutters-we-need-transparency-about-when-international-borders-might-reopen-157399">As Australia's COVID vaccine rollout splutters, we need transparency about when international borders might reopen</a>
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<img src="https://counter.theconversation.com/content/158416/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mary-Louise McLaws is a member of the World Health Organization Health Emergencies Ad-hoc COVID-19 Infection Prevention and Control Guidance Discussion Group. </span></em></p>We need to stop relying on small GP clinics and urgently move towards using mass vaccination hubs like stadiums, schools and parks.Mary-Louise McLaws, Professor of Epidemiology Healthcare Infection and Infectious Diseases Control, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1404212021-02-01T13:09:37Z2021-02-01T13:09:37ZPeople may become less likely to contribute to a virtual public good like Waze if they know many others are already doing it<figure><img src="https://images.theconversation.com/files/381435/original/file-20210129-18933-1mhrngr.jpg?ixlib=rb-1.1.0&rect=58%2C107%2C2937%2C1890&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Waze depends on users to voluntarily upload information about traffic accidents and road closures. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/screen-view-of-the-waze-traffic-gps-app-on-an-iphone-on-news-photo/462899188">Linda Davidson/The Washington Post via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>While people tend to contribute more to a virtual public good if they see others doing the same, this effect reverses if they become aware too many people are participating, according to <a href="http://dx.doi.org/10.2139/ssrn.3065303">research that I conducted over the summer</a>. <a href="https://theconversation.com/public-goods-made-america-great-and-can-do-so-again-74421">Public goods</a> are things that many people share. They can be physical, such as highways, clean air and blood banks, or virtual, like a free online encyclopedia or mobile traffic app. </p>
<p>Combining methods from geography, urban planning and big-data analysis, my co-authors and I studied millions of postings by users of a mobile navigation app called Waze, in which users voluntarily post traffic-related updates and road conditions in real time. All users of the app benefit as more of them freely contribute information about traffic accidents and road closures. Economists <a href="https://www.investopedia.com/terms/p/public-good.asp">describe this</a> as contributing to a public good. </p>
<p>We found that displaying the “density” of users’ activities on Waze – that is, real time information on how many people are on the app in one’s geographic location – can encourage participation from others in the area, just as it does in the real world. If you see a lot of people donating blood in your local neighborhood or many parents volunteering in your local school, it may motivate you to do the same. </p>
<p>But we also found evidence of a strong “bystander effect” that reverses this after a certain threshold is reached. The bystander effect refers to the phenomenon that an individual’s <a href="https://psycnet.apa.org/record/2002-18351-005">likelihood of engaging in a helpful act</a> decreases when bystanders are present in a critical situation. Paradoxically, our motivation to contribute to a public good could also decline when we see others doing something. For example, if you saw a lot of people donating blood, you may decide that they don’t need your blood too.</p>
<p>The idea is that <a href="https://www.doi.org/10.1037/a0023304">people perceive less urgency</a> or motivation to help others when others are present, akin to a diffusion of responsibility. </p>
<h2>Why it matters</h2>
<p>With more public goods moving online – for example, in-person pledge drives seeking charitable donations <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6722054">now happen through crowdfunding websites</a> such as Kiva or GoFundMe – it’s important to study how the motivations and behaviors of people change in a virtual setting.</p>
<p>Users’ motivation to contribute to public goods in the physical world depends on what is termed “impure altruism,” also known by economists as “<a href="https://www.jstor.org/stable/2234133?seq=1#metadata_info_tab_contents">warm glow giving</a>.” That is, participation is heavily influenced by an individual’s motives for public recognition. </p>
<p>My research shows that the same effects that happen in real life also seem to occur virtually, suggesting these online spaces should be designed in ways to overcome the bystander effect to encourage more participation. This can be done, for example, by offering <a href="https://doi.org/10.1080/07421222.2020.1831776">nonmonetary rewards</a> for participation such as virtual badges or making it feel like a game.</p>
<p>[<em>Insight, in your inbox each day.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=insight">You can get it with The Conversation’s email newsletter</a>.]</p>
<h2>What other research is being done</h2>
<p>Other researchers are also looking into how to influence the behavior of people in virtual spaces. </p>
<p>Some scholars suggest, for example, that participants in primarily digital environments need <a href="https://cacm.acm.org/magazines/2018/7/229029-digital-nudging/fulltext">digital nudges</a> and <a href="https://doi.org/10.1073/pnas.1921417117">interventions</a> to enhance a sense of community and create a shared sense of social self on these digital spaces. Studies from social question-and-answer sites in China seem to suggest that <a href="https://doi.org/10.1016/j.chb.2018.10.036">commitment toward the site, a shared language and shared vision</a> seem to foster a sense of participation.</p>
<p>Other studies suggest that rather than viewing such online public good platforms in terms of the immediate needs of an information seeker, these platforms should be designed for their <a href="https://dl.acm.org/doi/10.1145/2339530.2339665">long-lasting value</a> to a community of users. </p>
<p><em>Editor’s Note: The headline of this article was changed on Feb. 15, 2021 to more narrowly describe the focus of the research.</em></p><img src="https://counter.theconversation.com/content/140421/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anjana Susarla 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>Research suggests apps could be designed in ways so that the ‘bystander effect’ doesn’t kick in and demotivate people from contributing to public goods.Anjana Susarla, Omura-Saxena Professor of Responsible AI, Michigan State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1324792020-03-04T19:01:49Z2020-03-04T19:01:49ZVaccines without needles – new shelf-stable film could revolutionize how medicines are distributed worldwide<figure><img src="https://images.theconversation.com/files/318665/original/file-20200304-66112-9v1pww.jpg?ixlib=rb-1.1.0&rect=43%2C43%2C1115%2C817&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Films that dissolve rapidly when placed under the tongue or high in the cheek will make vaccines cheaper and more reliable.</span> <span class="attribution"><span class="source">Stephen C. Schafer</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>The race is on to identify an effective vaccine for the COVID-19 virus. Once discovered, the next challenge will be manufacturing and distributing it around the world. </p>
<p>My research group has developed a novel method to stabilize live viruses and other biological medicines <a href="https://doi.org/10.1126/sciadv.aau4819">in a rapidly dissolving film</a> that does not require refrigeration and can be given by mouth.</p>
<p>Since the ingredients to make the film are inexpensive and the process is relatively simple, it could make vaccine campaigns much more affordable. Large quantities could be shipped and distributed easily given its flat, space saving shape.</p>
<p>Globally, vaccination rates have improved over the past decade, but are still too low – 13.5 million children were <a href="https://ourworldindata.org/vaccination">not vaccinated in 2018</a>. This new technology, recently published <a href="https://doi.org/10.1126/sciadv.aau4819">in the journal Science Advances</a>, has the potential to dramatically improve global access to vaccines and other biological medicines.</p>
<h2>Inspired by hard candy</h2>
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<a href="https://images.theconversation.com/files/318397/original/file-20200303-66084-1403psg.jpg?ixlib=rb-1.1.0&rect=0%2C177%2C2297%2C1661&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/318397/original/file-20200303-66084-1403psg.jpg?ixlib=rb-1.1.0&rect=0%2C177%2C2297%2C1661&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/318397/original/file-20200303-66084-1403psg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=655&fit=crop&dpr=1 600w, https://images.theconversation.com/files/318397/original/file-20200303-66084-1403psg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=655&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/318397/original/file-20200303-66084-1403psg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=655&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/318397/original/file-20200303-66084-1403psg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=823&fit=crop&dpr=1 754w, https://images.theconversation.com/files/318397/original/file-20200303-66084-1403psg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=823&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/318397/original/file-20200303-66084-1403psg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=823&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">Not your grandmother’s vaccine.</span>
<span class="attribution"><span class="source">Maria Croyle</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p>My research team began developing this technology in 2007, when the National Institutes of Health asked us to develop a needle-free, shelf-stable delivery method for a vaccine. </p>
<p>The idea of developing a film was inspired by a documentary about how the DNA of insects and other living things can be preserved for millions of years in amber. This got us thinking about hard candy, like my grandmother used to make.</p>
<p>It was a simple idea, yet no one had tried it. So we went to work mixing a variety of formulations containing natural ingredients like sugars and salts and testing them for their ability to form a solid amber-like candy.</p>
<p>Initially, many of the preparations we tested either killed the organism as the film formed or crystallized during storage, shredding the virus or the bacteria we were trying to preserve.</p>
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<a href="https://images.theconversation.com/files/318668/original/file-20200304-66052-112hifn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/318668/original/file-20200304-66052-112hifn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/318668/original/file-20200304-66052-112hifn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=103&fit=crop&dpr=1 600w, https://images.theconversation.com/files/318668/original/file-20200304-66052-112hifn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=103&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/318668/original/file-20200304-66052-112hifn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=103&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/318668/original/file-20200304-66052-112hifn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=129&fit=crop&dpr=1 754w, https://images.theconversation.com/files/318668/original/file-20200304-66052-112hifn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=129&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/318668/original/file-20200304-66052-112hifn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=129&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 like those for measles, polio, influenza, hepatitis B and Ebola, as well as many of the therapeutic antibodies used to treat infections and cancer, can be carefully sandwiched between protective layers.</span>
<span class="attribution"><span class="source">Stephen C. Schafer</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p>But finally, after about 450 tries over the course of a year, we found a formulation that could suspend viruses and bacteria in a peelable film.</p>
<p>As we gained more experience with the production process, we worked to simplify it so extensive technical training would not be needed to make it. Additionally, we tweaked the ingredients so they would dry faster, enabling one to make a batch of vaccine in the morning and ship it after lunch. </p>
<p>I’m involved with a startup aiming to get this technology to market within the next two years. </p>
<h2>More benefits</h2>
<p>All stored vaccines lose their potency over time. The rate at which they do so mostly depends on the <a href="https://doi.org/10.1586/erv.09.20">temperature at which they are kept</a>. Keeping vaccines continuously refrigerated is <a href="https://doi.org/10.1016/j.vaccine.2007.02.052">difficult and expensive</a> – and in some parts of the world, <a href="https://theconversation.com/cracking-the-cold-chain-challenge-is-key-to-making-vaccines-ubiquitous-99329">nearly impossible</a>. So creating a vaccine that can be stored and transported at room temperature is a huge advantage. </p>
<p>The biggest breakthrough for this project came when we were finishing up our Ebola vaccine project and found films containing virus made three years ago, stored in a sealed container on the lab bench. On a whim, we rehydrated them and tested them to determine if the vaccine was still capable of inducing an immune response. To our surprise, more than 95% of the viruses in the film were still active. To achieve this kind of shelf-life for an unrefrigerated vaccine was astonishing.</p>
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<a href="https://images.theconversation.com/files/318436/original/file-20200303-66069-18ofksf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/318436/original/file-20200303-66069-18ofksf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/318436/original/file-20200303-66069-18ofksf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=361&fit=crop&dpr=1 600w, https://images.theconversation.com/files/318436/original/file-20200303-66069-18ofksf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=361&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/318436/original/file-20200303-66069-18ofksf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=361&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/318436/original/file-20200303-66069-18ofksf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=454&fit=crop&dpr=1 754w, https://images.theconversation.com/files/318436/original/file-20200303-66069-18ofksf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=454&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/318436/original/file-20200303-66069-18ofksf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=454&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The film can stabilize the vaccine in a space-saving format, making it easier to ship and distribute around the globe.</span>
<span class="attribution"><span class="source">Stephen Schafer and Maria Croyle</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
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</figure>
<p>The ecological footprint left by global immunization campaigns is not often considered. The 2004 Philippine Measles Elimination Campaign, which immunized 18 million children in one month, generated 19.5 million syringes, or 143 tons of sharps waste and nearly 80 tons <a href="https://noharm-global.org/documents/disposal-mass-immunization-waste-without-incineration">of nonhazardous waste</a> – empty vials, syringe wrappers, caps, cotton swabs and packaging. The implications for a larger campaign are significant.</p>
<p>Our film, by contrast, can be distributed by health workers equipped with only an envelope containing the vaccine. Once taken, it will leave no trace, except for a healthy global population.</p>
<p>[<em>Insight, in your inbox each day.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=insight">You can get it with The Conversation’s email newsletter</a>.]</p><img src="https://counter.theconversation.com/content/132479/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The film technology developed in the Croyle Laboratory at the College of Pharmacy, University of Texas at Austin, has been licensed to a new startup company based in Chapel Hill, North Carolina for which Dr. Croyle is a scientific advisor. Dr. Croyle currently receives funding from the National Institutes of Health. </span></em></p>Inspired by amber and hard candy, researchers figured out a new, needle-free, shelf-stable way to preserve vaccines, making them easier to ship and administer around the world.Maria Croyle, Professor of Pharmaceutics, The University of Texas at AustinLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/905802018-03-23T10:31:39Z2018-03-23T10:31:39ZInching closer to a world without polio<figure><img src="https://images.theconversation.com/files/211471/original/file-20180322-165571-ymubad.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">What will it take to finish polio off in the last three countries where it persists?</span> <span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Pakistan-Fighting-to-Vaccinate/6be7219ce1464481af4fdcf431f11bca/3/0">AP Photo/B.K. Bangash</a></span></figcaption></figure><p>At its height in the 1940s and ‘50s, <a href="https://www.cdc.gov/features/poliofacts/">polio paralyzed more than 35,000 Americans every year</a>. But thanks to vaccines as well as good hygiene and sanitation practices, polio has largely been forgotten in the developed world.</p>
<p>Now, even in less-developed regions, it’s close to being wiped out entirely. But there are still challenges to overcome before polio can join smallpox as a virus that has been eradicated worldwide. </p>
<p>With the support of the <a href="http://polioeradication.org">World Health Organization</a>, the <a href="https://www.gatesfoundation.org/What-We-Do/Global-Development/Polio">Bill & Melinda Gates Foundation</a> (a strategic partner of The Conversation US that provides funding for The Conversation internationally), <a href="https://my.rotary.org/en/take-action/end-polio">Rotary International</a> and others, public health workers and volunteers work tirelessly and in dangerous conditions to vaccinate every one of the world’s children. The number of polio cases globally dropped from 350,000 in 1988 to <a href="http://www.who.int/mediacentre/factsheets/fs114/en/">just 37 in 2016</a>. Thirty years ago, polio was regularly found in 125 of the world’s 190 or so countries. Today, only three countries continue to see regular cases: Pakistan, Nigeria and Afghanistan.</p>
<p>Of these, Pakistan is closest to becoming polio-free thanks to its persistent, innovative vaccination campaign programs. But its poor security, weak health system and lack of proper sanitation work against this effort.</p>
<p>The lessons infectious disease preparedness and response researchers <a href="https://scholar.google.com/citations?user=0M6hB44AAAAJ&hl=en&oi=ao">like</a> <a href="http://bush.tamu.edu/scowcroft/fellows/">us</a> are learning in Pakistan, during what’s hopefully a final push against polio, will also apply elsewhere, as public health experts work to wipe out other infectious diseases around the world.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/211397/original/file-20180321-165577-1hppxsa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/211397/original/file-20180321-165577-1hppxsa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/211397/original/file-20180321-165577-1hppxsa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=458&fit=crop&dpr=1 600w, https://images.theconversation.com/files/211397/original/file-20180321-165577-1hppxsa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=458&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/211397/original/file-20180321-165577-1hppxsa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=458&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/211397/original/file-20180321-165577-1hppxsa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=575&fit=crop&dpr=1 754w, https://images.theconversation.com/files/211397/original/file-20180321-165577-1hppxsa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=575&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/211397/original/file-20180321-165577-1hppxsa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=575&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Transmission electron micrograph of polioviruses.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Polioviruses.jpg">Graham Beards</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>Polio in people and in the environment</h2>
<p>Wild poliovirus is not particularly hardy and can’t survive for long in the environment. If the virus cannot find an unvaccinated person to serve as its host, it will die. This fact means vaccination efforts can fully exterminate the virus by denying it a place to live in human hosts.</p>
<p>The world’s polio eradication campaign has already done away with <a href="http://www.who.int/features/factfiles/polio/en/">two of the three naturally occurring wild polioviruses</a>. Wild poliovirus type 2 was last seen in 1999, and there has not been a case of wild poliovirus type 3 since 2012.</p>
<p>Polio spreads primarily through water contaminated with the feces of an infected person. Where sources of drinking water come into contact with sewage waste – often the case in developing countries like Pakistan – the virus spreads easily.</p>
<p>To complicate matters, nearly <a href="https://www.cdc.gov/polio/us/hcp.html">3 out of 4 people</a> infected with the poliovirus never have any symptoms at all. So most carriers of polio never know they harbor the virus, or that they’re spreading it to others.</p>
<p>In addition, those who do have symptoms usually seem to have the flu, with fever, headaches, body aches and vomiting. <a href="http://www.who.int/mediacentre/factsheets/fs114/en/">In only around 1 percent of cases</a> do symptoms include temporary or permanent paralysis.</p>
<p>This means that it is possible for the virus to exist and spread in a community even when there are no diagnosed cases of polio. For that reason, public health workers use two different measures to gauge the success of a vaccination effort: the number of people diagnosed with polio, and how much of the virus is found in the environment.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/211472/original/file-20180322-165547-tj50x0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/211472/original/file-20180322-165547-tj50x0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/211472/original/file-20180322-165547-tj50x0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=440&fit=crop&dpr=1 600w, https://images.theconversation.com/files/211472/original/file-20180322-165547-tj50x0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=440&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/211472/original/file-20180322-165547-tj50x0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=440&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/211472/original/file-20180322-165547-tj50x0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=553&fit=crop&dpr=1 754w, https://images.theconversation.com/files/211472/original/file-20180322-165547-tj50x0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=553&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/211472/original/file-20180322-165547-tj50x0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=553&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 health worker gives a polio vaccine to a child at a railway station in Pakistan.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Pakistan-Polio-Workers-Killed/225c7743762a4f499b5d9e859e459621/8/0">AP Photo/Fareed Khan</a></span>
</figcaption>
</figure>
<h2>Cultural challenges</h2>
<p>In Pakistan, these two measures paint somewhat different pictures of disease eradication. The not-so-good news is that <a href="http://www.endpolio.com.pk/images/polio-briefer/Pakistan-Polio-Update-DECEMBER-2017.pdf">16 percent of the water sources tested in 2017</a> contain the polio virus, a slight increase from 2016 levels. </p>
<p>The better news is that from 2014 to 2017, the number of new polio cases <a href="http://www.endpolio.com.pk/images/polio-briefer/Pakistan-Polio-Update-DECEMBER-2017.pdf">dropped a whopping 97 percent</a>, from 306 cases to just eight. The country’s government, with the support of the international community, has vaccinated most Pakistanis, which no doubt accounts for the impressive drop in diagnosed cases. However, because vaccination is not universal, the virus persists in some regions of Pakistan and poses a threat to those who are not vaccinated or who have not received vaccination boosters as scheduled.</p>
<p>There are several cultural barriers to wiping out polio in Pakistan. Vaccinations are usually given at health clinics and transit points, where public health workers can make contact with a large share of the population. <a href="http://polioeradication.org/where-we-work/pakistan/">Mobile vaccination units</a> reach people in other locations, but cannot safely get to children in high-conflict areas.</p>
<p>In many of these areas, <a href="https://blogs.cdc.gov/global/2017/10/24/overcoming-obstacles-to-polio-eradication-in-pakistan/">armed militants refuse</a> to let public health officials vaccinate children, claiming that the polio vaccine is part of a <a href="https://doi.org/10.1186/s12992-016-0195-3">Western plot</a> to sterilize Muslims. In 2012, the Taliban, which remain in control in some mountainous areas, <a href="https://doi.org/10.1186/s12992-016-0195-3">imposed a ban on vaccinations</a>, which slowed the polio eradication effort. Furthermore, polio vaccine campaign workers have been targets of violence, as seen most recently in the <a href="https://www.nytimes.com/2018/01/22/health/polio-pakistan-killing.html">killing of a mother-daughter vaccination team in January</a> and an <a href="https://www.independent.co.uk/news/world/asia/pakistan-polio-vaccination-team-militants-ambush-two-dead-islamic-extremism-cia-osama-bin-laden-a8261931.html">ambush this past week in a remote tribal area</a> that killed two medical workers and wounded two others.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/211473/original/file-20180322-165580-t3l6u3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/211473/original/file-20180322-165580-t3l6u3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/211473/original/file-20180322-165580-t3l6u3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/211473/original/file-20180322-165580-t3l6u3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/211473/original/file-20180322-165580-t3l6u3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/211473/original/file-20180322-165580-t3l6u3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/211473/original/file-20180322-165580-t3l6u3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/211473/original/file-20180322-165580-t3l6u3.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">With armed security, a Pakistani health worker marks a house after administering polio vaccine.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Pakistan-Polio/12b58f7c0a8c472a81b772618b592a36/1/0">AP Photo/Shakil Adil</a></span>
</figcaption>
</figure>
<p>In order to overcome some of the challenges, members of the eradication campaign <a href="https://doi.org/10.1186/s12992-016-0195-3">have coordinated vaccination efforts</a> with military operations. When a large military offense in 2015 pushed the Taliban out of the northern provinces of Pakistan, it <a href="https://www.rotary.org/en/new-polio-strategy-working-pakistan">cleared the way</a> for hundreds of thousands of children to receive vaccination. </p>
<p>High illiteracy rates, extreme poverty and religious beliefs also can cause <a href="https://doi.org/10.1186/s12992-016-0195-3">parents to refuse vaccines</a> – in Pakistan and elsewhere – for their children. In these instances, education and outreach are vitally important. Helping parents <a href="https://doi.org/10.1073/pnas.1504019112">understand the dangers of disease</a> may help overcome misinformation about the vaccine and increase positive association with vaccination, as it has in the United States. </p>
<h2>Pharmaceutical challenges</h2>
<p>Public health officials have <a href="https://www.cdc.gov/vaccines/vpd/polio/index.html">two types of polio vaccine</a> in their medical supply kit: an oral vaccine and an inactivated vaccine. Both are necessary to eradicate polio. The <a href="http://www.who.int/biologicals/areas/vaccines/polio/ipv/en/">oral vaccine</a> is made from live weakened virus. The inactivated version is made with dead virus.</p>
<p>The oral vaccination <a href="http://www.virology.ws/2015/09/10/why-do-we-still-use-sabin-poliovirus-vaccine/">works significantly better</a> against naturally occurring poliovirus, known as wild poliovirus. Additionally, the administration method – being given by mouth – is thought to increase vaccine uptake because it does not require an injection.</p>
<p>The body builds immunity from this live vaccine, and then can withstand the virus if exposed to it in the future. Countries where polio is present must use the oral vaccine in order to eliminate wild poliovirus because the inactivated vaccine does not <a href="https://www.pakistankakhudahafiz.com/understanding-polio-eradication-campaign-pakistan/">stop its transmission</a> since it <a href="http://www.virology.ws/2015/09/10/why-do-we-still-use-sabin-poliovirus-vaccine/">produces lower levels of mucosal immunity</a>. </p>
<p>Though necessary, using the live oral vaccine comes with some challenges. For example, it can cause <a href="http://www.who.int/features/qa/64/en/">vaccine-derived</a> cases of polio, which include <a href="https://www.sciencedirect.com/science/article/pii/B9781437716047004231">cases of paralysis</a>. In this unfortunate and extremely rare scenario, the vaccine meant to prevent a terrible illness directly transmits it. Of the 10 billion doses of oral polio vaccine administered since 2000, there have only been <a href="http://www.who.int/features/qa/64/en/">760 cases</a> of vaccine-derived polio. </p>
<p>Though the oral vaccine is vital to the eradication of wild poliovirus, its use must be discontinued as soon as the wild virus is wiped out. Otherwise, it runs the risk of hindering complete eradication by <a href="http://www.virology.ws/2015/09/10/why-do-we-still-use-sabin-poliovirus-vaccine/">perpetuating existence of poliovirus in the environment</a> through human excrement and continuing to introduce new vaccine-derived cases of the disease. </p>
<p>Once Pakistan is declared free of wild poliovirus, the eradication campaign must switch to using the inactivated vaccine.</p>
<p>Because the inactivated vaccine provokes a weaker immune response, it doesn’t effectively disrupt transmission of wild poliovirus. But it does <a href="https://doi.org/10.15585/mmwr.mm6649a4">protect against</a> the weaker vaccine-derived poliovirus, and it doesn’t contribute to vaccine-derived cases. Once the only remaining strains are vaccine-derived, inactivated vaccines can be used to completely wipe out the disease.</p>
<p>It is likely that a world without polio may not be too far off in the future — and then infectious disease researchers can make use of the lessons learned in Pakistan as they move the fight to other diseases elsewhere around the world.</p><img src="https://counter.theconversation.com/content/90580/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Pakistan had only eight new diagnoses of polio in 2017. The virus’ days look numbered – but health workers have their work cut out for them to eradicate the devastating disease once and for all.Christine Crudo Blackburn, Deputy Director, Pandemic & Biosecurity Policy Program, Scowcroft Institute of International Affairs, Bush School of Government and Public Service, Texas A&M UniversityMorten Wendelbo, Research Fellow, American University School of Public AffairsLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/712992017-01-23T18:06:04Z2017-01-23T18:06:04ZWhy it’s hard to run a mass measles campaign in Nigeria’s war-torn states<figure><img src="https://images.theconversation.com/files/153592/original/image-20170120-5234-186g7hu.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">Brian Snyder/Reuters</span></span></figcaption></figure><p><em>The World Health Organisation and the United Nations have embarked on a campaign to vaccinate <a href="http://www.un.org/apps/news/story.asp?NewsID=55955#.WHjIzPl97IU">4.7 million children against measles</a> in Nigerian states affected by conflict. Chief Executive Officer of the <a href="http://www.ncdc.gov.ng/">Nigeria Centre for Disease Control</a> Chikwe Ihekweazu explains the importance of the massive campaign.</em></p>
<p><strong>How prevalent is measles?</strong> </p>
<p>Measles is still one of the <a href="http://who.int/mediacentre/factsheets/fs286/en/">leading causes of death</a> among young children in the world. In 1980, before widespread vaccination, measles caused an estimated <a href="http://who.int/mediacentre/factsheets/fs286/en/">2.6 million</a> deaths each year.</p>
<p>But the measles vaccine is considered one of the best buys in public health. Between 2000 and 2015 an estimated <a href="http://who.int/mediacentre/factsheets/fs286/en/">20 million child deaths</a> were prevented as a result of the vaccine being administered. </p>
<p>By 2015, about <a href="http://www.who.int/mediacentre/factsheets/fs378/en/">85% of the world’s children</a> were getting one dose of the measles vaccine by their first birthday. But still <a href="http://www.who.int/gho/immunization/en/">134 200 children</a>, mostly under the age of 5, died from measles that year. That’s about 367 deaths every day or 15 deaths every hour.</p>
<p>In Africa there has been an incredible reduction of the number of measles cases in the last five to 10 years. This is mainly as a result of intensive vaccination campaigns. But there are still a few problem areas.</p>
<p><strong>Where are Africa’s hotspots and why have those countries not managed to crack the problem?</strong></p>
<p>Nigeria is one. The Democratic Republic of Congo is another. The challenge is not the vaccine – it’s one of the oldest and cheapest around. It’s the way in which the vaccine needs to be transported. It is injectable and must be delivered through a supply chain process, or cold chain. For the vaccine to be effective it needs to be kept cold during transportation, storage and handling. But many primary health care centres and clinics don’t have electricity so the vaccine can’t be kept cold, and can’t be stored for any length of time.</p>
<p>The aim globally has been to eliminate measles. As part of this we launched two large measles vaccination campaigns in Nigeria over the past two years. This contributed to a significant <a href="http://imsear.li.mahidol.ac.th/bitstream/123456789/175831/1/bjmmr2015v5n2p160.pdf">reduction in the case load</a>. But last year there were still cases being reported. This means that either the campaign was not as efficient as we thought it was or there was a problem with the cold chain. But there have been other contributing factors.</p>
<p>The first is malnutrition. Routine immunisation and vaccination campaigns in the North-Eastern parts of Nigeria have been particularly difficult due to the insurgency. These areas have been cut off from the rest of the country. One of the consequences is that children suffer from high levels of chronic under-nutrition. </p>
<p>Measles and malnutrition are a deadly combination. Once a child is malnourished and they contract measles, there is an increased chance that they will die. </p>
<p>Another challenge is the impact the insurgency has had on health care generally. Primary care infrastructure such as clinics have been affected significantly by the conflict. Thousands of people can’t access health centres as many have been destroyed. </p>
<p>This has disrupted vaccination activities which has increased the vulnerability of many children. </p>
<p><strong>Why is Nigeria running a campaign to vaccinate four million children in the north-eastern part of the country?</strong></p>
<p>The vaccination campaign was launched because it became possible to access areas previously out of reach. The conflict hasn’t stopped, but the government has made progress with the military to open up parts of conflict ridden areas. The vaccination campaign is one of several health initiatives that is being launched. There is also a feeding programme. The plan is to get this part of the country back up to speed. </p>
<p><strong>What is unique about this campaign? And what are the logistics?</strong> </p>
<p>It’s unique because it’s the first time that a vaccination campaign has been run involving the military and health care workers. Doctors and nurses who are part of the army have been working with civilian health care workers. </p>
<p>The vaccination campaigns have been well attended so far. People in these areas have been coming out in their hundreds. Our analysis is that people view the injection as more potent than any other form of vaccination. </p>
<p>But logistics remains a challenge. Vaccination campaigns are hugely expensive and require the recruitment, training and mobilisation of thousands of health care workers. </p>
<p>In addition, the terrain is difficult. The areas we’re working in are very hot and dry. The fact that the vaccines need to be moved in cold boxes makes timing very important: when you leave and how you get it to the venues are the most problematic.</p><img src="https://counter.theconversation.com/content/71299/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chikwe Ihekweazu is affiliated with the Nigeria Centre for Disease Control, the Centre is responsible for Measles surveillance in Nigeria. </span></em></p>Running an effective mass immunisation campaign, vaccinating children in Nigeria against measles is a logistical nightmare.Chikwe Ihekweazu, Senior Honorary Lecturer on Infectious Diseases, UCLLicensed as Creative Commons – attribution, no derivatives.