tag:theconversation.com,2011:/uk/topics/vaccination-rates-23435/articlesVaccination rates – The Conversation2023-05-11T17:16:48Ztag:theconversation.com,2011:article/2051742023-05-11T17:16:48Z2023-05-11T17:16:48ZWe can uphold the solidarity created by COVID-19 even though WHO ended the international emergency<figure><img src="https://images.theconversation.com/files/525497/original/file-20230510-14022-d28ca0.jpg?ixlib=rb-1.1.0&rect=27%2C73%2C3041%2C2139&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The end of the global emergency is the time to reflect on the lessons learned during the pandemic and how we can create more just and kind societies going forward.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/we-can-uphold-the-solidarity-created-by-covid-19-even-though-who-ended-the-international-emergency" width="100%" height="400"></iframe>
<p>The World Health Organization (WHO) has declared the <a href="https://www.nytimes.com/2023/05/05/health/covid-who-emergency-end.html">end of the global emergency caused by the COVID-19 pandemic</a>. Although <a href="https://www.thestar.com/politics/federal/2023/05/05/covid-19-is-still-with-us-even-as-who-says-it-is-no-longer-a-global-emergency-duclos.html">COVID-19 remains a danger for many</a>, especially with the possibility of new variants, experts are urging that we move forward to prepare for the next pandemic. </p>
<p>The pandemic caused significant suffering. The WHO estimates that around <a href="https://covid19.who.int/">6.9 million people died</a>, although the true death toll is <a href="https://globalnews.ca/news/8811410/covid-19-excess-deaths-who-global/">likely much higher</a>. Added to that is the loss and pain experienced by many around the world. </p>
<p>But the pandemic also created the circumstances for a type of global, national and local solidarity that has rarely been seen before. In Canada, we saw this unique solidarity in the homegrown “caremongering” movement, where volunteers organized online to offer a helping hand to neighbours and strangers.</p>
<p>During the height of the pandemic, there were at least <a href="https://www.solidarityandcare.org/stories/canadian-caremongering-exploring-the-complexities-and-centrality-of-community-care-during-the-covid-19-pandemic">191 caremongering groups in Canada</a>. The movement showcased the goodwill of “<a href="https://www.bbc.com/news/world-us-canada-51915723">kind Canadians</a>” and was praised worldwide.</p>
<h2>Caremongering</h2>
<p><a href="https://doi.org/10.1371%2Fjournal.pone.0245483">A study led by researchers at McMaster University</a> on caremongering Facebook groups found that the majority of posts were to request or offer materials like personal protective equipment, food and clothes or services like picking up groceries and prescriptions. </p>
<p>There was also a lot of information-sharing about COVID-19, community updates, inspiration and advice. News reports covered these heartwarming stories from coast to coast. From <a href="https://www.cbc.ca/news/canada/nova-scotia/nova-scotia-helping-eachother-covid-19-1.5499230">Halifax</a> to <a href="https://www.cbc.ca/news/canada/hamilton/caremongering-shopping-covid-19-1.5498581">Hamilton</a> and <a href="https://cfjctoday.com/2020/04/06/thousands-of-kamloops-residents-come-together-to-help-neighbours-during-pandemic/">Kamloops</a>, many caremongers called this help “<a href="https://www.cbc.ca/news/canada/toronto/covid-19-caremongering-1.5518092">lifesaving</a>.”</p>
<p>This was especially the case for vulnerable populations such as the elderly, people with disabilities and immunocompromized individuals. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/525489/original/file-20230510-17-644lbw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman wearing a face mask passes a bag of food to a man in a mask over a fence." src="https://images.theconversation.com/files/525489/original/file-20230510-17-644lbw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/525489/original/file-20230510-17-644lbw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525489/original/file-20230510-17-644lbw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525489/original/file-20230510-17-644lbw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525489/original/file-20230510-17-644lbw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525489/original/file-20230510-17-644lbw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525489/original/file-20230510-17-644lbw.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">During the height of the pandemic volunteers organized groups to offer a helping hand to neighbours and strangers.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<h2>Pandemic unveiled systemic issues</h2>
<p>It seems that during those early days, people forgot about their differences and banded together in unity <a href="https://policyoptions.irpp.org/magazines/april-2020/caremongering-and-the-risk-of-happy-washing-during-a-pandemic/">to feel stronger</a> against the common enemy of COVID-19. </p>
<p>But crises and disasters can also “<a href="https://items.ssrc.org/understanding-katrina/questions-about-power-lessons-from-the-louisiana-hurricane/">lift veils</a>.” They can be transformative or confirmatory, generate new ways of thinking or reinforce prevailing structures of power. </p>
<p>Disasters like the pandemic provide an opportunity to <a href="https://www.jstor.org/stable/24717185">examine the exception in order to understand the rule</a> and to expose the unequal social structures that are often hidden in everyday life.</p>
<p>A <a href="https://doi.org/10.1111/gwao.12794">University of Guelph study</a> found that in 2020, as the reality of the pandemic set in, discussions in caremonger groups turned towards difficult topics of social justice, inequality and colonization. </p>
<p>One group organizer who took part in the study shared that she felt COVID-19 unveiled the challenges faced by marginalized people.</p>
<blockquote>
<p>“[It] pulled a mask off of this but once COVID goes away, these problems do not go away … so right now is the time that we have to keep that mask off so that we make sure that whatever it looks like on the other side of COVID, there is more equity, there’s more justice, there’s more support and nurturing and recognition that we have been hiding people away and ignoring problems for far too long.” </p>
</blockquote>
<p>For example, the inequitable rollout of vaccines unveiled how governments have historically <a href="https://theconversation.com/with-covid-19s-third-wave-were-far-from-all-in-this-together-159178">overlooked lower-income and racialized communities</a>. It galvanized doctors, public health experts and community advocates to <a href="https://press.un.org/en/2021/ecosoc7039.doc.htm">demand better from the government</a>. </p>
<p>Many people saw the injustice in how the most affected neighbourhoods, <a href="https://www.ohscanada.com/pandemics-third-wave-hits-people-20s-30s-illness-blame/">where people were doing essential work in grocery stores, factories, delivery trucks and hospitals</a>, had the lowest vaccination rates while high-income neighbourhoods filled with white collar and remote workers had the <a href="https://www.thestar.com/news/gta/2021/04/11/a-tale-of-two-neighbourhoods-jane-and-finch-with-the-lowest-vaccination-rate-moore-park-with-the-highest.html">highest vaccination rates</a>. </p>
<h2>A more equitable post-pandemic world</h2>
<p>As the global emergency ends, we need to ask ourselves how a post-pandemic world could be more equitable, just and nurturing. </p>
<p>To begin, we can bring the energy of caring for others to our politics. The pandemic allowed people to connect with strangers in their neighbourhoods and country through the development of community good will across different geographies. This is what political scientist <a href="https://www.versobooks.com/en-ca/products/1126-imagined-communities">Benedict Anderson</a> called socially-constructed “imagined communities.” </p>
<p>During the pandemic, a light was shone on the needs of those rarely prioritized in politics such as seniors in long-term care, children, low-income households and immunocompromised individuals. </p>
<p><a href="https://doi.org/10.2307/1948299">Politics is about who gets what, where and how</a> and we saw that in action throughout the pandemic. </p>
<p>We can apply our newly gained political awareness in the upcoming elections <a href="https://www.cbc.ca/news/canada/toronto/toronto-mayoral-race-catch-me-up-1.6836019">in Toronto</a> <a href="https://www.elections.ab.ca/elections/albertas-next-election/">and Alberta</a> and aim to achieve a politics that strives for a more equitable, just and nurturing approach to the distribution of resources through <a href="https://archpublichealth.biomedcentral.com/articles/10.1186/s13690-022-00898-z">evidence-based policies</a>. </p>
<p>Second, the pandemic provided citizens with the time and motivation to think intentionally about life. Some have argued that the pandemic is an opportunity to “<a href="https://www.weforum.org/agenda/2021/01/7-things-leaders-can-learn-from-the-covid-19-crisis/?fbclid=IwAR0U9HLeq1hP0G4Z8t9PbOUIR9C97_O4fLlKqwu2U4lRdYPL0vVO0wvfiSo">rethink humanity’s future</a>” with a focus on reimagining the way we want to live going forward. Indeed, many people have adapted <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-11264-z">healthier behaviours</a> and more sustainable lifestyles. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/525496/original/file-20230510-29-gxl7ut.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="a sign at an airport that reads: Coronavirus travel restrictions." src="https://images.theconversation.com/files/525496/original/file-20230510-29-gxl7ut.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/525496/original/file-20230510-29-gxl7ut.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=371&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525496/original/file-20230510-29-gxl7ut.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=371&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525496/original/file-20230510-29-gxl7ut.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=371&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525496/original/file-20230510-29-gxl7ut.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=466&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525496/original/file-20230510-29-gxl7ut.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=466&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525496/original/file-20230510-29-gxl7ut.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=466&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">Travel restrictions around the world led to reduced fossil fuel emissions.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>In the U.K., <a href="https://www2.deloitte.com/uk/en/pages/press-releases/articles/four-out-of-five-uk-consumers-adopt-more-sustainable-lifestyle-choices-during-covid-19-pandemic.html">85 per cent of consumers reported adopting at least one sustainable lifestyle change</a> during the pandemic. </p>
<p>Pandemic travel restrictions also produced some <a href="https://www.cbc.ca/news/science/air-pollution-covid-1.5948200">positive environmental effects</a> around the world. <a href="https://news.un.org/en/story/2021/01/1082302">Air travel decreased significantly</a> and raised people’s thresholds for what justifies their carbon emissions. </p>
<p>Others have become more <a href="https://www.bbc.com/news/business-55630144">ethical consumers</a> as part of the <a href="https://www.theissuemagazine.ca/articles/the-shop-local-movement">shop local movement</a>. More than <a href="https://www.businesswire.com/news/home/20211115005092/en/New-Survey-Reveals-More-Than-80-of-Canadians-Care-More-About-Supporting-Local-Businesses-This-Holiday-Season-Because-of-the-Pandemic-and-Economic-Concerns">80 per cent of Canadians</a> reported a desire to support local small businesses during the 2021 holiday season.</p>
<p>All this symbolizes a shift in thinking. As we reflect on the last three years, let us seize the opportunity to use the experience to create a more equitable, just and nurturing post-pandemic world.</p><img src="https://counter.theconversation.com/content/205174/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yvonne Su does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The pandemic caused untold suffering around the world. It also created a new type of community solidarity rarely seen before. As we enter the post-pandemic era we must maintain that solidarity.Yvonne Su, Assistant Professor in the Department of Equity Studies, York University, CanadaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1989732023-02-15T23:11:04Z2023-02-15T23:11:04ZTo prepare for future pandemics, we can learn from the OECD’s top two performers: New Zealand and Iceland<figure><img src="https://images.theconversation.com/files/510213/original/file-20230214-16-jul1zd.jpg?ixlib=rb-1.1.0&rect=16%2C0%2C5572%2C3343&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock/Iryna Inshyna</span></span></figcaption></figure><p>A <a href="https://covid19.govt.nz/news-and-data/latest-news/royal-commission-to-draw-lessons-from-pandemic-response/">Royal Commission of Inquiry</a> into New Zealand’s COVID response began work this month, with a goal to prepare the country for future pandemics.</p>
<p>It will focus on lessons not only from New Zealand’s pandemic experience but also from other countries and jurisdictions.</p>
<p>Early in the pandemic, it became clear some countries had higher numbers of COVID deaths than others. New Zealand and Iceland had the lowest mortality among high-income nations: placed first and second in the OECD for <a href="https://ourworldindata.org/grapher/excess-deaths-cumulative-per-100k-economist?tab=chart&country=OWID_WRL%7ECHN%7EIND%7EUSA%7EIDN%7EBRA">lowest excess mortality</a> as of June 2022, respectively.</p>
<p>A previous <a href="https://theconversation.com/covid-19-and-small-island-nations-what-we-can-learn-from-new-zealand-and-iceland-145303">article</a> outlined lessons from both Iceland and New Zealand in September 2020. In a recently published <a href="https://doi.org/10.1177/14034948221149143">study</a>, we extended this comparison through to June 2022.</p>
<p>At the beginning of the pandemic, both countries rapidly implemented similar control measures, including testing, contact tracing, isolation and quarantine, gathering limits and physical distancing. Both nations were relatively slow to require mass masking. </p>
<p>Rapid border management was likely easier in these countries because both are island nations with only one (Iceland) or a few (New Zealand) international airports. However, both nations had to work quickly to increase testing and contact tracing capacity and purchase additional personal protective equipment for healthcare workers.</p>
<p>But apart from these measures, the two nations pursued different strategies. </p>
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<strong>
Read more:
<a href="https://theconversation.com/covid-19-and-small-island-nations-what-we-can-learn-from-new-zealand-and-iceland-145303">COVID-19 and small island nations: what we can learn from New Zealand and Iceland</a>
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<h2>Elimination or mitigation</h2>
<p>Iceland did not implement an elimination strategy and instead focused on mitigation, even though community transmission was eliminated early on. Iceland’s response did not involve the use of lockdowns or official border closures. </p>
<p>Meanwhile, New Zealand initially planned to follow a mitigation strategy, but then shifted quickly to an elimination strategy early in the pandemic. It employed the use of a strict lockdown and largely closed its international border (though low levels of essential travel continued with two weeks of quarantine for returning citizens at the border). </p>
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<img alt="One of Auckland's managed isolation and quarantine facilities" src="https://images.theconversation.com/files/510215/original/file-20230214-28-561l4o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/510215/original/file-20230214-28-561l4o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/510215/original/file-20230214-28-561l4o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/510215/original/file-20230214-28-561l4o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/510215/original/file-20230214-28-561l4o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/510215/original/file-20230214-28-561l4o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/510215/original/file-20230214-28-561l4o.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">All arrivals in New Zealand had to spent two weeks in a managed isolation and quarantine facility.</span>
<span class="attribution"><span class="source">Adam Bradley/SOPA Images/LightRocket via Getty Images</span></span>
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<p>Elimination seeks to <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)02489-8/fulltext">reduce transmission to zero</a> within a defined jurisdiction. By comparison, control strategies like suppression aim to keep case numbers low to minimise illness and death. Mitigation implies lighter controls, more calibrated towards preventing health systems becoming overwhelmed. </p>
<p>In New Zealand, the <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2025203">elimination strategy worked</a> in the early stages of the pandemic and allowed for a return to near-normal life for most people in the country. That was until late 2021, when an outbreak of the Delta variant led the government to shift to a suppression strategy. </p>
<p>Then, following a wave of the Omicron variant in early 2022, New Zealand began to reopen its border in stages, marking a <a href="https://www.health.govt.nz/covid-19-novel-coronavirus/covid-19-response-planning/covid-19-minimisation-and-protection-strategy-aotearoa-new-zealand">shift to mitigation</a>.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/the-costly-lesson-from-covid-why-elimination-should-be-the-default-global-strategy-for-future-pandemics-197806">The costly lesson from COVID: why elimination should be the default global strategy for future pandemics</a>
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<h2>The economic costs of the pandemic</h2>
<p>Iceland and New Zealand both introduced economic interventions shortly after the first COVID cases were detected. Government provision of financial assistance as a <a href="https://data.oecd.org/gdp/gross-domestic-product-gdp.htm#indicator-chart">proportion of GDP</a> in 2020 and 2021 was twice as high in New Zealand as in Iceland. </p>
<p>Despite economic support measures, both nations saw a contraction in GDP in 2020, although much greater in Iceland (-8·27% vs -1·22%). Iceland also experienced a higher peak unemployment rate (7·2% vs 5·3%), but with a quick rebound in 2021. This difference may in part reflect Iceland’s stronger reliance on its tourism sector, but it’s also possible the measures taken in New Zealand were more effective for supporting its economy.</p>
<p>There were many similarities between Iceland’s and New Zealand’s responses. Both nations had existing universal healthcare coverage and pandemic plans targeted towards influenza. However, neither country had a dedicated national institution to respond to infectious diseases.</p>
<p>There was clear communication involving regular briefings by senior officials in both Iceland and New Zealand. This included daily press briefings that were nationally broadcast and early communications about the pandemic framed as a shared threat. In Iceland the phrase “we are all civil protection” was commonly used, while in New Zealand, there was frequent reference to the “team of five million”.</p>
<p>Scientists also played a particularly prominent role in the response. There was a high level of public trust in the response in both countries, especially early in the pandemic.</p>
<h2>Differences in vaccination and testing</h2>
<p>Iceland performed much better than New Zealand with vaccination, beginning its campaign several months earlier. The slow progress with vaccination in New Zealand was a point of criticism at the time (along with delays in reaching Māori and Pasifika) and should be an area of focus for the Royal Commission of Inquiry. </p>
<figure class="align-center ">
<img alt="A sign inviting Pasifika to get vaccinated" src="https://images.theconversation.com/files/510216/original/file-20230214-3402-chrz4e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/510216/original/file-20230214-3402-chrz4e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/510216/original/file-20230214-3402-chrz4e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/510216/original/file-20230214-3402-chrz4e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/510216/original/file-20230214-3402-chrz4e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/510216/original/file-20230214-3402-chrz4e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/510216/original/file-20230214-3402-chrz4e.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">New Zealand’s vaccination campaign was slow to reach Māori and Pasifika.</span>
<span class="attribution"><span class="source">Shutterstock/Lakeview Images</span></span>
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<p>Nevertheless, New Zealand did catch up to Iceland. By June 2022, both countries had similar vaccination coverage rates. Differences in the timing of vaccination probably had little net effect.</p>
<p>Iceland’s success at keeping COVID cases and deaths relatively low without the use of stringent restrictions led to the question of whether New Zealand could have achieved similar results without a border closure and lockdowns. </p>
<p>It seems to us unlikely New Zealand could have achieved similar results without substantially increasing testing capacity. Iceland conducted almost four times more tests (per 1000 population) than New Zealand during the study period. This increase in capacity was made possible in part by <a href="https://www.cnbc.com/2017/04/06/icelands-genetic-goldmine-and-the-man-behind-it.html">collaboration</a> with <a href="https://www.decode.com/">deCODE Genetics</a>.</p>
<p>While efforts to increase testing capacity in New Zealand progressed rapidly in the first year of the pandemic, a backlog developed during the initial stage of the Omicron wave in early 2022 because many <a href="https://www.health.govt.nz/publication/covid-19-pcr-testing-backlog-rapid-review">laboratories were overwhelmed</a> by the number of tests.</p>
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Read more:
<a href="https://theconversation.com/the-keys-to-preventing-future-pandemics-153326">The keys to preventing future pandemics</a>
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</p>
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<p>Considering the impact of alternative pandemic responses is challenging, but country comparisons can give some clues. Also, <a href="https://doi.org/10.1098/rsos.210488">disease modelling</a> suggests that had New Zealand delayed implementing its lockdown, the first pandemic wave would have been larger and taken longer to control. Elimination might have become impossible. </p>
<p>Overall, many of the pandemic control measures deployed by Iceland and New Zealand appeared successful. Features of the responses in both countries could potentially be adopted by other jurisdictions to address future pandemic threats. Indeed, some of us have argued <a href="https://theconversation.com/the-costly-lesson-from-covid-why-elimination-should-be-the-default-global-strategy-for-future-pandemics-197806">elimination should be the default strategy</a> for future pandemics above a certain severity.</p><img src="https://counter.theconversation.com/content/198973/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Funding for this work was received from the University of Otago (grant number ORG 0122-0623) and the Health Research Council of New Zealand (grant number 20/1066).</span></em></p><p class="fine-print"><em><span>Amanda Kvalsvig's employer, the University of Otago, receives funding for her research on Covid-19 and other infectious diseases from the Health Research Council of New Zealand and the New Zealand Ministry of Health.</span></em></p><p class="fine-print"><em><span>Jennifer Summers receives funding from the Ministry of Health to conduct Covid-19 research and funding for this work was received from the University of Otago (grant number ORG 0122-0623).</span></em></p><p class="fine-print"><em><span>Magnús Gottfreðsson collaborates with deCODE Genetics on academic research related to infectious diseases, including Covid-19. He has also provided consultations to Gilead Sciences in the past.</span></em></p><p class="fine-print"><em><span>Michael Baker's employer, the University of Otago, receives funding for his research on Covid-19 and other infectious diseases from the Health Research Council of New Zealand and the New Zealand Ministry of Health.</span></em></p><p class="fine-print"><em><span>Nick Wilson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Both New Zealand and Iceland kept death rates from COVID low, but used different strategies. While New Zealand relied on lockdowns and border closures, Iceland ramped up its testing capacity.Leah M. Grout, Assistant Professor, University of VermontAmanda Kvalsvig, Research associate professor, University of OtagoJennifer Summers, Senior Research Fellow, University of OtagoMagnús Gottfreðsson, Professor, infectious diseases, University of IcelandMichael Baker, Professor of Public Health, University of OtagoNick Wilson, Professor of Public Health, University of OtagoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1951552022-12-02T13:42:01Z2022-12-02T13:42:01ZNurses’ attitudes toward COVID-19 vaccination for their children are highly influenced by partisanship, a new study finds<figure><img src="https://images.theconversation.com/files/498352/original/file-20221130-6065-agmvaq.jpg?ixlib=rb-1.1.0&rect=49%2C36%2C8130%2C5408&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">As of Nov. 30, 2022, 62.5% of children and adolescents are unvaccinated against COVID-19.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/nurse-putting-band-aid-on-patients-arm-after-covid-royalty-free-image/1340701756?phrase=nurses%20covid%20vaccines&adppopup=true">South_agency/E+ via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em> </p>
<h2>The big idea</h2>
<p>Children of nurses who identify as Republican are less likely to receive a COVID-19 vaccination compared with children of nurses who identify as Democrat, according to our recently published study in the <a href="https://doi.org/10.1007/s10900-022-01167-4">Journal of Community Health</a>. </p>
<p>We surveyed more than 1,000 nurses in South Dakota in June and July of 2022. Of those, 298 participants reported having children 5 to 17 years old. We asked this group about the vaccination status of their children and found that the children of nurses who identified as Democrats had a 13% higher probability of being vaccinated compared with the offspring of nurses who identified as Republican. </p>
<p>The timing of our survey only allowed us to measure the vaccination intention of parents of children from 6 months to 4 years old, since authorization of COVID-19 vaccines for that age group occurred just days before the survey. Of the 123 nurses who reported having children 6 months to 4 years old, those who identified as Democrats had a 14% higher probability of intending to vaccinate their children compared to self-identified Republicans. </p>
<p>Additionally, we found that those nurses who received a COVID-19 booster dose were more likely to vaccinate their children. On the other hand, gender, education and type of nursing credential had no effect.</p>
<h2>Why it matters</h2>
<p>Since the start of the COVID-19 pandemic, vaccination for children has been a <a href="https://www.vox.com/the-highlight/23438552/covid-vaccine-refusal-hesitancy-politics-polarization-pandemic-mandates">contentious issue</a>. In our study, we found that polarization among nurses split along political party lines in a similar fashion to the general public. </p>
<p>Despite the wide availability of safe and free COVID-19 vaccines for children and adolescents in the U.S., vaccination rates for people under age 18 are lower than for adults. As of Nov. 30, 2022, more than 60% of children <a href="https://www.cdc.gov/vaccines/imz-managers/coverage/covidvaxview/interactive/children.html">remain unvaccinated</a>. </p>
<p>Though children tend to be more resilient to COVID-19, there are still significant risks. The Centers for Diseases Control and Prevention has reported <a href="https://data.cdc.gov/NCHS/Deaths-by-Sex-Ages-0-18-years/xa4b-4pzv">more than 1,500 deaths of children under 18</a> from COVID-19, as of late November 2022. And children are <a href="https://doi.org/10.1038/s41598-022-13495-5">susceptible to “long” COVID</a> symptoms as well.</p>
<p>Nurses – and other health care workers – are at the forefront of efforts to contain COVID-19. They also advise patients who are deciding whether to vaccinate themselves and their families. Our study shows that among nurses, political partisanship appears to influence their attitudes toward vaccinating their own kids.</p>
<p>Public health officials are striving to boost COVID-19 vaccination rates. Yet the politicization of the pandemic continues to hinder these efforts. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/498542/original/file-20221201-16-luueet.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two nurse protesters stand near a street holding up signs arguing against vaccine mandates, with a large group of protesters in the background." src="https://images.theconversation.com/files/498542/original/file-20221201-16-luueet.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/498542/original/file-20221201-16-luueet.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=412&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498542/original/file-20221201-16-luueet.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=412&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498542/original/file-20221201-16-luueet.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=412&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498542/original/file-20221201-16-luueet.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=517&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498542/original/file-20221201-16-luueet.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=517&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498542/original/file-20221201-16-luueet.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=517&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Nurses protesting the Biden administration’s vaccine mandate, which has since been suspended, in Michigan in July 2021.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/protesters-holding-placards-expressing-their-opinion-while-news-photo/1234168497?phrase=nurses">SOPA Images/LightRocket via Getty Images</a></span>
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<p>Increasing vaccination rates among children will also protect the <a href="https://www.hhs.gov/immunization/basics/work/protection/index.html">most vulnerable members of society</a>, such as older adults and people with weakened immune systems. Nevertheless, some parents continue to resist vaccinating their children.</p>
<p>Our study shows that parents make COVID-19 vaccination decisions for the entire family. We found that nurses who received a booster dose of a COVID-19 vaccine are more likely to vaccinate their children and adolescents. However, the nurses who haven’t received a booster dose are far less likely to vaccinate their children. </p>
<h2>What other research is being done</h2>
<p>Our findings align with other research carried out by ourselves and others that shows the strong influence of partisan self-identification on COVID-19 attitudes and behaviors. </p>
<p>Other studies we’ve done show that Republicans are less likely than Democrats to <a href="https://doi.org/10.1111/ssqu.13147">receive a COVID-19 vaccination</a> and are less likely to <a href="https://doi.org/10.1177%2F1532673X221118888">support mandatory COVID-19 vaccination</a>. We also found that nurses who identify as Republican are less likely to receive a <a href="https://doi.org/10.1016/j.ajic.2022.11.014">COVID-19 booster dose</a>.</p>
<p>Our study joins a growing body of work that seeks to explore the factors behind COVID-19 vaccine hesitancy among health care workers. Other studies have linked <a href="https://doi.org/10.1001/jamanetworkopen.2021.21931">race and ethnicity</a>, as well as <a href="https://doi.org/10.3390/vaccines9111358">trust</a> in government, physicians and pharmaceutical companies, to the attitudes of health care workers toward COVID-19 vaccination.</p>
<h2>What’s next</h2>
<p>Given the politicization of the pandemic and the erosion of trust in authorities, it’s important that messages encouraging the vaccination of children <a href="https://theconversation.com/covid-19-vaccines-for-children-how-parents-are-influenced-by-misinformation-and-how-they-can-counter-it-173212">come from trusted sources</a>. </p>
<p>Our previous research suggests that <a href="https://doi.org/10.1080/03623319.2022.2049557">religious leaders</a> can help encourage compliance with COVID-19 prevention measures. In the future, we plan to investigate whether endorsements from trusted community leaders could convince parents to vaccinate their children.</p><img src="https://counter.theconversation.com/content/195155/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Nurses who identify as Democrats have a significantly higher likelihood of having their children vaccinated against COVID-19 than those who identify as Republicans.Filip Viskupič, Assistant Professor of Political Science, South Dakota State UniversityDavid Wiltse, Associate Professor of Political Science, South Dakota State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1877732022-07-29T00:19:46Z2022-07-29T00:19:46ZNew Zealand’s latest COVID wave is levelling off, with fewer people in hospital than feared<figure><img src="https://images.theconversation.com/files/476598/original/file-20220728-28783-69d6sn.jpg?ixlib=rb-1.1.0&rect=0%2C79%2C5881%2C3632&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Getty Images</span></span></figcaption></figure><p>New Zealand has likely passed the peak of the most recent COVID-19 wave, thanks to strong hybrid immunity in the community and with the number of hospitalisations at the lower end of what was originally expected. </p>
<p>The seven-day rolling average of new daily cases has fallen steadily from a peak of around 10,000 on July 15 to just under 7,800 yesterday.</p>
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<p>The number of reported cases depends on how many people actually test when they feel unwell. The true number of infections is likely to be significantly higher. But there is no reason to think testing has dropped off significantly in the past two weeks, or even in the past few months. </p>
<p>The levelling off and subsequent decline of cases fits with the wave naturally reaching a peak. The amount of virus being <a href="https://esr-cri.shinyapps.io/wastewater/#region=Canterbury&log_or_linear=log&period=allTimeButton">detected in wastewater</a> has also decreased in the past week. Altogether this means the fall in cases is likely to be real. </p>
<p>Importantly, cases have been falling in all age groups, including over-70s. This is particularly good news because the <a href="https://theconversation.com/a-new-omicron-wave-is-upon-new-zealand-with-older-people-now-most-at-risk-heres-what-to-expect-186394">increase in case rates in older age groups</a> had been a key driver of the steep rise in hospitalisations and deaths in this wave. </p>
<p>We may yet see an increase in cases in families with school-age children as they returned to school this week after the winter holiday break. But this is unlikely to be enough to reverse the falling trend, and hopefully won’t affect older age groups to the same extent. </p>
<iframe title="Number of COVID cases in New Zealand" aria-label="Interactive line chart" id="datawrapper-chart-o9S0r" src="https://datawrapper.dwcdn.net/o9S0r/1/" scrolling="no" frameborder="0" style="border: none;" width="100%" height="400"></iframe>
<p>Hospitalisations typically lag behind cases by a week or two. Consistent with this pattern, the number of people in hospital with COVID has recently shown <a href="https://www.rnz.co.nz/news/in-depth/450874/covid-19-data-visualisations-nz-in-numbers">signs of levelling off</a>. It will probably start to fall in the coming week. </p>
<iframe title="Number of hospitalisations in New Zealand" aria-label="Interactive line chart" id="datawrapper-chart-7Sk59" src="https://datawrapper.dwcdn.net/7Sk59/1/" scrolling="no" frameborder="0" style="border: none;" width="100%" height="400"></iframe>
<h2>Immunity from the first Omicron wave</h2>
<p>The BA.5 variant is driving the current wave. BA.5 has taken over from BA.2 as the <a href="http://esr2.cwp.govt.nz/assets/HEALTH-CONTENT/COVID-Genomics-Insights-Dashboard-CGID/CGID_16_20220721.pdf">dominant variant in New Zealand</a>, as it has in <a href="https://covariants.org/per-country">other countries</a>. </p>
<p>The leading hypothesis for why BA.5 has been able to outcompete BA.2 is its increased ability to evade immunity – whether that was acquired through vaccination or previous infection with a different variant. </p>
<p>However, new evidence from <a href="https://www.medrxiv.org/content/10.1101/2022.07.11.22277448v1">Qatar</a> and <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4165630">Denmark</a> (both yet to be peer-reviewed) suggests people who’ve had a previous Omicron infection have relatively strong immunity against BA.5. Qatar and Denmark both have <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&pickerSort=desc&pickerMetric=total_cases&Interval=7-day+rolling+average&Relative+to+Population=true&Color+by+test+positivity=false&country=DNK%7ENZL%7EQAT&Metric=Vaccine+booster+doses">highly vaccinated populations</a> and this is evidence of the strength of hybrid immunity.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/hybrid-immunity-a-combination-of-vaccination-and-prior-infection-probably-offers-the-best-protection-against-covid-183943">Hybrid immunity: a combination of vaccination and prior infection probably offers the best protection against COVID</a>
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<p>In England, it is estimated people who haven’t had COVID previously <a href="https://www.theguardian.com/world/2022/jul/22/why-do-the-minority-who-havent-had-covid-account-for-most-new-infections">still account for the majority</a> of new cases, despite being <a href="https://www.mrc-bsu.cam.ac.uk/now-casting/nowcasting-and-forecasting-15th-july-2022/">less than 15%</a> of the population. </p>
<p>The strength of hybrid immunity induced by high vaccination rates and the large and relatively recent BA.2 wave in Aotearoa likely means this BA.5 wave is smaller than it would have been otherwise.</p>
<h2>How long could it go on?</h2>
<p>Following the first Omicron wave in March, cases dropped relatively slowly and plateaued at case numbers between 5,000 and 8,000 for several months. It’s possible we will again see a relatively slow decline in cases. </p>
<p>But there are also grounds for optimism that hospitalisations and deaths could drop lower than they did between the BA.2 and BA.5 waves. Although immunity isn’t perfect and wanes over time, those who haven’t yet been infected with Omicron are the easiest targets for the virus. But they’re getting harder to find as the number of people in New Zealand who haven’t yet been infected dwindles. </p>
<p>The <a href="https://covid19.govt.nz/covid-19-vaccines/get-your-covid-19-vaccination/#booster">rollout of fourth doses</a> for eligible people more than six months after their last dose, coupled with building evidence for the strength of hybrid immunity, suggest New Zealand’s population is increasingly well protected against currently circulating variants.</p>
<h2>Tracking reinfections and future waves</h2>
<p>Currently, New Zealand is reporting around 500 potential reinfections per day, making up about <a href="https://twitter.com/Thoughtfulnz/status/1552194565305925632">6% of all cases</a>. Reinfections will certainly grow over time as immunity wanes. </p>
<p>The true number of reinfections is almost certainly a lot higher because cases can’t be classified as reinfections if the first infection wasn’t reported. And it’s possible people who know they’ve had COVID before are less likely to test, especially since their symptoms are likely to be <a href="https://www.nejm.org/doi/full/10.1056/NEJMc2108120">milder</a> the second time around. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/reinfection-will-be-part-of-the-pandemic-for-months-to-come-each-repeat-illness-raises-the-risk-of-long-covid-186733">Reinfection will be part of the pandemic for months to come. Each repeat illness raises the risk of long COVID</a>
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<p>But the fact reinfections are still a small proportion of cases is consistent with evidence that prior Omicron infection provides strong, albeit imperfect, protection against getting reinfected with BA.5. </p>
<p>Continuing to rely solely on people getting tested to keep track of where the virus is spreading will lead to greater and greater uncertainty, particularly if access to free testing becomes restricted in the future. </p>
<p>A <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/coronaviruscovid19infectionsurveypilot/previousReleases">regular prevalence survey</a> of a representative sample of the population would be a much more reliable indicator of the true prevalence of the virus in the community. </p>
<p>Another new variant is likely to trigger the next wave. It’s impossible to predict its timing or exact characteristics with any certainty. The Ministry of Health plans to <a href="https://www.newsroom.co.nz/random-testing-to-seek-covid-19-prevalence">launch a random testing survey</a> to determine the true community prevalence of the virus. </p>
<p>Having a prevalence survey in place before the next variant takes over would enable us to estimate the size and severity of the next wave more accurately. Combined with <a href="https://www.esr.cri.nz/our-expertise/covid-19-response/covid19-insights/">wastewater testing</a> and <a href="https://www.esr.cri.nz/our-services/consultancy/genomics-and-next-generation-sequencing/">genome sequencing</a>, this would give us a world-class COVID surveillance system that could provide a blueprint for managing other existing or newly emergent pathogens.</p><img src="https://counter.theconversation.com/content/187773/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Welch has received funding from HRC, MBIE, and ESR for Covid-19 modeling and genomic analysis.</span></em></p><p class="fine-print"><em><span>Jemma Geoghegan receives funding from the New Zealand Royal Society, Marsden Fund and Health Research Fund. </span></em></p><p class="fine-print"><em><span>Michael Plank works for the University of Canterbury and receives funding from the New Zealand Government for mathematical modelling of Covid-19.</span></em></p>Case numbers are falling in all age groups, including over-70s. This is good news as case rates in older people have been a key driver of the steep rise in hospitalisations and deaths in this wave.David Welch, Senior Lecturer, University of Auckland, Waipapa Taumata RauJemma Geoghegan, Senior Lecturer and Associate Scientist at ESR, University of OtagoMichael Plank, Professor in Applied Mathematics, University of CanterburyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1789722022-05-10T12:04:32Z2022-05-10T12:04:32ZCountries with lower-than-expected vaccination rates show unusually negative attitudes to vaccines on Twitter<figure><img src="https://images.theconversation.com/files/462048/original/file-20220509-20-ed0zvv.jpg?ixlib=rb-1.1.0&rect=148%2C175%2C6682%2C4809&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Social media sites like Twitter have been a major source of both true and false information regarding COVID-19 vaccines.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/syringes-forming-a-hashtag-symbol-on-blue-royalty-free-image/1216677104?adppopup=true">MicroStockHub/iStock 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>In countries with lower-than-expected COVID-19 vaccination rates, mentions of side effects and negative emotions <a href="https://doi.org/10.3390/vaccines10050735">dominated overall social media discourses on COVID-19 vaccines</a>, according to our new research published in the journal Vaccines.</p>
<p>Our team wanted to understand whether the tone of social media conversations around the world matched differing country-level vaccination rates. To do this, we analyzed more than 21.3 million tweets in 33 languages from 192 countries posted between November 2020 and August 2021, searching any tweet that mentioned “COVID-19” and “vaccine” or “vaccination.” We then calculated percentages of these tweets that mentioned keywords signifying adverse events of vaccination, such as side effects, blood clots or death. </p>
<p>In addition, we used <a href="https://www.brandwatch.com/blog/get-a-deeper-understanding-of-consumer-sentiment-with-emotion-analysis">an artificial intelligence algorithm</a> to analyze the sentiment and emotional tone of tweets. This algorithm can identify positive and negative sentiment as well as emotions in language – such as joy, fear, sadness or anger. We applied the algorithm to tweets mentioning COVID-19 vaccines, allowing us to measure the general emotional trends of different countries on Twitter.</p>
<p>Prior research has shown that emotions toward vaccines may <a href="https://nrchealth.com/uncovering-the-powerful-emotions-concealed-behind-covid-19-vaccine-hesitancy">influence whether a person decides to get a COVID-19 vaccination</a>. Our study allowed us to examine this theory at national scales.</p>
<p>Globally, 1.15% of tweets related to COVID-19 vaccines mentioned side effects. Sentiments toward vaccines were on average more negative than positive, with nearly two times more negative tweets than positive ones. But interestingly, negative emotions like fear, sadness or anger appeared only 0.7 times as often as joy worldwide. Using these numbers as baselines, our analysis controlled for national socioeconomic characteristics as well as numbers of COVID-19 cases and deaths and then compared countries’ Twitter trends and vaccination rates to global averages. We removed ads and spam from our analysis, but did not remove tweets that may be posted by bots, as they are a part of the Twitter landscape.</p>
<p>We found that when social media discourse on vaccination is more negative than the global average in a country, the vaccination rate tends <a href="https://doi.org/10.3390/vaccines10050735">to be lower than expected</a>. </p>
<p>In particular, a high prevalence of tweets mentioning “side effects” or displaying fear, sadness or anger were predictive of low vaccination rates. For example, 1.42% of tweets from South Africa mentioned “side effects” – higher than the global average of 1.15% – and negative emotions appeared in tweets 1.55 times as often as joy – more than double the global average. At the time of our analysis, South Africa reported a vaccination rate of 30%, lower than other countries with similar characteristics.</p>
<p>We found similar correlations between negative Twitter sentiments and lower-than-expected vaccination rates in <a href="https://doi.org/10.3390/vaccines10050735">many other countries</a>, including Namibia, Ukraine, Croatia, Poland, Mexico, the Philippines and Burma.</p>
<p>In the U.S., fear, sadness or anger appeared almost as often as joy – showing more negativity than the global average. At the time of the analysis, the vaccination rate in the U.S. was 72%, lower than the 80% or above in many other high-income countries, like Germany and Canada.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/462052/original/file-20220509-26-ue4k48.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A drawing of a person holding a phone with lots of images related to COVID-19 coming out of the back of their head." src="https://images.theconversation.com/files/462052/original/file-20220509-26-ue4k48.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/462052/original/file-20220509-26-ue4k48.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/462052/original/file-20220509-26-ue4k48.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/462052/original/file-20220509-26-ue4k48.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/462052/original/file-20220509-26-ue4k48.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/462052/original/file-20220509-26-ue4k48.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/462052/original/file-20220509-26-ue4k48.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">Negative emotions toward vaccines are tied to lower vaccination rates for individuals, and this research shows the trend holds at national level, too.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/symbol-of-the-manipulation-of-information-on-royalty-free-illustration/1287191706?adppopup=true">Pict Rider/iStock via Getty Images</a></span>
</figcaption>
</figure>
<h2>Why it matters</h2>
<p>In most developed countries – including the U.S. – many individuals are <a href="https://www.whitehouse.gov/wp-content/uploads/2022/03/NAT-COVID-19-PREPAREDNESS-PLAN.pdf">refusing vaccines even though vaccines are plentiful and easy to access</a>.</p>
<p>Social media has been a <a href="https://www.pewresearch.org/fact-tank/2021/08/24/about-four-in-ten-americans-say-social-media-is-an-important-way-of-following-covid-19-vaccine-news/">critical means of disseminating COVID-19 information</a>. But Twitter, Facebook and other platforms have also <a href="https://doi.org/10.2196/30642">been flooded with misinformation and disinformation</a> – as well as people’s personal sentiments on vaccination – since the beginning of the pandemic. Research shows that the more information about COVID-19 people are exposed to via social media, the <a href="https://doi.org/10.1371/journal.pone.0250123">less accurate their knowledge about COVID-19</a>.</p>
<p>Our research expands on these individual-level findings and shows social media discourses are also associated with vaccination behavior at the national level. </p>
<h2>What still isn’t known</h2>
<p>Our findings show a correlation between social media discourse and vaccination, but this type of analysis cannot identify causality. We also did not explore the reasons behind why some countries show more negative emotions in tweets than others. This might be linked to <a href="https://doi.org/10.1109/access.2020.3027350">cultural differences </a> among countries.</p>
<p>Another limitation is due to the vagueness of language. The AI system we used is relatively good at characterizing sentiments and emotions in a tweet, <a href="https://doi.org/10.1080/00913367.2020.1809576">but not 100% accurate</a>. Additionally, the AI is not as strong when analyzing tweets in languages other than English.</p>
<h2>What’s next</h2>
<p>The World Health Organization has declared the <a href="https://www.who.int/health-topics/infodemic#tab=tab_1">widespread misinformation about COVID-19 an infodemic</a>, and <a href="https://onu.delegfrance.org/IMG/pdf/cross-regional_statement_on_infodemic_final_with_all_endorsements.pdf">132 countries have agreed to combat it</a>. Our findings support the idea that global efforts to combat misinformation, address negative emotions and promote positive language surrounding COVID-19 vaccination on social media may help boost global vaccination rates.</p><img src="https://counter.theconversation.com/content/178972/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jungmi Jun received funding from the Social Media Core of Big Data Health Science Center, University of South Carolina.</span></em></p><p class="fine-print"><em><span>Ali Zain 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>A team analyzed more than 21 million tweets about COVID-19 vaccines and found that negative sentiments on social media were tied to lower-than-expected vaccination rates in many nations.Jungmi Jun, Associate Professor of Information and Communications, University of South CarolinaAli Zain, Ph.D. Student of Mass Communication, University of South CarolinaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1782762022-03-08T18:10:35Z2022-03-08T18:10:35ZNo, catching Omicron is not ‘inevitable’ – here’s why we should all still avoid the virus<figure><img src="https://images.theconversation.com/files/450554/original/file-20220308-51485-izb4i3.jpg?ixlib=rb-1.1.0&rect=0%2C30%2C5024%2C2870&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Fiona Goodall/Getty Images</span></span></figcaption></figure><p>Aotearoa New Zealand has entered new COVID territory, characterised by <a href="https://www.health.govt.nz/covid-19-novel-coronavirus/covid-19-data-and-statistics/covid-19-vaccine-data#total-vaccinations">high vaccination rates</a> but also the rapid spread of the Omicron variant and <a href="https://www.health.govt.nz/news-media/news-items/23894-community-cases-757-hospital-16-icu">rising numbers of hospitalisations</a>. </p>
<p>As we approach the peak of this wave, some have suggested it would be better to drop remaining public health measures, let the infection rip through our population and accept nearly all of us will get infected very soon. This is unwise for many reasons. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1498400703773298688"}"></div></p>
<p>First, simple measures we can all take will ensure that even in this big wave of infections, most of us can still avoid getting infected. Even if you share a household with an infected person, <a href="https://www.medrxiv.org/content/10.1101/2022.02.15.22271001v1">international</a> <a href="https://www.medrxiv.org/content/10.1101/2021.12.27.21268278v1.full">studies</a> show the risk of catching the virus is somewhere between 15% and 50%. </p>
<p>Second, not all infections are equal. </p>
<p>The Delta variant is still circulating and we can’t presume all infections are Omicron. While less virulent than Delta, Omicron can nevertheless cause severe disease and death, particularly among the unvaccinated who make up 3% of the vaccine-eligible population but <a href="https://www.health.govt.nz/news-media/news-items/23894-community-cases-757-hospital-16-icu">19.4% of hospitalisations</a>. </p>
<p>There are still many vulnerable people in the community we can protect by limiting the spread of the virus and ensuring they are less likely to encounter it. </p>
<p>Another reason to limit potentially infectious contact is that infection is more likely if an individual is exposed to a higher initial dose of the virus. An infection avoided or delayed is always a win as we move closer to even more effective vaccines and improved medical treatments for COVID.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-does-omicron-compare-with-delta-heres-what-we-know-about-infectiousness-symptoms-severity-and-vaccine-protection-172963">How does Omicron compare with Delta? Here's what we know about infectiousness, symptoms, severity and vaccine protection</a>
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<h2>Why outbreaks come in waves</h2>
<p>The reason we get large wave-like outbreaks that rise and fall quickly is because the virus becomes less able to find people to infect as the outbreak progresses. Crucially, this happens before everyone is infected. </p>
<p>This is related to the R number epidemiologists talk about. R0 is the average number of people an infectious person infects at the start of an outbreak. When R is greater than one, the number of cases increases, when it is below one, it decreases. </p>
<p>As the outbreak proceeds, more and more people get infected and recover. They cannot immediately be reinfected. For example, if R is 2 at the start of an outbreak, meaning each case on average transmits to two others, by the time half of the population has been infected and has recovered, the virus will only transmit to one other. </p>
<p>That is because it “tries” to infect two people but finds that, on average, one has already recovered and cannot be reinfected. In this example, the R number is now effectively 1 and infections will start to fall. </p>
<h2>Omicron’s rapid spread</h2>
<p>Despite New Zealand’s high vaccination rates, Omicron is spreading quickly here, as it has in other countries. There are many elements to this. </p>
<p>Omicron is good at avoiding immunity generated by vaccination and previous infection. We have very high rates of first and second doses, but fewer than 60% have received boosters, and we have a very short history of exposure to natural infection. </p>
<p>These characteristics make us prone to a rapid and large outbreak of Omicron. Further, vaccinations, including boosters, are very good at preventing illness, hospitalisation and death, but they don’t prevent infection and transmission quite as well. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/nzs-confirmed-covid-case-numbers-are-rising-fast-but-total-infections-are-likely-much-higher-heres-why-177901">NZ's confirmed COVID case numbers are rising fast, but total infections are likely much higher – here's why</a>
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<p>This means that even in a highly vaccinated population, you can still get high levels of transmission and infection, but the rates of illness and severe complications will be much lower. </p>
<p>Relaxation of public health measures and the impact of superspreader events may also be contributing to the current picture. Importantly, while the number of infections has increased dramatically with Omicron, the proportion of these that result in severe complications is much lower than during the earlier Delta outbreak.</p>
<h2>Our behaviour helps determine the size of the wave</h2>
<p>The earlier cases start to fall, the smaller the overall outbreak will be. If R is 2 at the start of an outbreak, a basic model says around 80% of the population will be infected. If the initial R number can be reduced to 1.5, only 58% of the population get infected. </p>
<figure class="align-center ">
<img alt="A graph showing the percentage of the population infected over the course of a closed outbreak for different values of R0." src="https://images.theconversation.com/files/450529/original/file-20220307-126059-137z59g.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/450529/original/file-20220307-126059-137z59g.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=489&fit=crop&dpr=1 600w, https://images.theconversation.com/files/450529/original/file-20220307-126059-137z59g.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=489&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/450529/original/file-20220307-126059-137z59g.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=489&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/450529/original/file-20220307-126059-137z59g.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=614&fit=crop&dpr=1 754w, https://images.theconversation.com/files/450529/original/file-20220307-126059-137z59g.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=614&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/450529/original/file-20220307-126059-137z59g.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=614&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The percentage of the population infected over the course of a closed outbreak for different values of R0.</span>
<span class="attribution"><span class="source">Calculated using the method described by Ottar N. Bjørnstad in Epidemics: Models and Data Using R</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Luckily we exert some control over the R number. Measures like mask wearing, good use of ventilation, self-isolation when symptomatic or after a positive test, vaccination, and avoiding crowded indoor areas all work to reduce R and the total number of people who will get infected. <a href="https://www.covid19modelling.ac.nz/a-preliminary-assessment-of-the-potential-impact-of-the-omicron-variant/">Local modeling suggests</a> that depending on how well we adopt these measures, somewhere between 25% and 60% of the population are likely to be infected in this outbreak.</p>
<p>Even when sharing the same household as a case, it is not inevitable everyone else will get infected. Studies from the <a href="https://www.medrxiv.org/content/10.1101/2022.02.15.22271001v1">UK</a>, <a href="https://www.medrxiv.org/content/10.1101/2021.12.27.21268278v1.full">Denmark</a> and <a href="https://wwwnc.cdc.gov/eid/article/28/3/21-2607_article">South Korea</a> have all looked at the probability of susceptible people in the same household as a positive case getting infected. </p>
<p>They found with Omicron, this probability is somewhere between 15% and 50%. In other words, you still have a better than even chance of avoiding infection through your infectious housemate. </p>
<p>All the measures that work generally to reduce spread also work within a household. Mask up inside, get air flowing through, where possible move the infected household member into their own bedroom and bathroom, and practice good basic hygiene.</p>
<p>The relationship between the initial exposure dose, infection and disease severity is a property of many infectious diseases, including respiratory diseases in humans and other animals. </p>
<p>A recent <a href="https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciab903/6397523">review</a> concluded that while there is good evidence of a direct relationship between the SARS-CoV-2 virus dose and infection in humans, evidence for a link between dose and severity is lacking, despite some evidence from <a href="https://doi.org/10.1371/journal.ppat.1009865">animal models</a>. </p>
<p>COVID severity is most likely driven by factors other than the initial exposure dose. These include the virus variant and host factors such as age or the presence of some pre-existing health conditions. </p>
<p>All the standard public and personal health measures will help us avoid getting infected and reduce transmission to the more vulnerable, thereby reducing the number of people with severe illnesses.</p><img src="https://counter.theconversation.com/content/178276/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Welch has received funding from MBIE, MoH and HRC.</span></em></p><p class="fine-print"><em><span>Nigel French is affiliated with Massey University and has received funding from MBIE and HRC. </span></em></p>As Omicron cases soar in New Zealand, most people can still avoid getting infected. Even if you share a household with an infected person, catching the virus is not at all inevitable.David Welch, Senior Lecturer, University of Auckland, Waipapa Taumata RauNigel French, Professor of Food Safety and Veterinary Public Health, Massey UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1760292022-01-31T07:00:57Z2022-01-31T07:00:57ZMorrison announces bonus of up to $800 to encourage workers to stay in highly stretched aged care system<p>With COVID deaths in aged care mounting and reports of neglect of residents due to acute workforce shortages, Scott Morrison on Monday announced bonus payments totalling up to $800 for staff.</p>
<p>Two payments of up to $400 each will be made on a pro rata basis, according to hours worked. The first payment will be provided next month, with a second by early May. The cost will be $209 million.</p>
<p>A main aim of the payment is to try to encourage qualified workers to stay in the system. </p>
<p>Both workers, who are low paid, and facilities have again been hit hard in recent weeks, as Omicron has raged. Aged care residents were early casualties of the pandemic, with many hundreds of deaths in Victoria in 2020. Now they are again in the frontline of casualties. In January some 447 people in residential aged care have died with COVID.</p>
<p>Staff shortages have been acute in the sector during Omicron with many workers having COVID or furloughed because of being close contacts. There have been reports of residents missing showers and meals being delayed, and many families are not able to visit when facilities have outbreaks.</p>
<p>On Monday NSW Premier Dominic Perrottet expressed concern about the significant number of aged care deaths. NSW Chief Health Officer Kerry Chant stressed the need for residents to receive their boosters and Perrottet offered state support to get the jabs finalised.</p>
<p>Aged care is a federal government responsibility.</p>
<p>Announcing the bonus, Morrison said none of Australia’s health outcomes “would be possible without the hard work, long hours and dedicated care offered by our frontline health and aged care workforce. </p>
<p>"Their resilience over the past two years has been inspiring.”</p>
<p>Morrison said the latest commitment built on the $393 million provided over three payments to 234,000 aged care workers earlier in the pandemic.</p>
<p>The payment will be for workers in government-subsidised home care and to aged care workers providing direct care, food or cleaning services in government-subsidised residential care.</p>
<p>Health Minister Greg Hunt said on Monday that about 99% of aged care facilities were expected to have had their boosters available by the end of the day, with the rest in “coming days”.</p>
<p>Hunt said 60% of the aged care deaths were people who were receiving palliative care.</p>
<p>He said there was a 99% vaccination rate among aged care staff (this means two shots).</p>
<p>Anthony Albanese said at the weekend the government should be supporting an increase in wages for age care workers in the case currently before the Fair Work Commission.</p><img src="https://counter.theconversation.com/content/176029/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Grattan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>With COVID deaths in aged care mounting and reports of neglect of residents due to workforce shortages, Scott Morrison on Monday announced bonus payments totalling up to $800 for staff.Michelle Grattan, Professorial Fellow, University of CanberraLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1741952022-01-09T13:14:44Z2022-01-09T13:14:44ZOmicron: Vaccines remain the best defence against this COVID-19 variant and others<figure><img src="https://images.theconversation.com/files/439616/original/file-20220106-13-ngc07h.jpg?ixlib=rb-1.1.0&rect=125%2C26%2C5622%2C4136&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The best way to stop new variants from arising is to increase the proportion of vaccinated individuals while maintaining infection prevention measures like wearing masks and social distancing.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 175px; border: none; position: relative; z-index: 1;" allowtransparency="" src="https://narrations.ad-auris.com/widget/the-conversation-canada/omicron--vaccines-remain-the-best-defence-against-this-covid-19-variant-and-others" width="100%" height="400"></iframe>
<p>We have made it through another pandemic winter holiday. Fortunately, COVID-19 fatalities have decreased since the year before, however, the numbers still weren’t ideal. Using Dec. 25 as a reference date, <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&pickerSort=asc&pickerMetric=location&Metric=Confirmed+deaths&Interval=7-day+rolling+average&Relative+to+Population=true&Align+outbreaks=false&country=USA%7ECAN">the death rate from COVID-19</a> in the United States was 4.27 per million in 2021, compared to 7.48 per million in 2020. In Canada, it was 0.42 per million in 2021, compared to 2.95 per million the previous year — a much more significant decrease. </p>
<p>The difference that vaccination is making becomes clear when comparing the <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&pickerSort=asc&pickerMetric=location&Metric=People+fully+vaccinated&Interval=7-day+rolling+average&Relative+to+Population=true&Align+outbreaks=false&country=USA%7ECAN">corresponding rates of fully vaccinated people: 61.4 per cent in the U.S. compared to 77.1 per cent in Canada</a>. The higher vaccination rate in Canada corresponds to the more sharply reduced death rate.</p>
<p>As a medical doctor and researcher of COVID-19, I am optimistic about the power of increased vaccination rates in combination with infection prevention practices to fight the pandemic. </p>
<p>Waiting for <a href="https://theconversation.com/5-failings-of-the-great-barrington-declarations-dangerous-plan-for-covid-19-natural-herd-immunity-148975">natural herd immunity</a> will not fix this or save lives. In the U.S., the <a href="https://www.nytimes.com/interactive/2021/us/covid-cases.html">55 million people who have tested positive for COVID-19</a> since the pandemic began represent only about 17 per cent of the roughly 330 million population — nowhere near the <a href="https://theconversation.com/covid-19-may-never-go-away-but-practical-herd-immunity-is-within-reach-162406">level needed for herd immunity</a>. The only ethical means of achieving herd immunity is vaccination.</p>
<h2>Omicron</h2>
<p>Unfortunately, the Omicron variant may have <a href="https://pubmed.ncbi.nlm.nih.gov/34873578/">greater potential to infect people than past variants</a>, and may be more able to infect fully vaccinated and boosted individuals, according to research awaiting peer review. This new form of the virus is a product of its natural evolution. The longer a pandemic lasts, the more changes occur with a virus. </p>
<p>The best way to stop new variants from arising is to increase the proportion of vaccinated individuals while maintaining infection prevention measures, like following recommendations for face masks and social distancing. <a href="https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html#:%7E:text=Evidence%20suggests%20the%20US%20COVID,interrupting%20chains%20of%20transmission.">Vaccinated individuals are less likely to pass on the virus if they do become infected</a>.</p>
<p>Most cases and deaths <a href="https://covid.cdc.gov/covid-data-tracker/#rates-by-vaccine-status">continue to affect unvaccinated individuals</a>. Further sickness and death are largely preventable, just as most of the illness and death in recent months were. Vaccine refusal, in the absence of valid medical reasons, and not adhering to infection prevention measures are largely responsible for the continued hardship of the pandemic. </p>
<h2>Vaccines and variants</h2>
<p>Vaccines remain an effective tool towards ending the pandemic, particularly against Omicron. This is despite research awaiting peer review indicating the new variant may have <a href="https://pubmed.ncbi.nlm.nih.gov/34873578/">greater potential to infect people than past variants</a>, and may be more able to infect fully vaccinated and boosted individuals. </p>
<p>More data is needed to establish how much more or less infectious the Omicron variant is compared to others, but <a href="https://asm.org/Articles/2021/December/How-Ominous-is-the-Omicron-Variant-B-1-1-529">Omicron’s ability to infect vaccinated individuals (albeit less so than unvaccinated individuals) is concerning</a>. That means infection prevention activities, like wearing a mask and social distancing regardless of vaccination status, are still essential. <a href="https://doi.org/10.1038/d41586-021-03614-z">Poor adherence to these measures can be enough to increase cases in a community</a>, even with many vaccinated folks. </p>
<figure class="align-center ">
<img alt="Illustration of a row of coronaviruses in a gradient of colours" src="https://images.theconversation.com/files/439629/original/file-20220106-19-173dcvj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/439629/original/file-20220106-19-173dcvj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=217&fit=crop&dpr=1 600w, https://images.theconversation.com/files/439629/original/file-20220106-19-173dcvj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=217&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/439629/original/file-20220106-19-173dcvj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=217&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/439629/original/file-20220106-19-173dcvj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=272&fit=crop&dpr=1 754w, https://images.theconversation.com/files/439629/original/file-20220106-19-173dcvj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=272&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/439629/original/file-20220106-19-173dcvj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=272&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The longer a pandemic lasts, the more changes occur with a virus.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>While vaccines are less protective against becoming infected with Omicron than other variants, <a href="https://directorsblog.nih.gov/2021/12/14/the-latest-on-the-omicron-variant-and-vaccine-protection/">they offer significant protection against developing an infection</a> and <a href="http://doi.org/10.1056/NEJMc2119270">severe illness</a>. </p>
<p>For those who have already had COVID-19 but have not been vaccinated, the evidence available so far suggests that they should still get vaccinated <a href="https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/covid-19/report-49-Omicron/">because past infection did not protect against Omicron</a>. While there are claims that Omicron produces milder illness, one cannot rely on this when infected individuals still face a significant chance of severe disease.</p>
<p>Several months of winter remain, and COVID-19 <a href="https://globalnews.ca/news/8479373/covid-canada-omicron-christmas/">cases are ballooning again</a>. There is reason to believe that the pandemic will get worse before it gets better. </p>
<h2>Pandemic toolkit</h2>
<p>Booster shots are readily available in the U.S. and are increasingly available in Canada. <a href="https://directorsblog.nih.gov/2021/12/14/the-latest-on-the-omicron-variant-and-vaccine-protection/">Boosters have been shown to confer increased protection against the Omicron variant</a>. </p>
<p>It is everyone’s social responsibility to get the booster, with the exception of the very few people who are allergic to vaccine components. Research showed that <a href="http://doi.org/10.1001/jamanetworkopen.2021.22255">being highly allergic to something that is not vaccine-related rarely equates with an expected severe allergic reaction to the vaccine</a>. </p>
<figure class="align-center ">
<img alt="Illustration of a hand holding a syringe pointed at a coronavirus against a background of stopwatches" src="https://images.theconversation.com/files/439630/original/file-20220106-27-1yqmm7w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/439630/original/file-20220106-27-1yqmm7w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=209&fit=crop&dpr=1 600w, https://images.theconversation.com/files/439630/original/file-20220106-27-1yqmm7w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=209&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/439630/original/file-20220106-27-1yqmm7w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=209&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/439630/original/file-20220106-27-1yqmm7w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=263&fit=crop&dpr=1 754w, https://images.theconversation.com/files/439630/original/file-20220106-27-1yqmm7w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=263&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/439630/original/file-20220106-27-1yqmm7w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=263&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Vaccines remain an effective tool towards ending the pandemic, particularly against Omicron.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
</figcaption>
</figure>
<p>I have an allergy to shellfish that has placed me in the hospital when I inadvertently consumed it. Nothing happened to me when receiving any of my three shots of COVID-19 vaccines, and the above research suggests that this would be the case for most people with non-vaccine allergies. </p>
<p>The risks of COVID-19 far outweigh the very small risk of having an allergic reaction to the vaccine. In the unlikely event that you did have an allergic reaction to the vaccine, such reactions are typically mild and readily treated.</p>
<p>The pandemic will get better if we work together. While news of Omicron and implications on vaccine effectiveness are disheartening, more systems are in place to respond to this change and future changes in the pandemic. Pfizer, one of the drug makers of the effective COVID-19 vaccines, <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-provide-update-omicron-variant">has already announced a readiness to produce vaccines adapted to the changing virus</a>. We can expect other manufacturers to follow suit, ensuring that the therapies needed to meet this challenge are available. </p>
<p>This leaves it up to consumers — us — to do our part in ending the pandemic.</p><img src="https://counter.theconversation.com/content/174195/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julian Daniel Sunday Willett does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Even with a variant like Omicron that may be more transmissible than earlier variants, vaccines remain the most effective tool for protection against COVID-19 and for ending the pandemic.Julian Daniel Sunday Willett, PhD Candidate, Quantitative Life Sciences, McGill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1729402021-12-01T22:15:38Z2021-12-01T22:15:38ZVerification will be essential as New Zealanders start using vaccine passes – to stop fraud and the spread of COVID<figure><img src="https://images.theconversation.com/files/435158/original/file-20211201-19-1avlpkp.jpg?ixlib=rb-1.1.0&rect=0%2C114%2C5452%2C3509&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Hannah Peters/Getty Images</span></span></figcaption></figure><p>When New Zealand switches to the <a href="https://www.beehive.govt.nz/sites/default/files/2021-11/291121_UAC_CPFSummary_A3.pdf">COVID-19 Protection Framework</a> tomorrow, people will have to present vaccine passes to access many public spaces and venues.</p>
<p>At this point, more than 2.4 million people have downloaded their official vaccine passes, which represents almost 70% of the 3.6 million people who are fully vaccinated. </p>
<p>The transition will likely exacerbate inequities that have already emerged during the vaccine rollout itself, and discriminate against vaccinated but “digitally excluded” people who have limited access to email or phone apps to carry a vaccine pass. People can now get their passes in person at some pharmacies, which helps but does not fully solve the problem.</p>
<p>Another major concern is the integrity of how we use and verify vaccine passes. Businesses and venues have different choices in how strongly they verify the legitimacy of the pass itself and whether or not they request an ID to verify the identity of the vaccine pass holder. This can make all the difference in how effective the system will be in reducing the spread of the virus. </p>
<h2>Verifying vaccine passes</h2>
<p>Last week, the government passed legislation under urgency to enact a “<a href="https://www.beehive.govt.nz/release/traffic-light-levels-announced">traffic light</a>” system, which places regions under certain settings. Under red and orange settings, many venues will only be open to fully vaccinated people who can present proof of vaccination.</p>
<p>The vaccine pass includes a QR code which can be presented on paper or on a smartphone. So far, the government has said the minimum requirement is only to visually check the pass. The next level of verification would be for staff to use the official <a href="https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-vaccines/my-covid-record-proof-vaccination-status/nz-pass-verifier">NZ Pass Verifier</a> app to scan the QR code to ensure the pass is legitimate, and that the details printed on the pass match the details encoded in the QR code. </p>
<p>But the highest level of verification is to ask for a photo ID to make sure the person carrying the pass is the person named on it. Taking all three steps provides the highest confidence the person is vaccinated.</p>
<figure class="align-center ">
<img alt="Image of someone setting up their vaccine pass on their phone" src="https://images.theconversation.com/files/435164/original/file-20211201-18-1ymcwfu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/435164/original/file-20211201-18-1ymcwfu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/435164/original/file-20211201-18-1ymcwfu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/435164/original/file-20211201-18-1ymcwfu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/435164/original/file-20211201-18-1ymcwfu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/435164/original/file-20211201-18-1ymcwfu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/435164/original/file-20211201-18-1ymcwfu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Almost 70% of fully vaccinated New Zealanders have downloaded their vaccine passes.</span>
<span class="attribution"><span class="source">Phil Walter/Getty Images</span></span>
</figcaption>
</figure>
<p>Understandably, some venues will consider this too much hassle or impractical. Requiring a photo ID will also discriminate against people who are fully vaccinated but may not have an ID (such as under-18s or people who have no need for one) or those who may not have a photo ID in their preferred name.</p>
<p>In my opinion, venues that are required to check for vaccine passes need to scan the QR code to lift confidence that the pass is legitimate. Otherwise, it is simply too easy to fake a vaccine pass.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-far-should-compulsory-proof-of-vaccination-go-and-what-rights-do-new-zealanders-have-165317">How far should compulsory proof of vaccination go — and what rights do New Zealanders have?</a>
</strong>
</em>
</p>
<hr>
<h2>QR Codes and data privacy</h2>
<p>Another challenge is that individuals also need to continue scanning in with their contact-tracing app (preferably <a href="https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-resources-and-tools/nz-covid-tracer-app">NZ COVID Tracer</a>). These apps are generally designed as anonymous systems and all of the data stays on the user’s device. </p>
<p>The vaccine pass verifier app inherently needs to know the identity of the person, and it operates on the venue’s device, which doesn’t store any of the data and works offline. This is why the two apps and functionalities cannot be combined into one.</p>
<p>Inevitably, people will have to provide a vaccine pass and possibly a photo ID to confirm they are allowed to enter. Then the visitor will also have to scan in to keep their own record for contact tracing. It might be annoying, but that’s what we have to do to keep ourselves safe.</p>
<p>The official pass verifier app does not store any data, but there might be some exceptions in which certain businesses create their own apps. </p>
<p>Examples include ticketing, where a person’s vaccination status may have to be verified at the time of purchase rather than entry to the venue. Businesses with repeat customers, such as gyms, may also want to keep a record of their customers’ vaccination status to avoid having to check their pass each time they enter.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1465814236769099777"}"></div></p>
<p>The COVID-19 protection framework legislation includes privacy protection that ensures information about people’s vaccination status can only be collected, used or disclosed for the purposes of managing COVID-19, with heavy penalties for breaches. </p>
<h2>Are vaccine passes effective?</h2>
<p>One major question is whether the passes actually mitigate the risk to public health. </p>
<p>Evidence from other jurisdictions suggests vaccinated people <a href="https://www.healthline.com/health-news/vaccinated-people-can-transmit-the-coronavirus-but-its-still-more-likely-if-youre-unvaccinated">transmit COVID-19 less than unvaccinated people</a>, hence the effort to prevent unvaccinated people from entering venues to avoid the spread of the virus. But in a New Zealand context, it remains to be seen whether or not the vaccine passes are effective at suppressing the reproduction rate.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/no-vaccinated-people-are-not-just-as-infectious-as-unvaccinated-people-if-they-get-covid-171302">No, vaccinated people are not 'just as infectious' as unvaccinated people if they get COVID</a>
</strong>
</em>
</p>
<hr>
<p>The government has been using vaccine passes as an incentive for people to get vaccinated by preventing unvaccinated people from accessing venues they might otherwise want to enter. But this motivation expires when we reach a sufficient percentage of people who are vaccinated – and simply aiming for a vaccination percentage raises ethical issues.</p>
<p>We should keep coming back to the public health reasons for why we need people to be vaccinated and why we separate vaccinated and unvaccinated individuals. And to uphold that, we have to make sure vaccine passes are used effectively. </p>
<p>This means, at the very least, scanning the QR code to check the passes are legitimate. And we have to reduce the barriers for people to get their vaccine pass so they aren’t excluded for the wrong reasons. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/to-be-truly-ethical-vaccine-mandates-must-be-about-more-than-just-lifting-jab-rates-169612">To be truly ethical, vaccine mandates must be about more than just lifting jab rates</a>
</strong>
</em>
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<p>Vaccine passes come at a cost. It’s a cost financially to the government and taxpayers in developing the system. But there’s also a cost socially in terms of exacerbating inequities, and a cost ethically in terms of privacy and restrictions on people’s freedom of movement. </p>
<p>If we were to weaken the system to the extent that people can easily fake a vaccine pass, then we aren’t separating vaccinated and unvaccinated individuals effectively and make no progress towards mitigating public health risk. That would mean the existence of vaccine passes is not justified.</p><img src="https://counter.theconversation.com/content/172940/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew has provided independent advice to the Ministry of Health and the Department of Prime Minister and Cabinet as an academic but is not paid by them.</span></em></p>Vaccine passes are easy to fake. Unless venues and businesses make sure to verify them and check the identity of the pass holder, COVID will likely continue to spread.Andrew Chen, Research Fellow at Koi Tū: The Centre for Informed Futures, University of Auckland, Waipapa Taumata RauLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1726822021-11-29T19:10:23Z2021-11-29T19:10:23ZAs Aucklanders anticipate holiday trips, Māori leaders ask people to stay away from regions with lower vaccination rates<figure><img src="https://images.theconversation.com/files/434354/original/file-20211129-21-1k19mzg.jpg?ixlib=rb-1.1.0&rect=80%2C56%2C5273%2C3475&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Phil Walter/Getty Images</span></span></figcaption></figure><p>Despite the emergence of the new Omicron variant, New Zealand will move to a new <a href="https://covid19.govt.nz/traffic-lights/covid-19-protection-framework/">COVID-19 Protection Framework </a> this Friday, with a traffic light system to mark the level of freedoms for each region.</p>
<p>Auckland and other parts of the North Island that are battling active outbreaks or have low vaccination rates will start at red, which means hospitality and businesses will be largely open only for fully vaccinated people. The rest of the country will be in orange, which allows for larger gatherings but restricts access for those who remain unvaccinated. </p>
<p>From December 15, the Auckland boundary will lift and Aucklanders will be free to travel around the country, despite the ongoing community outbreak in which <a href="https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-data-and-statistics/covid-19-case-demographics#vaccinations-details">23% of cases have been children under 12 and 14% were fully vaccinated</a>.</p>
<figure class="align-center ">
<img alt="Map of traffic light COVID-19 Protection Framework" src="https://images.theconversation.com/files/434350/original/file-20211129-13-pa5w88.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/434350/original/file-20211129-13-pa5w88.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=849&fit=crop&dpr=1 600w, https://images.theconversation.com/files/434350/original/file-20211129-13-pa5w88.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=849&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/434350/original/file-20211129-13-pa5w88.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=849&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/434350/original/file-20211129-13-pa5w88.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1066&fit=crop&dpr=1 754w, https://images.theconversation.com/files/434350/original/file-20211129-13-pa5w88.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1066&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/434350/original/file-20211129-13-pa5w88.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1066&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Parts of the North Island will continue to have restrictions in place, particularly for people who remain unvaccinated, once New Zealand shifts to a new system on Friday.</span>
<span class="attribution"><span class="source">Provided</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<p>To travel outside the Auckland boundary, anyone aged 12 or over will need to be fully vaccinated or have had a negative COVID-19 test within three days of departure. This will reduce the number of infected people leaving Auckland, but cases will spread across the country as people travel to see whānau and go on holidays.</p>
<p>As part of our research to build a <a href="https://www.auckland.ac.nz/en/news/2021/04/15/super-model-for-team-of-5m.html">population-based contagion network</a>, we used electronic transaction data from previous years to derive movement patterns across the country. We show that during weeks without public holidays, just over 100,000 travellers left Auckland to visit one or more other regions. </p>
<p>For the summer period of 2019-2020, close to 200,000 people left Auckland each week, with travel peaking over the Christmas and New Year period. The most common destinations for these trips were Thames-Coromandel (30,000 people), Tauranga (17,000 people) and Northland (15,000 people).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/new-zealanders-are-super-connected-when-restrictions-lift-in-auckland-it-wont-take-much-to-amplify-deltas-spread-170542">New Zealanders are super-connected. When restrictions lift in Auckland, it won't take much to amplify Delta's spread</a>
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<hr>
<h2>Vaccination remains the best protection</h2>
<p>While full (two-dose) vaccination levels in Auckland are almost at 90% — remembering that 90% of eligible people means only about 75% of the total population, with lower rates for Māori — rates are much lower in many places Aucklanders like to visit over summer. This provides much less protection, against both illness and transmission, and any outbreak would be larger and more rapid. </p>
<p>Vaccination coverage in these areas is increasing but is unlikely to be at 90% before Christmas. Holiday destinations also have health infrastructure designed for the much lower local population and face additional pressures if visitors get sick.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1464684782017675268"}"></div></p>
<p>New Zealand’s outdoor summer lifestyle might be an advantage; transmission is greatly reduced outdoors with good air movement. But people should remain mindful anytime they move into an environment with less ventilation, such as using the toilet at the beach or sharing a car. A good rule of thumb is if you can smell perfume in the air then there’s a transmission risk.</p>
<p>COVID-19 is passed on through the air we breathe, which is why masking remains important, as long as the mask <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/proper-mask-wearing-coronavirus-prevention-infographic">fits properly</a>.</p>
<p>People planning to travel should reduce their risk of exposure during the two weeks before a trip.</p>
<ul>
<li><p>Skip the office party (especially if they are held indoors)</p></li>
<li><p>consider postponing meetings until after the holidays rather than having them during the days before people are likely to travel around the country</p></li>
<li><p>if you decide to go ahead, make sure gatherings and parties are outdoors</p></li>
<li><p>avoid alcohol as it can increase the likelihood of risky behaviour</p></li>
<li><p>limit yourself to one meeting per week (if someone is infected, you’ll have a better chance to find out and self-isolate before passing it on)</p></li>
<li><p>use your contact tracer app, always</p></li>
<li><p>shop online</p></li>
<li><p>wear a mask anywhere there is a crowd, even outdoors.</p></li>
</ul>
<h2>Protecting people in regions with lower vaccination rates</h2>
<p>Vaccination is the best step to reduce spread and symptom severity. But it’s not perfect. The risk of “breakthrough” infections depends on the intensity of exposure – short exposure to an infected person is less likely to result in infection and meeting indoors poses a higher risk. </p>
<p>When people are vaccinated, we’d expect to see most transmission happening in dwellings where people are together for long periods of time. For anyone with a breakthrough infection, vaccination approximately halves the chance of transmitting the virus.</p>
<p>Vaccination also reduces the risk of developing symptoms, and greatly reduces the risk of needing hospitalisation. But having milder symptoms can make it harder to detect cases, which means it remains important to get tested.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/vaccine-mandates-for-nzs-health-and-education-workers-are-now-in-force-but-has-the-law-got-the-balance-right-171392">Vaccine mandates for NZ’s health and education workers are now in force – but has the law got the balance right?</a>
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<hr>
<p>The most popular places New Zealanders like to visit over summer are remote and people living there haven’t had the same easy access to vaccination as those living in bigger cities. </p>
<p>Nearly a third of Northland’s eligible population remains unvaccinated, the East Cape is only 65% fully vaccinated and parts of the Coromandel Peninsula are also sitting well under ideal vaccination rates. </p>
<p>These places also have fewer testing facilities, which could mean outbreaks become harder to detect and manage. Many rural communities aren’t connected to town supply, so wastewater testing won’t be as useful, and emergency medical attention is harder to access. </p>
<h2>Planning to manage COVID infections</h2>
<p>Many residents in these remote towns, including <a href="https://waateanews.com/2021/11/18/border-opening-no-christmas-treat-for-taitokerau/">iwi leaders</a>, are <a href="https://tinangata.com/2021/11/21/painting-a-covid-picture/">asking holiday makers to stay away</a>, regardless of vaccination status. Māori are already disproportionately represented in our COVID-19 statistics and have more young people who can’t be vaccinated yet.</p>
<p>By travelling to areas with low vaccination rates among the Māori population we risk <a href="https://www.newsroom.co.nz/people-will-die-at-home-covids-unstoppable-summer">compounding tragedy</a> in places where health services would not cope with the level of illness.</p>
<p>Anyone choosing to go on holiday after weighing these factors should have a plan for what they’ll do if they or someone on their group develops COVID-like symptoms while away from their usual health support systems.</p>
<p>Questions to ask include: </p>
<ul>
<li><p>Where will you go to get a test?</p></li>
<li><p>What will you do while you wait for test results?</p></li>
<li><p>Will it be possible for you to self-isolate while you wait for a test result?</p></li>
<li><p>Where is the closest medical centre? Do they operate after hours? </p></li>
<li><p>Is there an ambulance service and how far is the nearest hospital?</p></li>
<li><p>Is there good phone reception? If not, what will you do in a health emergency?</p></li>
<li><p>How would you manage an outbreak in your holiday accommodation?</p></li>
</ul>
<p>Campers should take extra precautions by wearing masks in shared kitchens and bathrooms and using their own cleaning and hygiene products. They should keep good social distance wherever possible and minimise contact with people they don’t know.</p>
<p>Family gatherings will also bring together different generations, with elders who may be more vulnerable and younger people who are more mobile and more likely to be infected. A group of New Zealanders who experienced COVID-19 put together a <a href="https://docs.google.com/spreadsheets/d/1e2v-rOztBgQfFBKHJN0R59RrinRtq2RmjuFhEZP9JfM/edit#gid=0">management kit</a> with a list of things anyone travelling will find useful.</p>
<hr>
<p><em>We would like to acknowledge the contribution of Kylie Stewart, a member of the team at Te Pūnaha Matatini and the HRC-funded project <a href="https://www.auckland.ac.nz/en/news/2021/04/15/super-model-for-team-of-5m.html">Te Matatini o te Horapa</a> — a population-based contagion network for Aotearoa New Zealand.</em></p><img src="https://counter.theconversation.com/content/172682/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dion O'Neale receives funding from the Health Research Council and the Department of Prime Minister and Cabinet to provide research and advice on the spread of COVID-19 in Aotearoa, including the equity impacts of contagion. He is a Principal Investigator in Te Pūnaha Matatini.</span></em></p><p class="fine-print"><em><span>Andrew Sporle runs a research consultancy which receives funding from the Health Research Council, MBIE (via research projects at the Universities of Otago, Victoria and Auckland), The University of Auckland and Ministry of Social Development, Oranga Tamariki. He is a executive member of Te Mana Raraunga and the Virtual Health Information Network.</span></em></p><p class="fine-print"><em><span>Emily Harvey receives funding from the Health Research Council and the Department of Prime Minister and Cabinet to provide research and advice on the spread of COVID-19 in Aotearoa, including the equity impacts of contagion. She is a Principal Investigator in Te Pūnaha Matatini, and Senior Researcher at ME Research.</span></em></p><p class="fine-print"><em><span>Steven Turnbull receives funding from the Health Research Council and the Department of Prime Minister and Cabinet to provide research and advice on the spread of COVID-19 in Aotearoa, including the equity impacts of contagion. He is a Research Fellow in Te Pūnaha Matatini.</span></em></p>Vaccination and testing requirements will limit the number of infected people leaving Auckland, but cases are likely to spread across the country as people travel in the lead-up to the holiday season.Dion O'Neale, Lecturer - Department of Physics, University of Auckland; Principal Investigator - Te Pūnaha Matatini, University of Auckland, Waipapa Taumata RauAndrew Sporle, Honorary associate professor, University of Auckland, Waipapa Taumata RauEmily Harvey, Principal Investigator, Te Pūnaha Matatini, University of Auckland, Waipapa Taumata RauSteven Turnbull, Te Pūnaha Matatini Post-Doctoral Research Fellow, University of Auckland, Waipapa Taumata RauLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1722962021-11-22T19:11:06Z2021-11-22T19:11:06ZWill Australia follow Europe into a fourth COVID wave? Boosters, vaccinating kids, ventilation and masks may help us avoid it<figure><img src="https://images.theconversation.com/files/433027/original/file-20211122-23-7m16s5.jpg?ixlib=rb-1.1.0&rect=5%2C10%2C3373%2C2239&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://photos-cdn.aap.com.au/Image/20211120001598249730?path=/aap_dev2/imagearc/2021/11-20/d3/81/52/aapimage-7ihaosf7p5xfux9o2223_layout.jpg">AP Photo/Lisa Leutner</a></span></figcaption></figure><p>Europe is facing <a href="https://www.news.com.au/world/coronavirus/global/covid-fourth-wave-erupts-in-europe-as-who-declares-it-the-only-place-deaths-still-rising/news-story/7bb81d83bd1e2a7ef4404b32092edf91">a fourth wave of COVID</a>. As we watch on, it is reasonable to ask whether Australia will be confronted with the same fate. </p>
<p>Several factors will determine this: vaccination rates, high uptake of third dose boosters, vaccination of children and whether a comprehensive strategy of ventilation with <a href="https://ozsage.org/ventilation-and-vaccine-plus/">vaccine-plus</a> measures including masks, testing and tracing are used. </p>
<p>New <a href="https://ozsage.org/">OzSAGE</a> modelling for NSW <a href="https://ozsage.org/media_releases/updated-modelling-of-nsw-roadmap-nov-22-2021/">shows possible</a> increasing cases from mid-December with a predicted peak in February 2022, despite high vaccination rates. OzSAGE warns if contact tracing is not maintained and children 5–11 remain unvaccinated, hospitals may be overwhelmed again. But if we vaccinate young kids and maintain high testing and tracing, the outlook is good.</p>
<h2>If not for Delta …</h2>
<p>If the ancestral strains of the virus that dominated infections in 2020 were still in pole position, <a href="https://www.sciencedirect.com/science/article/pii/S0264410X21005016?via%3Dihub">we would now have COVID well controlled</a> in countries that achieved higher than 70% of the whole population vaccinated.</p>
<p>Unfortunately, just as the vaccines became available, new variants of concern began emerging. The currently dominant Delta variant raises the stakes because it is far more contagious and has some potential to <a href="https://www.nature.com/articles/s41586-021-03777-9">escape the protection</a> offered by vaccines. This means we need very high rates of vaccination across whole populations – probably over 90% of everyone vaccinated including younger children – to control the virus.</p>
<p>In addition, we need to start thinking about “fully vaccinated” being triple, not double, vaccinated. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/433040/original/file-20211122-23-wc3nl5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="covid cases by country graph" src="https://images.theconversation.com/files/433040/original/file-20211122-23-wc3nl5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/433040/original/file-20211122-23-wc3nl5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/433040/original/file-20211122-23-wc3nl5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/433040/original/file-20211122-23-wc3nl5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/433040/original/file-20211122-23-wc3nl5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/433040/original/file-20211122-23-wc3nl5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/433040/original/file-20211122-23-wc3nl5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=532&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"></span>
<span class="attribution"><a class="source" href="https://ourworldindata.org/covid-cases">World in Data</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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</figure>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/no-vaccinated-people-are-not-just-as-infectious-as-unvaccinated-people-if-they-get-covid-171302">No, vaccinated people are not 'just as infectious' as unvaccinated people if they get COVID</a>
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</em>
</p>
<hr>
<h2>Boosters are key</h2>
<p>Patchy third dose booster policies in Europe may partially be to blame for the COVID surges we are seeing in countries there now. </p>
<p>Germany, for example, in October recommended boosters for people 70 years and over and certain risk groups. On November 18, it belatedly <a href="https://www.dw.com/en/covid-germany-recommends-booster-shot-for-everyone-over-18/a-59852732">changed the recommendation</a> to people aged 18 years and over in response to the large resurgence of COVID.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/433024/original/file-20211122-25-oqevdc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Seriously ill hospital patient" src="https://images.theconversation.com/files/433024/original/file-20211122-25-oqevdc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/433024/original/file-20211122-25-oqevdc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/433024/original/file-20211122-25-oqevdc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/433024/original/file-20211122-25-oqevdc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/433024/original/file-20211122-25-oqevdc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/433024/original/file-20211122-25-oqevdc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/433024/original/file-20211122-25-oqevdc.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">Germany has entered into a ‘nationwide state of emergency’ because of surging COVID infections.</span>
<span class="attribution"><a class="source" href="https://photos-cdn.aap.com.au/Image/20211120001598271438?path=/aap_dev4/device/imagearc/2021/11-20/3f/cf/11/aapimage-7ihbkmxfj2d724031inh_layout.jpg">Matthias Balk/dpa via AP</a></span>
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</figure>
<p>France, too, has been slow and restrictive in making boosters available for adults, with people over 50 <a href="https://edition.cnn.com/2021/11/09/europe/france-covid-19-booster-intl/index.html">eligible</a> from this December. Likewise, Ireland only <a href="https://www.euractiv.com/section/politics/short_news/ireland-extends-vaccination-booster-shot-programme/">approved boosters</a> for people 60 years and over at the end of October.</p>
<p>The evidence is clear that <a href="https://theconversation.com/australians-will-soon-receive-covid-booster-vaccines-why-do-we-need-them-and-how-effective-are-they-170368">boosters are needed</a>. So, on the background of <a href="https://ourworldindata.org/covid-vaccinations?country=OWID_WRL">inadequate vaccination rates</a> ranging from 64% in Austria to 76% in Denmark, a slow and restrictive approach to boosters, together with abandoning other measures such as masks, has left many European countries vulnerable. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australians-will-soon-receive-covid-booster-vaccines-why-do-we-need-them-and-how-effective-are-they-170368">Australians will soon receive COVID booster vaccines. Why do we need them, and how effective are they?</a>
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</em>
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<hr>
<p>Austria, with one of the lowest vaccination rates, has one of the highest rates of COVID, prompting it to be the first European country to <a href="https://www.theguardian.com/world/2021/nov/19/austria-plans-compulsory-covid-vaccination-for-all">mandate vaccines</a>.</p>
<p>Much of the fourth wave is also being driven by transmission in children. The EU has been slow to approve vaccines for younger children, prompting Austria to commence vaccinating children <a href="https://www.nytimes.com/2021/11/05/world/europe/vienna-vaccinate-young-children.html">without EU approval</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/433039/original/file-20211122-19-mubm8l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="vaccination by country graph" src="https://images.theconversation.com/files/433039/original/file-20211122-19-mubm8l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/433039/original/file-20211122-19-mubm8l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/433039/original/file-20211122-19-mubm8l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/433039/original/file-20211122-19-mubm8l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/433039/original/file-20211122-19-mubm8l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/433039/original/file-20211122-19-mubm8l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/433039/original/file-20211122-19-mubm8l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=532&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="attribution"><a class="source" href="https://ourworldindata.org/covid-vaccinations">World in Data</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<h2>Too much reliance on vaccines?</h2>
<p>The fourth wave follows the relaxation of COVID restrictions like masks, density limits, testing and tracing; and failure to address <a href="https://ozsage.org/wp-content/uploads/2021/09/Safe-Indoor-Air-advice.pdf">safe indoor air</a>. </p>
<p>The Delta virus is a tenacious beast, and the <a href="https://theconversation.com/relying-only-on-vaccination-in-nsw-from-december-1-isnt-enough-heres-what-we-need-for-sustained-freedom-168833">vaccine alone is not enough</a> to tame it. Country after country has shown this, including Denmark, which ceased all restrictions, including masks in September and is <a href="https://edition.cnn.com/2021/11/09/europe/denmark-restrictions-europe-covid-intl/index.html">now facing a large surge in cases</a> despite relatively high vaccination rates.</p>
<p>The prospect of a fourth wave also depends on the epidemiology of SARS-CoV-2. There is a high probability new variants will emerge that will challenge us further, either because they are even more contagious or more vaccine-resistant. </p>
<p>That said, we have seen spectacular advances in science, with vaccines produced in less than a year. There are many more second generation vaccines and matched boosters in the pipeline, and <a href="https://www.cnbc.com/2021/11/17/how-covid-antiviral-drugs-from-merck-and-pfizer-work-effectiveness.html">promising new antivirals</a> for early treatment. So our ability to fight this virus will keep improving.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/pfizers-pill-is-the-latest-covid-treatment-to-show-promise-here-are-some-more-171589">Pfizer's pill is the latest COVID treatment to show promise. Here are some more</a>
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</em>
</p>
<hr>
<h2>What about Australia then?</h2>
<p>So will Australia also face a fourth wave? Yes, it’s likely because SARS-CoV-2 is an epidemic infection. It will continue to cause the waxing and waning cycles of true epidemic infections just like smallpox did for thousands of years, and like measles still does. However, it’s possible <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30633-2/fulltext">we can achieve elimination of COVID</a> just as we have with measles, and only see small outbreaks. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/433059/original/file-20211122-27-67hz6u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="patterns of disease graph" src="https://images.theconversation.com/files/433059/original/file-20211122-27-67hz6u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/433059/original/file-20211122-27-67hz6u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=387&fit=crop&dpr=1 600w, https://images.theconversation.com/files/433059/original/file-20211122-27-67hz6u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=387&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/433059/original/file-20211122-27-67hz6u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=387&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/433059/original/file-20211122-27-67hz6u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=486&fit=crop&dpr=1 754w, https://images.theconversation.com/files/433059/original/file-20211122-27-67hz6u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=486&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/433059/original/file-20211122-27-67hz6u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=486&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="attribution"><span class="license">Author provided</span></span>
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<p>If we’re successful, outbreaks may still occur – but they will not become sustained or uncontrollable. Here’s what Australia can learn from Europe and other countries:</p>
<ul>
<li><p>firstly, we need to aim for at least 90% of the whole population vaccinated – this should be done equitably for all states and territories, for remote and regional areas and for all subgroups including children</p></li>
<li><p>we need to be agile and responsive to evidence, including the need for subsequent boosters. If a new vaccine or Delta-matched booster comes along that improves protection, we need to add that to the tool box rapidly </p></li>
<li><p>childcare and schools are fast becoming the <a href="https://www.smh.com.au/politics/federal/experts-warn-childcare-will-be-the-next-covid-frontline-as-sector-calls-for-safety-plan-20211026-p5933q.html">new frontier of COVID</a>. We must ensure <a href="https://ozsage.org/media_releases/back-to-school-protecting-children-from-covid-19-and-making-schools-and-childcare-safer/">safe indoor air, masks and vaccination for younger children</a> by the time students return from summer holidays in 2022</p></li>
<li><p>vaccines alone are not enough, so let’s not be like Denmark and embark on magical thinking. We need to address <a href="https://youtu.be/nWnOR3O-ZF0">safe indoor air</a> and have a vaccine-plus strategy. That means masks in indoor settings, maintaining high testing and tracing levels, protecting younger kids until they are eligible for vaccination and ensuring high uptake of boosters. </p></li>
</ul>
<p>If we acknowledge the airborne transmission of COVID and <a href="https://theconversation.com/the-pressure-is-on-for-australia-to-accept-the-coronavirus-really-can-spread-in-the-air-we-breathe-160641">adopt effective ways of preventing</a> this virus, we can defeat it. </p>
<p>But that requires a layered, comprehensive strategy of ventilation, vaccine-plus measures and the ability to move quickly with evidence as it becomes available. </p>
<p>New vaccines and new ways of employing them are hopefully on their way. Until they eventuate, we’ll need to be ambitious in our COVID strategy and keep using ventilation, masks and other measures to avoid a severe fourth wave.</p><img src="https://counter.theconversation.com/content/172296/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Raina MacIntyre is a member of the WHO COVID-19 Vaccine Composition Technical Advisory group, a member of OzSAGE, and has consulted for or been on advisory boards for Janssen, AstraZeneca and Seqirus on COVID-19 vaccines. She has been on advisory boards for Sanofi and Seqirus for influenza vaccines in the past 5 years. She is currently working on a clinical trial of a non-COVID vaccine for Moderna. She currently receives funding from NHMRC (Principal Research Fellowship, Centre for Research Excellence) and the Medical Research Futures Fund, and has done COVID 19 modelling for the Tasmanian Government.</span></em></p>For starters, we need to start thinking of fully vaccinated as three doses, not two. But vaccines alone won’t be enough.C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1686362021-11-10T13:40:52Z2021-11-10T13:40:52ZThe chickenpox virus has a fascinating evolutionary history that continues to affect peoples’ health today<figure><img src="https://images.theconversation.com/files/429786/original/file-20211102-19-1gjsqqg.jpg?ixlib=rb-1.1.0&rect=57%2C0%2C5406%2C3489&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Most children today receive the chickenpox vaccine as a routine part of childhood immunizations. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/chickenpox-royalty-free-image/1144939011?adppopup=true">Solidcolours/E+ via Getty Images</a></span></figcaption></figure><p>In July 2021, a Centers for Disease Control and Prevention presentation <a href="https://www.washingtonpost.com/context/cdc-breakthrough-infections/94390e3a-5e45-44a5-ac40-2744e4e25f2e/">obtained by the press</a> noted that the delta variant of COVID-19 “is as transmissible as chickenpox.” </p>
<p>As some researchers have pointed out, <a href="https://www.npr.org/sections/goatsandsoda/2021/08/11/1026190062/covid-delta-variant-transmission-cdc-chickenpox">the CDC’s comparison was an overstatement</a>. Based on various studies and projections, on average a person infected with the delta strain of COVID-19 can infect six or seven people, whereas someone infected with chickenpox can infect nine or 10. Nonetheless, both diseases are highly contagious, although the viruses that cause them are very different.</p>
<p>While many diseases, such as <a href="https://www.cdc.gov/vhf/ebola/about.html">Ebola</a> and <a href="https://theconversation.com/influenzas-wild-origins-in-the-animals-around-us-91058">influenza</a>, originate from viruses that made relatively recent “jumps” from animals to humans, other disease-causing pathogens have been with humans throughout evolution. The virus that causes chickenpox is one of these, coexisting with the human evolutionary line for <a href="https://doi.org/10.1128/JVI.00357-12">millions of years</a>. </p>
<p>I am a microbiologist interested in <a href="https://biology.indiana.edu/about/faculty/foster-patricia.html">pathogens and the diseases they cause</a>. Chickenpox is a childhood disease, and until a couple of decades ago, nearly <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/chickenpox">all children in the United States got it</a>. A vaccine campaign that began in the 1990s has made the disease rare in children in the U.S., but the virus lingers in the body and can reappear in unvaccinated adults years later as shingles. The virus’s ability to do this disappearing-and-reappearing trick may be the key to its <a href="https://doi.org/10.1128/JVI.00357-12">long evolutionary history</a>.</p>
<h2>Chickenpox and shingles stem from the same virus</h2>
<p>I became painfully aware of the virus that causes chickenpox a few years ago when my husband developed shingles soon after starting a stressful job. <a href="https://doi.org/10.1111/bjd.19832">Chronic stress is one trigger</a> for reactivation of the dormant virus, as it is for the closely related <a href="https://doi.org/10.3389/fmicb.2019.00016">herpes viruses</a>.</p>
<p>The virus that causes both chickenpox and shingles, varicella-zoster, is only known to <a href="https://doi.org/10.1038/nrdp.2015.16">infect humans</a>. “Varicella” means “<a href="https://www.merriam-webster.com/dictionary/varicella">little variola</a>,” or little smallpox, because both diseases cause skin blisters.</p>
<figure class="align-center ">
<img alt="Varicella zoster (chickenpox) virus, illustration." src="https://images.theconversation.com/files/427906/original/file-20211021-22-18g4m4p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427906/original/file-20211021-22-18g4m4p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=429&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427906/original/file-20211021-22-18g4m4p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=429&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427906/original/file-20211021-22-18g4m4p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=429&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427906/original/file-20211021-22-18g4m4p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=540&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427906/original/file-20211021-22-18g4m4p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=540&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427906/original/file-20211021-22-18g4m4p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=540&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Varicella-zoster, the virus depicted in this illustration, causes both chickenpox in children and shingles in adults.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/varicella-zoster-viruses-illustration-royalty-free-illustration/1209159885?adppopup=true">Roger Harris/Science Photo Library/Science Photo Library via Getty Images</a></span>
</figcaption>
</figure>
<p>Shingles is known in medical terms as herpes zoster. Both “zoster” and “shingles” derive from words for belt or girdle in <a href="https://www.merriam-webster.com/dictionary/zoster">Greek</a> and <a href="https://www.merriam-webster.com/dictionary/shingles">Latin</a>, respectively, referring to the typical arrangement of blisters on the torso during shingles outbreaks. </p>
<h2>Chickenpox is primarily a childhood disease</h2>
<p>Chickenpox is spread by inhalation, and children are infectious a few days before <a href="https://www.cdc.gov/chickenpox/about/transmission.html">symptoms appear</a>. The blisters also contain live viruses that can become <a href="https://doi.org/10.1038/nrdp.2015.16">airborne and inhaled</a> or can be transmitted through direct contact. After inhalation, chickenpox viruses invade the cells of the respiratory tract, replicate in the lymph nodes and are spread by white blood cells throughout the body. Eventually, they <a href="https://www.cdc.gov/vaccines/pubs/pinkbook/varicella.html">lodge in the skin</a>, causing the itchy blisters that are characteristic of the disease.</p>
<p>In healthy children, chickenpox lasts about a week and goes away without medical intervention. But it can be more severe in adolescents, adults and people with compromised immune systems. Infection with chickenpox typically provides <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/chickenpox">lifelong immunity to reinfection</a>.</p>
<h2>Shingles mostly affects older adults</h2>
<p>Even after the chickenpox blisters are gone, the varicella-zoster virus is not. The viruses travel to nerve root clusters <a href="https://www.cdc.gov/vaccines/pubs/pinkbook/herpes-zoster.html">located along the spinal cord</a>. There, the viruses establish a persistent, dormant state in the <a href="https://doi.org/10.1038/nrdp.2015.16">nuclei of the nerve cells</a>.</p>
<p>Over the course of a person’s life, the viruses may reactivate, but usually the immune system eliminates the active viruses before they can appear as shingles. However, as the immune system weakens with age, or as a result of illness or stress, reactivated viruses can travel back along the nerves and erupt again as painful blisters. Typically, only one nerve-root cluster is involved, and the blisters appear in the area of the skin supplied by those nerves. This leads to the classic <a href="https://www.cdc.gov/vaccines/pubs/pinkbook/herpes-zoster.html">belt-like appearance</a>, although the blisters can localize to other areas of the skin.</p>
<p>Although even children can develop shingles, the risk of that happening and the severity of the disease increases sharply after the age of 50. The CDC estimates that 1 in 3 people in the U.S. <a href="https://www.cdc.gov/shingles/surveillance.html">will have shingles</a> at some point in their lives. In healthy adults, a shingles outbreak typically lasts from seven to 10 days; however, about 15% of shingles sufferers develop persistent, often debilitating, neurological pain, called <a href="https://doi.org/10.1038/nrdp.2015.16">postherpetic neuralgia</a>, that can last for months or even years. </p>
<h2>Varicella-zoster has a long, slow evolutionary history</h2>
<p>Unlike the COVID-19 and influenza viruses, which have genomes of <a href="https://asm.org/Articles/2020/July/COVID-19-and-the-Flu">single-stranded RNA</a>, varicella-zoster’s genome is double-stranded DNA. This makes its genome more stable and able to be copied more accurately than <a href="https://doi.org/10.1128/JVI.00694-10">single-stranded RNA genomes</a>. </p>
<p>Although experts disagree on the exact rate at which varicella-zoster accumulates genetic changes, called mutations, a reasonable estimate of its evolution rate is one new mutation every <a href="https://doi.org/10.1099/0022-1317-75-3-513">200</a> to <a href="https://doi.org/10.1371/journal.pone.0022527">400</a> years. This rate is in contrast to influenza, for example, whose RNA genome is copied so sloppily that it accumulates about 40 new mutations every year, according to my calculations based on <a href="https://doi.org/10.1128/JVI.02163-13">data published here</a>. </p>
<p>Varicella-zoster is a member of a large group of viruses, the Herpesviridae, that <a href="https://doi.org/10.1007/s00705-008-0278-4">infect mammals, birds and reptiles</a>. Although there have been some “<a href="https://doi.org/10.1093/ve/veab025">jumps” between hosts in the distant past</a>, these viruses tend to infect only specific hosts. Thus, scientists can deduce the evolutionary history of the viruses by looking at the known <a href="https://doi.org/10.1006/jmbi.1995.0152">evolutionary relationships of their hosts</a>. </p>
<p>Such analyses indicate that the viruses that eventually led to varicella-zoster and its relatives existed 200 million years ago in the <a href="https://doi.org/10.1093/ve/veab025">Triassic/Jurassic period</a> – the age of dinosaurs! The closest existing relative to varicella-zoster infects an <a href="https://doi.org/10.1006/viro.2001.0912">old-world monkey</a>. The evolutionary lines that led to humans and old-world monkeys split <a href="https://doi.org/10.1093/molbev/msg050">23 million years ago</a>; thus, our cohabitation with varicella-zoster goes back at least that far.</p>
<p>Recent DNA analysis of varicella-zoster strains currently infecting humans complicates this history somewhat. The data indicates that the virus is accumulating <a href="https://doi.org/10.1093/infdis/jiz227">mutations faster</a> than would be consistent with its evolutionary history, and that the ancestor of the current strains appeared only <a href="https://doi.org/10.1093/molbev/msu406">about 8,000 years ago</a>. Such discrepancies between short-term and long-term evolutionary rates have appeared in <a href="https://doi.org/10.1016/j.cub.2021.08.020">numerous similar studies</a>, and scientists are <a href="https://doi.org/10.1146/annurev-ecolsys-011921-023644">currently analyzing why this is so</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/429783/original/file-20211102-39236-xwqges.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Close-up of Shingles vaccine with syringe in background." src="https://images.theconversation.com/files/429783/original/file-20211102-39236-xwqges.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/429783/original/file-20211102-39236-xwqges.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/429783/original/file-20211102-39236-xwqges.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/429783/original/file-20211102-39236-xwqges.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/429783/original/file-20211102-39236-xwqges.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/429783/original/file-20211102-39236-xwqges.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/429783/original/file-20211102-39236-xwqges.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The CDC recommends that all adults age 50 and older get vaccinated for shingles.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/shingles-vaccine-syringe-stock-photo-royalty-free-image/1264660305?adppopup=true">Fotolgahan/iStock via Getty Images Plus</a></span>
</figcaption>
</figure>
<p>The ability to enter a latent state may have given varicella-zoster a survival advantage. Ancient hunter-gatherers would have lived in small groups where an outbreak of chickenpox could have infected the whole population. <a href="https://doi.org/10.1128/JVI.00357-12">A credible theory</a> proposed by Charles Grose, a pediatric infectious disease specialist at the University of Iowa, holds that, since chickenpox conveys lifelong immunity, the survivors could not be reinfected. And without new hosts, the virus would die out. However, by persisting for years in survivors in its latent state, varicella-zoster could reappear after a new generation of children was born. Since the shingles blisters are infectious, these children would get chickenpox and a new cycle would begin.</p>
<h2>Vaccines for chickenpox and shingles are effective</h2>
<p>Prior to 1995, when the chickenpox vaccine was introduced, nearly all U.S. children got infected with <a href="https://doi.org/10.1038/nrdp.2015.16">chickenpox by age 10</a>. Although usually mild, rare complications resulted in more than <a href="https://www.cdc.gov/chickenpox/vaccine-infographic.html">10,000 hospitalizations and 100 deaths per year</a>. </p>
<p>The two-dose vaccine has resulted in greater than 90% protection against infection. Currently the vaccination rate among schoolchildren <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7003a2.htm">approaches 95%</a>. By preventing the virus from spreading, this level of vaccination <a href="https://www.cdc.gov/vaccines/pubs/pinkbook/varicella.html">protects unvaccinated children</a> through <a href="https://theconversation.com/what-is-herd-immunity-a-public-health-expert-and-a-medical-laboratory-scientist-explain-170520">herd immunity</a>. </p>
<p>The chickenpox vaccine is a live, attenuated varicella-zoster strain that, like the original strain, stays in the body in a dormant state. But the vaccine strain is <a href="https://doi.org/10.1542/peds.2018-2917">weakened for activation</a>, and as of 2016 <a href="https://doi.org/10.1093/cid/ciy954">data show</a> that children vaccinated for chickenpox develop shingles less frequently than children did when chickenpox was common. Public health experts do not yet know whether the rate of vaccine-derived shingles will rise as the vaccinated population ages and becomes more susceptible to the disease.</p>
<p>Shingrix, an effective, protein-based vaccine against shingles, has been available since 2017. The CDC recommends <a href="https://www.cdc.gov/shingles/multimedia/shringrix-50-older.html">everyone over age 50 to get vaccinated</a> for shingles, whether or not they have had chickenpox, shingles or have been vaccinated with Zostavax – a former shingles vaccine that was less effective. Shingrix reduces the incidence of shingles an average of 97% and, if a case occurs, reduces the <a href="https://www.cdc.gov/vaccines/vpd/shingles/public/shingrix/index.html#how-well-does-shingrix-work">incidence of postherpetic neuralgia by 91%</a>.</p>
<p>Vaccination requires two doses and is known, so far, to be protective for <a href="https://doi.org/10.1093/infdis/jiab387">at least 10 years</a>. As of 2018, <a href="https://www.cdc.gov/nchs/products/databriefs/db370.htm?deliveryName=USCDC_171-DM32740">34.5% of U.S. adults 60 and over</a> were vaccinated against shingles, most with Zostavax.</p>
<p>With effective vaccines against both chickenpox and shingles now available, I believe that the countries with high vaccination rates could eventually be free of both of the diseases caused by varicella-zoster – ultimately making the chickenpox-shingles duo go the way of the dinosaurs.</p>
<p>[<em>Get our best science, health and technology stories.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-best">Sign up for The Conversation’s science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/168636/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Patricia L. Foster is affiliated with the Union of Concerned Scientists and Concerned Scientists at Indiana University.</span></em></p>Chickenpox has largely disappeared from the public’s memory thanks to a highly effective vaccine. But the virus’s clever life cycle allows it to reappear in later adulthood in the form of shingles.Patricia L. Foster, Professor Emerita of Biology, Indiana UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1697172021-10-20T23:45:42Z2021-10-20T23:45:42ZNew Zealand’s mass vaccination event lifts uptake but highlights dangerous inequities as the country prepares to open up<figure><img src="https://images.theconversation.com/files/427639/original/file-20211020-63784-1241abu.jpg?ixlib=rb-1.1.0&rect=48%2C72%2C5343%2C3176&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Jacinda Ardern and partner Clarke Gayford visit a pop-up vaccination clinic on 'Super Saturday'.</span> <span class="attribution"><span class="source">Hagen Hopkins/Getty Images</span></span></figcaption></figure><p>New Zealand’s mass vaccination event last Saturday, when more than 130,000 people turned up to get their first or second dose, surpassed Prime Minister Jacinda Ardern’s expectations. </p>
<p>Super Saturday and a televised “vaxathon” were part of the government’s push towards a 90% vaccination goal. About 85% of New Zealanders have now had their first dose, and <a href="https://www.health.govt.nz/news-media/media-releases/super-saturday-covid-19-vaccination-data-update">65% of the population are fully vaccinated</a>. </p>
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<p>But only 65% of the Māori population have had their first dose. By ethnicity, Māori had the highest proportion of first doses on Super Saturday, with 50% of all Māori vaccinations being the first dose. </p>
<p>The mass vaccination showed that improved access through pop-up and walk-in clinics, community events and <a href="https://heartofthecity.co.nz/article/what-city-centre-doing-support-super-saturday">free transportation</a> can make a big difference in uptake. But it also highlighted ongoing gaps and structural inequities in New Zealand’s vaccine rollout. </p>
<p>Ardern is expected to announce a new system this week to replace the current COVID-19 alert levels and to ease restrictions gradually, once higher vaccination rates are achieved across the population.</p>
<p>Tairāwhiti had the lowest Super Saturday turnout, and the region also has some of the worst access to vaccination services. The East Cape is served by just two permanent facilities and, as of October 19, there were no appointments available within <a href="https://www.waikato.ac.nz/nidea/access-to-vaccination-services">the next week</a>. </p>
<p>Out of concern that public health protections could be removed before people in the region had a chance to get vaccinated, members of the Te Aroha Kanarahi Trust decided to <a href="https://www.rnz.co.nz/news/national/453741/tairawhiti-trust-floored-and-thankful-at-money-donated-for-vaccination-van">take matters into their own hands</a> and crowd-fund for a mobile vaccination clinic. </p>
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Read more:
<a href="https://theconversation.com/new-zealand-cannot-abandon-its-covid-elimination-strategy-while-maori-and-pasifika-vaccination-rates-are-too-low-168278">New Zealand cannot abandon its COVID elimination strategy while Māori and Pasifika vaccination rates are too low</a>
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<h2>Access and availability</h2>
<p>Issues of access and availability are similar for rural towns and regions across Aotearoa New Zealand. </p>
<p>Rural areas have <a href="https://www.stuff.co.nz/national/health/coronavirus/126655152/covid19-rural-vaccinations-falling-behind-urban-counterparts-research-reveals">lower vaccination rates</a> than urban areas and the gap is widest in the most remote regions. Access to vaccination services is worse in rural areas, particularly <a href="https://www.theguardian.com/world/2021/oct/20/in-kawerau-one-thing-impedes-the-effort-to-vaccinate-maori-new-zealands-history">rural Māori communities</a>. The vaccination rate for rural Māori is <a href="https://www.otago.ac.nz/news/news/otago833708.html">10% lower than for urban Māori</a>. </p>
<p>As commentator Morgan Godfery <a href="https://www.theguardian.com/world/2021/oct/20/in-kawerau-one-thing-impedes-the-effort-to-vaccinate-maori-new-zealands-history">points out</a>, the high levels of government distrust and socioeconomic constraint exacerbate issues of inequitable access. </p>
<p>Recently, the Ministry of Health released suburb-level <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/covid-19-vaccination-uptake-rates-across-nz">COVID-19 vaccination rates</a> for the first time. There was an inevitable rush to see which towns were doing the best, and who was lagging behind. </p>
<figure class="align-center ">
<img alt="This map shows travel times to vaccination centres with appointments available within seven days." src="https://images.theconversation.com/files/427638/original/file-20211020-16-1evq7q9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427638/original/file-20211020-16-1evq7q9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=847&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427638/original/file-20211020-16-1evq7q9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=847&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427638/original/file-20211020-16-1evq7q9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=847&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427638/original/file-20211020-16-1evq7q9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1065&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427638/original/file-20211020-16-1evq7q9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1065&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427638/original/file-20211020-16-1evq7q9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1065&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">This map shows travel times to vaccination centres with appointments available within seven days.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Murupara was <a href="https://www.rnz.co.nz/news/national/453117/vaccinations-by-suburb-data-murupara-slowest-in-nz">identified</a> as the nation’s “slowest town”. However, this title is unhelpful, and misses a lot of important contextual information. </p>
<p>One reason Murupara’s vaccination rates are low is that the town has one of the lowest levels of <a href="https://www.waikato.ac.nz/nidea/access-to-vaccination-services">access</a> to vaccination services in Aotearoa. The nearest permanent vaccination site is more than a 50-minute drive away. </p>
<p>Another reason is that most residents haven’t even been eligible for the vaccine until early September. The median age of Murupara in 2018 was <a href="https://www.stats.govt.nz/tools/2018-census-place-summaries/murupara">29 years</a>, placing most people firmly at the tail end of <a href="https://covid19.govt.nz/covid-19-vaccines/how-to-get-a-covid-19-vaccination/covid-19-vaccine-rollout-groups/">Group 4</a> of the vaccination rollout. </p>
<p>On the other hand, suburbs in central Auckland, Wellington and Queenstown – “leading the way” with high first-dose vaccination rates – tend to have good access to vaccination services. Of the top 30 “most-vaxed” suburbs, the longest drive time to a vaccination centre was just five minutes. </p>
<figure class="align-center ">
<img alt="Queue of people waiting to be vaccinated." src="https://images.theconversation.com/files/427642/original/file-20211020-15011-1bdbnmg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427642/original/file-20211020-15011-1bdbnmg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427642/original/file-20211020-15011-1bdbnmg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427642/original/file-20211020-15011-1bdbnmg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427642/original/file-20211020-15011-1bdbnmg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427642/original/file-20211020-15011-1bdbnmg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427642/original/file-20211020-15011-1bdbnmg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">More than 130,000 people received their first or second vaccine dose during a mass vaccination event last Saturday.</span>
<span class="attribution"><span class="source">Fiona Goodall/Getty Images</span></span>
</figcaption>
</figure>
<h2>Long-running structural inequities</h2>
<p>Associating neighbourhood ethnic composition with <a href="https://twitter.com/marcdaalder/status/1445964020171771912">vaccination uptake</a> also masks key contextual information and risks creating a racist pile-on. It hides the structural inequities within Aotearoa’s health system, and the vaccination rollout specifically, by placing the blame for low vaccination on individuals and communities. </p>
<p>Neighbourhoods with a high proportion of Māori residents have younger populations, <a href="https://researchcommons.waikato.ac.nz/handle/10289/14271">worse access to health services</a>, more experiences of <a href="https://doi.org/10.1016/j.puhe.2019.03.027">racism</a> within the <a href="https://doi.org/10.1111/1753-6405.12835">health system</a>, higher levels of <a href="https://www.taylorfrancis.com/chapters/edit/10.4324/9781315465456-18/cities-indigenous-communities-john-ryks-naomi-simmonds-jesse-whitehead">poverty</a>, and worse access to <a href="https://journal.nzma.org.nz/journal-articles/will-access-to-covid-19-vaccine-in-aotearoa-be-equitable-for-priority-populations-open-access">COVID-19 vaccination services</a>. </p>
<p>Findings from <a href="https://www.science.org/doi/10.1126/sciadv.abj2099">international research</a> suggest we need geographic and ethnic targeting of vaccination programmes to address inequitable outcomes, including a higher risk of death. Te Rōpū Whakakaupapa Urutā have been calling for this approach in <a href="https://www.nzherald.co.nz/nz/dr-rawiri-jansen-no-maori-age-priority-in-covid-19-vaccine-rollout-a-complete-failure/IHVUKN7ZYTRA7C6G36NK2P27HY/?ref=readmore">Aotearoa</a>. </p>
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Read more:
<a href="https://theconversation.com/nz-needs-a-more-urgent-vaccination-plan-with-nearly-80-now-single-dosed-the-majority-will-support-it-168926">NZ needs a more urgent vaccination plan — with nearly 80% now single-dosed, the majority will support it</a>
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<p>We have long known that Māori, Pasifika and poorer populations are at the highest risk of COVID-19 infection and death, and are likely to have the <a href="https://journal.nzma.org.nz/journal-articles/will-access-to-covid-19-vaccine-in-aotearoa-be-equitable-for-priority-populations-open-access">worst access to vaccination services</a>. </p>
<p>The age-based sequencing of the vaccination rollout was rational and important for prioritising older people who are at a higher risk of COVID-19 infection, hospitalisation and death. But rational policies can result in <a href="https://doi.org/10.1016/j.apgeog.2015.01.020">discriminatory outcomes</a>. </p>
<p>By default, prioritising by age meant <em>de-prioritising</em> the elevated risks <a href="https://journal.nzma.org.nz/journal-articles/estimated-inequities-in-covid-19-infection-fatality-rates-by-ethnicity-for-aotearoa-new-zealand">Māori, Pasifika and poorer populations</a> face. </p>
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Read more:
<a href="https://theconversation.com/research-shows-maori-are-more-likely-to-die-from-covid-19-than-other-new-zealanders-145453">Research shows Māori are more likely to die from COVID-19 than other New Zealanders</a>
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<p>Māori and Pasifika have much <a href="http://nzdotstat.stats.govt.nz/">younger age structures</a>, with median ages of 25.6 and 23.7 respectively, compared to 41.2 for European New Zealanders. During the Delta outbreak, this means a large proportion of Māori and Pasifika people remain unvaccinated and at risk. </p>
<p>In fact, more than 25% of both Māori and Pasifika communities can’t be vaccinated because they are children <a href="http://nzdotstat.stats.govt.nz/">under the age of 12</a>.</p>
<p>Vaccination rates need to be very high, across the country, for all communities, before we open up. As the pressure mounts on communities to adopt the “individual armour of vaccination” before protective public health measures are removed, we need to shift resources and control over vaccination programmes to local solutions. </p>
<p>Māori and Pasifika community organisations and leaders need the resources, support and <a href="https://www.waipareira.com/why-maori-are-lagging-behind-in-vaccinations/">data</a> required to enable them to reach and vaccinate their people.</p><img src="https://counter.theconversation.com/content/169717/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jesse Whitehead receives funding from the Health Research Council of New Zealand and the National Science Challenge</span></em></p>As pressure mounts to adopt the “individual armour of vaccination” before public health measures are removed, New Zealand needs to shift resources and control to locally run vaccination programmes.Jesse Whitehead, Postdoctoral Researcher, University of WaikatoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1699262021-10-15T02:00:56Z2021-10-15T02:00:56ZWhy Jacinda Ardern’s ‘clumsy’ leadership response to Delta could still be the right approach<figure><img src="https://images.theconversation.com/files/426591/original/file-20211015-27-1j6j5ni.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5391%2C3589&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">GettyImages</span></span></figcaption></figure><p>Leading people through the pandemic is clearly no easy task. But does the <a href="https://www.rnz.co.nz/news/political/453182/the-week-in-politics-transition-confusion-and-auckland-s-road-to-nowhere">criticism</a> currently directed at New Zealand Prime Minister Jacinda Ardern reveal a major misstep on her part, or something deeper about the nature of leadership itself?</p>
<p>Ardern has previously won widespread <a href="https://www.washingtonpost.com/opinions/2020/08/25/yes-new-zealand-is-confronting-new-coronavirus-outbreak-its-still-way-ahead-us/">praise</a> for her COVID-19 response and crisis communication, topping Fortune magazine’s “<a href="https://fortune.com/worlds-greatest-leaders/2021/">world’s greatest leaders</a>” list in 2021. </p>
<p>Focused on minimising harm to both lives and livelihoods, her <a href="https://journals.sagepub.com/doi/full/10.1177/1742715020929151">pandemic leadership</a> has comprised three main strands: reliance on expert advice, mobilising collective effort and cushioning the pandemic’s disruptive effects. </p>
<p>These built the trust needed to secure high levels of voluntary compliance for measures designed to limit the spread of the virus.</p>
<p>Then came the Delta outbreak in mid-August, which sees Auckland still under lockdown measures nearly eight weeks later. Despite the efforts of many, elimination proved elusive – a daunting reality that Ardern and her cabinet colleagues appear to have accepted.</p>
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<h2>A strategic shift</h2>
<p>This shift by Ardern, who <a href="https://www.stuff.co.nz/national/health/coronavirus/300334921/we-used-our-luck-well-jacinda-arderns-key-science-advisor-sheds-light-on-covid19-response">engages deeply</a> with the scientific evidence, has <a href="https://thespinoff.co.nz/politics/11-10-2021/the-week-the-world-beating-covid-response-turned-sour/">confused and angered</a> many, even those who normally support her. </p>
<p>With vaccination rates climbing, in early October, Ardern announced the beginning of a “<a href="https://www.beehive.govt.nz/speech/auckland-roadmap-%E2%80%93-restrictions-eased-steps">gradual transition</a>” away from the established “zero COVID” strategy in favour of suppression of inevitable outbreaks. </p>
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Read more:
<a href="https://theconversation.com/three-reasons-why-jacinda-arderns-coronavirus-response-has-been-a-masterclass-in-crisis-leadership-135541">Three reasons why Jacinda Ardern's coronavirus response has been a masterclass in crisis leadership</a>
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<p>This included a three-step “roadmap” to guide Auckland “carefully” towards reduced restrictions. What criteria will be used to trigger movement through those steps, however, have not been specified.</p>
<p>Both the strategic shift and the roadmap’s ambiguity have become the source of heated debate. But beyond merely choosing sides, how can we make sense of Ardern’s leadership at this point?</p>
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<img alt="Jacinda Ardern talking to reporters outdoors" src="https://images.theconversation.com/files/426595/original/file-20211015-22-1t06lca.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/426595/original/file-20211015-22-1t06lca.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=377&fit=crop&dpr=1 600w, https://images.theconversation.com/files/426595/original/file-20211015-22-1t06lca.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=377&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/426595/original/file-20211015-22-1t06lca.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=377&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/426595/original/file-20211015-22-1t06lca.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=474&fit=crop&dpr=1 754w, https://images.theconversation.com/files/426595/original/file-20211015-22-1t06lca.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=474&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/426595/original/file-20211015-22-1t06lca.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=474&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">Jacinda Ardern visiting a drive-through vaccination centre in Hastings during a national tour to promote the government’s campaign.</span>
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<h2>Wicked and adaptive problems</h2>
<p>The pandemic presents a particular type of problem for political leaders, described as “<a href="https://wickedproblems.fm/2020/12/18/keith_grint_leadership_covid19/">wicked</a>” or “<a href="https://hbr.org/2002/06/a-survival-guide-for-leaders">adaptive</a>” by leadership experts Keith Grint and Ronald Heifetz, respectively. </p>
<p>Basically, wicked or adaptive problems have complex and contentious causes, generating equally complex and contentious responses. </p>
<p>Their “wickedness” isn’t fundamentally a question of morality, although they do typically entail making values-based choices. Rather, it refers to how difficult they are to contend with. Poverty, the housing crisis and climate change are other good examples of these kinds of problems.</p>
<p>Wicked/adaptive problems don’t have clear boundaries, nor are they static. They have multiple dynamic dimensions. Their effects typically spill out into many parts of our lives and organisations, creating confusion, harmful consequences and disruption to established routines.</p>
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<h2>“Clumsy” leadership</h2>
<p>To make matters worse, there simply aren’t tried and trusted solutions that can resolve or dissolve such problems. Instead, they require leaders to accustom people to uncomfortable and disruptive changes to established ways of thinking and acting.</p>
<p>Unsurprisingly, many leaders avoid facing up to such difficulties, requiring as it does the cobbling together of a range of imperfect responses to ever-changing circumstances. It requires constant engagement, mobilising people to help craft a way forward.</p>
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Read more:
<a href="https://theconversation.com/anniversary-of-a-landslide-new-research-reveals-what-really-swung-new-zealands-2020-covid-election-169351">Anniversary of a landslide: new research reveals what really swung New Zealand's 2020 'COVID election'</a>
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<p>Leaders can’t and don’t have all the answers to such problems. Whatever answers they do have likely need to keep changing as things unfold. The best possible scenario is what Grint calls a “clumsy” solution – a patchwork of adaptive initiatives that blunt the problem’s worst effects.</p>
<p>Only genuinely transformative change can truly overcome these wicked or adaptive problems in the long run.</p>
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<h2>Conflict and criticism are inevitable</h2>
<p>In the meantime, “clumsy” leadership will typically trigger conflict between leaders and citizens (or employees in a work setting), and among those people too. There will be blame, recrimination, avoidance, denial, grief, “what ifs” and “if onlys”, as people struggle to deal with the changes needed. </p>
<p>Indeed, all these very normal responses have characterised much of the commentary about the Ardern government’s decision to change tack.</p>
<p>That criticism, however, doesn’t mean she has failed in her leadership responsibilities. Instead, she has required the population to face up to an adaptive challenge. It’s unavoidably contentious and painful. </p>
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Read more:
<a href="https://theconversation.com/phased-border-reopening-faster-vaccination-be-ready-for-delta-jacinda-ardern-lays-out-nzs-covid-roadmap-165957">Phased border reopening, faster vaccination, be ready for Delta: Jacinda Ardern lays out NZ's COVID roadmap</a>
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<p>For all that we can debate whether different decisions could or should have been made, the difficulties involved in facing the new reality are unavoidable.</p>
<p>To help people navigate this, Ardern is seeking to “regulate distress”, as Heifetz recommends. She has repeatedly assured people a cautious approach remains in place and has appeared not to have been distracted by the criticism.</p>
<p>Instead, she has stayed focused on mobilising the individual and collective effort to follow the rules and get vaccinated.</p>
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Read more:
<a href="https://theconversation.com/the-covid-zero-strategy-may-be-past-its-use-by-date-but-new-zealand-still-has-a-vaccination-advantage-169251">The COVID-zero strategy may be past its use-by date, but New Zealand still has a vaccination advantage</a>
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<h2>Least-worst options</h2>
<p>Wicked/adaptive problems are not amenable to resolution by way of quick, easy or elegant answers. They aren’t fixed by recourse to command and control, although some top-down decisions are needed. </p>
<p>They entail ambiguity and uncertainty, a constant piecing together of efforts to outflank, mitigate or adapt, giving rise to inevitably imperfect or “clumsy” solutions. </p>
<p>Asking people to adjust to efforts to achieve the least-worst outcome possible from a range of unpalatable options may not be the easiest path to political popularity. But it is arguably what responsible leaders do.</p><img src="https://counter.theconversation.com/content/169926/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Suze Wilson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Dealing with what have been called ‘wicked’ and ‘adaptive’ problems is a huge challenge for political leaders. A ‘clumsy’ response can be inevitable – and even desirable.Suze Wilson, Senior Lecturer, Executive Development, Massey UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1692512021-10-05T18:07:34Z2021-10-05T18:07:34ZThe COVID-zero strategy may be past its use-by date, but New Zealand still has a vaccination advantage<figure><img src="https://images.theconversation.com/files/424631/original/file-20211005-17-13eig1l.jpg?ixlib=rb-1.1.0&rect=0%2C6%2C4427%2C2935&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">GettyImages</span></span></figcaption></figure><p>The announcement today that New Zealand will <a href="https://www.rnz.co.nz/news/national/452941/pm-announces-covid-19-vaccine-certificate">introduce a vaccination certificate</a> by November is welcome news. Whether by “carrot” or “stick”, vaccination rates must keep climbing, as it is now likely <a href="https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-data-and-statistics/covid-19-current-cases#current-situation">case numbers</a> will climb under alert level 3 conditions in Auckland. </p>
<p>We’ve seen a growing number of mystery cases over the past couple of weeks – people testing positive after going to hospital for <a href="https://www.health.govt.nz/news-media/media-releases/exposure-event-auckland-city-hospital">non-COVID reasons</a>, or from essential worker <a href="https://www.health.govt.nz/news-media/media-releases/auckland-based-truck-driver-tests-positive-covid-19">surveillance testing</a>. </p>
<p>These cases suggest there is a significant amount of undetected community transmission, and that makes it much harder to stamp out.</p>
<p>While the slight <a href="https://www.rnz.co.nz/news/political/452885/auckland-to-remain-in-alert-level-3-some-restrictions-ease">easing of restrictions</a> announced yesterday may or may not accelerate the growth in cases, it is unlikely to slow it. This has led to some debate about whether the government has <a href="https://www.stuff.co.nz/national/explained/300422753/why-new-zealands-covid19-elimination-strategy-is-over">abandoned its elimination strategy</a> in favour of suppression of cases.</p>
<p>To some extent this is a semantic argument. Elimination has been defined as “zero tolerance” for community transmission, as opposed to zero cases. The fact that New Zealand was able to get to zero cases for much of the past 18 months has inevitably come to define what elimination has meant in practice.</p>
<p>Before vaccines were widely available, having zero cases was crucial in allowing us to enjoy level 1 freedoms. But New Zealand is now transitioning into a new phase of the pandemic, and this was always going to happen. Borders can’t remain closed forever and the virus was always going to arrive sooner or later. </p>
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<h2>Return to tougher restrictions still a possibility</h2>
<p>In an ideal world, our border defences would have kept Delta out and New Zealand would have been able to stay at alert level 1 until the vaccine rollout was complete. But the Delta outbreak has forced our hand to some extent.</p>
<p>Whether another week or two at level 4 would have been enough to eliminate this outbreak is impossible to know. Given the outbreak is spreading in very <a href="https://www.nzherald.co.nz/nz/covid-19-delta-outbreak-how-the-government-response-can-help-marginalised-communities/2DOJMW4NKZOAPREB2QOE4K4RZM/">difficult-to-reach communities</a>, stamping out every chain of transmission is extremely challenging.</p>
<p>As we shift from an elimination to a suppression strategy, the country will have to tread a very narrow path to avoid overwhelming our hospitals and throwing our at-risk populations under the bus. </p>
<p>This includes Māori and Pasifika, who were effectively put at the <a href="https://thespinoff.co.nz/atea/09-07-2021/what-new-zealands-huge-gap-in-covid-outcomes-tells-us-about-systemic-racism/">back of the vaccine queue</a> by dint of their younger populations, despite being at <a href="https://journal.nzma.org.nz/journal-articles/maori-and-pacific-people-in-new-zealand-have-a-higher-risk-of-hospitalisation-for-covid-19-open-access">higher risk of severe COVID-19</a>. </p>
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Read more:
<a href="https://theconversation.com/nz-needs-a-more-urgent-vaccination-plan-with-nearly-80-now-single-dosed-the-majority-will-support-it-168926">NZ needs a more urgent vaccination plan — with nearly 80% now single-dosed, the majority will support it</a>
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<p>We are now relying on a combination of restrictions and immunity through vaccination to prevent cases growing too rapidly. As vaccination rates increase, restrictions can be progressively eased. </p>
<p>But if we relax too much, there is a risk the number of hospitalisations could start to spiral out of control. When the <a href="https://www.bbc.com/news/health-52473523">R number</a> is above 1, cases will continue to grow relentlessly until either more immunity or tougher restrictions bring it back under 1. </p>
<p>Getting vaccination rates up is crucial but will take time, so the government may yet be forced to tighten restrictions to protect our healthcare systems.</p>
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Read more:
<a href="https://theconversation.com/new-zealand-cannot-abandon-its-covid-elimination-strategy-while-maori-and-pasifika-vaccination-rates-are-too-low-168278">New Zealand cannot abandon its COVID elimination strategy while Māori and Pasifika vaccination rates are too low</a>
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<h2>The vaccination advantage</h2>
<p>New Zealand was always going to have to grapple with these really tough decisions, though Delta has forced us to do this earlier than we would have liked.</p>
<p>But our elimination strategy has given us has an important advantage – <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#total-vaccinations">almost 70% of the total population</a> has had at least one dose of the vaccine before experiencing any large-scale community transmission. </p>
<p>We still have a lot of work ahead, but having access to the vaccine before being exposed to the virus is a luxury people in most countries didn’t have. </p>
<p>There is a lot that could happen between now and Christmas. Currently, the Australian state of Victoria has <a href="https://www.coronavirus.vic.gov.au/victorian-coronavirus-covid-19-data">over 100 people in intensive care</a>, which is equivalent to almost a third of <a href="https://www.nzherald.co.nz/nz/covid-19-coronavirus-delta-outbreak-have-we-boosted-hospital-icu-capacity-enough/BYKEKZQYWNBFKWQ5ZEE5Q5PWNE/">New Zealand’s total ICU capacity</a>. Those ICU beds are normally full with patients with conditions other than COVID-19. </p>
<p>The implications for the healthcare system are obvious. If New Zealand goes the way of Melbourne, harsher restrictions will probably be inevitable.</p>
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<h2>Not a white flag</h2>
<p>The more optimistic scenario is that a combination of restrictions, vaccination and contact tracing is just enough to keep a lid on the case numbers. It’s almost inevitable cases will increase. But if it isn’t too rapid and hospitals can meet the demand, it could tide us over until we have the high vaccine coverage we need.</p>
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Read more:
<a href="https://theconversation.com/new-zealand-government-takes-a-calculated-risk-to-relax-aucklands-lockdown-while-new-cases-continue-to-appear-168269">New Zealand government takes a calculated risk to relax Auckland's lockdown while new cases continue to appear</a>
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<p>And while vaccination rates are not yet high enough, they are still helping a lot, cutting the R number to around half what it would be with no vaccine. The country is in a far better position now than it would have been if the Auckland outbreak had happened in May or June. </p>
<p>Everyone can do their bit by doing two things: <a href="https://www.nzherald.co.nz/nz/covid-19-delta-outbreak-the-90-project-behaviour-change-experts-21-tips-to-help-nz-get-vaccinated/SKZ2KBPVFMF6LPFPWC5XBOBH7M/">help and encourage</a> those around you to get vaccinated, and stick to <a href="https://covid19.govt.nz/alert-levels-and-updates/regional-advice/auckland/">the rules</a>. </p>
<p>We have to keep community transmission rates low to keep pressure off our hospitals and help us get to the next step of the road map. Moving away from a literal interpretation of elimination does not mean waving a white flag.</p><img src="https://counter.theconversation.com/content/169251/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Plank is affiliated with the University of Canterbury and receives funding from the New Zealand Ministry of Business, Innovation and Employment (MBIE) and Te Pūnaha Matatini, New Zealand's Centre of Research Excellence in complex systems.</span></em></p>Most countries experienced serious outbreaks of COVID before widespread vaccination was available. Will it make the difference as New Zealand walks a narrow path towards opening up?Michael Plank, Professor in Applied Mathematics, University of CanterburyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1689262021-10-03T23:29:07Z2021-10-03T23:29:07ZNZ needs a more urgent vaccination plan — with nearly 80% now single-dosed, the majority will support it<figure><img src="https://images.theconversation.com/files/424349/original/file-20211003-101695-l48f6.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C5455%2C3579&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">GettyImages</span></span></figcaption></figure><p>With vaccination rates still too low in Auckland and around Aotearoa New Zealand, and with unexpected cases still showing up, there are few options ahead of today’s <a href="https://www.stuff.co.nz/national/health/coronavirus/126568006/covid19-how-likely-is-level-2-for-auckland-pm-says-other-options-on-the-table">government decision</a> on alert levels.</p>
<p>Until there are high levels of immunity, any relaxation of restrictions within Aotearoa when Delta is in the community will dramatically increase the speed at which the virus spreads through the population.</p>
<p>The time has come for a concerted vaccination drive, mandatory vaccination for more workers, and a clear signal that eligible but unvaccinated people will face restricted access to travel and other activities.</p>
<p>With Delta, there is no “herd immunity” — almost everyone who has not been vaccinated will eventually (and sooner rather than later) get infected. Vaccinated people are about 75% less likely than unvaccinated people to develop a COVID infection if exposed, and over 90% less likely to develop severe disease.</p>
<p>In the current Auckland outbreak, only 3% of the more than 1,000 cases were fully vaccinated. There has been only one fully vaccinated patient among the more than 100 hospitalised cases.</p>
<p>With fewer than 10,000 New Zealanders having been infected by COVID-19, unlike most other countries we are completely dependent on high levels of vaccination to provide high levels of immunity.</p>
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<h2>System overload</h2>
<p>Left to its own devices, Delta spreads like wildfire – from 1 person to 6, to 36, to 216, to 1296 and so on – at high speed until there is a high enough vaccination level. This rapid exponential spread is the main threat to health and other essential services.</p>
<p>No hospital system, however many ICU beds per capita, could cope, and no amount of testing would be able to get on top of Delta in an opened-up Aotearoa. Contact tracing systems would be overwhelmed in days.</p>
<p>Without a high vaccination level, increasing hospital capacity or investing in new drugs would be the equivalent of rearranging deck chairs on the Titanic.</p>
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Read more:
<a href="https://theconversation.com/new-zealand-cannot-abandon-its-covid-elimination-strategy-while-maori-and-pasifika-vaccination-rates-are-too-low-168278">New Zealand cannot abandon its COVID elimination strategy while Māori and Pasifika vaccination rates are too low</a>
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<p>Beyond the hospitals, COVID will spread through the unvaccinated 5–11-year-olds at school, who will then infect their teachers, parents and grandparents. Who will be able to care for whom?</p>
<p>Beyond the schools, businesses with clusters of unvaccinated staff will shut down because up to half the unvaccinated infected people will be too sick to work, and up to one in ten could be hospitalised. Asymptomatic infected staff will infect other staff, clients, customers and their families and friends.</p>
<p>Then there is long COVID. A large <a href="https://www.bmj.com/content/373/bmj.n853">British study</a> has reported one in three hospitalised COVID cases needed to be readmitted. </p>
<p>In <a href="https://www.bmj.com/content/372/bmj.n693">another British study</a>, more than half admitted to hospital had long COVID symptoms three months after discharge. Symptoms were worse among those aged under 50, women and those with higher pre-COVID fitness levels.</p>
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<h2>What are the acceptable costs?</h2>
<p>Every national and international health authority has always accepted the only possible sustainable way to deal with COVID is through the development of immunity. </p>
<p>Since the introduction of safe and effective vaccines, every health authority has recommended high levels of vaccination as the only safe and acceptable way to achieve high levels of immunity.</p>
<p>Today, in semi-vaccinated Aotearoa, only two questions are relevant to any plan to open up:</p>
<ul>
<li><p>is there a high target vaccination level and what does the target imply about the numbers of infections, hospitalisations, deaths and cases of long COVID considered an “acceptable cost” of opening up?</p></li>
<li><p>how does the plan propose to achieve the vaccination target required to meet the “acceptable cost”?</p></li>
</ul>
<p>Aotearoa’s most respected COVID-19 modellers, from <a href="https://www.tepunahamatatini.ac.nz/">Te Pūnaha Matatini</a>, have provided robust scenarios of the likely impacts of a one-year outbreak at different vaccination levels.</p>
<p>Their modelling assumes moderate public health measures, including a full testing, tracing, isolation and quarantine system. Their predictions are remarkably similar to equivalent predictions from Australian modelling groups (aside from the one used by the federal government).</p>
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<h2>More radical plan needed</h2>
<p>The National Party’s recently announced “<a href="https://www.national.org.nz/opening-up">Opening Up</a>” plan was based on nationwide lockdowns no longer being necessary when 70-75% of the population aged 12+ are fully vaccinated.</p>
<p>Based on the Te Pūnaha Matatini models, this suggests the acceptable cost, in the event of a new outbreak, would be somewhere between 1.5 million and 1.8 million cases, 80,000–105,000 hospitalisations and 10,000–13,000 deaths annually.</p>
<p>The plan states international borders would open at a 12+ vaccination level of 85-90%. It’s unclear why there are different thresholds for opening internally and externally. If COVID comes back, whether through an opened border or under the current border restrictions, the consequences will be the same without lockdowns.</p>
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<strong>
Read more:
<a href="https://theconversation.com/new-zealand-government-takes-a-calculated-risk-to-relax-aucklands-lockdown-while-new-cases-continue-to-appear-168269">New Zealand government takes a calculated risk to relax Auckland's lockdown while new cases continue to appear</a>
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<p>National’s proposals for increasing vaccination rates are excellent, although most are already happening to a greater or lesser extent. If the government hasn’t already done so, however, the proposal to order a supply of booster shots should be adopted immediately, as we are very likely to need these as immunity wanes.</p>
<p>The key problem with the plan is that it’s not sufficiently radical to achieve either the 85-90% target or the more humane target of 95% or higher. Even at 95%, there could be 40,000 cases, 1,000 hospitalisations, over 100 deaths and over 10,000 cases of long COVID.</p>
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<h2>Vaccine ‘passports’ now</h2>
<p>In most countries that have already achieved targets above 90%, the main motivation has been fear due to daily exposure to death and hospitalisations. Fortunately, this does not apply in New Zealand yet, although it might if lockdowns were removed as a strategy at 70–75% vaccination rates.</p>
<p>The most effective intervention now required to convince the last 20% of the eligible population to be vaccinated will be some form of vaccination authentication — a vaccine “passport”.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/new-zealand-has-ramped-up-vaccination-rates-but-too-many-people-remain-concerned-about-vaccine-safety-167984">New Zealand has ramped up vaccination rates, but too many people remain concerned about vaccine safety</a>
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<p>Internationally, this approach has been very successful. It has included mandatory vaccination in many jobs beyond border or healthcare, and restricted access to flying, hospitality and other activities for unvaccinated eligible people.</p>
<p>Both major parties have so far only hinted at many of these options, other than that vaccination should be mandated for healthcare workers. This should have been implemented months ago.</p>
<h2>A non-partisan approach</h2>
<p>It is not surprising politicians are reluctant to make vaccination compulsory for some, restrict activities for the unvaccinated, or allow businesses to exclude workers, clients and customers if they are unvaccinated. But we won’t achieve an acceptable target without it.</p>
<p>Among other international precedents, Victoria will require all school and childcare staff to have their first shot or a booking by October 18. In the US, all federal workers must be vaccinated by November 22. And vaccine “passports” are already required for access to hospitality in much of Western Europe.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/why-a-domestic-nz-covid-passport-raises-hard-questions-about-discrimination-inequality-and-coercion-167703">Why a domestic NZ COVID ‘passport’ raises hard questions about discrimination, inequality and coercion</a>
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<p>New Zealand now needs a unified, non-partisan and radical approach to achieving a minimum 95% of eligible people vaccinated. Ideally this will include 5-11-year-olds if the Pfizer vaccine is approved for this age group.</p>
<p>Mandated vaccination for a wide range of jobs should be introduced, and limits on various activities put in place for unvaccinated eligible people. These may only be required for 12 months, but without them the current restrictions will have to remain.</p>
<p>With almost 80% of all eligible New Zealanders already having had their first vaccination shot, the country will be overwhelmingly behind such a proposal.</p><img src="https://counter.theconversation.com/content/168926/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rod Jackson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>With the government decision on alert levels due today, it’s clear a more radical approach to vaccination is needed — including restrictions for eligible but unvaccinated people.Rod Jackson, Professor of Epidemiology, University of Auckland, Waipapa Taumata RauLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1684472021-09-24T12:34:57Z2021-09-24T12:34:57ZHalf of unvaccinated workers say they’d rather quit than get a shot – but real-world data suggest few are following through<figure><img src="https://images.theconversation.com/files/422713/original/file-20210922-16-19jusqx.jpg?ixlib=rb-1.1.0&rect=85%2C44%2C2910%2C1953&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Forceful words don't always result in strong action.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreak/cba4aed4a26d495d9110c205d2bade61/photo?Query=vaccine%20AND%20mandate&mediaType=photo&sortBy=arrivaldatetime:desc&dateRange=Anytime&totalCount=277&currentItemNo=9">AP Photo/Damian Dovarganes</a></span></figcaption></figure><p>Are workplace vaccine mandates prompting some employees to quit rather than get a shot?</p>
<p>A hospital in Lowville, New York, for example, <a href="https://www.npr.org/2021/09/13/1036521499/covid-workers-resign-new-york-hospital-stops-baby-delivery">had to shut down its maternity ward</a> when dozens of staffers left their jobs rather than get vaccinated. At least 125 employees at Indiana University Health <a href="https://www.newsweek.com/vaccine-refusal-prompts-more-100-employees-quit-major-indiana-hospital-system-1629993">resigned after refusing to take the vaccine</a>.</p>
<p>And several surveys have shown that <a href="https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-june-2021">as many as half of unvaccinated workers</a> insist they would leave their jobs if forced to get the shot, which has <a href="https://riverheadlocal.com/2021/09/20/new-york-officials-worry-vaccine-mandate-will-drive-healthcare-worker-shortage/">raised alarms</a> <a href="https://www.wral.com/coronavirus/dozens-of-unc-health-workers-quit-over-vaccine-mandate/19886823/">among some</a> that <a href="https://theconversation.com/whos-covered-by-a-vaccine-mandate-heres-a-quick-guide-to-americas-patchwork-of-covid-19-shot-requirements-167765">more mandates</a> could lead to an exodus of workers in many industries. New York, for example, <a href="https://www.npr.org/2021/09/26/1040780961/new-york-health-care-worker-vaccine-mandate-staffing-shortages-national-guard">is preparing for an exodus of health care workers</a> – and may even call in the National Guard to help – as its vaccine mandate takes effect on Sept. 27, 2021. </p>
<p>But how many will actually follow through? </p>
<h2>Strong words</h2>
<p>In June 2021, we conducted a nationwide survey, funded by the Robert Wood Johnson Foundation, that gave us a sample of 1,036 people who mirrored the diverse makeup of the U.S. We plan to publish the survey in October. </p>
<p>We asked respondents to tell us what they would do if “vaccines were required” by their employer. We prompted them with several possible actions, and they could check as many as they liked. </p>
<p>We found that 16% of employed respondents would quit, start looking for other employment or both if their employer instituted a mandate. Among those who said they were “vaccine hesitant” – almost a quarter of respondents – we found that 48% would quit or look for another job. </p>
<p><a href="https://morningconsult.com/2021/08/02/workplace-incentives-to-join-leave-polling">Other polls</a> have shown similar results. A <a href="https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-june-2021/">Kaiser Family Foundation survey put</a> the share of workers who would quit at 50%. </p>
<p>Separately, we found in our survey that 63% of all workers said a vaccine mandate would make them feel safer. </p>
<h2>Quieter actions</h2>
<p>But while it is easy and cost-free to tell a pollster you’ll quit your job, actually doing so when it means losing a paycheck you and your family may depend upon is another matter. </p>
<p>And based on a sample of companies that already have vaccine mandates in place, the actual number who do resign rather than get the vaccine is much smaller than the survey data suggest. </p>
<p>Houston Methodist Hospital, for example, required its 25,000 workers to get a vaccine by June 7. Before the mandate, <a href="https://www.nytimes.com/2021/07/23/briefing/vaccination-mandates-delta-breakthrough-infections.html">about 15% of its employees were unvaccinated</a>. By mid-June, that percentage had dropped to 3% and hit 2% by late July. A total of <a href="https://www.msn.com/en-us/news/us/more-than-150-houston-hospital-workers-were-fired-or-quit-after-refusing-covid-19-vaccine/ar-AALkAnT">153 workers were fired or resigned</a>, while another <a href="https://www.msn.com/en-us/news/us/more-than-150-houston-hospital-workers-were-fired-or-quit-after-refusing-covid-19-vaccine/ar-AALkAnT">285 were granted medical or religious exemptions</a> and 332 were allowed to defer it. </p>
<p>At Jewish Home Family in Rockleigh, New Jersey, <a href="https://abcnews.go.com/Business/wireStory/nursing-home-workers-vaccine-lose-job-79272024">only five of its 527 workers</a> quit following its vaccine mandate. <a href="https://abcnews.go.com/Business/wireStory/nursing-home-workers-vaccine-lose-job-79272024">Two out of 250 workers left Westminster Village</a> in Bloomington, Illinois, and even in deeply conservative rural Alabama, a state with <a href="https://www.mayoclinic.org/coronavirus-covid-19/vaccine-tracker">one of the lowest vaccine uptake rates</a>, Hanceville Nursing & Rehab Center lost <a href="https://abcnews.go.com/Business/wireStory/nursing-home-workers-vaccine-lose-job-79272024">only six of its 260 employees</a>. </p>
<p>Delta Airlines didn’t mandate a shot, but in August it did subject unvaccinated workers to a US$200 per month health insurance surcharge. Yet the airline said fewer than <a href="https://www.bloomberg.com/news/articles/2021-09-09/delta-air-says-new-covid-policy-is-boosting-worker-vaccinations">2% of employees have quit over the policy</a>.</p>
<p>And at Indiana University Health, the 125 workers who quit <a href="https://www.newsweek.com/vaccine-refusal-prompts-more-100-employees-quit-major-indiana-hospital-system-1629993">are out of 35,800 total employees</a>, or 0.3%. </p>
<h2>Making it easy</h2>
<p>Past vaccine mandates, such as for the flu, <a href="http://doi.org/10.1515/jbbbl-2019-0005">have led to similar outcomes</a>: Few people actually quit their jobs over them. </p>
<p>And our research suggests in public communications there are a few things employers can do to minimize the number of workers who quit over the policy.</p>
<p>It starts with <a href="https://www.ahrq.gov/sites/default/files/wysiwyg/nursing-home/materials/invest-in-trust-guide.pdf">building trust</a> with employees. Companies should also make it <a href="https://documents.nam.org/comm/COVID-19/MI-UF_VaccineGuide.pdf">as easy as possible to get vaccinated</a> – such as by providing on-site vaccine drives, paid time off to get the shot and deal with side effects, and support for child care or transportation. </p>
<p>Finally, <a href="https://documents.nam.org/comm/COVID-19/MI-UF_VaccineGuide.pdf">research shows it helps</a> if companies engage trusted messengers including doctors, colleagues and family to share information on the vaccine.</p>
<p>In other words, vaccine mandates are unlikely to result in a wave of resignations – but they are likely to lead to a boost in vaccination rates. </p>
<p><em>This story was updated to include reference to New York health care vaccine mandate.</em></p>
<p>[<em>Research into coronavirus and other news from science</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-corona-research">Subscribe to The Conversation’s new science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/168447/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jack J. Barry receives funding from the Robert Wood Johnson Foundation and has received funding from the Agency for Healthcare Research Quality.</span></em></p><p class="fine-print"><em><span>Ann Christiano receives funding from the Robert Wood Johnson Foundation and has received funding from the Agency for Healthcare Research Quality. </span></em></p><p class="fine-print"><em><span>Annie Neimand receives funding from the Robert Wood Johnson Foundation and has received funding from the Agency for Healthcare Research Quality.</span></em></p>While surveys have shown a large share of unvaccinated workers threatening to quit over a mandate, the reality is few actually do.Jack J. Barry, Postdoctoral Research Associate in Public Interest Communications, University of FloridaAnn Christiano, Director, Center for Public Interest Communications, University of FloridaAnnie Neimand, Research Director, Center for Public Interest Communications, College of Journalism and Communications, University of FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1683642021-09-21T08:30:21Z2021-09-21T08:30:21ZDoherty modelling update provides the goalposts, but local insights will determine play<p>The Doherty Report, released <a href="https://www.doherty.edu.au/uploads/content_doc/DohertyModelling_NationalPlan_and_Addendum_20210810.pdf">10 August</a>, underpins the vaccination targets in the federal government’s national reopening plan of 70% and 80% of the population aged over 16. However, since we began <a href="https://www.doherty.edu.au/our-work/institute-themes/viral-infectious-diseases/covid-19/covid-19-modelling/modelling">this modelling</a>, we have seen large outbreaks in New South Wales and Victoria. These outbreaks prompt questions about how community prevalence affects reopening plans.</p>
<p>The interim report, released <a href="https://www.doherty.edu.au/news-events/news/doherty-institute-modelling-report-for-national-cabinet-sep-18">on Saturday</a>, addresses the impact of higher daily case numbers when we reach the 70% and 80% threshold; how public health and social measures could be applied between 70% and 80%; and differences between the strategy in each state and territory.</p>
<p>Our first report recommended ongoing “low” restrictions throughout the reopening phase to support vaccination and public health responses. The new results show that if a state or territory has high caseloads when it reaches 70% coverage, cases could still grow quickly at this level of restrictions, leading to a much larger outbreak. </p>
<p>Applying “medium” restrictions until 80% coverage is reached, will greatly reduce the likelihood and potential size of an outbreak. From the 80% coverage level, vaccines do more of the heavy lifting to control infection spread, and so only low level restrictions are likely to be needed. </p>
<h2>What does ‘overshoot’ mean and how can we prevent it?</h2>
<p>Overshoot refers to the people who get infected as the pandemic is slowing. </p>
<p>When enough of the population is immune to COVID, through a combination of vaccination and past infection, the disease can’t spread any further, and the proportion of population immunity required to prevent spread is reduced through public health and social measures, and contact tracing.</p>
<p>So, as we increase vaccine coverage, there will come a point where each COVID-infected person transmits to fewer than one person on average. But epidemics have momentum and take time to stop. Anyone who gets infected as the epidemic is slowing is part of the overshoot. The danger of significant overshoot is that it will greatly increase the total number of people infected, leading to more hospitalisations and deaths.</p>
<p>By keeping community prevalence low as we transition to high vaccination coverage, we reduce overshoot and keep the total number of infections low.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-will-likely-shift-from-pandemic-to-endemic-but-what-does-that-mean-167782">COVID will likely shift from pandemic to endemic — but what does that mean?</a>
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<h2>Differences by state and territory</h2>
<p>When Australia reaches 70% and 80% coverage, every state and territory will be in a different position, both in their own coverage and in COVID prevalence. That means every state and territory will have their own path through these transition phases, as allowed for in the National Plan. </p>
<p>With higher case numbers, there will likely be stronger restrictions for longer, while with lower case numbers the contact tracing system is likely to be more effective and able to control outbreaks with lighter restrictions. </p>
<p>Beyond COVID prevalence, there are also differences in the potential for COVID to spread in each state and territory, which we track using the transmission potential (TP) metric. These differences are driven by a combination of demographics and because baseline behaviours are markedly different across Australia. Higher TP means faster spread, and a TP below 1 means cases should decline. </p>
<p>Projecting the TP when we reach 80% coverage, we predict that if “baseline” population behaviour in Victoria is similar to December 2020, the TP would be 1. However, for Western Australia the TP would be 1.6, if we assume people behave as they did in March 2021. These differences further support our recommendations that ongoing “low” restrictions will provide a more stable level of disease control moving forward. </p>
<p>Situational assessment of <a href="https://www.doherty.edu.au/uploads/content_doc/Technical_report_15_Maypdf.pdf">TP</a> and short term COVID infection projections are provided <a href="https://www.health.gov.au/resources/collections/coronavirus-covid-19-common-operating-picture">weekly</a> for all jurisdictions and will be essential to support decision making over the coming weeks and months. </p>
<p>The National Plan provides flexibility for states and territories to adjust restrictions and policies to manage local case numbers throughout the reopening phases for best outcomes.</p>
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Read more:
<a href="https://theconversation.com/with-a-post-lockdown-victoria-in-sight-the-more-we-can-contain-transmission-now-the-easier-the-road-ahead-168245">With a post-lockdown Victoria in sight, the more we can contain transmission now, the easier the road ahead</a>
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<h2>Where to from here?</h2>
<p>The modelling has aimed to inform broad national targets for reopening, but there are many more granular issues to explore and work through at state and local levels to give more detailed advice. These ongoing projects include helping to define sustainable and effective public health responses; optimising local disease control through vaccines and other measures in at-risk populations and settings; and supporting plans to reconnect Australians with the wider world.</p>
<p>Contact tracing will need to shift from an extinction model — chasing down every last contact — to a more sustainable model to identify efficient ways to reduce transmission in the community. We have already seen New South Wales and Victoria moving to text messages to initially notify cases, rather than a phone call.</p>
<p>Fresh research about the <a href="https://www.cdc.gov/coronavirus/2019-ncov/variants/delta-variant.html">severity of the Delta variant</a> confirms that it is more likely to lead to hospitalisation and death than the Alpha variant. This new evidence further endorses our recommendations for a multi-pronged approach to disease control to keep case numbers as low as possible so the health system is able to manage anticipated clinical loads. We will factor this and other emerging evidence into ongoing modelling, including regular situational assessments.</p>
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Read more:
<a href="https://theconversation.com/whiteness-in-the-time-of-covid-australias-health-services-still-leaving-vulnerable-communities-behind-167701">Whiteness in the time of COVID: Australia's health services still leaving vulnerable communities behind</a>
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<p>As we move towards reopening, it is critical we carefully monitor the epidemic situation and continually update models as the situation unfolds. If cases grow faster than expected, we should be flexible to either alter restrictions, postpone lifting of restrictions or retreat if indicated. </p>
<p>On the other hand, if baseline health measures or vaccines are more effective than we expect, we may find ourselves in a position to lift restrictions earlier than anticipated.</p>
<p>While there are uncertainties about our future, there is one thing we are certain of. The higher our fully vaccinated coverage goes above 80%, the easier it will be to control COVID, enabling a return to a (COVID) normal life.</p>
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<figcaption><span class="caption">A panel of experts answer questions about vaccines, from ‘Are they safe?’ to ‘What if I’m pregnant?’</span></figcaption>
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<p class="fine-print"><em><span>Christopher Baker receives funding from The Australian Government Departments of Health and Foreign Affairs and Trade.</span></em></p><p class="fine-print"><em><span>Jodie McVernon receives funding from The Australian Government Departments of Health and Foreign Affairs and Trade, and the National Health and Medical Research Council</span></em></p>Experts at the Doherty Institute have updated their modelling to heighten caution around reopening for business and play.Christopher Baker, Research Fellow in Statistics for Biosecurity Risk, The University of MelbourneJodie McVernon, Professor and Director of Doherty Epidemiology, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1679842021-09-20T20:05:15Z2021-09-20T20:05:15ZNew Zealand has ramped up vaccination rates, but too many people remain concerned about vaccine safety<figure><img src="https://images.theconversation.com/files/422062/original/file-20210920-17-1iwhxm3.jpg?ixlib=rb-1.1.0&rect=40%2C163%2C5422%2C3268&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Fiona Goodall/Getty Images</span></span></figcaption></figure><p>After five weeks in the strictest lockdown, Auckland will move to level 3 restrictions from midnight on Tuesday, for at least two weeks.</p>
<p>Prime Minister Jacinda Ardern said the decision was based on low community spread and an accelerated vaccination rollout. A targeted vaccination campaign will now focus on about 23,000 people in Auckland who are older than 65 but have not yet received their first dose. </p>
<p>GPs and pharmacies are offering vaccinations, walk-in or drive-through vaccination centres have been set up, and <a href="https://www.stuff.co.nz/national/health/coronavirus/126375780/covid19-mr-whippystyle-vaccination-bus-to-roll-in-auckland">mobile vaccination buses</a> are delivering doses throughout Auckland. </p>
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<p>According to the Ministry of Health, 37% of New Zealand’s eligible population are now <a href="https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-data-and-statistics/covid-19-vaccine-data">fully vaccinated</a>, while 72% have received their first dose. But as our new <a href="https://www.researchgate.net/publication/354615019_COVIDHesitancyWorkingPaper">research</a> shows, about 20% choose not to be vaccinated, often because they remain unsure about vaccine safety.</p>
<h2>Barriers to vaccination uptake</h2>
<p>While the vaccine rollout has been criticised for being <a href="https://www.rnz.co.nz/news/political/449840/analysis-sluggish-vaccine-rollout-deserves-an-explanation">sluggish</a>, it picked up pace since the start of the outbreak in August. </p>
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<img alt="This chart shows the number of vaccine doses administered on a given day" src="https://images.theconversation.com/files/422033/original/file-20210920-47336-ecsyfu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/422033/original/file-20210920-47336-ecsyfu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=280&fit=crop&dpr=1 600w, https://images.theconversation.com/files/422033/original/file-20210920-47336-ecsyfu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=280&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/422033/original/file-20210920-47336-ecsyfu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=280&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/422033/original/file-20210920-47336-ecsyfu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=352&fit=crop&dpr=1 754w, https://images.theconversation.com/files/422033/original/file-20210920-47336-ecsyfu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=352&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/422033/original/file-20210920-47336-ecsyfu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=352&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">This chart shows the number of vaccine doses administered on a given day from the COVID-19 immunisation register.</span>
<span class="attribution"><span class="source">Ministry of Health</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p>But a significant number of people continue to say they are not likely to get the vaccine. A recent <a href="https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-vaccines/covid-19-vaccine-strategy-planning-insights/covid-19-vaccine-research-insights">report</a> commissioned by the Ministry of Health shows 71% of those unvaccinated at the time were intending to get vaccinated. In this group, 67% of Māori and 62% of Pacific respondents said they would get vaccinated. </p>
<p>But 20% of unvaccinated people said they were unlikely to have a vaccine, and of those, 11% would “definitely not” get vaccinated. </p>
<p>A similar study in July showed only four in five New Zealanders said they planned on getting vaccinated. </p>
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Read more:
<a href="https://theconversation.com/four-in-five-new-zealanders-plan-to-get-vaccinated-but-many-people-want-more-information-about-vaccine-safety-164322">Four in five New Zealanders plan to get vaccinated, but many people want more information about vaccine safety</a>
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<p>Both studies point to numerous barriers to uptake, such as lack of exposure to the virus, misinformation about vaccination and lack of confidence in the vaccine. The main reasons for being unsure continue to be concerns about long-term effects, safety and waiting to see if others have side effects.</p>
<p>Our <a href="https://www.researchgate.net/publication/354615019_COVIDHesitancyWorkingPaper">work</a>, conducted between June and August 2021, examined two of these barriers: misunderstandings about the vaccine and confidence in the vaccine. </p>
<p>We found 76.2% of our participants identified as physically able to be vaccinated. The remainder (23.8%) identified as physically unable to receive a vaccine due to pre-existing medical conditions or philosophical views. </p>
<p>But of the latter group only 28.9% actually meet the criteria set by groups such as the <a href="https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-vaccines/covid-19-vaccine-health-advice">Ministry of Health</a> or the US Centers for Disease Control and Prevention (<a href="https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Fcovid-19%2Finfo-by-product%2Fclinical-considerations.html">CDC</a>).</p>
<p>The people in this group most often asserted they could not get the jab because they have asthma, want to get pregnant or their doctor or a religious leader told them they shouldn’t. This lack of understanding about who can get the vaccine is a challenge for the vaccination rollout and the government. </p>
<h2>Vaccine confidence is key to uptake</h2>
<p>As the rollout continues and the government pursues its elimination strategy, it must clearly address issues about who can and cannot be vaccinated for medical reasons. </p>
<p>When asked if they would get the COVID-19 vaccine, 70.9% of those who said they are physically or medically unable to do so said they would eventually get it if they had to. </p>
<p>Of those who said they are able to get vaccinated, 76.9% said they would get the jab. Split by political affiliations, 42.5% of National, 66.4% of Labour, 49.5% of Green, 67.5% of Māori Party, 40.6% of “other” political party and 73.7% of non-affiliated voters said they would get vaccinated. </p>
<p>In terms of demographics, 65.2% of Pākehā, 57.7% of Māori, 33.5% of Pasifika and 72.4% of the “other” group (Indian/Asian) said they were likely to get vaccinated. These results for Pākehā, Māori and Pasifika are marginally lower than those reported in the Ministry of Health <a href="https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-vaccines/covid-19-vaccine-strategy-planning-insights/covid-19-vaccine-research-insights">study</a>. </p>
<p>The critical element to understanding the patterns in our research was vaccine confidence. We found significant differences in confidence in COVID-19 vaccines between ethnic groups in New Zealand. Pacific respondents had the lowest levels of confidence, while those who identified as “other” had the highest. </p>
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<p>Māori and Pasifika communities are particularly vulnerable to COVID-19. There is a growing anti-vax movement within some parts of the Pacific community, which Pacific leaders and communities are currently <a href="https://www.tvnz.co.nz/one-news/new-zealand/vaccine-hesitancy-worrying-pasifika-health-providers">addressing</a>. </p>
<p>Recent modelling has shown that unless New Zealand can get its vaccination rate up to 90% and above, the threat of large-scale outbreaks, mass hospitalisations and thousands of deaths is possible once borders reopen.</p>
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Read more:
<a href="https://theconversation.com/at-least-four-in-five-new-zealanders-will-have-to-be-vaccinated-before-border-controls-can-be-fully-relaxed-163486">At least four in five New Zealanders will have to be vaccinated before border controls can be fully relaxed</a>
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<p>To improve our nation’s vaccine rollout, the government should expand messaging on who can and cannot get vaccinated. Further messaging about the safety of the vaccine must continue with Pacific communities. </p>
<p>While the government has discussed the safety of the Pfizer vaccine, it’s clearly not enough. Additional work must be done at the grass-roots level (community centres, churches) to demonstrate the safety and increase confidence in the vaccine.</p><img src="https://counter.theconversation.com/content/167984/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A survey found almost a quarter of participants thought they could not receive a vaccine because of medical conditions. But only 28.9% of this group actually meet the criteria set by health agencies.Stephen Croucher, Professor and Head of School of Communication, Journalism, and Marketing, Massey UniversityDoug Ashwell, Senior lecturer, Massey UniversityJo Cullinane, Deputy Pro-Vice Chancellor, Massey UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1671302021-09-08T14:37:38Z2021-09-08T14:37:38ZCOVID-19: It’s time to look at the finer details of South Africa’s pandemic picture<figure><img src="https://images.theconversation.com/files/419565/original/file-20210906-25-168t1ze.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">SARS-CoV-2 variants have also played an integral part in driving the course of the pandemic.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><em>Almost 18 months into the COVID-19 pandemic, the release of new case <a href="https://www.nicd.ac.za/">numbers</a> is an integral part of the day for many South Africans. Questions like “When will the third wave end?” and “Will there be a fourth wave?” abound and opinions, even among experts, are varied. The challenges in interpreting COVID-19 case and <a href="https://www.nicd.ac.za/diseases-a-z-index/disease-index-covid-19/surveillance-reports/">hospitalisation data</a> are enormous. They are likely to become even more complex as SARS-CoV-2 <a href="https://sacoronavirus.co.za/latest-vaccine-statistics/">vaccine coverage</a> is added to the epidemiological mix. The Conversation Africa asked three experts whose job it is to keep track of it all – Michelle Groome, Harry Moultrie and Adrian Puren, all at the <a href="https://www.nicd.ac.za/">National Institute for Communicable Diseases (NICD)</a> – what the data tell us.</em></p>
<h2>What picture are you getting from the statistics now?</h2>
<p>The NICD is a specialised division of the National Health Laboratory Service and plays a key role in communicable disease surveillance. It works with other organisations to support the national health department’s management of the current pandemic. For example, the NICD provides routine reports and analyses, epidemic modelling, advisories, surveillance and research related to COVID-19.</p>
<p>The current resurgence driven by the Delta variant finally appears to be subsiding in all nine provinces. There were differences at provincial, district and sub-district levels in the timing and scale of the previous two waves but these differences have been more pronounced in the third wave. The current resurgences in the Northern Cape and Free State started in April and subsided in June and July, before resuming in August. The patterns seen in these two provinces were likely the result of early initial resurgences driven by the Beta variant, with a later superimposed resurgence driven by the more transmissible Delta variant. In comparison, Gauteng experienced a very rapid and large resurgence in June and July. This is possibly a result of a relatively smaller and truncated second wave combined with the introduction of the Delta variant. </p>
<p>We have also seen a shift in the age distribution of cases. Since mid-July the incidence and proportion testing positive among people under 20 years has increased relative to older age groups. During waves 1 and 2 schools were closed for extended periods, resulting in lower exposure and therefore lower immunity in younger people. The reopening of schools in late July, together with the Delta variant, has led to school outbreaks in August. </p>
<p>Differences in immunity, vaccination coverage and timing, and behavioural responses are likely to result in variable provincial and district patterns continuing over the next few months. Thus looking only at the national epidemiological picture is becoming less useful. The “wave” terminology to describe the ongoing pandemic is also becoming less useful.</p>
<h2>How does testing affect the picture?</h2>
<p>Case ascertainment is heavily influenced by access to laboratory testing for the SARS-CoV-2 virus, individual reasons for testing (or not testing) and provincial testing strategies. Testing rates vary considerably between provinces, with Limpopo and Eastern Cape consistently on the lower side of the spectrum.</p>
<p>Consistent reporting of antigen tests has <a href="https://www.nicd.ac.za/wp-content/uploads/2021/08/GUIDE-TO-ANTIGEN-TESTING-FOR-SARS-COV-2-IN-SOUTH-AFRICA_V4_06.07.2021-DR-NDJEKA.pdf">also been problematic</a>. PCR tests are conducted in laboratories and results are generally submitted to the health department through automated laboratory information systems. But point-of-care antigen test results have to be manually captured and submitted to the department via a web portal. The profusion of sites offering antigen tests makes it very difficult to ensure that they are all submitting results. </p>
<p>The <a href="https://www.bbc.com/news/world-africa-57822460">social unrest</a> in KwaZulu-Natal in mid-July resulted in a substantial decline in testing volumes and thus case detection in the province. </p>
<p>Differential testing patterns may also be responsible for the age distribution of cases. The third wave has seen an increase in the number of children of school-going age testing positive for <a href="https://www.nicd.ac.za/diseases-a-z-index/disease-index-covid-19/surveillance-reports/weekly-epidemiological-brief/">the virus</a> compared to previous waves. This may be driven by case detection in schools and subsequent contact tracing and increased testing of this age group. </p>
<p>Tests are sometimes conducted in asymptomatic individuals or prior to routine surgical procedures, and those with severe symptoms may not be able to access testing or prefer not to test. Testing policies and strategies may vary by province based on strategic decision-making and availability of resources. </p>
<p>Estimates of seroprevalence, the proportion of the population who have developed antibodies to SARS-CoV-2, <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3855442">suggest</a> that there have been at least eight times more people infected than cases detected. Daily case numbers only reflect tests conducted and reported. They are not a true picture of overall infections by province or age group.</p>
<h2>What trends are you seeing by province?</h2>
<p>We have seen interesting trends in provincial case numbers. Eastern Cape and Western Cape were the first provinces to see increasing case numbers at the start of the second wave, followed by KwaZulu-Natal. Gauteng saw the rise in cases much later, once heightened restrictions were in place, and had a relatively small wave in comparison to the coastal provinces. The third wave saw case numbers in the Free State and Northern Cape slowly start on an upward trajectory. This was followed by North West and Gauteng where case numbers catapulted past the peaks seen with the first two waves. </p>
<p>There are several interdependent factors responsible for these differences. They include underlying immunity from previous infections, population movement patterns, adherence to non-pharmaceutical interventions, level of restrictions with respect to timing of the surge, and climatic factors. </p>
<p>SARS-CoV-2 variants have also played an integral part in driving the course of the pandemic. The increased transmissibility and immune escape of the Beta variant fuelled the second wave, only to be replaced by the even more transmissible <a href="https://www.cdc.gov/coronavirus/2019-ncov/variants/delta-variant.html#:%7E:text=The%20Delta%20variant%20is%20more,previous%20variants%20in%20unvaccinated%20people.">Delta variant</a>. Circulation of these variants of concern likely contributed to the differential provincial pattern. Sequencing data suggest that the Beta variant was still circulating widely when the Free State and Northern Cape began to see rising case numbers in April 2021 . Dominance of the Delta variant was partly responsible for driving the devastating third wave in Gauteng. It seems probable that the dominance of Delta is now fuelling an ongoing increase in cases in <a href="https://www.nicd.ac.za/diseases-a-z-index/disease-index-covid-19/sars-cov-2-genomic-surveillance-update/">Northern Cape and Free State</a>. </p>
<p>Delta is unlikely to be the last variant we see and emergence of new variants will continue to shape the trajectory of the pandemic for the <a href="https://www.medrxiv.org/content/10.1101/2021.08.20.21262342v2">immediate future</a>. </p>
<h2>What can we expect next?</h2>
<p>Differential vaccine coverage at a provincial, district, sub-district and ward level is also going to have an impact on the epidemiological patterns in the months to come. Communities with high vaccine coverage rates are likely to see lower case numbers, hospitalisations and deaths related to COVID-19 compared to those with poor vaccine coverage. </p>
<p>Even with slightly lower efficacy of the SARS-CoV-2 vaccines currently in use against the pervading variants of concern, there will be a dramatic reduction in severe COVID-19 disease as a result of the national vaccine rollout. Any epidemiological analyses will need to take the vaccine coverage into account in order to make sense of the data.</p>
<p>Moving forward, how we interpret the daily case numbers and deaths will change. Waves will likely be less distinct as a result of drivers acting on multiple timescales. How we respond to each new cluster or resurgence in COVID-19 infections will change. South Africa will need to be more agile in its approach. </p>
<p>We need to accept that surges will occur, new variants will appear and booster shots will be needed. We need to move away from considering South Africa to be in a wave or between waves or preparing for the next wave, and start accepting the reality of living with this virus in a world where we can now prevent severe disease.</p><img src="https://counter.theconversation.com/content/167130/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Groome receives funding from the South African Medical Research Council and the Bill & Melinda Gates Foundation. </span></em></p><p class="fine-print"><em><span>Adrian Puren receives funding from the NIH in support HIV Vaccine Trall Network and PEPFAR. </span></em></p><p class="fine-print"><em><span>Harry Moultrie does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Communities with high vaccine coverage rates are likely to see lower case numbers, hospitalisations and deaths related to COVID-19 compared to those with poor vaccine coverage.Michelle J. Groome, Head of the Division of Public Health Surveillance and Response, National Institute for Communicable DiseasesAdrian Puren, Acting executive director, National Institute for Communicable DiseasesHarry Moultrie, Senior medical epidemiologist, Centre for Tuberculosis, National Institute for Communicable DiseasesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1667542021-08-26T18:13:32Z2021-08-26T18:13:32ZVital Signs: with vaccine thresholds come the danger of repeating past mistakes<p>In 2020 when people talked about “living with COVID” it was code for letting the virus rip. It was really a plan for many to “die with COVID”.</p>
<p>Thankfully our political leaders listened to experts. </p>
<p>In general, Australia managed the pandemic’s public health and economic challenges better than most countries. The glaring exceptions were, of course, our vaccination strategy and our quarantine arrangements. </p>
<p>With vaccines we didn’t buy a properly diversified portfolio of vaccines, didn’t act with a sense of urgency — “<a href="https://theconversation.com/view-from-the-hill-new-expert-advice-is-in-dont-say-its-not-a-race-161935">It’s not a race</a>,” said the Prime Minister and other ministers — and didn’t have an effective plan for getting jabs into arms quickly. </p>
<p>With quarantine arrangements we failed to build fit-for-purpose facilities akin to the one in Howard Springs outside Darwin. Instead we relied on poorly ventilated hotels in the heart of our biggest and most densely populated cities.</p>
<p>Now, with the roll-out of high-efficacy vaccines against COVID-19, we are beginning to have a national discussion genuinely about how to live with COVID.</p>
<p>It is vital that during that discussion we don’t repeat the mistakes of 2020. </p>
<p>Those mistakes all sprang from false economies. </p>
<p>The federal government thought we could save a few bucks by gambling on vaccine purchases. It favoured vaccines that could be made locally more as a back-door industry policy rather than strategic supply-chain management. It thought using hotels as quarantine facilities could help financially support the hospitality sector.</p>
<p>Pinching pennies cost us. Big time.</p>
<p>It is imperative we don’t fall into the trap of false economies again by opening up too soon, before what is needed to stay open is in place.</p>
<h2>Vaccination milestones</h2>
<p>The <a href="https://www.pm.gov.au/sites/default/files/media/national-plan-to-transition-australias-national-covid-19-response-july2021.pdf">national plan</a> about when Australia will “reopen” is pegged to vaccination milestones.</p>
<p>We’re still in the first of the four-phase plan. We will move to Phase B (the “vaccine transition phase”) when 70% of eligible Australians over the age of 16 are vaccinated. At 80% we move to Phase C (the “vaccination consolidation phase”).</p>
<p>At this 80% threshold the plan is for only “highly targeted lockdowns”, the end of passenger caps for vaccinated Australians returning home, and restarting outbound travel for vaccinated Australians.</p>
<p>There are important epidemiological debates about whether 70% and 80% are the right thresholds. I’m just an economist, so I’m not going to get into that here.</p>
<p>But if we accept, for the sake of argument, that 80% is the practically relevant threshold for moving to Phase C of the national plan, then we should at least insist on getting the arithmetic right.</p>
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<iframe title="National percentage of adults vaccinated" aria-label="Bar Chart" id="datawrapper-chart-7I7IS" src="https://datawrapper.dwcdn.net/7I7IS/4/" scrolling="no" frameborder="0" style="width: 0; min-width: 100% !important; border: none;" height="296" width="100%"></iframe>
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<p>On this, there are two key questions.</p>
<h2>80% of what?</h2>
<p>The first is about the vaccination rate. Moving to Phase C calls for 80% of the “eligible” population to be fully vaccinated. </p>
<p>But that’s not 80% of <a href="https://www.abs.gov.au/AUSSTATS/abs%40.nsf/Web%2BPages/Population%2BClock?opendocument=&ref=HPKI">Australia’s population</a> of 25.8 million. </p>
<p>Rather, it’s 80% of the population <a href="https://www.doherty.edu.au/uploads/content_doc/DohertyModelling_NationalPlan_and_Addendum_20210810.pdf">aged 16 and over</a> — about 16.6 million people, or 64% of the population. </p>
<p>If the national plan is changed to make it 80% of the population aged 12 and over, that would be about 17.6 million people, or 68% of the population.
To paraphrase the United States politician <a href="https://www.senate.gov/artandhistory/history/minute/Senator_Everett_Mckinley_Dirksen_Dies.htm">Everett Dirksen</a>, a million here, a million there, and pretty soon you’re talking about real numbers.</p>
<p>There are two points here. </p>
<p>First, the much-touted 80% threshold is really only 64% of the whole population. Yet herd-immunity levels — where outbreaks die out — are typically expressed as a proportion of the entire population. Given the basic reproduction rate of the Delta variant and current vaccine effectiveness, the actual <a href="https://www.medrxiv.org/content/10.1101/2020.12.15.20248278v2.full">herd immunity vaccination threshold</a> could easily be north of 85%.</p>
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Read more:
<a href="https://theconversation.com/how-will-delta-evolve-heres-what-the-theory-tells-us-165243">How will Delta evolve? Here's what the theory tells us</a>
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<p>Second, the longer that lockdowns continue, the stronger the temptation for politicians to shift to targets that are easier to achieve. Though this might be politically convenient, it would be disastrous.</p>
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Read more:
<a href="https://theconversation.com/should-we-give-up-on-covid-zero-until-most-of-us-are-vaccinated-we-cant-live-with-the-virus-166269">Should we give up on COVID-zero? Until most of us are vaccinated, we can't live with the virus</a>
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<h2>80% plus how long?</h2>
<p>The second question is how long after hitting the 80% threshold do we begin moving from Phase C to Phase D.</p>
<p><a href="https://www.nejm.org/doi/10.1056/NEJMoa2034577?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">Clinical trial data</a> for the Pfizer vaccine suggests the best immune response occurs about two weeks after the second dose. The federal <a href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/is-it-true/is-it-true-how-long-does-it-take-to-have-immunity-after-vaccination">Department of Health emphasises</a> that:</p>
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<p>Individuals may not be fully protected until 7-14 days after their second dose of the Pfizer (Comirnaty) or AstraZeneca (Vaxzevria) vaccine. </p>
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Read more:
<a href="https://theconversation.com/how-long-do-covid-vaccines-take-to-start-working-161876">How long do COVID vaccines take to start working?</a>
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<p>So if the government is going to stick to the spirit of the national plan, we really should be waiting until two weeks after 80% of the 12+ population has been vaccinated.</p>
<p>Again, there will be a big political temptation to reopen the day of the “threshold” second jab, rather than when it really becomes effective.</p>
<h2>Don’t fall at the final hurdle</h2>
<p>Australians have put up with a lot since early 2020. A devastating virus, lockdowns, uncertainty, isolation from loved ones, economic pain, and differing degrees of government competence.</p>
<p>It is essential we finish this race properly. We must not let our political leaders reopen too early by redefining the targets they have signed up for. It would be the ultimate false economy.</p><img src="https://counter.theconversation.com/content/166754/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Richard Holden is President-elect of the Academy of Social Sciences in Australia.</span></em></p>Australia could again fall into the trap of false economies by opening up too soon.Richard Holden, Professor of Economics, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1659592021-08-18T12:11:15Z2021-08-18T12:11:15ZCan health insurance companies charge the unvaccinated higher premiums? What about life insurers? 5 questions answered<figure><img src="https://images.theconversation.com/files/416367/original/file-20210816-15-7tqby.jpg?ixlib=rb-1.1.0&rect=571%2C200%2C4378%2C2953&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Laws restrict the ways insurers can use vaccination status to affect coverage or premiums.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakCaliforniaSchools/1a48e81ef35d4521a2e956195aa618eb/photo?Query=Vaccine%20AND%20shot&mediaType=photo&sortBy=arrivaldatetime:desc&dateRange=Anytime&totalCount=3632&currentItemNo=36">AP Photo/Marcio Jose Sanchez</a></span></figcaption></figure><p><em>The current COVID-19 wave in the U.S. is mostly affecting unvaccinated Americans, who <a href="https://www.cnn.com/2021/07/31/health/fully-vaccinated-people-breakthrough-hospitalization-death/index.html">represent more than 95% of current cases of hospitalization and death</a>.</em></p>
<p><em>Given the average cost of a COVID-19 hospitalization in 2020 <a href="https://doi.org/10.1101/2021.05.26.21257879">ran about US$42,200 per patient</a>, will the unvaccinated be asked to bear more of the cost of treatment, in terms of insurance, as well?</em></p>
<p><em>We asked economists <a href="https://scholar.google.com/citations?user=fjl_qjwAAAAJ&hl=en&oi=ao">Kosali Simon</a> and <a href="https://scholar-google-com.proxy.library.cornell.edu/citations?user=S9Fo9fgAAAAJ&hl=en">Sharon Tennyson</a> to explain the rules governing how health and life insurers can discriminate among customers based on vaccination status and other health-related reasons.</em> </p>
<h2>1. Can insurers charge the unvaccinated more?</h2>
<p>This is a really interesting question and depends on the type of insurance. </p>
<p>Life insurance companies have the freedom to charge different premiums based on risk factors that predict mortality. Purchasing a life insurance policy often entails a health status check or medical exam, and asking for vaccination status is not banned. </p>
<p>Health insurers are a different story. A <a href="https://doi.org/10.1016/j.jpubeco.2004.07.003">slew of state and federal regulations</a> in the last three decades <a href="http://www.doi.org/10.1257/000282802760015720">have heavily restricted</a> their ability to use health factors in issuing or pricing polices. In 1996, the Health Insurance Portability and Accountability Act <a href="https://www.hhs.gov/hipaa/index.html">began prohibiting</a> the use of health status in any group health insurance policy. And the Affordable Care Act, passed in 2014, <a href="https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs5">prevents insurers</a> from pricing plans according to health – with one exception: smoking status.</p>
<h2>2. Are premiums or coverage being affected yet?</h2>
<p>Fortune recently reported that while <a href="https://www.yahoo.com/now/unvaccinated-still-able-life-insurance-150000872.html/">several of the biggest U.S. life insurance companies aren’t yet asking customers</a> for their vaccination status, a few insurers told the magazine they are doing so for people at high risk. It wasn’t clear from the article whether this is affecting premiums.</p>
<p>A recent study comparing life insurance policies from 2014 through February 2021 found that <a href="https://doi.org/10.1111/jori.12344">premiums and coverage didn’t change a lot</a> during the pandemic. The study did find some evidence that policy terms for the oldest individuals and those with high-risk health conditions did worsen. </p>
<p>The authors of the study suggested that the rapid development of vaccines may be why life insurance markets haven’t yet shown a dramatic response to COVID-19, but their work does not distinguish the vaccinated from the unvaccinated.</p>
<p>It’s important to note that no matter what, premiums and coverage on existing life insurance plans won’t change, so a death due to COVID-19 will definitely be covered. In general, denial of life insurance claims is rare and <a href="https://content.naic.org/sites/default/files/inline-files/JIR-ZA-36-10-EL.pdf">occurs only for specific documented reasons</a>.</p>
<h2>3. So smokers may pay higher premiums?</h2>
<p>In life insurance, smokers definitely pay higher premiums, as do people who are obese. </p>
<p>ValuePenguin, a unit of LendingTree that provides research and analysis, <a href="https://www.valuepenguin.com/life-insurance-smokers">found that smokers typically pay</a> over three times more for life insurance than non-smokers. </p>
<p>The site also found that <a href="https://www.valuepenguin.com/life-insurance-overweight-obese">obesity increases premiums</a> by about 150% – or more if the person also has medical conditions associated with being overweight.</p>
<p>As for health insurance pricing, the Affordable Care Act <a href="https://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Market-Reforms/Market-Rating-Reforms">allows insurers to increase premiums</a> by up to 50% for smokers. The difference between what smokers and non-smokers pay may actually be higher because the former <a href="http://www.doi.org/10.1377/hlthaff.2020.00015">can’t use a key government subsidy</a> to pay for the smoker surcharge. </p>
<p>The ACA makes no similar exception for obesity.</p>
<h2>4. How about discounts for the vaccinated?</h2>
<p>There is a tool health insurers – including self-insured employers – have to lower premiums to those who are vaccinated: wellness incentives. </p>
<p>Just as insurers and companies offer discounts for things like trying to lose weight or stop smoking, <a href="https://www.kff.org/coronavirus-covid-19/fact-sheet/what-can-employers-do-to-require-or-encourage-workers-to-get-a-covid-19-vaccine">they are also permitted</a> to reduce the health insurance premiums that vaccinated employees pay.</p>
<p>In 2019, the average maximum incentive <a href="https://www.kff.org/private-insurance/issue-brief/trends-in-workplace-wellness-programs-and-evolving-federal-standards">offered by employers</a> for workers to participate in wellness activities was $783 per year.</p>
<p>Some employers are already incentivizing COVID-19 vaccinations this way. For example, Missouri State University <a href="https://www.missouristate.edu/Human/wellness-incentive.htm">offers a $20-a-month discount</a> on health insurance premiums for employees who got a COVID-19 jab. <a href="https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/employers-ponder-health-plan-premium-surcharges-for-the-unvaccinated.aspx">Others are considering similar discounts</a>. </p>
<p>And so, even though insurers can’t charge the unvaccinated higher premiums, people who refuse to get a shot can end up paying more than their vaccinated colleagues. </p>
<h2>5. Do insurers consider other vaccine or flu shots in rates?</h2>
<p>To the best of our knowledge, insurers haven’t specifically used vaccination status or getting a flu shot in setting premiums. </p>
<p>As part of having access to your medical records, life insurers might get to know whether you received vaccinations, but there are no systems in place to verify each year whether you got your flu shot. Health insurers can’t ask about vaccine status for the reasons listed above.</p>
<p>Employers can offer incentives to get a flu shot through their wellness programs.</p>
<p>[<em>Like what you’ve read? Want more?</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=likethis">Sign up for The Conversation’s daily newsletter</a>.]</p><img src="https://counter.theconversation.com/content/165959/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kosali Simon's research has received funding from U.S. National Institutes for Health; she currently serves on the U.S. Congressional Budget Office Panel of Health Advisors and serves on the board of the non-profit Health Care Cost Institute; none of these affiliations are perceived as presenting a conflict of interest but are related to the topic of health care financing. </span></em></p><p class="fine-print"><em><span>Sharon Tennyson has engaged in research and expert testimony funded by property-liability insurance companies and their affiliates but has no professional associations with life insurance companies or organizations. She is a Senior Associate Editor of the Journal of Risk and Insurance, in which the Harris, Yelowitz and Courtmanche article is published.</span></em></p>Two economists explain what insurers can and can’t do to factor vaccination status into their coverage and rates.Kosali Simon, Professor of Health Economics, Indiana UniversitySharon Tennyson, Professor of Public Policy and Economics, Cornell UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1631692021-07-07T12:36:46Z2021-07-07T12:36:46ZUS Black and Latino communities often have low vaccination rates – but blaming vaccine hesitancy misses the mark<figure><img src="https://images.theconversation.com/files/409523/original/file-20210702-15-1k69t74.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">With many vaccine-eligible people in the U.S. staying away, some vaccine sites have no lines.
</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/sign-displays-the-types-of-covid-19-vaccination-doses-news-photo/1325495649?adppopup=true">Mario Tama/Getty Images</a></span></figcaption></figure><p>By early July 2021, <a href="https://covid.cdc.gov/covid-data-tracker/#vaccinations">nearly two-thirds</a> of all U.S. residents 12 years and older had received at least one dose of a COVID-19 vaccine; 55% were fully vaccinated. But uptake varies drastically by region – and it is <a href="https://covid.cdc.gov/covid-data-tracker/#vaccination-demographic">lower on average among non-white people</a>.</p>
<p>Many blame the <a href="https://covid.cdc.gov/covid-data-tracker/#vaccination-demographic">relatively lower vaccination rates in communities of color</a> on “vaccine hesitancy.” But this label overlooks persistent barriers to access and lumps together the varied reasons people have for refraining from vaccination. It also places all the responsibility for getting vaccinated on individuals. Ultimately, homogenizing peoples’ reasons for not getting vaccinated diverts attention away from <a href="https://www.kff.org/coronavirus-covid-19/issue-brief/implications-of-covid-19-for-social-determinants-of-health/">social factors</a> that research shows play a critical role in health status and outcomes. </p>
<p><a href="https://www.isu.edu/mph/faculty-and-staff/">As medical</a> <a href="https://scholar.google.com/citations?user=3lNCB0IAAAAJ&hl=en">anthropologists</a>, <a href="https://anthropology.ua.edu/people/stephanie-mcclure/">we take</a> a more nuanced view. Working together as lead site investigators for <a href="https://www.communivax.org/local-teams">CommuniVax</a>, a <a href="https://www.communivax.org">national initiative to improve vaccine equity</a>, we and our teams in Alabama, California and Idaho, along with CommuniVax teams elsewhere in the nation, have documented a variety of stances toward vaccination that simply can’t be cast as “hesitant.” </p>
<h2>Limited access hampers vaccination rates</h2>
<p>People of color have long suffered an <a href="https://www.nytimes.com/2020/01/13/upshot/bad-medicine-the-harm-that-comes-from-racism.html">array of health inequities</a>. Accordingly, due to a <a href="https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/index.html">combination of factors</a>, these communities have experienced higher hospitalization due to COVID-19, higher <a href="https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/disparities-illness.html#ref17">disease severity</a> upon admission, higher chances for being placed on breathing support and progression to the intensive care unit, and higher rates of death. </p>
<p>CommuniVax data, including some 200 in-depth interviews within such communities, confirm that overall, those who have directly experienced this kind of <a href="https://theconversation.com/how-californias-covid-19-surge-widens-health-inequalities-for-black-latino-and-low-income-residents-143243">COVID-19-related trauma</a>, are not hesitant. They dearly want vaccinations. For example, in San Diego’s heavily Latino and very hard-hit “South Region,” COVID-19 vaccine uptake is remarkably high – about <a href="https://www.sandiegocounty.gov/content/dam/sdc/hhsa/programs/phs/Epidemiology/COVID-19%20Vaccinations%20Demographics.pdf">84% as of July 6, 2021</a>. </p>
<p>However, vaccine uptake is far from universal in these communities. This is in part due to access issues that go beyond the <a href="https://doi.org/10.1001/jama.2021.1205">well documented challenges</a> of transportation, internet access and skills gaps, and a lack of information on how to get vaccinated. For example, some CommuniVax participants had heard of non-resident white people usurping doses that were meant for communities of color. African American participants, in particular, reported feeling that the <a href="https://www.cnbc.com/2021/03/10/jj-covid-vaccine-distribution-in-poor-black-communities-raises-race-questions.html">Johnson & Johnson vaccines promoted in their communities</a> were the least safe and effective. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/409527/original/file-20210702-21-1oq8we1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="U.S. First Lady Jill Biden gives comfort to a patient at a vaccination clinic" src="https://images.theconversation.com/files/409527/original/file-20210702-21-1oq8we1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/409527/original/file-20210702-21-1oq8we1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409527/original/file-20210702-21-1oq8we1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409527/original/file-20210702-21-1oq8we1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409527/original/file-20210702-21-1oq8we1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409527/original/file-20210702-21-1oq8we1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409527/original/file-20210702-21-1oq8we1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The Biden Administration fell short of its Fourth of July target to have at least one shot to 70% of adults.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/first-lady-jill-biden-comforts-a-nervous-patient-at-the-news-photo/1233600284?adppopup=true">Tom Brenner/Pool/AFP via Getty Images</a></span>
</figcaption>
</figure>
<p>Our participant testimony shows that many unvaccinated people are not “vaccine hesitant” but rather “vaccine impeded.” And exclusion can happen not just in a physical sense; <a href="https://www.aafp.org/journals/fpm/blogs/inpractice/entry/countering_vaccine_hesitancy.html">providers’ attitudes towards vaccines matter too</a>. </p>
<p>For instance, Donna, a health care worker in Idaho, said, “I chose not to get it because if I were to get sick, I think I would recover mostly or more rapidly.” This kind of attitude by health care providers <a href="https://doi.org/10.1016/j.vaccine.2016.10.042">can have downstream effects</a>. For example, Donna may not encourage vaccination when on duty or to people she knows; some, just observing her choices, may follow suit. Here, what appears as a community’s hesitancy to vaccinate is instead a reflection of vaccine hesitancy within its health care system.</p>
<p>More directly impeded are community members who, like Angela in Idaho, skipped vaccination because she couldn’t risk having a negative reaction that might require intervention. Although a trip to the doctor is a highly unlikely outcome after a vaccine, it remains a concern for some. “My insurance doesn’t cover as much as it possibly, you know, should,” she noted. And we have encountered many reports of undocumented individuals who fear deportation although, according to <a href="https://www.boundless.com/blog/can-immigrants-get-the-covid-19-vaccine/">current laws</a>, immigration status should not be questioned in relation to the vaccine. </p>
<p>Christina, in San Diego, illustrates another type of practical barrier. She cannot get vaccinated, she said, because she has no one to care for her babies should she fall ill with side effects. Her husband, similarly, can’t take time off from his job – “It doesn’t work that way.” Likewise, Carlos – who made sure that his centenarian father got vaccinated – says he can’t take the vaccine himself due to his dad’s deep dementia: “If I took my vaccine and I got sick, he’d be screwed.” </p>
<h2>Indifference, resilience and ambivalence</h2>
<p>Another segment of unvaccinated people obscured by the “hesitant” label are the “vaccine indifferent.” For various reasons, they <a href="https://doi.org/10.1001/jama.2021.7707">remain relatively untouched</a> by the pandemic: COVID-19 just isn’t on their radar. This might include people who are self-employed or working under the table, people living in rural and remote places, and those whose children are not in the public school system.</p>
<p>Such people thus are not consistently connected to COVID-19-related information. This is particularly true if they forego social or news media and socialize with others who do the same, and if there are significant language barriers. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/409528/original/file-20210702-25-1f0nmfn.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="vaccine recruitment effort by CommuniVax in June" src="https://images.theconversation.com/files/409528/original/file-20210702-25-1f0nmfn.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/409528/original/file-20210702-25-1f0nmfn.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409528/original/file-20210702-25-1f0nmfn.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409528/original/file-20210702-25-1f0nmfn.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409528/original/file-20210702-25-1f0nmfn.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409528/original/file-20210702-25-1f0nmfn.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409528/original/file-20210702-25-1f0nmfn.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">CommuniVax researchers Sarah Song and Grecia Guerrero talk with potential participants outside a grocery store in June.</span>
<span class="attribution"><span class="source">Diego Ceballos/CommuniVax</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>We also learned that, among some of our participants, the initial messaging about <a href="https://www.washingtonpost.com/health/2021/06/21/young-adults-covid-vaccine/">prioritizing high-risk groups backfired</a>, leaving some under 65 and in relatively good health with the impression it wasn’t necessary for them to get the vaccine. Without incentives – travel plans, being accepted to a college or having an employer that mandates vaccination – inertia carries the day.</p>
<p>The indifferent are not against vaccination. Rather, “if it ain’t broke, don’t fix it” and “you do you” tend to typify their views. As Jose from Idaho reported, “I’m not worried because I’ve always taken care of myself.”</p>
<p>We also saw a modified form of indifference in those who believed that the protective steps they already were taking would be enough to keep them COVID-19-free. A janitor said, “I am an essential worker… So from the beginning we took … all the precautions … face masks, taking [social] distance [and using] natural medicines and vitamins for the immune system.” He had, indeed, so far avoided contracting COVID-19.</p>
<p>The view of vaccines as not immediately necessary is magnified among some Latino people by the cultural value placed on the need to endure – “aguantar” in Spanish — to bear up, push through and avoid complaining about daily struggles. This perspective can be seen in many immigrant or impoverished populations, where getting sick or injured <a href="https://www.npr.org/2020/08/26/904045354/our-communities-are-in-crisis-latinos-and-covid-19">can be a precursor</a> to household ruin through job loss and exorbitant, unpayable medical bills. </p>
<p>Yet another dynamic we learned of is what we term “vaccine ambivalence.” Some participants who view COVID-19 as a significant health threat believe the vaccine poses an equivalent risk. We saw this particularly among African Americans in Alabama – not necessarily surprising given that the health care system has not always had <a href="https://doi.org/10.17226/10260">these communities’</a> <a href="https://doi.org/10.1089/heq.2017.0045">best interests</a> at heart. The perceived conundrum leaves people stuck on the fence. Given the <a href="https://doi.org/10.1007/s40615-020-00928-y">legacy of unequal treatment</a> in communities of color, when balancing the “known” of COVID-19 against the unknown of vaccination, their inaction may seem reasonable – especially when coupled with mask-wearing and social distancing.</p>
<h2>Attending to blind spots</h2>
<p>At this point in the pandemic, those with the means and will to get vaccinated have done so. Providing viable <a href="https://doi.org/10.1080/14797585.2021.1886425">counternarratives to misinformation</a> can help bring more people on board. But continuing to focus solely on individual mistrustfulness toward vaccines or so-called hesitancy obscures the other complex reasons people have for being wary of the system and bypassing vaccination. </p>
<p>[<em>Over 100,000 readers rely on The Conversation’s newsletter to understand the world.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=100Ksignup">Sign up today</a>.]</p>
<p>Moreover, an overly narrow focus on the vaccine leaves a lot outside the frame. A wider view reveals that the problems leading to inequitable vaccination coverage are the same structural problems that have, historically, prevented people of color from <a href="https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html">having a fair shot</a> at good health and economic outcomes to begin with – problems that even a 100% vaccination rate cannot resolve.</p><img src="https://counter.theconversation.com/content/163169/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>People who haven’t gotten vaccinated for COVID-19 often have complex reasons for their relunctance or may face other barriers. Lumping them all together undercuts the vaccination campaign.Elisa J. Sobo, Professor and Chair of Anthropology, San Diego State UniversityDiana Schow, Visiting Assistant Professor of Community and Public Health; Executive Director, Southeast Idaho Area Health Education Center, Institute of Rural Health, Idaho State University, Idaho State UniversityStephanie McClure, Assistant Professor of Biocultural Medical Anthropology, University of AlabamaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1632212021-06-30T15:52:07Z2021-06-30T15:52:07ZWill COVID-19 vaccination enthusiasm last? Lessons from polio and H1N1<figure><img src="https://images.theconversation.com/files/408260/original/file-20210624-13-vxe6fk.jpg?ixlib=rb-1.1.0&rect=1%2C0%2C909%2C618&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Two public health nurses vaccinate adults at a polio clinic in Southey, Sask. in 1960.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/lac-bac/49587866686/in/photolist-2m3Vqeq-T7XMum-ovDmHk-oerCAi-odc6cv-tkGxDo-owgyyA-2ixUM9J-xrxZmo-xHttWf-xFN125-xnv3jo-od9pYA-x8jPuc-sG6bND-tAzahh-xb5kzq-xsFWuV-odcPp7">(Canadian Nurses Association fonds. Library and Archives Canada)</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><iframe style="width: 100%; height: 175px; border: none; position: relative; z-index: 1;" allowtransparency="" src="https://narrations.ad-auris.com/widget/the-conversation-canada/will-covid-19-vaccination-enthusiasm-last--lessons-from-polio-and-h1n1" width="100%" height="400"></iframe>
<p>Canadian enthusiasm for COVID-19 vaccination is impressive. After repeated lockdowns, long separations from friends and family and economic losses, Canadians are lining up overnight at <a href="https://toronto.ctvnews.ca/hundreds-line-up-as-pop-up-clinics-offer-covid-19-vaccines-to-children-aged-12-and-over-1.5433466">pop-up clinics</a> and <a href="https://www.thestar.com/news/gta/2021/05/03/miss-out-amid-this-mornings-scramble-to-get-a-vaccine-appointment-for-people-18-in-covid-19-hot-spots-you-werent-alone.html">crashing websites</a> with their eagerness to book appointments.</p>
<p><a href="https://ourworldindata.org/covid-vaccinations">Canada is currently a global leader</a> with over <a href="https://health-infobase.canada.ca/covid-19/vaccination-coverage/">75 per cent of the eligible population</a>, as of June 25, having received their first dose.</p>
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<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
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<p>Does this mean we can stop worrying about vaccine uptake? Experience from history suggests not. As historians <a href="https://doi.org/10.1503/cmaj.171238">Heather MacDougall and Laurence Monnais</a> have argued, people do not get the recommended vaccines for a variety of reasons, including apathy. Another reason is misinformation, like the <a href="https://www.historyofvaccines.org/content/articles/do-vaccines-cause-autism">unfounded and discredited claim that the measles, mumps and rubella vaccine can cause autism</a>. </p>
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Read more:
<a href="https://theconversation.com/private-messages-contribute-to-the-spread-of-covid-19-conspiracies-162725">Private messages contribute to the spread of COVID-19 conspiracies</a>
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<p>Some <a href="https://doi.org/10.1080/10810730.2017.1312720">are not convinced</a> that the disease in question will impact them or their families. Others are deterred by the difficulty of accessing the vaccine. More than a few are scared of <a href="https://doi.org/10.1016/j.vaccine.2012.05.011">needles</a>. We have seen all of these factors play out in past epidemics.</p>
<p>We examined the response to polio and the H1N1 vaccines in Canada. At the height of the epidemics, Canadians were keen to get vaccinated, but vaccine enthusiasm waned once the crisis had passed.</p>
<h2>The case of polio</h2>
<p>Parents were terrified by polio in the early decades of the 20th century. Usually striking in the otherwise carefree summer months, <a href="https://www.who.int/news-room/fact-sheets/detail/poliomyelitis">polio could leave children paralyzed</a>. In some cases children were confined in <a href="https://longreads.com/2020/05/26/among-the-last-in-an-iron-lung/">iron lungs</a> and in the very worst cases, death. </p>
<p>The first trial of the Salk polio vaccine took place in the United States in 1954, <a href="https://www.thecanadianencyclopedia.ca/en/article/canada-and-the-development-of-the-polio-vaccine">using a vaccine produced in Toronto’s Connaught Laboratories</a>. </p>
<p>The vaccine proved highly effective. Other laboratories were licensed to product the vaccine, but one of them, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1383764/">the Cutter Laboratories, failed to properly de-activate the polio virus</a> and 10 children died from polio. The U.S. <a href="https://www.nytimes.com/1955/05/07/archives/u-s-halts-flow-of-polio-vaccine-pending-a-study-u-s-halts-flow-of.html">halted the vaccination program</a> on May 7, 1955.</p>
<p>In Canada, a trial using the vaccine produced at the Connaught Laboratories continued. Health officials assured Canadians that the Connaught Laboratories product <a href="https://news.google.com/newspapers?nid=QBJtjoHflPwC&dat=19550509&printsec=frontpage&hl=en">was safe and effective</a>. By June 1956, <a href="https://www.jstor.org/stable/41981152">1.8 million Canadian children had been vaccinated</a>. But this did not eradicate polio — there were significant epidemics in the late 1950s and early 1960s. </p>
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<img alt="A nurse stands next to man in an iron lung" src="https://images.theconversation.com/files/408414/original/file-20210625-28-jwj8ja.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/408414/original/file-20210625-28-jwj8ja.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/408414/original/file-20210625-28-jwj8ja.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/408414/original/file-20210625-28-jwj8ja.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/408414/original/file-20210625-28-jwj8ja.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/408414/original/file-20210625-28-jwj8ja.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/408414/original/file-20210625-28-jwj8ja.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">A photo of a man in an iron lung from July 1957.</span>
<span class="attribution"><span class="source">(Library and Archives Canada)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>The Salk vaccine schedule required three separate doses, making it a challenge to complete the full course of vaccination. </p>
<p>Many adults believed that polio only impacted children and were reluctant to take the vaccine. <a href="https://www.jstor.org/stable/41981576">Only 10 per cent of Canadian adults</a> had received the required three doses of the Salk vaccine by June of 1959, compared to a rate of 90 per cent among school-aged children. </p>
<p>The year 1959 was one of the worst years for polio in Canada, with nearly <a href="https://www.cpha.ca/story-polio">2,000 paralytic cases</a>. In Montréal <a href="https://news.google.com/newspapers?nid=Fr8DH2VBP9sC&dat=19591015&printsec=frontpage&hl=en">there were over 950 cases and 51 fatalities</a>. Across Canada, more young adults died than children between the ages of five and 19, most of the cases occurring among those who had not been vaccinated. </p>
<p>During the 1959 epidemic people swamped the vaccination clinics in Montréal. And three years later, following <a href="https://news.google.com/newspapers?nid=Fr8DH2VBP9sC&dat=19620829&printsec=frontpage&hl=en">an outbreak in Hull, Que.</a>, residents came to the vaccination clinics in droves. </p>
<h2>Introduction of oral vaccine</h2>
<p>The introduction of the oral polio vaccine (Sabin vaccine) in 1961 led to an uptick in polio vaccinations. </p>
<p>In just three months in 1962, over <a href="https://www.jstor.org/stable/pdf/41983496.pdf">four million Canadians</a> received the oral polio vaccine. Many adults who had resisted earlier appeals to get the Salk vaccine <a href="https://news.google.com/newspapers?nid=Fr8DH2VBP9sC&dat=19620521&printsec=frontpage&hl=en">showed up to sip</a> the tasteless Sabin vaccine, often served on a sugar cube. <a href="https://news.ourontario.ca/88728/page/278074?q=polio+OR+vaccine">Newspapers raved</a> that no needles were necessary. And by the 1970s, polio had all but disappeared in Canada. </p>
<p>When the Salk vaccine came out, parents were very keen to have their children vaccinated, but young adults were not convinced that they were at risk and did not get vaccinated. Only after additional epidemics showed that that they too could die or be paralyzed by polio did adults turn up to get vaccinated. The vaccination effort was further aided by tasty Sabin vaccine.</p>
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<img alt="Group of people waiting for vaccines" src="https://images.theconversation.com/files/408264/original/file-20210624-23-19pt0mr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/408264/original/file-20210624-23-19pt0mr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=471&fit=crop&dpr=1 600w, https://images.theconversation.com/files/408264/original/file-20210624-23-19pt0mr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=471&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/408264/original/file-20210624-23-19pt0mr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=471&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/408264/original/file-20210624-23-19pt0mr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=591&fit=crop&dpr=1 754w, https://images.theconversation.com/files/408264/original/file-20210624-23-19pt0mr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=591&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/408264/original/file-20210624-23-19pt0mr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=591&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">People lined up to get their H1N1 vaccination in Oct. 2009 in St. Eustache Que. Waiting times of seven hours were common as vaccination centres were overwhelmed by the demand.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Ryan Remiorz</span></span>
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<h2>H1N1 vaccination campaign</h2>
<p>In spring of 2009, a novel H1N1 influenza virus began spreading in <a href="https://doi.org/10.1016/S0140-6736(09)61638-X">Mexico</a>. The first cases were reported in <a href="https://www.thecanadianencyclopedia.ca/en/article/h1n1-flu-of-2009-in-canada">Canada</a> that April.</p>
<p>In June, the <a href="https://www.cdc.gov/h1n1flu/who/">World Health Organization</a> declared H1N1 to be a global pandemic. Like the flu of 1918-19, which killed as many as <a href="https://www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html">50 million people</a> around the world, the 2009 flu had a disproportionate impact on <a href="https://www.thestar.com/life/health_wellness/news_research/2009/10/28/h1n1_is_serious_but_no_need_to_panic.html">younger people</a>. </p>
<p>That fall, vaccination clinics opened across Canada for priority groups. Early polls showed that only <a href="https://www.thestar.com/life/health_wellness/news_research/2009/10/22/h1n1_vaccine_headed_to_a_clinic_near_you.html">one-third of Canadians</a> planned to get the H1N1 vaccine, which was <a href="https://www150.statcan.gc.ca/n1/pub/82-624-x/2015001/article/14218-eng.htm">on par with seasonal flu shot vaccination rates</a>. Less than <a href="https://doi.org/10.1093/infdis/jis283">perfect efficacy rates</a> of the seasonal flu shot did little to inspire the Canadian public to seek out the H1N1 vaccine. </p>
<p>But four days after vaccination clinics opened in Ontario, a previously healthy <a href="https://toronto.ctvnews.ca/boy-killed-by-h1n1-was-my-best-friend-says-dad-1.447725">boy in Toronto died</a>. The tragic news stirred fear among Ontarians, prompting thousands to <a href="https://www.macleans.ca/news/canada/swine-flu-screw-up/">rush to clinics</a>. Many waited in line for hours, while others were turned away.</p>
<p>Vaccines became available to all Ontarians in November 2009, but by then, people’s fears had eased — it seemed that H1N1 <a href="https://doi.org/10.1503/cmaj.100900">was not as lethal as had originally been feared</a>. </p>
<p>Ultimately, <a href="https://www.thecanadianencyclopedia.ca/en/article/h1n1-flu-of-2009-in-canada">between 40 and 45 per cent</a> of the Canadian population was vaccinated against H1N1. </p>
<p>Once again, vaccine enthusiasm was high in the middle of the crisis, but it diminished after the flu appeared to be less dangerous.</p>
<h2>Lessons for COVID-19</h2>
<p>Polio and H1N1 reveal the complexities of vaccine enthusiasm. People rush to get vaccines when they perceive an immediate health risk to themselves or their family members. But without that fear, it is easier to delay or avoid getting vaccinated.</p>
<p>Many Canadians know someone who has gotten sick from COVID-19 and many have lost friends and family members to the disease. It’s no wonder we are eager to get vaccinated. But enthusiasm may wane as case counts fall. </p>
<p>If it proves that we need boosters, but case counts are low, will people make the same effort to get out to the vaccine clinics?</p>
<p>The biggest challenge may be ensuring the continuing uptake of vaccines once the initial crisis has passed. In addition to measures to <a href="https://theconversation.com/how-canadians-can-use-social-media-to-help-debunk-covid-19-misinformation-155653">combat vaccine misinformation</a>, public health authorities need to ensure that vaccines are readily available and convenient to access. </p>
<p><em>Do you have a question about COVID-19 vaccines? Email us at <a href="mailto:ca-vaccination@theconversation.com">ca‑vaccination@theconversation.com</a> and vaccine experts will answer questions in upcoming articles.</em></p><img src="https://counter.theconversation.com/content/163221/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catherine Carstairs has received funding from SSHRC, AMS Healthcare and the University of Guelph. This research was funded by a grant from the University of Guelph, SSHRC Institutional Explore Grant.</span></em></p><p class="fine-print"><em><span>Curtis Fraser does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>At the height of polio and H1N1, Canadians were keen to get vaccinated, but vaccine enthusiasm waned once the crisis had passed — what does that mean for COVID-19?Catherine Carstairs, Professor, Department of History, University of GuelphCurtis Fraser, Graduate Student, History, University of GuelphLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1616762021-06-01T19:03:45Z2021-06-01T19:03:45ZThe real challenge to COVID-19 vaccination rates isn’t hesitancy — it’s equal access for Māori and Pacific people<figure><img src="https://images.theconversation.com/files/403692/original/file-20210601-23-1a0mhzy.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5447%2C3637&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">GettyImages</span></span></figcaption></figure><p>Reports of potentially higher rates of <a href="https://www.rnz.co.nz/national/programmes/morningreport/audio/2018786055/maori-communities-rate-of-vaccine-hesitancy-alarmingly-high-peeni-henare">vaccine hesitancy</a> among <a href="https://www.rnz.co.nz/news/ldr/442341/whanganui-health-providers-grapple-with-covid-19-vaccine-hesitancy">Māori</a> and <a href="https://www.nzherald.co.nz/nz/covid-19-coronavirus-battle-to-spread-truth-about-vaccine-in-pacific-communities/YLTW4PBLYGCA7WIVP7GZH4PZJE/">Pacific</a> populations have seen the government target COVID-19 vaccine and information campaigns at those communities.</p>
<p>And there are excellent reasons for such a targeted approach, designed and delivered by Māori and Pacific leaders for Māori and Pacific people. More so, given <a href="https://www.hhrjournal.org/2020/06/the-waitangi-tribunals-wai-2575-report-implications-for-decolonizing-health-systems/">existing inequities</a> within the <a href="https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-019-1057-4">health-care system</a> that have fostered unequal health outcomes and <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jpc.15309">distrust in health institutions</a> themselves.</p>
<p>But it is also important to confront the inference that Māori and Pacific people are more prone to believe COVID-19 vaccine conspiracy theories, and that this might be the most significant barrier to vaccination uptake.</p>
<p>Using data collected from a <a href="https://openaccess.wgtn.ac.nz/articles/journal_contribution/COVID-19_Vaccine_Hesitancy_and_Acceptance_in_a_Cohort_of_Diverse_New_Zealanders/14658885">diverse sample</a> of New Zealanders, we found no basis for this. When modelling accounts for the key factors we know are associated with vaccine hesitancy, such as education and age, ethnic differences are no longer statistically significant.</p>
<p>That is, differences in vaccine hesitancy rates for Māori and Pacific communities are explained by their younger age structure and lower educational attainment. Indeed, across all communities, these are the main factors associated with vaccine hesitancy.</p>
<p>These findings are, of course, fairly intuitive when we look at the <a href="https://www.tandfonline.com/doi/full/10.1080/1177083X.2021.1879181">successful leadership</a> from Māori and Pacific communities during the early pandemic response, including initiatives such as a <a href="https://www.nzherald.co.nz/nz/local-focus-covid-card-experiment-underway-in-ngongotaha/XBL4CSMBIQCNMIJQKNGSD6IKBY/">contact tracing card trial</a> and <a href="https://thespinoff.co.nz/society/10-05-2020/community-checkpoints-an-important-and-lawful-part-of-nzs-covid-response/">community checkpoints</a>.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/TcIQATtAkS0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A government campaign to encourage New Zealanders to get the Covid-19 vaccine is noticably Māori and Pacific focused.</span></figcaption>
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<h2>The risk of inequitable vaccination rates</h2>
<p>The real risk is that the intention to be vaccinated doesn’t translate into actual uptake. Early data on the COVID-19 vaccine rollout suggests <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">fewer Māori and Pacific people are fully immunised</a>. </p>
<p>This matters because these populations have a <a href="https://www.nzma.org.nz/journal-articles/estimated-inequities-in-covid-19-infection-fatality-rates-by-ethnicity-for-aotearoa-new-zealand">greater risk</a> of COVID-19 transmission, severe infection, ICU admission or even death. </p>
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Read more:
<a href="https://theconversation.com/a-year-after-new-zealands-first-covid-19-lockdown-discrimination-and-racism-are-on-the-rise-160858">A year after New Zealand's first COVID-19 lockdown, discrimination and racism are on the rise</a>
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<p>Despite the Ministry of Health’s <a href="https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-vaccines-archived/covid-19-getting-vaccine/covid-19-vaccine-rollout">phased rollout plan</a>, it seems some populations could be protected sooner than others due to the geographic and other barriers faced by Māori and Pacific people.</p>
<p>This mirrors known trends in health-care access in Aotearoa where services are <a href="https://researchcommons.waikato.ac.nz/bitstream/handle/10289/14271/Chapter%206%20Mixed%20methods%20NZPR-46_Whitehead-et-al_final.pdf?sequence=2&isAllowed=y">inequitably distributed</a>. Wealthier, healthier and whiter populations tend to have the best access to facilities and high-quality care. </p>
<h2>Time and distance are the real barriers</h2>
<p>Our analysis shows that offering vaccination at existing health facilities and pop-up sites <a href="https://www.nzma.org.nz/journal-articles/will-access-to-covid-19-vaccine-in-aotearoa-be-equitable-for-priority-populations-open-access">would be inequitable</a>. Māori, older people and poorer communities would be disproportionately affected by distance and travel times from where they live. </p>
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<a href="https://images.theconversation.com/files/403243/original/file-20210527-13-ph2i8x.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/403243/original/file-20210527-13-ph2i8x.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/403243/original/file-20210527-13-ph2i8x.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=425&fit=crop&dpr=1 600w, https://images.theconversation.com/files/403243/original/file-20210527-13-ph2i8x.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=425&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/403243/original/file-20210527-13-ph2i8x.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=425&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/403243/original/file-20210527-13-ph2i8x.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=534&fit=crop&dpr=1 754w, https://images.theconversation.com/files/403243/original/file-20210527-13-ph2i8x.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=534&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/403243/original/file-20210527-13-ph2i8x.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=534&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">Estimated travel times to five types of potential COVID-19 vaccine delivery site.</span>
<span class="attribution"><span class="source">NZ Medical Journal</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Schools and GP clinics are clearly the most easily accessible sites. However, converting schools into vaccination centres might not be feasible. The best option could be combining effective outreach programs with vaccination centres run from GP clinics, Māori providers and Pacific health services.</p>
<p>While some will find ways to overcome access barriers, others won’t have the time, money or resources. These obstacles become mountains if people are already vaccine-hesitant — regardless of ethnicity. </p>
<p>If they postpone or forgo the vaccine altogether it will make existing inequities worse and challenge the overall COVID-19 elimination strategy, especially when borders open and the risk of community transmission increases. </p>
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Read more:
<a href="https://theconversation.com/vaccination-alone-will-not-provide-full-protection-when-borders-open-nz-will-still-be-managing-covid-19-158414">Vaccination alone will not provide full protection. When borders open, NZ will still be managing COVID-19</a>
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<h2>The threat of other infectious diseases</h2>
<p>We know many people have deferred routine health care during the pandemic, including <a href="https://www.rnz.co.nz/news/national/416113/fears-of-measles-resurgence-as-vaccinations-drop-away-in-lockdown">childhood immunisation</a> against other infectious diseases. This has happened against a backdrop of <a href="https://www.health.govt.nz/system/files/documents/publications/improving-new-zealands-childhood-immunisation-rates-sep19.pdf">already declining immunisation</a> rates among children in general, and among tamariki Māori and Pacific children in particular. </p>
<p>The result has been <a href="https://www.stuff.co.nz/national/health/300200870/just-20-per-cent-of-dhbs-meeting-vaccination-targets-nz-cant-afford-to-slip--expert">worsening coverage rates</a> in some regions with persistently low coverage anyway, as people <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jpc.15551">stayed away</a> from primary health-care providers. </p>
<p>Closing the borders and restricting movement to stop COVID-19 transmission also reduced the spread of <a href="https://www.nature.com/articles/s41467-021-21157-9">other infectious diseases</a>. When these controls are lifted the risk of serious childhood disease outbreaks, such as measles and pertussis, will increase. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-increase-covid-19-vaccine-uptake-and-decrease-vaccine-hesitancy-in-young-people-161071">How to increase COVID-19 vaccine uptake and decrease vaccine hesitancy in young people</a>
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<p>High childhood vaccination coverage must be prioritised to counter the vulnerability of Māori and Pacific communities to the immediate and long-term burdens of these diseases. </p>
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<h2>Avoiding a perfect storm</h2>
<p>This winter’s influenza immunisation campaign and the MMR (measles, mumps and rubella) catch-up program are particularly focused on young Māori and Pacific adults. The priority is to prevent further devastating <a href="https://www.nzma.org.nz/journal-articles/a-measles-epidemic-in-new-zealand-why-did-this-occur-and-how-can-we-prevent-it-occurring-again">outbreaks of measles</a>.</p>
<p>However, the resources <a href="https://www.stuff.co.nz/national/health/300266885/flu-vaccine-rollout-set-to-start-for-over-65s-rest-of-nz-to-wait-longer-than-usual?rm=a">currently prioritised</a> for the COVID-19 vaccine campaign inevitably affect other immunisation campaigns. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-vaccine-hesitancy-spell-out-the-personal-rather-than-collective-benefits-to-persuade-people-new-research-160824">COVID vaccine hesitancy: spell out the personal rather than collective benefits to persuade people — new research</a>
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<p>Communities across Aotearoa may soon face a perfect storm: fewer resources available to address low childhood immunisation rates, delayed influenza protection and MMR catch-ups, and the potential for the inequitable delivery of COVID-19 vaccines. </p>
<p>These factors, combined with increasing freedom of movement, are likely to result in infectious disease spread, particularly in Māori and Pacific communities. </p>
<p>For the health system to be adequately responsive, it should engage Māori and Pacific leadership in the governance, design and delivery of vaccination campaigns. It will require resourcing, monitoring and accountability to build adaptable solutions that ensure community aspirations are met.</p><img src="https://counter.theconversation.com/content/161676/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Age and education level are the main factors associated with vaccine hesitancy. While this affects Māori and Pacific communities, basic access to health care and information is more important.Jesse Whitehead, Postdoctoral Researcher, University of WaikatoKate C. Prickett, Director of the Roy McKenzie Centre for the Study of Families and Children, Te Herenga Waka — Victoria University of WellingtonPolly Atatoa Carr, Associate Professor, University of WaikatoLicensed as Creative Commons – attribution, no derivatives.