tag:theconversation.com,2011:/uk/topics/vaccine-confidence-in-canada-107061/articlesVaccine confidence in Canada – The Conversation2022-03-21T18:54:18Ztag:theconversation.com,2011:article/1785872022-03-21T18:54:18Z2022-03-21T18:54:18ZResearch dispels myth that COVID-19 vaccines cause infertility, but misinformation persists<figure><img src="https://images.theconversation.com/files/453231/original/file-20220321-19-10uqz5z.jpg?ixlib=rb-1.1.0&rect=714%2C14%2C4191%2C3130&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Misinformation about COVID-19 vaccines affecting fertility have no realistic basis.</span> <span class="attribution"><span class="source"> (AP Photo/John Locher)</span></span></figcaption></figure><p><a href="https://theconversation.com/the-fault-in-our-stars-aaron-rodgers-reminds-us-why-celebrity-shouldnt-trump-science-171648">Misinformation</a> about <a href="https://www.npr.org/sections/health-shots/2021/07/20/1016912079/the-life-cycle-of-a-covid-19-vaccine-lie">COVID-19 vaccines and fertility</a> has propagated online despite the vaccines’ <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/safety-of-vaccines.html">clear safety profile</a>. </p>
<p>Fortunately, those considering having kids can relax when it comes to these crucial shots. These claims <a href="https://doi.org/10.1001/jama.2022.2404">lack any realistic basis</a>. As a medical doctor and a COVID-19 genetics researcher, I’d like to discuss what the evidence says.</p>
<h2>Misinformation about fertility</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
</figcaption>
</figure>
<p>Some sources of <a href="https://www.factcheck.org/2021/06/scicheck-research-rebuts-baseless-claims-linking-covid-19-vaccines-to-male-infertility/">misinformation claim that the COVID-19 vaccines cause male sterility</a>. For this to be true, the vaccines would have to damage sperm quality, drastically reduce sperm count or interfere with the mechanisms inherent in male ejaculation. Quality clinical evidence has demonstrated that none of these parameters are affected by the vaccine, so men are not being made sterile. </p>
<p>A <a href="https://doi.org/10.1001/jama.2021.9976">study in Florida</a> recruited around 45 men and compared their sperm measures before and after receiving a COVID-19 vaccine. Interestingly, the study found that men who received the vaccine had more sperm, greater semen volume, and sperm more able to move around and fertilize an egg.</p>
<p>Pregnancy can be an exciting time but can also <a href="https://www.anxietycanada.com/articles/common-worries-during-pregnancy/">provoke worry</a> about the the safety of anything that enters the body, including vaccines. Fortunately, the COVID-19 vaccines are safe during pregnancy. </p>
<p>Sources of misinformation have claimed that COVID-19 vaccines can lead to loss of pregnancy, <a href="https://www.bbc.com/news/health-57552527">with vague references to antibody responses or other concepts that sound scientific</a>. However, the COVID-19 vaccines will not make a pregnant woman any more likely to have a miscarriage. </p>
<figure class="align-center ">
<img alt="A pregnant woman sitting a table across from a health-care worker in scrubs and a face mask who is preparing to give her a shot." src="https://images.theconversation.com/files/453237/original/file-20220321-17-qf3rlx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/453237/original/file-20220321-17-qf3rlx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=405&fit=crop&dpr=1 600w, https://images.theconversation.com/files/453237/original/file-20220321-17-qf3rlx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=405&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/453237/original/file-20220321-17-qf3rlx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=405&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/453237/original/file-20220321-17-qf3rlx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=509&fit=crop&dpr=1 754w, https://images.theconversation.com/files/453237/original/file-20220321-17-qf3rlx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=509&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/453237/original/file-20220321-17-qf3rlx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=509&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">COVID-19 vaccines do not increase the risk of miscarriage.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>A group of physicians spanning the United States <a href="https://doi.org/10.1001/jama.2021.15494">studied the pregnancy outcomes for over 100,000 pregnancies</a>. When the study was done, around 14 per cent of everyone investigated had received at least one dose of the COVID vaccine. They found that women who had the shot were no more likely to have a miscarriage than those who did not. </p>
<p><a href="https://doi.org/10.1001/jama.2022.2404">There are other misinformation claims along the lines of antibodies attacking the placenta, shots equating with infertility or interference with hormones</a>. Unsurprisingly, all of these have been debunked.</p>
<h2>The real danger is COVID-19 infection</h2>
<p>While there is no evidence that the COVID-19 vaccine can impact fertility or pregnancy, there is evidence that a COVID-19 infection can cause harm. At its extreme, the disease can be fatal — <a href="https://doi.org/10.1136/bmj.m3320">an outcome that is more likely if COVID-19 infection happens during pregnancy</a>. </p>
<p><a href="https://doi.org/10.1371/journal.pone.0255994">Multiple studies have also documented an increased risk of miscarriage following a COVID-19 infection</a>. However, miscarriage is not the only risk. The respiratory distress that can come with COVID-19, as well as the inflammation, can affect fetal growth, which could lead to <a href="https://doi.org/10.1016/j.brainres.2011.01.032">health and developmental problems</a> in a baby carried to term. </p>
<p>Carried to term is an important point here because pregnant women with COVID-19 are more likely to <a href="https://doi.org/10.1136/bmj.m3320">deliver their babies early</a>. This is associated with health risks for the baby, including an increased risk of <a href="https://www.ncbi.nlm.nih.gov/books/NBK11385/">requiring intensive care</a>.</p>
<h2>The case for COVID-19 vaccination</h2>
<p>It makes sense to get a COVID-19 vaccine. The risk of developing COVID-19 still exists and is still dangerous. This remains true while the case counts have trended downwards in North America to the tens of thousands from nearly one million a day in January. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A line graph showing decreasing COVID-19 cases since the end of December 2021 until March 19, 2022." src="https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/453215/original/file-20220321-25-4mlpln.png?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>
<figcaption>
<span class="caption">As COVID-19 remains a danger, vaccination remains the best protection.</span>
<span class="attribution"><span class="source">(Johns Hopkins University CSSE COVID-19 Data)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Fortunately, the <a href="https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html">vaccine offers excellent protection</a> against developing an infection. It also dramatically decreases the chance of severe disease if infection does occur. When considering what poses the greatest danger to a pregnant woman or a couple looking to have children, severe illness poses the most significant risk of causing fertility or pregnancy problems.</p>
<p>COVID-19 misinformation is not going to go away. Previous vaccine misinformation has lingered despite a complete lack of evidence. For example, <a href="https://dx.doi.org/10.1503/cmaj.109-3179">the myth of a vaccine-autism link was debunked in 1998</a>, but vaccine hesitancy has persisted despite copious amounts of clinical evidence that these claims lack any sound basis. Articles like this one will not change some people’s minds, but ultimately that is not the goal. </p>
<p>The goal of sharing medical information from a physician’s point of view is to provide people with the knowledge that they need to make an informed health-care decision. While I strongly recommend the vaccine to everyone, individuals are the ones who choose what they seek to do with their bodies. </p>
<p>Public health can appropriately guide individuals towards making decisions in their and their community’s best interests, as with vaccine mandates. Individuals still maintain their autonomy, even if accompanied by consequences like employment issues. If one reflects on what is best for a baby, the evidence is clear. It is an individual’s prerogative on what to do with that information.</p><img src="https://counter.theconversation.com/content/178587/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>Some of the most persistent myths about COVID-19 vaccination have been false rumours that it can affect fertility in men or women. There has never been any evidence to support this misinformation.Julian Daniel Sunday Willett, PhD Candidate, Quantitative Life Sciences, McGill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1698142022-02-17T17:31:30Z2022-02-17T17:31:30ZVaccine hesitancy: Why ‘doing your own research’ doesn’t work, but reason alone won’t change minds<figure><img src="https://images.theconversation.com/files/446385/original/file-20220214-138710-1tbheys.JPG?ixlib=rb-1.1.0&rect=175%2C53%2C2770%2C1926&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Reason is not the only factor that guides vaccine decisions. Understanding human decision-making is the first step in changing behaviour.</span> <span class="attribution"><span class="source"> THE CANADIAN PRESS/Chad Hipolito</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/vaccine-hesitancy--why--doing-your-own-research--doesn-t-work--but-reason-alone-won-t-change-minds" width="100%" height="400"></iframe>
<p>When the Green Bay Packers lost a playoff game to the San Francisco 49ers on Jan. 22, <a href="https://twitter.com/gregolear/status/1485104599740698625">Twitter users were quick to roast Packers’ quarterback</a> Aaron Rodgers’ anti-vaccination beliefs. </p>
<p>Rodgers misled his teammates about his vaccination status before testing positive for COVID-19 last November, <a href="https://theconversation.com/the-fault-in-our-stars-aaron-rodgers-reminds-us-why-celebrity-shouldnt-trump-science-171648">revealing he was unvaccinated</a> and stating that he was a critical thinker who had done his own research. Responses to Rodgers’ admission <a href="https://www.newsweek.com/twitter-drags-aaron-rodgers-over-vaccine-comments-he-nicki-minajs-cousins-friend-1646652">included Twitter mockery</a>, but also <a href="https://www.factcheck.org/2021/11/scicheck-aaron-rodgers-inaccurate-covid-19-claims/">fact-checking articles that addressed misinformation</a>.</p>
<p>Earlier last fall, another celebrity’s COVID-19 vaccine comments drew even more attention, similarly divided. In September, when Nicki Minaj tweeted about her cousin in Trinidad, <a href="https://www.forbes.com/sites/danidiplacido/2021/09/14/nicki-minajs-insane-vaccine-anecdote-goes-viral-on-twitter-and-beyond/">some ridiculed it</a>, while others — <a href="https://www.npr.org/2021/09/16/1037832909/nicki-minaj-covid-vaccine-side-effects-white-house">including the White House</a> — offered to put her in touch with medical experts who could correct her misconceptions. </p>
<p>Both types of response are equally futile.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1437532566945341441"}"></div></p>
<p>Notice that both responses assume reason (and only reason) is responsible for human behaviour. Both responses assume a failure of reason; the only difference is the source of the failure. </p>
<p>The mockery assumes that some people lack the cognitive capacity or education to draw the correct inference from the data. The correction of misinformation assumes a lack of accurate information is preventing a rational conclusion. </p>
<h2>Reason alone does not drive behaviour</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
</figcaption>
</figure>
<p>As a cognitive neuroscientist who studies reasoning, I want to suggest that both of these responses make the same two mistakes.</p>
<p>The first mistake is a misunderstanding of the type of reasoning involved in making vaccine decisions. The second is more fundamental. It is based on an incomplete model of human behaviour.</p>
<p>The first mistake is obvious and can be quickly set aside. Most of us are not capable of “doing our own research” on COVID-19 vaccines. We do not have the training plus years of postdoctoral experience specializing in viruses and vaccines to seriously evaluate the primary literature, much less generate our own research. Even my family doctor, neurologist and cardiologist depend on the research produced by immunologists and vaccinologists.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1485105777291390981"}"></div></p>
<p>The only thing most of us can do is follow the <a href="https://www.wiley.com/en-us/Are+We+All+Scientific+Experts+Now%3F-p-9780745682044">advice of specialists</a>. “Doing our own research” simply amounts to making a decision on whom to believe. Do we believe the celebrities offering shocking and entertaining — but uncorroborated — opinions, the next-door neighbour, or the <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/index.html">specialists at the Centers for Disease Control</a> who have spent their lives studying viruses and vaccines? </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-fault-in-our-stars-aaron-rodgers-reminds-us-why-celebrity-shouldnt-trump-science-171648">The fault in our stars: Aaron Rodgers reminds us why celebrity shouldn't trump science</a>
</strong>
</em>
</p>
<hr>
<p>This is an appropriate question to approach with reason. But our overly abstract notion of reason as detached from biology is a myth. </p>
<h2>The tethered mind</h2>
<p>A more realistic conception of the human mind is one where we are reasoning creatures, but the reasoning system is interconnected — or tethered — to other biological systems that evolved earlier and function without our conscious input or awareness. Some examples are autonomic, instinctive and associative systems. This is a common-sense idea with deep implications developed in my book <a href="https://mitp-web.mit.edu/books/reason-and-less"><em>Reason and Less: Pursuing Food, Sex and Politics</em></a>. What it means is that human behaviour is affected by all of these systems — not just reason, as is often assumed. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/426314/original/file-20211013-23-1acgmd5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Diagram of different aspects of behaviour." src="https://images.theconversation.com/files/426314/original/file-20211013-23-1acgmd5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/426314/original/file-20211013-23-1acgmd5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/426314/original/file-20211013-23-1acgmd5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/426314/original/file-20211013-23-1acgmd5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/426314/original/file-20211013-23-1acgmd5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/426314/original/file-20211013-23-1acgmd5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/426314/original/file-20211013-23-1acgmd5.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"></a>
<figcaption>
<span class="caption">Reason is not the only factor in determining behaviour. Instinctive, automatic and associative systems also play a role.</span>
<span class="attribution"><span class="source">(V. Goel)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>How these systems interact is guided by feelings: pleasure and displeasure. In some situations, the same action may be triggered by multiple systems. In other situations, different systems trigger different — even contradictory — actions. The overall response is guided by the principle of maximizing pleasure and minimizing displeasure, determined by combining the individual system responses</p>
<h2>In-groups and out-groups</h2>
<p>Deciding who to believe activates <a href="https://www.jstor.org/stable/24927662">in-group/out-group</a> systems. The in-group is always good and righteous. The out-group is of questionable virtue and held in lower regard. This bias is often regarded as <a href="https://mitpress.mit.edu/books/bias-divides-us">based in belief or reason</a>. If this were the case, we should be able to change it by changing beliefs, but we cannot.</p>
<p>I argue in my book that in-group bias is actually an instinct. Instinctive systems involve <a href="https://www.jstor.org/stable/24944850">very different conceptual and neural mechanisms</a> than reasoning systems. Instinctive behaviours, belonging to older brain systems, are automatically triggered and not easily changeable, certainly not by changing beliefs and desires. </p>
<p>So, if the real issue is who to believe — and we are subject to in-group/out-group instincts — and if we believe scientists belong to the in-group, this instinct will push us in the same direction as reason and enhance the pleasure/satisfaction associated with a decision based solely on reason. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/446386/original/file-20220214-137087-ithwy1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A person in shadow holding a sign depicting a skull and crossed vaccine syringes" src="https://images.theconversation.com/files/446386/original/file-20220214-137087-ithwy1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/446386/original/file-20220214-137087-ithwy1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/446386/original/file-20220214-137087-ithwy1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/446386/original/file-20220214-137087-ithwy1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/446386/original/file-20220214-137087-ithwy1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/446386/original/file-20220214-137087-ithwy1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/446386/original/file-20220214-137087-ithwy1.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">Instinctive behaviours involve very different conceptual and neural mechanisms than reasoning systems, and are not easy to change. This can add to the challenge of addressing anti-vaccine views.</span>
<span class="attribution"><span class="source">(AP Photo/Rebecca Blackwell)</span></span>
</figcaption>
</figure>
<p>If, however, scientists belong to the out-group, then the instinct pushes us in the opposite direction: they are evil and trying to deceive and harm us. In this case, if the pleasure we derive from exercising the in-group instinct is greater than that derived from other contributing forces, then we will be among the vaccine hesitant.</p>
<p>The issue is further complicated when the reason is used to intentionally sow doubt on the motives of experts to accentuate out-group differences. For example, “<a href="https://www.foxnews.com/opinion/tucker-carlson-how-many-americans-have-died-after-taking-the-covid-vaccine">they don’t tell you how many people have died from the vaccine</a>” or “<a href="https://www.foxnews.com/opinion/tucker-carlson-government-forced-sterilization-vaccines">if they can force you to have a vaccine under the guise of a so-called pandemic, what other medical procedures can they force upon you?</a>”</p>
<p>This makes it even more difficult to overcome the instinctual bias. Any information to the contrary, no matter how clear or factual, will be less effective because it is pushing in the opposite direction to the instinct. </p>
<p>Notice that the same mechanisms and procedures are at play in both the vaccinated and the vaccine hesitant. The only difference is group membership. This is not a flaw in the system. This is how the tethered mind works.</p>
<h2>Changing behaviour</h2>
<p>Within this tethered mind model, how does one address vaccine hesitancy? Assuming that the vaccine hesitant lack reason or just need more information about vaccines and viruses is not correct or helpful. We need to factor in the non-reasoning systems that also drive behaviour and decisions. </p>
<p>According to tethered rationality, the following three strategies may be more successful: </p>
<ol>
<li><p>Get the vaccine hesitant to expand their in-group to incorporate vaccine scientists. However, this is difficult because human in-group formation can be arbitrary and disjointed. For example, if the scientists are lumped with government, Big Pharma or other out-groups, assimilation into the in-group will be difficult for many. </p></li>
<li><p>Enable the vaccine hesitant to <em>feel</em> the severity of COVID-19 on a more visceral level, similar to the way anti-smoking campaigns from the ‘70s and ‘80s used <a href="https://dx.doi.org/10.2105/AJPH.2009.161638">graphic pictures of diseased lungs and emotional videos of dying cancer patients</a>. These campaigns were more effective at changing behaviour than the earlier approach of printing the surgeon general’s health warning on cigarettes packs (appealing to reason alone). </p></li>
<li><p>Offer sufficient reward or penalty to tip the balance away from the pleasure associated with in-group membership. </p></li>
</ol>
<p>Notice that none of these strategies targets reason. Reason is not the stumbling block. The stumbling block is the reality that reason is tethered to evolutionarily older systems that also have a say in behaviour. The first step in successfully changing a behaviour is having an accurate model of it.</p><img src="https://counter.theconversation.com/content/169814/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Vinod Goel receives funding from NSERC. </span></em></p>Vaccine hesitancy is often met with one of two responses: Ridicule, or factual information. Both assume a failure of reason, but human behaviour is more complex than reason, so both responses fail.Vinod Goel, Professor of Cognitive Neuroscience, York University, CanadaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1754162022-02-01T13:48:13Z2022-02-01T13:48:13ZPoliticizing COVID-19 vaccination efforts has fuelled vaccine hesitancy<figure><img src="https://images.theconversation.com/files/442995/original/file-20220127-4399-1rikmc1.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3600%2C2392&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Health-care workers watch from a window as demonstrators gather outside Toronto General Hospital in September 2021 to protest against COVID-19 vaccines, mandates and restrictions.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Chris Young </span></span></figcaption></figure><p>The current political landscape has become increasingly intertwined with vaccine policy.</p>
<p>Platforms from political parties have included vaccine mandates, <a href="https://toronto.ctvnews.ca/ontario-liberals-want-only-vaccinated-people-to-be-allowed-at-lcbo-and-cannabis-stores-1.5753680">third-dose policies</a> and <a href="https://ontarioliberal.ca/ontario-liberals-call-for-universal-vaccinations-in-schools/">mandatory vaccination proposals aimed at children</a>. <a href="https://www.cbc.ca/news/canada/montreal/unvaccinated-health-contribution-quebec-1.6311054">Québec has even proposed</a> taxing people who remain unvaccinated. </p>
<p>This is concerning, particularly given that vaccination efforts are driven by the combined efforts of health-care providers, public health agencies and community leaders.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
</figcaption>
</figure>
<p>We’re clinical providers who have implemented vaccination programs from the time they were first available, and we recognize how profoundly vaccines reduce the severity of COVID-19. Based on our experiences running vaccine programs, we have concerns about the use of increasingly punitive policies towards people who remain unvaccinated. </p>
<p>While many equate vaccine mandates with vaccine uptake, much of the work was done prior to imposing mandates. In Ontario, for example, 77 per cent of the population 12 and up had already received two doses when the proof-of-vaccination requirement was announced on Sept. 1, 2021. That number only rose another 12 per cent <a href="https://covid-19.ontario.ca/data#ontariansVaccinated">to 89 per cent</a> as of late January 2022. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1487806738531336192"}"></div></p>
<p>In keeping with traditional public health practice, proactive community engagement, counselling and outreach has resulted in the vast majority of vaccinations provincially, a fact easily lost in the rhetoric of politicians.</p>
<h2>‘Booster Games’</h2>
<p>Those grassroots efforts need to be put in place in order to maximize third doses proactively, too. Ontario’s booster rollout amid the Omicron wave has been <a href="https://www.thestar.com/opinion/star-columnists/2021/12/23/doug-fords-booster-rollout-is-hunger-games-all-over-again-there-is-a-better-way.html">widely criticized as a “Hunger Games” approach,</a> favouring those who could stand in long queues or refresh their Twitter accounts. Only <a href="https://www.ices.on.ca/DAS/AHRQ/COVID-19-Dashboard#vaccinehighlights">75 per cent of adults over the age of 70</a> have been able to access a booster to date.</p>
<p>This is a large gap among those who most benefit from the booster, suggesting more outreach efforts are needed. In Ontario, the third-dose rate in those experiencing homelessness is only 32 per cent for people over 65 and 10 per cent for those under 65, <a href="https://www.ices.on.ca/%7E/media/Files/COVID-19/ICES-COVID19-Vaccine-Coverage-by-Priority-Group.ashx?la=en-CA">according to provincial data</a>. </p>
<p>Even within Toronto, <a href="https://www.ices.on.ca/%7E/media/Files/COVID-19/ICES-COVID19-Vaccination-Data-by-FSA.ashx?la=en-CA">the same data shows the wealthy Rosedale neighbourhood has a third-dose rate of 50 per cent while it’s 16 per cent in the working-class Jane-Finch area</a>. </p>
<figure class="align-center ">
<img alt="People line up along a sidewalk outside a brown apartment building. One man is sitting in a camping chair." src="https://images.theconversation.com/files/442998/original/file-20220127-4399-13vemp2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/442998/original/file-20220127-4399-13vemp2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/442998/original/file-20220127-4399-13vemp2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/442998/original/file-20220127-4399-13vemp2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/442998/original/file-20220127-4399-13vemp2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/442998/original/file-20220127-4399-13vemp2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/442998/original/file-20220127-4399-13vemp2.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">Residents of Toronto’s Jane and Finch neighbourhood line up at a pop-up vaccine clinic in April 2021. Residents of the area continue to struggle with the lowest vaccination rates in the city.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Cole Burston</span></span>
</figcaption>
</figure>
<p>These findings are consistent with data from the <a href="https://www.ft.com/content/1587a9c2-37b2-4b17-8bcc-700d3bffc0bc">United States suggesting racialized communities</a> have the lowest rate of vaccine uptake. </p>
<p>This means structural barriers clearly need to be addressed before third doses are mandated. Further enforcement could lead to more hesitancy and create deeper divides and segregation among vulnerable communities.</p>
<h2>Disparities among children, too</h2>
<p>In children, the same differences arise, despite growing calls for vaccine mandates in schools. There is a much higher vaccine uptake in richer communities than in poorer ones. In Ontario, two-dose vaccination rates in 12- to 17-year-olds in the <a href="https://www.publichealthontario.ca/en/data-and-analysis/infectious-disease/covid-19-data-surveillance">poorest communities is 20 per cent lower than in the richest</a>. </p>
<p>As a society, are we willing to keep the most economically disadvantaged out of school over vaccination given the snowball effects from prolonged lack of in-class education, especially among communities where education may be the road out of poverty? </p>
<p>While some may cite the mandatory immunizations required for schools, many of the vaccines on the list had decades of clinical experience prior to being mandated. The COVID-19 vaccine in five- to 11-year-old children has been approved in Canada for only three months, and while all data points to it being both safe and effective, <a href="https://www.canada.ca/content/dam/phac-aspc/documents/services/immunization/national-advisory-committee-on-immunization-naci/updated-recommendations-use-covid-19-vaccines-children-5-11-years-age.pdf">even our National Advisory Committee on Immunizations notes</a>:</p>
<blockquote>
<p>“Parents are supported and respected in their decisions regarding COVID-19 vaccinations for their children, whatever decisions they make, and are not stigmatized for accepting, or not accepting, the vaccination offer.”</p>
</blockquote>
<figure class="align-center ">
<img alt="A girl in a pink face mask sits in a man's lap as she's vaccinated.THE CANADIAN PRESS/Ryan Remiorz" src="https://images.theconversation.com/files/443000/original/file-20220127-6492-12p9zrd.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/443000/original/file-20220127-6492-12p9zrd.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=492&fit=crop&dpr=1 600w, https://images.theconversation.com/files/443000/original/file-20220127-6492-12p9zrd.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=492&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/443000/original/file-20220127-6492-12p9zrd.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=492&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/443000/original/file-20220127-6492-12p9zrd.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=618&fit=crop&dpr=1 754w, https://images.theconversation.com/files/443000/original/file-20220127-6492-12p9zrd.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=618&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/443000/original/file-20220127-6492-12p9zrd.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=618&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A young girl is held by her father as she gets her COVID-19 vaccination at a clinic in Montréal in November 2021.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Ryan Remiorz</span></span>
</figcaption>
</figure>
<p>Importantly, two doses of vaccine remain highly protective against severe disease among most people. Should an 18-year-old with two doses, with a hospitalization risk of 0.1 per cent with two doses according <a href="https://news.gov.bc.ca/files/1.21.22_COVID_Hospitalizations.pdf">to data compiled in British Columbia</a>, be excluded from society because a third dose reduces personal risk to even less than 0.1 per cent?</p>
<h2>Efficacy decline?</h2>
<p>It is still unclear if protection from booster shots wanes over time, with a recent British report suggesting a decline in efficacy to 40 per cent against infection 15 weeks after <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1050721/Vaccine-surveillance-report-week-4.pdf">people get boosters.</a> </p>
<p>Finally, there’s the prospect of infection-derived immunity. Nearly <a href="https://www.euro.who.int/en/media-centre/sections/statements/2022/statement-update-on-covid-19-omicron-wave-threatening-to-overcome-health-workforce">50 per cent of people in certain regions</a> are expected to be infected with COVID-19 in the coming weeks. U.K. data suggests those with two doses of vaccine plus infection-derived immunity <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1048395/technical-briefing-34-14-january-2022.pdf">show similar protection to three doses and no infection</a>.</p>
<p>Health-care practitioners and community leaders who encourage and empower their patients and community to get vaccinated comprise a sustainable, positive health intervention. It reinforces the therapeutic bond between health-care providers and patients. Politicians attempting to force those patients to get third doses run the risk of eroding this trust. </p>
<p>What’s more, as the pandemic endures, what happens when a <a href="https://brighterworld.mcmaster.ca/articles/researchers-to-begin-human-trials-for-promising-new-inhaled-covid-19-vaccines-designed-to-combat-variants-of-concern/">newer generation of vaccines arises</a> that are required for the population to reach optimal immunity? </p>
<p>What happens if <a href="https://www.cnet.com/health/could-a-universal-vaccine-put-an-end-to-covid-pandemics-the-army-is-counting-on-it/">a pan-coronavirus vaccine</a> is made available?</p>
<p>Given the divisions created by vaccine mandates, the use of these future tools may be significantly compromised if we push people too hard now. </p>
<h2>Politicians fuelling division</h2>
<p>The antagonism that’s being created by political interference risks fuelling hesitancy even further. COVID-19 isn’t going to be the last pandemic or public health emergency necessitating public buy-in, and any gains with mandating third doses may lead to challenges in long-term engagement with the primary consumer of public health — the public.</p>
<p>During the English leaders’ debate during last fall’s federal election, five leadership candidates came together to encourage vaccination across the political spectrum.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1436345807511380002"}"></div></p>
<p>It was a moment of unity in health promotion messaging in Canada. </p>
<p>Today, government and opposition leaders should promote policies to increase resources for proactive uptake and outreach that encourages vaccination and empowers people, rather than basing policies in mandates and penalties.</p>
<p>Health-care providers, public health organizations and community leaders should be a positive force in vaccination. To ensure success, policies should be driven by community engagement, empowerment, equity and education. </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/175416/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stefan Baral receives funding from the National Institutes of Health and the Canadian Institute of Health Research. Stefan Baral only has funding from government bodies but no personal salary, consulting, or funding from for-profit companies.</span></em></p><p class="fine-print"><em><span>Kwadwo Kyeremanteng and Zain Chagla 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>The antagonism driven by political interference in COVID-19 vaccination is fuelling hesitancy. Mass vaccination campaigns require public buy-in via trusted health-care providers and community leaders.Zain Chagla, Associate Professor, Division of Infectious Diseases, Department of Medicine, McMaster UniversityKwadwo Kyeremanteng, Associate Professor, Department of Medicine, L’Université d’Ottawa/University of OttawaStefan Baral, Professor, Department of Epidemiology, Johns Hopkins School of Public Health, Johns Hopkins UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1731272022-01-17T19:21:24Z2022-01-17T19:21:24Z‘Never’ or just ‘not yet?’ How timing affects COVID-19 vaccine hesitancy<figure><img src="https://images.theconversation.com/files/441139/original/file-20220117-23-1saz01x.jpeg?ixlib=rb-1.1.0&rect=119%2C119%2C6200%2C4600&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Researchers sought to understand how thinking about COVID-19 vaccine availability along different timelines might influence a person’s vaccine decisions.</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/-never--or-just--not-yet--how-timing-affects-covid-19-vaccine-hesitancy" width="100%" height="400"></iframe>
<p>As <a href="https://health-infobase.canada.ca/covid-19/epidemiological-summary-covid-19-cases.html">COVID-19 case counts continue to rise</a> across Canada, it is clear that we’re far from out of the woods with this pandemic. While much is still unknown about the Omicron variant, it seems very likely that existing vaccines will offer protection against severe cases of COVID-19, and <a href="https://www.canada.ca/content/dam/phac-aspc/documents/services/immunization/national-advisory-committee-on-immunization-naci/guidance-booster-covid-19-vaccine-doses/guidance-booster-covid-19-vaccine-doses.pdf">Canada is rapidly administering booster shots</a> in an effort to help to <a href="https://theconversation.com/why-its-normal-for-covid-19-vaccine-immunity-to-wane-and-how-booster-shots-can-help-171786">bolster immunity</a>. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
</figcaption>
</figure>
<p>While vaccination coverage against COVID-19 is relatively high (<a href="https://health-infobase.canada.ca/covid-19/vaccination-coverage/">76.49 per cent of the total population is fully vaccinated at the time of writing</a>), there remains a substantial group of Canadians who are either unvaccinated, or only partially vaccinated against COVID-19. </p>
<p>At this point in the pandemic (more than six months after most Canadian adults became eligible to receive a COVID-19 vaccine), should we declare this level of vaccination coverage as the “vaccine ceiling?” <a href="https://doi.org/10.3390/vaccines9121417">Our research</a> suggests the answer is no.</p>
<h2>Vaccine hesitancy in a COVID-19 world</h2>
<p>As defined by the World Health Organization’s Strategic Advisory Group of Experts (SAGE), the term “vaccine hesitancy” is used to describe “<a href="https://apps.who.int/iris/bitstream/handle/10665/242296/WER8950_561-576.PDF?sequence=1&isAllowed=y">a delay or refusal of vaccination, despite availability of vaccination services</a>.” The range of reasons why some Canadians remain unvaccinated is wide, including (but not limited to) <a href="https://angusreid.org/canada-unvaccinated-freedom-reasons/">concerns about “personal freedom,” health concerns and the belief that COVID-19 is not as serious a health threat as it’s made out to be</a>.</p>
<figure class="align-center ">
<img alt="A hand with a syringe in it with stopwatches in the background" src="https://images.theconversation.com/files/440545/original/file-20220112-22694-6xjmg0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/440545/original/file-20220112-22694-6xjmg0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=359&fit=crop&dpr=1 600w, https://images.theconversation.com/files/440545/original/file-20220112-22694-6xjmg0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=359&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/440545/original/file-20220112-22694-6xjmg0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=359&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/440545/original/file-20220112-22694-6xjmg0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=452&fit=crop&dpr=1 754w, https://images.theconversation.com/files/440545/original/file-20220112-22694-6xjmg0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=452&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/440545/original/file-20220112-22694-6xjmg0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=452&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Timing plays a role in decisions, so vaccine hesitancy may not mean that a person will never choose to be vaccinated.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
</figcaption>
</figure>
<p>Much of the existing research on vaccine hesitancy has focused on identifying personal or demographic factors associated with vaccine hesitancy, such as age, gender and socio-economic status. <a href="https://www.mdpi.com/2076-393X/9/12/1417">Our research</a> investigated the role of timing in vaccine uptake. </p>
<p>Given the unique nature of the COVID-19 pandemic and its vaccines, <a href="https://www.cbc.ca/news/canada/covid19-vaccine-rollout-plans-canada-1.5836262">not all Canadians gained access to a vaccine at the same time</a> — and many around the world are still waiting for access. As a result, people had to start thinking about their vaccine decisions in hypothetical or future contexts. Because of this, we sought to understand how thinking about COVID-19 vaccine availability along different timelines might influence a person’s vaccine decisions.</p>
<h2>Survey results</h2>
<p>In December 2020 (<a href="https://www.cbc.ca/news/politics/vaccine-rollout-trudeau-anand-coronavirus-covid-1.5952276">just prior to broad vaccine availability in Canada</a>), we asked Canadian survey respondents about their impending vaccine decisions. Each participant was presented with one variation of the question: </p>
<blockquote>
<p>“If a coronavirus vaccine was available to you (today, or in one month, or in six months, or in one year), would you get vaccinated, or not?” </p>
</blockquote>
<p>In analyzing results from this experiment, we found that the proportion of most enthusiastic participants (those who selected “Yes, as soon as possible” as a response) increased substantially as the proposed date of vaccine availability became more distant. </p>
<p>Even more interesting was our finding that the proportion of hesitant people decreased as the proposed date of vaccination moved further into the future. The proportion who responded that they would “Wait some time” before vaccination, and the proportion who responded, “No, I would not get a coronavirus vaccine,” both decreased as vaccine availability became more distant in time.</p>
<figure class="align-center ">
<img alt="A series of images of people with their sleeve rolled showing a bandage over a vaccination site" src="https://images.theconversation.com/files/440549/original/file-20220112-15-1bu18mg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/440549/original/file-20220112-15-1bu18mg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=152&fit=crop&dpr=1 600w, https://images.theconversation.com/files/440549/original/file-20220112-15-1bu18mg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=152&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/440549/original/file-20220112-15-1bu18mg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=152&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/440549/original/file-20220112-15-1bu18mg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=191&fit=crop&dpr=1 754w, https://images.theconversation.com/files/440549/original/file-20220112-15-1bu18mg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=191&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/440549/original/file-20220112-15-1bu18mg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=191&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">While the swift uptake of a COVID-19 vaccine might be the ideal scenario for squashing case counts, those who are hesitant aren’t guaranteed to refuse the vaccine altogether.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>This has important implications for Canadian policy-makers. While the swift uptake of a COVID-19 vaccine might be the ideal scenario for squashing case counts, these findings suggest that those who are hesitant aren’t necessarily going to refuse the vaccine altogether. </p>
<p>This finding may also be useful for <a href="https://www.reuters.com/article/health-coronavirus-vaccine-idUSL8N2OQ4T5">countries that are much further behind on mass vaccination efforts</a>, as it suggests a delayed vaccine rollout might encounter less hesitancy and have faster uptake. </p>
<h2>What are they waiting for?</h2>
<p>We also asked open-ended questions about what Canadians would wait for, before getting the vaccine. What we found is that many Canadians who said they were waiting for “some time to pass” were couching their true concerns (for example, waiting for a certain number of other people to be successfully vaccinated first) within the more broad category of “timing.” </p>
<p>It may be useful to remember this finding when having conversations with folks who might be vaccine hesitant. Offering space for people to elaborate on their vaccine concerns might help bypass default responses and reveal alternative reasoning that has the potential to be addressed. </p>
<p>In some cases, these concerns might even be addressed with <a href="https://theconversation.com/how-better-conversations-can-help-reduce-vaccine-hesitancy-for-covid-19-and-other-shots-159321">empathetic listening</a>, by input from trusted experts or from evidence that speaks to the values and beliefs of those who have questions.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-19-vaccine-hesitancy-can-be-overcome-through-relatable-stories-and-accessible-information-169221">COVID-19 vaccine hesitancy can be overcome through relatable stories and accessible information</a>
</strong>
</em>
</p>
<hr>
<p>As recent Omicron surges remind us, vaccination alone is not a silver bullet in the fight against COVID-19. However, it remains an important tool in mitigating the spread and severity of the disease, and the United Nations Foundation still positions <a href="https://unfoundation.org/blog/post/3-things-omicron-tells-us-about-how-to-defeat-covid-19/">vaccine equity as our best exit strategy</a> for the pandemic. </p>
<p>It seems nearly certain that there will remain a group of Canadians who choose to never receive a COVID-19 vaccine. However, our findings suggest that it is unwise to assume that all Canadians who have not yet been vaccinated will never do so. They may just be waiting.</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/173127/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This project was funded by a grant awarded by the Social Sciences and Humanities Research Council. </span></em></p><p class="fine-print"><em><span>Eric B. Kennedy has received funding from the Social Sciences and Humanities Research Council, the BC Ministry of Health, and the National Science Foundation.</span></em></p><p class="fine-print"><em><span>Jean-François Daoust 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>Vaccine hesitancy may be a waiting game. Even those who said they would never get the COVID-19 vaccine if it were available immediately became more likely to do so when it was available in the future.Vivian Harbers, Project Manager, COVID-19 Canadian Social Impacts Research Study, University of GuelphEric B. Kennedy, Assistant Professor, Disaster and Emergency Management, York University, CanadaJean-François Daoust, Assistant Professor, The University of EdinburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1745802022-01-17T17:34:19Z2022-01-17T17:34:19ZMyocarditis: COVID-19 is a much bigger risk to the heart than vaccination<figure><img src="https://images.theconversation.com/files/440923/original/file-20220114-19-c1e1zo.jpg?ixlib=rb-1.1.0&rect=91%2C51%2C6244%2C4469&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Myocarditis is an inflammation of the heart muscle most commonly caused by a virus.</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/myocarditis--covid-19-is-a-much-bigger-risk-to-the-heart-than-vaccination" width="100%" height="400"></iframe>
<p>The <a href="https://doi.org/10.1161/CIRCRESAHA.121.317997">heart has played a central role</a> in COVID-19 since the beginning. Cardiovascular conditions are among the highest risk factors for hospitalization. A significant number of patients hospitalized with SARS-CoV-2 infections have signs of heart damage, and many recover from infection with lasting cardiovascular injury.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
</figcaption>
</figure>
<p>It’s not surprising that debates over COVID-19 vaccines frequently centre around issues involving cardiovascular health. The high-profile <a href="https://theathletic.com/news/christian-eriksen-hospital-collapse-euro-2020/Jtev3AXbH8H4/">collapse of Danish soccer player Christian Eriksen in June</a> initiated a myth about the link between <a href="https://www.science20.com/w_glen_pyle/a_false_start_for_sudden_cardiac_death_in_athletes_and_covid19_vaccines-255817">sudden cardiac death and vaccination among athletes</a> that persists several months later. </p>
<p>Perhaps the <a href="https://montrealgazette.com/opinion/columnists/christopher-labos-how-worried-should-we-be-about-myocarditis">most common point of conflict concerning COVID-19 vaccines</a> is the risk of myocarditis following immunization, particularly among young people.</p>
<p>What do the numbers tell us about COVID-19, vaccines and myocarditis?</p>
<h2>What is myocarditis?</h2>
<p>Myocarditis is an inflammation of the heart muscle most commonly caused by a virus like <a href="https://doi.org/10.1038/s41569-020-00435-x">influenza, coxsackie, hepatitis or herpes</a>. Other causes include bacteria, fungi, toxins, chemotherapy and autoimmune conditions.</p>
<p>Some viruses infect heart muscle and cause direct injury to the heart, while others cause heart damage indirectly through the immune system. Activation of the immune system in response to an infection triggers the release of chemicals in the body called <a href="https://www.livescience.com/what-are-cytokines.html">cytokines</a>, which help clear infections. In some cases, the levels of cytokines rise to unusually high levels to produce a “cytokine storm” that causes damage to heart muscle.</p>
<h2>Myocarditis by the numbers</h2>
<figure class="align-center ">
<img alt="A soccer player on the field in a red uniform" src="https://images.theconversation.com/files/440920/original/file-20220114-28-6aopnv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/440920/original/file-20220114-28-6aopnv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/440920/original/file-20220114-28-6aopnv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/440920/original/file-20220114-28-6aopnv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/440920/original/file-20220114-28-6aopnv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/440920/original/file-20220114-28-6aopnv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/440920/original/file-20220114-28-6aopnv.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">Soccer player Alphonso Davies, 21, of Canada’s national men’s team, was sidelined by heart inflammation after having COVID-19.</span>
<span class="attribution"><span class="source">(AP Photo/Efrem Lukatsky)</span></span>
</figcaption>
</figure>
<p>Before COVID-19 the incidence of myocarditis was between <a href="https://doi.org/10.1016/j.jacc.2016.09.937">one and 10 cases per 100,000 people per year</a>. Rates are highest in males between 18 and 30 years old. Interestingly, most cases of myocarditis in the <a href="https://www.myocarditisfoundation.org/about-myocarditis/">highest risk group are in otherwise healthy and active people</a>. </p>
<p>According to the <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7035e5.htm">U.S. Centers for Disease Control and Prevention</a>, the risk of myocarditis after infection with COVID-19 is much higher, at 146 cases per 100,000. The risk is higher for males, older adults (ages 50+) and children under 16 years old. Soccer player Alphonso Davies, 21, of Canada’s national men’s team, was sidelined by heart inflammation after having COVID-19.</p>
<h2>Post-vaccination myocarditis</h2>
<p>Myocarditis following COVID-19 vaccination is rare and the risk is much smaller than the risks of cardiac injury linked to COVID-19 itself. </p>
<p>Based on <a href="http://doi.org/10.1056/NEJMoa2110737">a study out of Israel</a>, the risk of post-vaccine myocarditis is 2.13 cases per 100,000 vaccinated, which is within the range usually seen in the general population. This study is consistent with others in the United States and Israel which put the <a href="https://doi.org/10.1038/s41569-021-00662-w">overall incidence of post-vaccine myocarditis between 0.3 and five cases per 100,000 people</a>.</p>
<figure class="align-center ">
<img alt="A young person wearing a face mask getting a vaccination" src="https://images.theconversation.com/files/440922/original/file-20220114-22-icdnc7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/440922/original/file-20220114-22-icdnc7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/440922/original/file-20220114-22-icdnc7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/440922/original/file-20220114-22-icdnc7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/440922/original/file-20220114-22-icdnc7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/440922/original/file-20220114-22-icdnc7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/440922/original/file-20220114-22-icdnc7.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">In the rare cases of myocarditis following COVID-19 vaccination, the vast majority are mild and resolve quickly.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>The kids are alright</h2>
<p>The highest incidence of myocarditis after vaccination with mRNA vaccines has occurred within three to four days after the second vaccination in <a href="http://doi.org/10.1056/NEJMoa2109730">males who are under age 30</a>. In <a href="https://doi.org/10.1161/CIRCULATIONAHA.121.056583">pediatric data</a>, the median age is 15.8 years, with most patients being male (90.6 per cent) and white (66.2 per cent) or Hispanic (20.9 per cent). Reliable data on booster shots in this age group is not yet available.</p>
<p>Most studies show a clear benefit of COVID-19 mRNA vaccination with respect to myocarditis. Only <a href="https://doi.org/10.1038/s41591-021-01630-0">one study by Martina Patone, from the University of Oxford, and colleagues</a> found more ambiguous results for those under 40 years of age based on myocarditis rates alone. However, if considering the other ill effects of infection with SARS-CoV-2 — both cardiac and not — there was still a strong benefit in immunizing younger people with COVID-19 vaccines other than Moderna, <a href="https://doi.org/10.1136/bmj-2021-068665">which research suggests has a higher risk for myocarditis than Pfizer’s vaccine</a>.</p>
<h2>Repairing the damage</h2>
<p>The <a href="https://doi.org/10.1161/CIRCRESAHA.118.313578">treatment for myocarditis</a> varies depending on its severity. Adults with mild forms of myocarditis typically need only rest and non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen. More severe cases require medications or even mechanical circulatory supports like left ventricular assist devices to support heart function. In some cases when treatment is no longer effective, a heart transplant is required.</p>
<p>In a <a href="https://doi.org/10.1161/CIRCULATIONAHA.121.056583">multicentre series of patients under 21 years old</a>, those with mild symptoms received only NSAIDs or no anti-inflammatory therapy at all. Patients with more severe symptoms can receive stronger therapies including intravenous immunoglobulin, glucocorticoids or colchicine in addition to NSAIDs.</p>
<h2>How serious is it?</h2>
<figure class="align-right ">
<img alt="Illustration of a heart" src="https://images.theconversation.com/files/440924/original/file-20220114-28-2c4vs6.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/440924/original/file-20220114-28-2c4vs6.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=720&fit=crop&dpr=1 600w, https://images.theconversation.com/files/440924/original/file-20220114-28-2c4vs6.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=720&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/440924/original/file-20220114-28-2c4vs6.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=720&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/440924/original/file-20220114-28-2c4vs6.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=905&fit=crop&dpr=1 754w, https://images.theconversation.com/files/440924/original/file-20220114-28-2c4vs6.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=905&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/440924/original/file-20220114-28-2c4vs6.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=905&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Adults who develop myocarditis from COVID-19 have poorer outcomes than non-myocarditis COVID-19 cases, including a higher risk of death.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
</figcaption>
</figure>
<p>Over 80 per cent of <a href="https://doi.org/10.1161/JAHA.119.015351">myocarditis cases</a> not related to COVID-19 or COVID-19 vaccination resolve spontaneously, while five per cent of patients die or require a heart transplant within one year of diagnosis. </p>
<p>Adults who develop <a href="https://doi.org/10.1111/eci.13679">myocarditis from COVID-19 have poorer outcomes</a> than non-myocarditis COVID-19 cases, including a higher risk of death. It should be noted that myocarditis associated with SARS-CoV-2 infection is just one of several heart conditions linked to COVID-19 with outcomes that are worse than non-COVID-19 cases.</p>
<p>In cases of myocarditis following COVID-19 vaccination, the vast majority of cases are mild and resolve quickly. In adults, <a href="http://doi.org/10.1056/NEJMoa2109730">95 per cent of cases were deemed to be mild</a>. Similarly, in children, <a href="https://doi.org/10.1161/CIRCULATIONAHA.121.056583">98.6 per cent are mild</a>, and there has not been any reported need for mechanical heart support (extracorporeal membrane oxygenation, when blood is pumped outside the body to a heart-lung machine) or deaths. All children who had heart weakness had complete normalization of their heart function on followup.</p>
<h2>Take-home message</h2>
<p>The dynamic changes in the global pandemic, combined with rapid developments in research, make it challenging for the public to take in all the information about the risks and benefits of COVID-19 vaccines. In cases like this it is useful to turn to the guidance of medical organizations whose mandates are to protect the health and welfare of society. </p>
<p>Considering all of the available research, organizations including the <a href="https://www.heart.org/en/coronavirus/coronavirus-questions/questions-about-covid-19-vaccination">American Heart Association</a>, <a href="https://ccs.ca/app/uploads/2021/05/CCS_Vaccine_Info_May2021_v2.pdf">Canadian Cardiovascular Society</a>, <a href="https://www.heartandstroke.ca/how-you-can-help/advocate/covid19-vaccines-what-we-are-doing">Heart and Stroke Foundation of Canada</a>, <a href="https://cps.ca/en/documents/position/covid-19-vaccine-for-children">Canadian Paediatric Society</a> and the <a href="https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/children-and-covid-19-vaccination-trends/">American Academy of Pediatrics</a> encourage all who are eligible to be vaccinated against COVID-19.</p>
<p>That’s a message we should all take to heart.</p>
<p><em>This is an updated version of a story originally published on Jan. 17, 2022. It clarifies that a study found patients with myocarditis from COVID-19 had poorer outcomes compared to COVID-19 patients who did not develop myocarditis.</em></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/174580/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Glen Pyle receives funding from the Canadian Institutes of Health Research, the Heart and Stroke Foundation of Canada, and the Natural Sciences and Engineering Research Council of Canada. He is the co-lead for COVID-19 Resources Canada "Science Explained", a member of Science Up First, and is part of the advisory council for Royal City Science.</span></em></p><p class="fine-print"><em><span>Jennifer H. Huang 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>Myocarditis following COVID-19 vaccination is rare, and the risk is much smaller than the risks of cardiac injury linked to COVID-19 itself.Glen Pyle, Professor, Laboratory of Molecular Cardiology, University of GuelphJennifer H. Huang, Associate Professor of Pediatric Cardiology, Oregon Health & Science UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1684792021-12-20T20:48:42Z2021-12-20T20:48:42ZThe nanoparticles in mRNA vaccines are nothing to fear: We interact with many useful, tiny particles every day<figure><img src="https://images.theconversation.com/files/437870/original/file-20211215-19-6a71aq.jpg?ixlib=rb-1.1.0&rect=14%2C0%2C3244%2C2428&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">We interact with nanoparticles in multiple ways every day. The nanoparticles in this illustration are delivering drugs to cells.</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/the-nanoparticles-in-mrna-vaccines-are-nothing-to-fear--we-interact-with-many-useful--tiny-particles-every-day" width="100%" height="400"></iframe>
<p>Let’s be honest: there are many ways in which size matters, and for some purposes small is beautiful. However, sometimes very small things, like nanoparticles, are misunderstood.</p>
<p>In recent months, many people have had difficult conversations with friends and family members who were hesitant about taking the COVID-19 vaccine. In some cases, this hesitance arose because they have been led to believe that <a href="https://ca.style.yahoo.com/covid-19-vaccine-nanotechnology-microchip-theories-214017318.html">vaccines can’t be trusted because they contain nanoparticles</a>. It is lipid nanoparticles — called liposomes — that <a href="https://theconversation.com/what-happens-when-the-covid-19-vaccines-enter-the-body-a-road-map-for-kids-and-grown-ups-164624">carry the mRNA molecule</a> in the COVID-19 mRNA vaccines. </p>
<h2>The nanoparticles in mRNA vaccines</h2>
<p>Those <a href="https://www.ted.com/talks/kaitlyn_sadtler_and_elizabeth_wayne_how_the_covid_19_vaccines_were_created_so_quickly">liposomes act as vehicles delivering the viral protein template</a> to where it can interact with the immune system and trigger the production of antibodies. Their small size allows them to do that job faster and more effectively. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
</figcaption>
</figure>
<p>Liposomes are minuscule droplets of fat that mimic the membranes of our cells. This allows the particles to not only travel to their destination in the body without triggering an immune reaction, but also to fuse with our cells that can then uptake the mRNA molecule and synthesize the protein for which it codes. Once delivery is complete, these lipid nanoparticles are degraded by our body just like any other lipid. </p>
<p>This technology has been made possible through years of concerted efforts by the scientific community. These types of nanoparticles are a potentially useful vehicle for all sorts of other medicines. These include <a href="https://theconversation.com/3-mrna-vaccines-researchers-are-working-on-that-arent-covid-157858">other vaccines</a>, and also <a href="https://doi.org/10.1124/pr.115.012070">promising cancer treatments</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-19-vaccines-how-pfizers-and-modernas-95-effective-mrna-shots-work-149957">COVID-19 vaccines: How Pfizer's and Moderna's 95% effective mRNA shots work</a>
</strong>
</em>
</p>
<hr>
<p>As scientists who <em>make</em> nanoparticles, we had hoped that at least our loved ones would be less fearful of our work. Thankfully, they are all now fully vaccinated, but vaccine hesitancy stemming from the novelty of the terms nanoparticles and nanotechnology leaves us concerned. </p>
<p>With the rise of COVID cases due to the Omicron variant, efforts to address vaccine hesitancy across the globe need to be ramped up, including information about nanoparticles. The terms nanoparticles and nanotechnology may be uncommon to a lot of people, but humans have been interacting with nanoparticles for millennia, and each one of us comes into contact with nanotechnology-based products every single day. </p>
<h2>Nanoparticles</h2>
<p>One of the authors — Keroles Riad — mass-produces nanoparticles by literally <a href="https://www.concordia.ca/cunews/offices/vprgs/sgs/public-scholars-20/2021/03/16/i-set-things-on-fire-intentionally.html">setting chemicals on fire</a> (very satisfying). This process — called flame spray pyrolysis — can produce special nanoparticles called <a href="https://pubs.acs.org/doi/abs/10.1021/acsomega.0c06227">quantum dots</a>, which are used in lithium batteries and gas-sensing devices. But nanotechnology has uses in every aspect of our lives, affecting things like our wine, our guts and our climate.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/LfMrMsBPezs?wmode=transparent&start=3842" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p>The nanoparticles in mRNA vaccines are not the first nanoparticles used for health applications. For instance, co-author Sylvie Ouellette is currently synthesizing lipid nanodiscs <a href="https://www.youtube.com/watch?v=YYBmI_cfRQQ">in her lab</a>. This consists of breaking down the lipid layer of <em>E. coli</em> bacteria into small pieces, to study the proteins it contains as if they were still in their natural environment. Since these proteins are involved in antibiotic resistance, lipid nanodiscs are an important tool in the fight against infection. </p>
<p>Sylvie has also studied <a href="https://doi.org/10.1038/s41598-017-10872-3">gold nanoparticles</a> to assess their usefulness in diagnosing and treating cancer and other health conditions.</p>
<p>Nanoparticles have been used for centuries. In fourth century China, <a href="https://doi.org/10.1016/j.culher.2012.02.001">nanoparticles were made via flame and used as inks</a>. </p>
<p>Gold nanoparticles have been at the core of <a href="https://doi.org/10.1166/jbn.2011.1205">Ayurveda, a traditional Indian healing practice</a>, for thousands of years. Although the jury is still out as to whether these gold nanoparticles in and of themselves confer healing properties, the method by which they are synthesized has paved the way for their use in modern medicine. They are now studied as a vehicle <a href="https://doi.org/10.1021/acs.molpharmaceut.8b00810">to target medically active compounds to tissue or cells involved in various diseases such as cancer</a>.</p>
<h2>How small is a nanometer?</h2>
<p>“Nano” comes from a <a href="https://nanoscience.ch/en/about-us/nanosciences/what-does-nano-mean/">Greek word meaning “dwarf</a>.” In essence, it means “very small.” A nanometer is 70,000 times smaller than the thickness of a human hair. A nanoparticle is anything that is so small that its size ranges from one to a few hundred nanometers. If you cut a block of wood to pieces that are about 0.0000001 centimetres (one nanometer), you will have made nanoparticles. </p>
<p>Nanoparticles can be made out of almost anything, from metals to fat. They can form naturally or inadvertently, and can also be synthesized in research or industrial laboratories. </p>
<figure class="align-center ">
<img alt="A line of containers containing different coloured powders." src="https://images.theconversation.com/files/438370/original/file-20211219-13-1ecv083.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/438370/original/file-20211219-13-1ecv083.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=107&fit=crop&dpr=1 600w, https://images.theconversation.com/files/438370/original/file-20211219-13-1ecv083.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=107&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/438370/original/file-20211219-13-1ecv083.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=107&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/438370/original/file-20211219-13-1ecv083.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=134&fit=crop&dpr=1 754w, https://images.theconversation.com/files/438370/original/file-20211219-13-1ecv083.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=134&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/438370/original/file-20211219-13-1ecv083.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=134&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Different coloured copper oxide quantum dots from Keroles’s lab.</span>
<span class="attribution"><span class="source">(Andrew Kingsley Jeyaraj)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Perhaps one of the most common nanoparticles today is <a href="https://www.mdpi.com/2073-4360/13/4/538/htm">carbon black</a>, which is used to reinforce our car tires and improve their wear resistance, <a href="https://www.alliedmarketresearch.com/carbon-black-market">constituting a US$17.5 billion dollar industry in 2018</a>. We <a href="https://coatings.specialchem.com/selection-guide/complete-guide-on-titanium-dioxide">paint the walls in our homes</a> with titanium white nanoparticles. The pills we swallow to treat our headaches or serious illnesses are usually <a href="https://tdma.info/the-crucial-role-of-titanium-dioxide-in-modern-pharmaceuticals/">coated</a> with silica or titanium nanoparticles. </p>
<p>More recently, several brands of anti-aging creams have boasted higher efficacy thanks to their <a href="https://www.taylorfrancis.com/chapters/edit/10.1201/9780429291470-7/liposomes-cosmetics-guy-vanlerberghe">active compounds being contained in liposomes</a> — the same type of nano-sized fat particles that are at the core of the mRNA COVID vaccines. </p>
<p>Given the broad incidence and wide variety of nanoparticles, there are also some that are not beneficial. For example, the <a href="https://dx.doi.org/10.7554%2FeLife.09623">nano-sized soot particles from cigarettes</a> that smokers inhale are very harmful to the lungs. </p>
<p>Other types of soot nanoparticles enter the atmosphere when planes and cargo ships burn fuel, where they are the third major contributor to the climate crisis. However, unlike other greenhouse gases, <a href="https://carleton.ca/eptl/research/">soot’s stay in the atmosphere is only a few weeks long</a> (compared to a hundred years in the case of carbon dioxide). That means that if we were to stop emitting soot today, the benefits would be immediate. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-9-psychological-barriers-that-lead-to-covid-19-vaccine-hesitancy-and-refusal-168643">The 9 psychological barriers that lead to COVID-19 vaccine hesitancy and refusal</a>
</strong>
</em>
</p>
<hr>
<p>Small is good when used beneficially, but nanoparticles can sometimes trigger fear or mistrust. Just like the conversations we’ve had with our own families, helping people understand how nanoparticles are part of our everyday lives may help dissolve some of those fears.</p>
<hr>
<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/168479/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>Some vaccine hesitancy is based on a fear of the nanoparticles used in mRNA vaccines. But humans have been interacting with nanoparticles for millennia, and we use nanotechnology-based devices every day.Keroles Riad, Postdoctoral fellow, Chemical and Materials Engineering, Concordia UniversitySylvie Ouellette, PhD Candidate, Chemistry/Biochemistry, Concordia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1740322021-12-19T11:14:36Z2021-12-19T11:14:36ZAnswers from COVID experts: How do you talk to family members who aren’t vaccinated? How can the vaccines be safe if they were developed so quickly? Is natural immunity better than being vaccinated?<figure><img src="https://images.theconversation.com/files/438294/original/file-20211218-23072-19asa4x.JPG?ixlib=rb-1.1.0&rect=4%2C4%2C2991%2C1962&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">With the holiday season approaching, people wait to receive a COVID-19 vaccination in Montréal as the pandemic continues in Canada and around the world. </span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Graham Hughes </span></span></figcaption></figure><p><em>The Conversation Canada and McMaster University recently co-hosted a live event on vaccine hesitancy. Editor-in-Chief Scott White spoke with four researchers from McMaster: Medical doctor, educator and researcher Zain Chagla; immunologist Dawn Bowdish; Manali Mukherjee, an assistant professor in the division of respirology at McMaster’s department of medicine; political scientist Clifton van der Linden, who has been conducting ongoing public opinion surveys on COVID-19. Viewers submitted questions to the panel. This is an edited excerpt from the discussion, but you can watch the entire event in the video below.</em></p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/Q2xgJUOPH50?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<p><strong>Scott White</strong>: How many of you have a vaccine hesitant person in your inner circle? What have you tried to say to them to persuade them that vaccines are safe?</p>
<p><strong>Dawn Bowdish</strong>: All the good practices that I use with strangers, I have a hard time implementing with my own family. I think one of the important parts about vaccine hesitancy is it’s not my facts versus your facts and I have all the right facts and you have all the wrong facts, because people who are vaccine hesitant have lots of information, and there’s no metric to say that makes them feel that my information is better than theirs. So I feel like listening to people’s concerns and being really specific and not making judgment calls about what their concerns might be. Because to be honest, the vaccine hesitancy spectrum is huge. So where I have gone wrong with my own family is doing all the things that you shouldn’t do. I talked more than I listened. I threw scientific facts as opposed to listening to people’s stories and concerns. And I appealed to the authority. “I’ve got a PhD. I’ve been working on this for 20 plus years,” and that was a mistake. And so those are the things I would caution people against when you have your own conversations with your vaccine hesitant family members or friends.</p>
<p><strong>Zain Chagla</strong>: We know from things like smoking cessation where the more times that conversation happens in a nonjudgmental and non-confrontational matter, it often ends up with the right outcome at the end of the day. So again, it’s not a conversation to win to the other side and get someone to the pharmacy that afternoon. It’s a conversation to start another conversation and start another conversation and keep going along those lines.</p>
<p><strong>Scott White</strong>: Cliff, you’ve done a lot of work on taking the public pulse on this. What have you learned on trying to convince someone?</p>
<p><strong>Clifton van der Linden</strong>: Certainly, no matter how we model the public opinion data coming in on attitudes towards COVID-19, when it comes to vaccine hesitancy, trust is really the major factor. I think we are in an era where there’s a real sense of anti-intellectualism that’s being cultivated in certain corners of the internet. I think the social media discourse has a huge role to play in the way that trust has eroded as a society. But there are factors in the way that government has conducted itself. There are factors in the bad faith in which certain public actors have conducted themselves. And so there are lots of reasons for mistrust at an institutional level. So I do think that trying to ground conversations with people we love in that framework of trust, knowing that we are concerned about them, that we’re approaching them not because we want to be right but because the consequences of them being wrong are so dire for themselves and for our families and loved ones.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
</figcaption>
</figure>
<h2>Why are there such strong reactions against vaccines?</h2>
<p><strong>Scott White</strong>: One thing that’s always puzzled me is that there seems to be this really rabid reaction against vaccines, but not other medical procedures like surgery, which is far more invasive, or taking medicine. What is it about vaccines that really seems to cause this hesitancy or resistance?</p>
<p><strong>Dawn Bowdish</strong>: My belief is that it’s partly because it’s a needle and partly because there’s this big mystery about how the immune system works and how it (the vaccine) could be so powerful. The active ingredients in our current vaccines is like 10 micrograms. If you look in your medicine cabinet at your Tylenol, your Advil or whatever, you’ll see that we work in milligrams. But 10 micrograms, a thousand times less, has this incredible powerful effect to be able to create a whole immune response. The amount of stuff that’s in the vaccine is negligible. It’s nothing. But this incredibly powerful immune event, I think is a little bit humbling in some ways.</p>
<p><strong>Clifton van der Linden</strong>: I think that especially in the last five or six years, we have been flooded with discussions of fake news, misinformation, disinformation. I mean, we are told not to trust what we hear from government, depending on who’s running government. The idea that you can trust one day and then not trust the next when there’s a change of party, it leaves people in the state of constant cynicism about the good faith I think particularly of elected officials, but also of government institutions in general. I think there’s a difference in Canada compared to countries like the U.S., where in Canada we do see that the public tends not to trust elected officials, but we still do have a lot of trust in our public health institutions in Canada.</p>
<h2>The safety of vaccines that were developed so quickly</h2>
<p><strong>Scott White</strong>: At <em>The Conversation</em>, we’ve been running <a href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">a series of articles about vaccine confidence and vaccine hesitancy</a> and have been inviting questions from the public. And sort of one of the recurring questions that we get is that people seem to have trouble wrapping their head around the fact that the COVID vaccines have been developed so quickly and that scientists don’t know the long-term effects.</p>
<p><strong>Dawn Bowdish</strong>: The apparent speed was based on decades of fundamental research. I love this as a story because often times as a university academic, the general public thinks we waste time working on things that are fundamentally unimportant. In fact, we did have mRNA based vaccines in the pipeline for many different infections. One of the beauties of the mRNA technology is that it’s fairly easy to alter. Many of the features of vaccination – the dosing intervals, the amount of doses, how we de develop things for kids and for adults and older people – are all based on decades and decades of experience.</p>
<h2>Pregnancy and vaccines</h2>
<p><strong>Scott White</strong>: We get a lot of questions about the potential impact of vaccines on fertility. Zain, from a medical perspective, what are the dangers of not being vaccinated if you are pregnant?</p>
<p><strong>Zain Chagla</strong>: Look, no one is going to deny that most people do get through their infections and don’t die. I think we know this very well, but it doesn’t say that everyone is safe. We do know that elderly people are much more at risk of complications. We know what people with comorbidities are in much more risk of complications. And we have seen young people, who despite looking great on paper, are sitting in our ICUs ventilated, because again, once this virus gets out of control, once the immune system gets super jacked up, it really can cause chaos. And we sometimes don’t know who is that person that it’s going to be chaotic in and not. Pregnant women, I think we’re recognizing much more are in that risk group now. And then we have seen some fairly sick pregnant women. They’re physiologically unwell. They’re obviously carrying a baby. The concerns of having severe COVID not only in the mother, but in the baby, are also a major issue. Unfortunately, we’ve had to deliver babies prematurely for the fact that it would spare the mother their lives more and then make their mother’s oxygenation better.</p>
<p><strong>Dawn Bowdish</strong>: We don’t have a single example of a vaccine leading to long term fertility issues or leading to, I don’t even know what people are envisioning with the context of fertility, but the immune system attacking your ovaries or whatever. And in fact, all those mythologies I think were incredibly clever by the anti-vax group. Because if you’re a parent, what more do you want than grandchildren? And so what is going to trigger your emotional response and your desire to wait and to see more than that threat?</p>
<h2>What is long COVID?</h2>
<p><strong>Scott White</strong>: Manali, you’ve not only researched long COVID, but you’re dealing with it personally. I’m not sure that people fully understand the term and the impact that it can have on your life. So can you tell us about that? And then also speak about the best way to avoid it.</p>
<p><strong>Manali Mukherjee</strong>: A considerable proportion of people who have been infected with COVID-19, irrespective of how severe they were, whether they were in the hospital or whether they recover at home, they continue to have symptoms or actually develop new symptoms long after they have so-called recovered. So the public health gives you that call and tells you, “You know, you have recovered. If you’re feeling fine, go back to work.” But there are a number of people who still feel sick, who have lingering symptoms. These symptoms can range anywhere from chronic fatigue, sense of smell not being there, completely being distorted, having diffused pain, and of course all these can lead to anxiety, palpitations and cognitive impairment. So it’s a constellation of symptoms that’s kind of lingering. And none of these symptoms can be attributed to a clinical diagnosis that they either had before getting COVID. We are trying to look at what might be the reason behind it. I have reasons to believe that it’s deep seated within the immune system. I think that after having COVID, the immune system is still so hyper and it still thinks that the virus is possibly hiding somewhere or there is something still going on and the symptoms are a clinical manifestation of that misunderstanding that the immune system has. So that’s what we are trying to right now unravel and understand and makes sense.</p>
<p><strong>Scott White</strong>: Who’s more susceptible to long COVID? Is it younger people? Older people? Do we know?</p>
<p><strong>Manali Mukherjee</strong>: In my study, I’m seeing people from all age groups, all ethnicities coming in. Even asymptomatic people, people who have the infection, PCR positive test was in asymptomatic. Now they’re having symptoms. So really, we don’t know who’s going to get affected, why they’ll be affected. And worse, we just don’t know when this will stop or whether it will. What worries me right now is we don’t know much right now about the long COVID cases that we have from the original virus, the Wuhan virus to the alpha, beta, delta strains, how long COVID symptoms vary. And now the omicron has come in where we don’t know how it’s really going to be affecting our immune system given that it seems to have a higher transmissibility. And having been said, despite having a milder load, we don’t know how it’s going to really affect those with a longer COVID kind of situation. Will it affect more people with lingering, longer persisting symptoms than actually having a more severe acute infection phase? We don’t know. If you are vaccinated, there is data out there that it kind of reduces your long COVID symptoms. So if you are vaccinated and then still you get omicron, the logic tells me that your immune system might be a better streamlined, the way Dawn said, to handle that infection in a better mode as to not confuse it and make it more rowdier and lead to those lingering long COVID symptoms. So that is again another thing that tells me that vaccination and taking the boosters might actually be in our benefit as a society and community going towards natural immunity or herd immunity.</p>
<h2>Natural immunity vs. vaccine immunity</h2>
<p><strong>Scott White</strong>: There’s been a lot of discussion about herd immunity and on social media, instant experts say natural immunity is better than being vaccinated. Dawn, tell us about herd immunity and natural immunity versus vaccinated – especially as we’re now dealing with the omicron variant.</p>
<p><strong>Dawn Bowdish</strong>: Well, I mean, Manali just gave you an example of natural immunity, right? Long COVID is a natural immune response in some people. I don’t think there’s anything unnatural about a vaccine response. It’s giving your immune system the opportunity to work without distraction, right? So when you get infected with a virus, the virus doesn’t just say, “Oh, whoa. It was me. The immune system’s coming to get me.” It’s destroying tissues. The immune system in many cases is misdirecting and attacking those tissues. So some of the tissue damage we see is mediated by natural immunity, because it gets confused where there’s tissue damage in the context of infections. So natural immunity works sometimes, but vaccine immunity is natural immunity. It’s immunity working without distraction, letting the immune system do its thing without having this virus that’s fighting back and trying to thwart it. The thing about herd immunity is, let’s go back to a time before we had vaccines, antibiotics and doctors. One in three to one in five children died. There were more miscarriages, spontaneous abortions and babies born with severe complications because having an infection during pregnancy is problematic. Sure, if you were one of the lucky ones to survived your first birthday, you might have some level of protection until you got older or until you’ve had some immune compromising event or other illness. So a herd immune system gives a small percentage of the population a little bit of time to be protected from that. But as soon as a new baby’s born, a new pregnancy started, that susceptibility happens all over again. So the idea that we would just let a new virus run rampant in a population and take those risks to the young, the old, the random healthy adults is just cruel from my perspective. Really cruel. The best way for us to reach herd immunity is to get us all vaccinated.</p>
<p><strong>Zain Chagla</strong>: Right now our health-care system is burned to a crisp. We can’t deal with our current caseloads because we have complex patients coming in every day. We have ICU beds that are still allotted for COVID patients and we have health-care workers that are burnt out and have left the profession and are not coming back. So there is a lot of worry in the coming weeks and months as this circulates, that we’re going to see health systems overload. We’re going to see a lot of people test positive regardless of the vaccine status. And we’re going to see a lot of isolation and complications from that. The good news out of all of this though, is boosters do seem to really change the dynamic of vaccines and offer higher level of protection. We’re getting better data by the day that really is suggesting this. And so, I think there is work being done right now across the country, in particular Ontario, to make sure people do have access to a booster shot when their time comes.</p>
<h2>A lack of trust in expertise</h2>
<p><strong>Scott White</strong>: Some people don’t trust government. They don’t trust pharmaceutical companies. And although they may trust their personal doctor, they don’t trust intellectuals and they don’t trust people at universities. Why is that Cliff?</p>
<p><strong>Clifton van der Linden</strong>: We’ve seen a rise in populism throughout western democracies. And along with that rising populism, we’ve seen an unprecedented strain of anti-intellectualism, rejection of science in ways that we have not seen in the post-war era. So I think this is tied up in ideological convictions of partisanship, but really also in polarization. It’s no longer acceptable to have reasonable disagreements. I do think that the structure of public discourse on social media has conditioned us in such a way as to stick to our guns no matter what, to really not be permitted to make mistakes or reverse our judgment even if that means rejecting the decades of scientific research that have been undertaken. And then also looking for signals that substantiate that existing bias that one has.</p>
<h2>Isolation is not a protection strategy</h2>
<p><strong>Scott White</strong>: We had a question sent in to us about someone who’s homeschooled their kids and therefore they believe that that minimizes exposure to others. Again, you hear this from some people. “I don’t get out much” or “I don’t work in an office” or “I work outside, so therefore I don’t really need to be vaccinated.” How would you respond to someone who said something like that?</p>
<p><strong>Zain Chagla</strong>: I have seen people who have tried their best to isolate people that were homebound, but are reliant on certain people to be in their environment for their care that have gotten COVID. So number one, reducing your contacts and staying at home will reduce your risk, but it’s fallible. There are ways that people can get through it. People have to still go to the grocery store, people eventually have to see family, people have to get in public transit, and other ways that people came at exposed. Number two, there is this overlying belief that COVID-19 is somehow going to disappear from the face of this earth. And it’s not, right? This is going to be one of our endemic viruses. It’s not there yet. We’re still seeing epidemic spread, but this is going to be there today, it’s going to be there tomorrow, it’s going to be there the next day. And so, unless you plan on you and your family living a lifestyle where you’re going to be homeschooled and staying at home for the foreseeable decade or two, you’re going to encounter COVID at some point or another. And again, the best thing you can do for your body is have immunity to the virus and have a head start so that when you are encountering this virus, you can deal with it.</p>
<h2>Can minds be changed at this stage?</h2>
<p><strong>Scott White</strong>: Cliff, as someone who’s taking the pulse of the public all the time, do you think that at this stage, almost a year to when the vaccines have been available, is there anything that can be done to convince those who haven’t been vaccinated to actually make that decision now?</p>
<p><strong>Clifton van der Linden</strong>: I think there are some difficult decisions that policy makers have to engage with around this. We’ve seen the efficacy of mandatory vaccinations in certain sectors that has led to people who don’t want to be vaccinated, but nevertheless have made the decision to be vaccinated based on the policies that were put in place. That’s not something that should be done lightly. I think there are reasonable concerns about the government imposing mandatory measures, but there are choices to be made about the collective health of the population. And I will say that what we see in the data of public opinion is that the people who are reluctant to get vaccinated are not a homogenous group. There are different clusters within that group who have different motivations, ideas. They’re basing their decisions on different information and intuition and feelings. And they have different interactions with the public health-care system. But in terms of what we can do, I think it goes back to almost the beginning of the conversation and the really insightful things that my colleagues on this panel have spoken about, which is certainly any frame or any conversation that seeks to patronize or belittle the reasons that people have for not getting vaccinated is probably not going to end up being a successful path to convincing them otherwise. And these are not by and large people who haven’t read anything or who haven’t looked up information in the vaccine or who haven’t taken this very seriously. They do take it seriously. They read a lot about it. But there have been decades of concerted efforts to undermine science when it conflicts with certain interests. Look at the science on climate change for example. This is not something that’s new that has eroded confidence in science in general. We have also consistently underfunded STEM in our public education systems. And that lack of funding has led to an inability to discern authentic information from disinformation and misinformation in the broader public. So it’s almost a perfect storm of institutional and political failings that has led us at this point. I don’t fault individuals by and large. I think we have to think about the system that has led us to the place in which we are now.</p><img src="https://counter.theconversation.com/content/174032/count.gif" alt="The Conversation" width="1" height="1" />
A panel of experts answer questions about vaccines, omicron and other COVID-related issues in a discussion with The Conversation.Scott White, CEO | Editor-in-Chief, The Conversation CanadaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1733612021-12-14T16:01:04Z2021-12-14T16:01:04ZCOVID-19 vaccine inequity allowed Omicron to emerge<figure><img src="https://images.theconversation.com/files/437133/original/file-20211213-17-15ypeah.png?ixlib=rb-1.1.0&rect=56%2C44%2C1940%2C1197&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">While people in the wealthy West have had preferred access to multiple rounds of vaccines, vast numbers of people, especially in Africa and on the Indian subcontinent, haven’t received a single dose.</span> <span class="attribution"><span class="source">(Pixabay/Canva)</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/covid-19-vaccine-inequity-allowed-omicron-to-emerge" width="100%" height="400"></iframe>
<p><a href="https://health-infobase.canada.ca/covid-19/vaccination-coverage/">Canada’s COVID-19 vaccination rate</a> is 76 per cent — <a href="https://ourworldindata.org/explorers/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&facet=none&pickerSort=desc&pickerMetric=total_vaccinations_per_hundred&Metric=Vaccine+doses&Interval=Cumulative&Relative+to+Population=true&Align+outbreaks=false&country=Africa%7ECAN">10 times higher</a> than it is across the continent of Africa.</p>
<p>While people in the wealthy West have had preferred access to multiple rounds of vaccines, vast numbers of people, especially in Africa and on the Indian subcontinent, <a href="https://ourworldindata.org/covid-vaccinations">haven’t received a single dose</a>. This has permitted the virus to thrive and <a href="https://www.oxfam.org/en/press-releases/two-thirds-epidemiologists-warn-mutations-could-render-current-covid-vaccines">accelerated the process of mutation</a>, adding months and perhaps years to the pandemic.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
</figcaption>
</figure>
<p>Wherever COVID-19 has the chance to linger, <a href="https://www.theguardian.com/commentisfree/2021/nov/26/new-covid-variant-rich-countries-hoarding-vaccines">variants develop and travel</a>. This entirely predictable pattern is destined to repeat itself unless countries with resources <a href="https://news.un.org/en/story/2021/08/1098882">share vaccines</a> with others that cannot afford them. </p>
<p><a href="https://www.cbc.ca/radio/asithappens/as-it-happens-thursday-edition-1.6219522/rich-countries-only-shared-14-of-covid-19-vaccine-doses-promised-to-poorer-nations-report-1.6219969">Wealthy countries have yet to meet their pledges</a> to provide equitable global access to vaccines via <a href="https://www.unicef.ca/en/covax-ensuring-global-access-covid-19-vaccines?ea.tracking.id=20DIAQ01OTE&19DIAQ02OTE=&gclid=Cj0KCQiAzMGNBhCyARIsANpUkzP5fE37OazUDpzB8MnRHS-_hAe1K8l08m_x1dIRTGPh5YjyjSxW7QoaAjQMEALw_wcB">COVAX</a> (an international collaboration to procure and distribute COVID-19 vaccines) and other initiatives. The resulting lack of broad global vaccine coverage made the rise of another variant like Omicron inevitable. </p>
<p>For Canada, it is more critical than ever to carefully balance the supply of vaccines available for domestic use while prioritizing international sharing — and encouraging regional manufacturing. </p>
<h2>Millions of pre-ordered vaccine doses</h2>
<p>When the COVID-19 crisis started, major manufacturers pre-sold their vaccines to governments as they were being developed but before they were tested, as a way of funding their work, including clinical trials. </p>
<p><a href="https://theconversation.com/canadas-me-first-covid-19-vaccine-strategy-may-come-at-the-cost-of-global-health-146908">Canada and other developed countries ordered millions of doses</a>, enough to cover their populations many times over, with promises to share their excess vaccines with other countries. That has not happened quickly enough. While logistical, legal and other barriers did impede the wider distribution of vaccines, there appears to be <a href="https://globalnews.ca/news/8243635/bolivian-minister-canada-covid-vaccine-waiver/">a lack of will</a> to overcome them. </p>
<p>The momentum gained by accelerating the development of vaccinations has now been lost. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/437136/original/file-20211213-19-874kcv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Hundreds of vials with red lids on a conveyor belt" src="https://images.theconversation.com/files/437136/original/file-20211213-19-874kcv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/437136/original/file-20211213-19-874kcv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/437136/original/file-20211213-19-874kcv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/437136/original/file-20211213-19-874kcv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/437136/original/file-20211213-19-874kcv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/437136/original/file-20211213-19-874kcv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/437136/original/file-20211213-19-874kcv.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">Vials waiting to be filled with Pfizer’s COVID-19 vaccine at a production plant in France. Developed countries pre-purchased millions of doses of COVID-19 vaccines while they were still in development.</span>
<span class="attribution"><span class="source">(AP Photo/Christophe Ena)</span></span>
</figcaption>
</figure>
<p><a href="https://www.wsj.com/articles/pfizer-biontech-covid-19-vaccine-loses-significant-effectiveness-against-omicron-in-early-study-companies-say-11638964121">Third doses and booster shots</a> will be important to controlling both the ongoing threat of Delta and the spread of Omicron. Canadians should certainly heed public health guidance and get their shots when they are recommended. Once vaccine doses are in Canadian freezers and fridges they aren’t going anywhere, and declining a dose won’t mean that it is redistributed to other parts of the world that need them. </p>
<p>On a federal level, Canada should only buy what is needed domestically and commit to accelerating the distribution of vaccines elsewhere. The same is true for all wealthy countries.</p>
<h2>The rise of Omicron</h2>
<p>Watching the rise of Omicron is particularly frustrating. It has been apparent since the outset that the spread of COVID-19 needed to be slowed globally, precisely to prevent variants from emerging. That message should have been clearer after the spread of the agile <a href="https://www.ox.ac.uk/news/2021-07-23-alpha-variant-spread-super-seeding-event-warning-over-covid-19-variants">Alpha variant</a>. It should have been clearer still from the swift attack of the <a href="https://theconversation.com/why-is-delta-such-a-worry-its-more-infectious-probably-causes-more-severe-disease-and-challenges-our-vaccines-163579">Delta variant</a>.</p>
<p>Variants like Delta and Omicron will arise when the burden of infection is high and vaccination rates are low, as is the case with many countries in the Global South. <a href="https://theconversation.com/coronavirus-variants-have-new-names-we-can-finally-stop-stigmatising-countries-159652">Identifying variants by their country of origin</a> perpetuates a long legacy of <a href="https://theconversation.com/calling-covid-19-a-chinese-virus-is-wrong-and-dangerous-the-pandemic-is-global-134307">representing racialized people as originators or carriers of disease</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/437130/original/file-20211213-21-1kicdyj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two people in lab coats, gloves and masks in a laboratory" src="https://images.theconversation.com/files/437130/original/file-20211213-21-1kicdyj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/437130/original/file-20211213-21-1kicdyj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/437130/original/file-20211213-21-1kicdyj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/437130/original/file-20211213-21-1kicdyj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/437130/original/file-20211213-21-1kicdyj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/437130/original/file-20211213-21-1kicdyj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/437130/original/file-20211213-21-1kicdyj.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">Scientists at the Ndlovu Research Center in Elandsdoorn, South Africa, part of the Network for Genomic Surveillance in South Africa, which discovered the Omicron variant.</span>
<span class="attribution"><span class="source">(AP Photo/Jerome Delay)</span></span>
</figcaption>
</figure>
<p>In fact, the world has been served well by South Africa’s admirable investments in disease surveillance that turned up the newest COVID-19 threat.</p>
<p>There is no way to know where in the world the Omicron variant actually emerged, even though it was first detected in South Africa. South Africa has been down this road before with HIV, and had a <a href="https://www.nicd.ac.za/diseases-a-z-index/disease-index-covid-19/sars-cov-2-genomic-surveillance-update/">well-developed pandemic surveillance system that allowed it to detect this variant</a>. </p>
<h2>Investing in global health</h2>
<p>Canada has not historically invested in global health, infectious disease research or in vaccine innovation and manufacturing. </p>
<figure class="align-right ">
<img alt="A collage of world flags in the shape of a coronavirus" src="https://images.theconversation.com/files/437135/original/file-20211213-27-11wu2pc.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/437135/original/file-20211213-27-11wu2pc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/437135/original/file-20211213-27-11wu2pc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/437135/original/file-20211213-27-11wu2pc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/437135/original/file-20211213-27-11wu2pc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=755&fit=crop&dpr=1 754w, https://images.theconversation.com/files/437135/original/file-20211213-27-11wu2pc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=755&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/437135/original/file-20211213-27-11wu2pc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=755&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Regional manufacturing in Canada and abroad could enable quicker worldwide vaccine distribution.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
</figcaption>
</figure>
<p>As a result, our country is <a href="https://www.cbc.ca/news/politics/domestic-vaccine-manufacturing-canada-1.6004427">a consumer of COVID-19 vaccines rather than a contributor to the global supply</a>. Despite having small manufacturing facilities that had capacity to contribute a few million doses, Canada lacked the political will to repurpose these facilities to assist with the global vaccine effort. </p>
<p>Regional manufacturing here and abroad could enable quicker worldwide vaccination. Vaccine manufacturers are already contracting local manufacturers in <a href="https://caravanmagazine.in/health/will-600-million-india-made-doses-of-johnson-and-johnson-vaccine-be-exported-to-rich-western-countries">India</a> and <a href="https://www.nytimes.com/2021/08/16/business/johnson-johnson-vaccine-africa-exported-europe.html">Africa</a> to make vaccine doses, but these doses are being shipped to the West instead of being available locally. Sharing knowledge and technology that can help countries in the Global South develop vaccines and vaccinate their own populations will have a greater long-term benefit for the world than trying to stop variants by closing borders.</p>
<p>As the crisis has worn on, we have <a href="https://www.ic.gc.ca/eic/site/151.nsf/eng/00006.html">invested in domestic manufacturing in Canada</a>, but it will take years to staff these plants with trained personnel, let alone create innovative vaccines that are more suitable for distribution to the Global South. </p>
<p>Rather than being consumers who contribute to inequitable vaccine distribution, we have an opportunity to weave vaccine equity into these investments. </p>
<p>We can commit to training people from countries where vaccines are needed most to equalize access to expertise. We can commit to global partnerships to distribute manufacturing equitably and we can be advocates for change. </p>
<p>As we rebuild and invest in vaccine development and production, we have an opportunity to become leaders in vaccine equity and reduce the burden of infectious disease now and in the future. </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/173361/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dawn ME Bowdish receives funding from the COVID-19 Immunity Task Force, the Canadian Institutes for Health Research and the National Sciences and Engineering Research Council. She is on the Board of Directors for the Lung Health Foundation and has occasionally consulted with vaccine manufacturers. </span></em></p><p class="fine-print"><em><span>Chandrima Chakraborty receives funding from the Social Sciences and Humanities Research Council of Canada. </span></em></p>In places with low vaccination rates, COVID-19 has the chance to linger, and variants develop and travel. Without global vaccine equity, this entirely predictable pattern will repeat itself.Dawn ME Bowdish, Canada Research Chair in Aging & Immunity, McMaster UniversityChandrima Chakraborty, Professor, English and Cultural Studies; Director, Centre for Peace Studies, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1733242021-12-09T16:53:37Z2021-12-09T16:53:37ZChildren ages 5 to 11 are getting COVID-19 vaccinations: What this might mean for the holidays and the Omicron variant<figure><img src="https://images.theconversation.com/files/436447/original/file-20211208-140109-sdogbt.png?ixlib=rb-1.1.0&rect=0%2C0%2C973%2C785&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Young children are rolling up their sleeves to get vaccinated, protecting themselves against COVID-19 and helping to curb the pandemic.</span> <span class="attribution"><span class="source">(Dasantila Golemi-Kotra)</span>, <span class="license">Author provided</span></span></figcaption></figure><p><a href="https://www.thestar.com/news/canada/2021/11/18/health-canada-is-set-to-approve-the-pfizer-covid-vaccine-for-kids-heres-what-you-need-to-know.html">Public Health Canada</a> approved the use of <a href="https://www.canada.ca/en/health-canada/services/drugs-health-products/covid19-industry/drugs-vaccines-treatments/vaccines/pfizer-biontech.html">Pfizer/BioNTech</a> mRNA vaccine for children ages five to 11 on Nov. 19. The decision was highly anticipated as parents — including one of the authors — have been waiting to protect school-age children in the face of growing SARS-CoV-2 positive cases and spare them from another interruption of the school year. (Children ages five to 11 represent <a href="https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci/recommendations-use-covid-19-vaccines/pfizer-biontech-10-mcg-children-5-11-years-age.html">7.5 per cent</a> of all the cases in Canada, with potentially <a href="https://theconversation.com/im-an-infectious-disease-doctor-yes-im-vaccinating-our-5-year-old-against-covid-19-here-is-why-you-should-too-171001">life-threatening consequences</a>.)</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
</figcaption>
</figure>
<p>As soon as the provincial online booking system became available on Nov. 23, Dasantila booked her daughter for an appointment over the weekend, not wanting her to miss any school days. Then she started planning how to offer comfort on the day of the vaccination: her daughter does not like needles — the sight of a needle on TV or in a magazine or even mentioning one makes her cringe, and she instinctively covers her left arm and says she is in pain.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/if-your-child-is-afraid-of-or-refusing-a-medical-procedure-heres-how-to-help-170923">If your child is afraid of — or refusing — a medical procedure, here’s how to help</a>
</strong>
</em>
</p>
<hr>
<p>The following day, however, she came home and asked whether her vaccination had been booked. When gently informed that it would be on the weekend, she inquired why not sooner? Dasantila was shocked that her little one, who usually had to be coaxed with chocolate to get her shots, was not happy that her vaccination was not booked sooner. Hiding her shock, Dasantila asked why she wanted it sooner, and her daughter said everyone in her class was getting it sooner.</p>
<p>It’s a reminder that children may be stronger than we imagine them to be, and may exceed our expectations. It’s also another reason to thank teachers who have been consistent in their message about the importance of public health measures to protect themselves and others.</p>
<h2>What is the vaccination coverage in Canada?</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/436451/original/file-20211208-25-1us6nae.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A person out-of-frame holds a smartphone camera in the foreground as a girl gets vaccinated" src="https://images.theconversation.com/files/436451/original/file-20211208-25-1us6nae.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/436451/original/file-20211208-25-1us6nae.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=431&fit=crop&dpr=1 600w, https://images.theconversation.com/files/436451/original/file-20211208-25-1us6nae.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=431&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/436451/original/file-20211208-25-1us6nae.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=431&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/436451/original/file-20211208-25-1us6nae.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=542&fit=crop&dpr=1 754w, https://images.theconversation.com/files/436451/original/file-20211208-25-1us6nae.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=542&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/436451/original/file-20211208-25-1us6nae.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=542&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A mother takes a picture of her daughter receiving a COVID-19 vaccine during the second day of vaccination for children aged five to 11 years old in Montréal.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Paul Chiasson</span></span>
</figcaption>
</figure>
<p>The approval of vaccination for children ages five to 11 years comes at a <a href="https://health-infobase.canada.ca/covid-19/epidemiological-summary-covid-19-cases.html">critical point in the pandemic here in Canada</a>. In <a href="https://www.publichealthontario.ca/-/media/documents/ncov/epi/covid-19-vaccine-uptake-ontario-epi-summary.pdf?la=en">Ontario</a>, where we live, cases are <a href="https://globalnews.ca/news/8404305/ontario-covid-cases-november-26-coronavirus/">slowly creeping up</a> (the <a href="https://health-infobase.canada.ca/covid-19/epidemiological-summary-covid-19-cases.html">positivity rate</a> — the percentage of people tested who get a positive result — is fluctuating around three per cent), and <a href="https://www.ontario.ca/page/covid-19-cases-schools#section-1">outbreaks in the province’s elementary schools</a> are at their <a href="https://www.cbc.ca/news/canada/toronto/covid-19-ontario-dec-8-2021-school-outbreaks-rapid-tests-1.6277720">highest level since the pandemic began</a>.</p>
<p>A slow increase in positive cases was expected as people gather more indoors due to the cold weather, more venues opened to full capacities and travel bans were lifted. But we don’t know at what rate this trend will continue, so public health measures and vaccines are the thread we must hold on to. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/needle-fears-can-cause-covid-19-vaccine-hesitancy-but-these-strategies-can-manage-pain-and-fear-165009">Needle fears can cause COVID-19 vaccine hesitancy, but these strategies can manage pain and fear</a>
</strong>
</em>
</p>
<hr>
<p>The participation of five-to-11-year-old children in vaccination programs will make 90 per cent of the population eligible to get vaccinated (this age groups accounts for as many as <a href="https://www.statista.com/statistics/444868/canada-resident-population-by-age-group/">three million</a> children). This level of vaccination can make a substantial difference in “making it or breaking it” for the health-care system in Canada, which has been strained and not at a full capacity when it comes to <a href="https://theconversation.com/collateral-damage-the-unmet-health-care-needs-of-non-covid-19-patients-145934">serving non-COVID-19 patients</a>. </p>
<p>Currently, in Canada, <a href="https://health-infobase.canada.ca/covid-19/vaccination-coverage/">76 per cent of the total population is fully vaccinated</a> (86 per cent of people 12 and older). In Ontario, <a href="https://www.publichealthontario.ca/-/media/documents/ncov/epi/covid-19-vaccine-uptake-ontario-epi-summary.pdf?la=en">77 per cent of total population is fully vaccinated</a> (87 per cent of people 12 and older). Partial vaccination coverage (single dose) among children ages five to 11 is 5.8 per cent in <a href="https://health-infobase.canada.ca/covid-19/vaccination-coverage/">Canada</a> and 22 per cent in <a href="https://covid-19.ontario.ca/data">Ontario</a>.</p>
<h2>Where we are heading?</h2>
<p>A study by the Laboratory for Industrial and Applied Mathematics at York University shows that, with the current Ontario level of full vaccination in the population of 12 and older and in the absence of vaccination for children under 12, the COVID-19 attack ratio (defined as the proportion of infected individuals in the population during an outbreak) among kids <a href="https://doi.org/10.1101/2021.09.25.21263542">under age 12 can reach 18 per cent</a> (the study is not yet peer reviewed).</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/436453/original/file-20211208-136652-fayxzx.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A boy wearing glasses and a mask gets vaccinated by a health-care worker wearing PPE" src="https://images.theconversation.com/files/436453/original/file-20211208-136652-fayxzx.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/436453/original/file-20211208-136652-fayxzx.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=447&fit=crop&dpr=1 600w, https://images.theconversation.com/files/436453/original/file-20211208-136652-fayxzx.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=447&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/436453/original/file-20211208-136652-fayxzx.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=447&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/436453/original/file-20211208-136652-fayxzx.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=562&fit=crop&dpr=1 754w, https://images.theconversation.com/files/436453/original/file-20211208-136652-fayxzx.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=562&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/436453/original/file-20211208-136652-fayxzx.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=562&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The approval of vaccination for children ages five to 11 years comes at a critical point in the pandemic.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Ryan Remiorz</span></span>
</figcaption>
</figure>
<p>This level of infection in this age group can persist even if the social activity of the populations aged 12 and above remains below 75 per cent of the pre-pandemic level. An effective vaccination among kids five to 11 years old, fortunately, can reduce this attack ratio to under 0.2 per cent. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/im-an-infectious-disease-doctor-yes-im-vaccinating-our-5-year-old-against-covid-19-here-is-why-you-should-too-171001">I'm an infectious disease doctor. Yes, I'm vaccinating our 5-year-old against COVID-19. Here is why you should too.</a>
</strong>
</em>
</p>
<hr>
<p>A recent report by the same group, published in the PHAC modelling group <a href="https://nccid.ca/covid-19-phac-modelling-group/">Weekly Report</a> (October Report) shows that the attack ratio among all kids under 12 can be lowered to below two per cent if half of kids in this age group are fully vaccinated, and to 0.17 per cent with a 90 per cent vaccination rate in this age group. A game changer!</p>
<h2>Omicron and the holidays</h2>
<p>The emergence of Omicron, a variant that is considered to be <a href="https://www.macleans.ca/news/omicron-variant-will-likely-be-worse-than-delta-according-to-early-research/">more transmissible than Delta</a>, adds more urgency to getting younger ones vaccinated to curb circulation in the community and protect those that remain vulnerable even after being fully vaccinated (including the booster shots). Numerous studies show that <a href="https://theconversation.com/covid-19-vaccine-faqs-efficacy-immunity-to-illness-vs-infection-yes-theyre-different-new-variants-and-the-likelihood-of-eradication-154569">vaccines protect against severe cases of COVID-19 disease</a>, and reduce infection and transmission. </p>
<p>So as the holidays approach, encourage and support those who remain on the fence when it comes to the vaccines, and continue to embrace public health measures: face masks, physical distancing, limited gatherings and hand hygiene. The holidays may seem a bit brighter this way!</p>
<p><em>Do you have a question about COVID-19 vaccines? Email us at <a href="mailto:ca-vaccination@theconversation.com">ca-vaccination@theconversation.com</a> and vaccine experts will answer questions in upcoming articles.</em></p><img src="https://counter.theconversation.com/content/173324/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jianhong Wu receives funding from the Natural Sciences and Engineering Research Council of Canada (NSRRC) and from the Canadian Institute of Health Research. NSERC has also joined force with Sanofi Pasteur Canada in funding his Industrial Research Chair program in Vaccine Mathematics, Modelling and Manufacturing.</span></em></p><p class="fine-print"><em><span>Dasantila Golemi-Kotra does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The participation of five-to-11-year-old children in vaccination programs will make 90 per cent of the population eligible to get vaccinated against COVID-19.Dasantila Golemi-Kotra, Professor, Biology, York University, CanadaJianhong Wu, Professor and Canada Research Chair in Industrial and Applied Mathematics, York University, CanadaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1717862021-11-25T16:33:16Z2021-11-25T16:33:16ZWhy it’s normal for COVID-19 vaccine immunity to wane, and how booster shots can help<figure><img src="https://images.theconversation.com/files/433624/original/file-20211124-27-ojxnki.png?ixlib=rb-1.1.0&rect=45%2C8%2C1822%2C1069&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Vaccines, including those given for childhood diseases, rarely draw out a perfect response after only one dose.</span> <span class="attribution"><span class="source">(Backyard Productions/Canva)</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/why-it-s-normal-for-covid-19-vaccine-immunity-to-wane--and-how-booster-shots-can-help" width="100%" height="400"></iframe>
<p>Vaccines are the holy grails of disease prevention. These medical marvels confer significant protection against diseases — whether a childhood infection, annual influenza or a novel coronavirus — that can easily cause undue suffering. </p>
<p>The polio vaccine prevents polio, a highly contagious viral childhood illness that causes nerve damage and can lead to paralysis and a permanent inability to breathe. The chickenpox vaccine prevents the itchy rash in children <a href="https://doi.org/10.1080/14760584.2019.1646129">and its potential reappearance in adults as shingles</a>, given that the chickenpox virus stays with people after the infection and can reactivate later in life. The COVID-19 vaccine prevents serious illness, hospitalization and death due to a virus that has <a href="https://coronavirus.jhu.edu/map.html">killed millions and caused prolonged suffering in millions more</a>. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
</figcaption>
</figure>
<p>Vaccines can be unpleasant, but they are incredibly safe. <a href="https://doi.org/10.1016/j.vaccine.2009.10.010">A prick in the arm is much better than the disease</a>. </p>
<p>Vaccines, however, rarely draw out a perfect response after only one dose. Vaccines administered for childhood diseases, such as polio, measles, mumps and rubella, require boosters for the vaccine to become and remain effective. Viruses also change over time, which means re-vaccination can be necessary, as with seasonal influenza. </p>
<p>The COVID-19 vaccines approved by Health Canada and the World Health Organization are no exception. Recent research shows that some people need an additional dose to remain protected. Now, some health-care systems, such as in the United States, are advising everyone to receive a booster vaccine. As a doctor and COVID-19 researcher, I believe everyone who can should get a COVID-19 booster.</p>
<h2>The evidence</h2>
<p>Several scientific studies released in October reported on the effectiveness of the Pfizer-BioNTech COVID-19 vaccine in people <a href="https://doi.org/10.1056/nejmoa2114583">six months</a> after <a href="https://doi.org/10.1056/nejmoa2114228">they had received</a> the <a href="https://doi.org/10.1016/s0140-6736(21)02183-8">second jab</a>. </p>
<p>I have great trust in these sources because they studied what happened for many people — roughly 5,000, five million and 3.5 million, respectively, and the articles were all published in journals known for their scientific rigour. While the authors of the <a href="https://doi.org/10.1016/s0140-6736(21)02183-8">last study</a> disclosed they had conflicts of interest because Pfizer funded the study, their findings were roughly consistent with research that was not funded by the manufacturer. </p>
<figure class="align-left ">
<img alt="A health professional administers a vaccine to an older person" src="https://images.theconversation.com/files/433627/original/file-20211124-26-g1r50k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/433627/original/file-20211124-26-g1r50k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=899&fit=crop&dpr=1 600w, https://images.theconversation.com/files/433627/original/file-20211124-26-g1r50k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=899&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/433627/original/file-20211124-26-g1r50k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=899&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/433627/original/file-20211124-26-g1r50k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/433627/original/file-20211124-26-g1r50k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/433627/original/file-20211124-26-g1r50k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The rate of virus-neutralizing antibodies decreased fastest for men, those over 65 and those with a suppressed immune system.</span>
<span class="attribution"><span class="source">(Unsplash)</span></span>
</figcaption>
</figure>
<p>All the studies showed that the COVID-19 vaccine became less effective over time, which is consistent with the dynamics of other vaccines. <a href="https://www.cdc.gov/vaccines/hcp/vis/vis-statements/tdap.html">Adults require a tetanus vaccine every 10 years</a>, for example.</p>
<p>The first study, which was a laboratory-based investigation of about 5,000 people, found that <a href="https://doi.org/10.1056/nejmoa2114583">the levels of antibodies that monitor for the virus decreased steadily in the six months after receiving the second dose of the vaccine</a>. Those that kill the virus decreased rapidly in the first three months. </p>
<p>Critically, the researchers found the rate of virus-neutralizing antibodies went down the fastest for men, those over 65, and those with a suppressed immune system. This data supports earlier medical advice that encouraged <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/booster-shot.html">higher-risk individuals to get a booster</a>. </p>
<p>While that may sound concerning, <a href="https://doi.org/10.1038/s41577-020-00479-7">it is consistent with a typical immune response to a vaccine</a>. Public health agencies are taking action now because most people have a reasonable risk of re-exposure to the virus that causes COVID-19, which can cause complications even if one is vaccinated. It’s prudent to maintain high levels of antibodies to more rapidly fight off potential infections.</p>
<figure class="align-center ">
<img alt="A storage container rolls out of a cargo plane at night" src="https://images.theconversation.com/files/433616/original/file-20211124-17-1r1jby9.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/433616/original/file-20211124-17-1r1jby9.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/433616/original/file-20211124-17-1r1jby9.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/433616/original/file-20211124-17-1r1jby9.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/433616/original/file-20211124-17-1r1jby9.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/433616/original/file-20211124-17-1r1jby9.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/433616/original/file-20211124-17-1r1jby9.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">Ground crew offload a plane carrying the first shipment of the Pfizer-BioNTech COVID-19 vaccine for children, in Hamilton, Ont., on Nov. 21, 2021.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Tijana Martin</span></span>
</figcaption>
</figure>
<p>While these studies solely covered the Pfizer vaccine, not the Moderna, AstraZeneca or J&J vaccines, one would expect similar observations, given that the vaccines have similar effects on the immune system. </p>
<p>The U.S. Centers for Disease Control and Prevention updated its guidance on Nov. 19. It <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/booster-shot.html?s_cid=11706:cdc%20covid%20booster%20shot%20guidelines:sem.ga:p:RG:GM:gen:PTN:FY22">advises those over 50 or living in long-term care settings to get a booster, and says that everyone over 18 may get a booster</a>. Given that the young can infect the old, and with many young people having suffered over the pandemic, truly everyone over 18 should get the booster.</p>
<p>Health Canada has <a href="https://www.canada.ca/en/health-canada/news/2021/11/health-canada-authorizes-the-use-of-the-moderna-spikevax-covid-19-vaccine-as-a-booster-shot.html">approved the Moderna</a> and <a href="https://www.canada.ca/en/health-canada/news/2021/11/health-canada-authorizes-the-use-of-the-pfizer-biontech-comirnaty-covid-19-vaccine-as-a-booster-shot.html">Pfizer-BioNTech</a> COVID-19 vaccines as boosters for adults 18 years of age and older. The provinces are rolling out their booster programs now.</p>
<h2>Making it through another winter of COVID-19</h2>
<p>Anxiety about being infected with COVID-19 is still high. Despite my diligence and vaccinated status, I am concerned that I could develop COVID-19 and pass it to my elderly parents. </p>
<p>Illnesses like COVID-19 and the flu can be deadly for older relatives. I see this repeatedly in my COVID-19 research where I am investigating the genetic features that increase the risk of severe disease. </p>
<p>Fortunately, we all have advice now on protecting ourselves and our loved ones. Get another dose of the COVID-19 vaccine. Get a flu shot. </p>
<p>Maybe I will have a sore arm and be a bit tired for a day or two after receiving my vaccines (boosters are extremely low-risk medical procedures, just like one’s primary vaccines). If it means that I know that my family and friends are safe, the inconvenience is worth it. The peace of mind in itself is a significant boon.</p>
<p>There is hope for a post-pandemic world, but we must still be diligent. We owe it to ourselves and our loved ones.</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/171786/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>Booster shots are a common necessity for vaccines to keep working. Recent research shows COVID-19 booster shots are recommended for high-risk individuals — and may benefit the rest of us too.Julian Daniel Sunday Willett, PhD Candidate, Quantitative Life Sciences, McGill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1716482021-11-12T00:38:32Z2021-11-12T00:38:32ZThe fault in our stars: Aaron Rodgers reminds us why celebrity shouldn’t trump science<figure><img src="https://images.theconversation.com/files/431590/original/file-20211111-27-13d17uz.jpg?ixlib=rb-1.1.0&rect=44%2C13%2C2815%2C1971&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Green Bay Packers quarterback Aaron Rodgers implied he was vaccinated against COVID-19 when he was not, and made statements about the vaccines based on misinformation.</span> <span class="attribution"><span class="source">(AP Photo/Rick Scuteri) </span></span></figcaption></figure><p>They say never meet your heroes. Take football hero Aaron Rodgers. The Green Bay Packers quarterback is undeniably great at playing football. He has won <a href="https://www.si.com/college/cal/news/aaron-rodgers-wins-third-mvp">Most Valuable Player</a> of the National Football League (NFL) three times. His team <a href="https://www.britannica.com/biography/Aaron-Rodgers">won the Superbowl</a> in 2011 and he holds numerous records.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
</figcaption>
</figure>
<p>But it’s what’s happening above the shoulder pads that has recently received attention: <a href="https://www.theglobeandmail.com/sports/football/article-aaron-rodgers-sought-treatments-instead-of-covid-19-vaccine/">After insinuating that he was protected against COVID-19</a>, it turns out that he never received a vaccine. And he has recently tested positive for COVID-19. </p>
<h2>Celebrity platforms</h2>
<p>As a doctor, I am not here to take pleasure in his misfortune or say, “We told you so,” even if getting vaccinated is <a href="https://laist.com/news/health/health-experts-urge-people-to-get-vaccinated-as-covid-cases-continue-to-climb">exactly what medical experts have recommended as the best protection against COVID-19</a>. I am not here to challenge Rodgers’ freedom of speech. </p>
<p>I am here to say that my colleagues and I are burned out by the pandemic’s effects on an already-broken system and that misinformation from Rodgers and others with a celebrity platform or a large following is harmful. </p>
<p>Misinformation emboldens those who believe falsehoods and has led to <a href="https://www.theglobeandmail.com/opinion/article-as-a-doctor-promoting-vaccination-i-live-in-fear/">physical violence against doctors</a>, <a href="https://vancouver.citynews.ca/2021/02/24/conspiracists-fantasizing-henry-execution/">death threats against</a> public health officials and <a href="https://www.cbc.ca/news/canada/toronto/covid-hospital-protests-canada-1.6173437">protesters blocking cancer patients</a> from entering hospitals.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/nicki-minajs-covid-19-vaccine-tweet-about-swollen-testicles-signals-the-dangers-of-celebrity-misinformation-and-fandom-168242">Nicki Minaj’s COVID-19 vaccine tweet about swollen testicles signals the dangers of celebrity misinformation and fandom</a>
</strong>
</em>
</p>
<hr>
<p>Since the scientific triumph of safe and effective vaccines against the SARS-CoV-2 virus I have had many discussions with patients. The ones that start with “I’m not an anti-vaxxer” inevitably lead to vaccine denial. Similarly, Rodgers defends his celebrity credibility as someone who is “<a href="https://www.si.com/college/cal/news/aaron-rodgers-responds-to-critics">not some sort of anti-vaxx flat Earther. I am somebody who’s a critical thinker</a>” who “did his own research.” </p>
<p>Yet he has amplified dangerous and disproven myths about the COVID-19 vaccine. </p>
<h2>Myth-busting Rodgers’ statements</h2>
<p>Rodgers said that vaccines <a href="https://www.miamiherald.com/news/coronavirus/article255644891.html">could impact fertility</a>; there is <a href="https://doi.org/10.1007/s11845-021-02807-9">neither proof nor plausibility</a> to this statement. </p>
<p>He said he’s “allergic to an ingredient” in both the Pfizer and Moderna products, despite no mention of having these <a href="http://doi.org/10.1001/jamanetworkopen.2021.22255">rare allergies</a> confirmed by an allergist. </p>
<p>He said “we don’t know a whole lot about” the vaccine although after <a href="https://www.bloomberg.com/graphics/covid-vaccine-tracker-global-distribution/">seven billion doses</a> we know a lot. And so far the evidence is clear: the vaccine is effective against a <a href="https://coronavirus.jhu.edu">virus that has killed over five million people globally and more than 750,000 in Rodgers’ America</a>.</p>
<figure class="align-center ">
<img alt="Green Bay Packers quarterback Aaron Rodgers leaving the field giving the No. 1 sign, with photographers behind him" src="https://images.theconversation.com/files/431591/original/file-20211111-17-kb64ra.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/431591/original/file-20211111-17-kb64ra.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/431591/original/file-20211111-17-kb64ra.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/431591/original/file-20211111-17-kb64ra.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/431591/original/file-20211111-17-kb64ra.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/431591/original/file-20211111-17-kb64ra.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/431591/original/file-20211111-17-kb64ra.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">Aaron Rodgers was fined US$14,650 by the NFL for violating the league’s COVID-19 protocol.</span>
<span class="attribution"><span class="source">(AP Photo/Ross D. Franklin)</span></span>
</figcaption>
</figure>
<p>Rodgers also repeats other common unfounded anti-vaccine arguments in saying, “this idea that it’s the pandemic of the unvaccinated is just a total lie … If the vaccine is so great, then how come people are still getting COVID and spreading COVID?” </p>
<p>Studies show that unvaccinated people <a href="https://www.cdc.gov/media/releases/2021/p0607-mrna-reduce-risks.html">are more likely to get COVID-19</a>. They’re more likely to <a href="https://doi.org/10.1101/2021.09.28.21264260">spread COVID-19</a> (the research awaiting peer review). And are more likely to get really sick and die from COVID-19. The vaccine is not perfect, but it leads to <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7032e1.htm?s_cid=mm7032e1_w">better protection than “natural immunity.”</a> Avoiding vaccination because some vaccinated people get sick is like saying that impaired driving laws are useless because some sober drivers still have car accidents.</p>
<p>Rodgers believes strongly in “bodily autonomy.” Others care about that too. Like people most at risk of COVID-19, such as those with cancer or autoimmune diseases that both increase their risk of infection while also diminishing their ability make antibodies after immunization. Know who else cares? Parents like me with young children who are not yet eligible to get the vaccine. </p>
<p>Rodgers also dogwhistles his followers in citing <a href="https://www.cbsnews.com/news/aaron-rodgers-packers-covid-vaccine-ivermectin-woke-mob/">ivermectin and homeopathy</a>. Ivermectin <a href="https://theconversation.com/ivermectin-whether-formulated-for-humans-or-horses-is-not-a-treatment-for-covid-19-167340">has not been shown in studies</a> to improve COVID-19 outcomes and a rare publication that did show an effect was <a href="https://retractionwatch.com/2021/11/02/ivermectin-covid-19-study-retracted-authors-blame-file-mixup/">retracted because the authors fabricated trial participants</a> that didn’t exist. <a href="https://dx.doi.org/10.15252%2Fembr.201947761">Homeopathy has not proven better than placebo</a> for any condition. </p>
<p>Further to his anti-science and anti-vaccine statements, Rodgers has shown anti-mask behaviour, appearing without facial covering indoors at work and in the community, endangering himself and others. The NFL <a href="https://www.nfl.com/news/packers-fined-300k-aaron-rodgers-allen-lazard-fined-14k-for-violation-of-covid-p">fined Rodgers US$14,650</a>, or 0.04 per cent of his US$33.5 million salary. </p>
<h2>Science-informed celebrities</h2>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1377251952304750593"}"></div></p>
<p>I get that vaccination is an emotional subject; if the battle were about facts then anti-vaccine sentiments would have been eradicated years ago like smallpox. Trust is vitally important. And for every Aaron Rodgers who is free to speak untruths, we need more science-informed celebrities like <a href="https://twitter.com/VancityReynolds/status/1377251952304750593?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1377251952304750593%7Ctwgr%5E%7Ctwcon%5Es1_&ref_url=https%3A%2F%2Fwww.buzzfeed.com%2Fmorgansloss1%2Fcelebrities-for-covid-vaccine-and-against-it">Ryan Reynolds</a>, <a href="https://www.instagram.com/p/CN3FEvRLG3z/?utm_source=ig_embed&ig_rid=39439f39-cda4-4ab6-a9c6-56fc71d0b22b">Mindy Kaling</a>, <a href="https://twitter.com/ArianaGrande/status/1421890761939984388?ref_src=twsrc%5Etfw%7Ctwcamp%5Etweetembed%7Ctwterm%5E1421890761939984388%7Ctwgr%5E%7Ctwcon%5Es1_&ref_url=https%3A%2F%2Fwww.buzzfeed.com%2Fmorgansloss1%2Fcelebrities-for-covid-vaccine-and-against-it">Ariana Grande</a>, <a href="https://people.com/movies/tyler-perry-sets-up-covid-vaccination-site-studio-staff-crew-250-vaccinated/">Tyler Perry</a> and <a href="https://www.usatoday.com/story/news/factcheck/2020/11/21/fact-check-dolly-parton-donated-modernas-covid-19-vaccine-studies/6373339002/">Dolly Parton, who also helped fund Moderna vaccine research</a>. </p>
<p>Historically, <a href="https://www.npr.org/sections/health-shots/2021/05/03/988756973/cant-help-falling-in-love-with-a-vaccine-how-polio-campaign-beat-vaccine-hesitan">Elvis Presley, Sammy Davis Jr., Louis Armstrong and Ella Fitzgerald</a> were critical in instilling trust in the government’s vaccine rollout when polio vaccine hesitancy was 50 per cent.</p>
<p>So when it comes to meeting your heroes, maybe it’s a good thing. Rather than supporting the view that they are untouchable stars up high, they remind us that we are all human and susceptible to viruses and viral misinformation alike.</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/171648/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eric Cadesky 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>NFL star Aaron Rodgers has amplified dangerous and disproven myths about the COVID-19 vaccine. Here’s why his statements are not only untrue, but also harmful because they spread misinformation.Eric Cadesky, Clinical Associate Professor, Faculty of Medicine, University of British ColumbiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1709112021-11-11T15:41:51Z2021-11-11T15:41:51ZHow cognitive biases and adverse events influence vaccine decisions (maybe even your own)<figure><img src="https://images.theconversation.com/files/430453/original/file-20211105-25-wktftj.jpg?ixlib=rb-1.1.0&rect=1041%2C431%2C3862%2C2110&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Vaccine hesitancy has been a growing challenge for more than a decade. Concerns about vaccine safety and adverse events are the most commonly cited reasons.</span> <span class="attribution"><span class="source">(AP Photo/Rogelio V. Solis) </span></span></figcaption></figure><iframe style="width: 100%; height: 175px; border: none; position: relative; z-index: 1;" allowtransparency="" src="https://narrations.ad-auris.com/widget/the-conversation-canada/how-cognitive-biases-and-adverse-events-influence-vaccine-decisions--maybe-even-your-own-" width="100%" height="400"></iframe>
<p>The <a href="https://www.who.int/immunization/research/forums_and_initiatives/1_RButler_VH_Threat_Child_Health_gvirf16.pdf">World Health Organization</a> recognized vaccine hesitancy as a growing challenge in 2011, and identified it as <a href="https://www.who.int/wer/2011/wer8621.pdf">a new priority topic</a>. This was mostly because of the return of vaccine-preventable diseases like <a href="https://doi.org/10.1038/s41390-019-0354-3">measles in Europe and the United States</a>. </p>
<p>Ten years later, in 2021, we see that vaccine hesitancy has become an even more significant challenge despite all the efforts. The COVID-19 pandemic has brought it to a peak, and all efforts to manage the pandemic depend on the people’s willingness to take the vaccination. However, <a href="https://doi.org/10.3390/vaccines9020160">the numbers are not very promising as some percentage of populations in every country are reluctant to vaccinate</a>.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
</figcaption>
</figure>
<p>Vaccine hesitancy means “<a href="https://doi.org/10.1016/S2352-4642(19)30092-6">delay in acceptance or refusal of vaccines despite availability of vaccination services</a>.” Vaccine-hesitant people cite <a href="https://doi.org/10.1016/j.vaccine.2015.01.068">distrust in vaccine safety and concerns over vaccine adverse events</a> as the most common reasons for reluctance to get vaccinated. </p>
<p>Vaccines are used in healthy people to prevent a disease that might harm them in the future. However, as they are healthy at the time of vaccination, they may worry about the vaccine’s safety.</p>
<p>Our team of business analytics and artificial intelligence researchers at Concordia University, along with a professor of epidemiology at McGill University, has published a paper in the <a href="https://doi.org/10.1186/s12889-021-11745-1"><em>BMC Public Health</em></a> journal that investigated this critical concern from two perspectives. </p>
<p>First, we addressed vaccine safety concerns by analyzing data from vaccine adverse events systems. These are vaccine surveillance systems where adverse events following immunization are reported, monitored and stored in a database. Canada’s system is called the <a href="https://www.canada.ca/en/public-health/services/immunization/canadian-adverse-events-following-immunization-surveillance-system-caefiss.html#_About_the_system">Canadian Adverse Events Following Immunization Surveillance System (CAEFISS)</a>.</p>
<p>Second, we focused on cognitive science and highlighted the critical role of cognitive biases in people’s vaccination decision-making that might lead to vaccine hesitancy.</p>
<h2>Data-driven evidence to address vaccine safety</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/430455/original/file-20211105-19-6xhu5j.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A vaccination centre with Ontario Premier Doug Ford in the background touring the facility and a line of people waiting to greet him in the foreground" src="https://images.theconversation.com/files/430455/original/file-20211105-19-6xhu5j.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/430455/original/file-20211105-19-6xhu5j.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430455/original/file-20211105-19-6xhu5j.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430455/original/file-20211105-19-6xhu5j.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430455/original/file-20211105-19-6xhu5j.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430455/original/file-20211105-19-6xhu5j.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430455/original/file-20211105-19-6xhu5j.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Ontario Premier Doug Ford tours a vaccine centre in Windsor, Ont. Distrust in vaccine safety and concerns over vaccine adverse events are the most cited reasons for vaccine hesitancy.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/ Geoff Robins</span></span>
</figcaption>
</figure>
<p>A solution to mitigate distrust in vaccines safety is to <a href="https://doi.org/10.1177/0272989X15607855">provide evidence-based meaningful information about vaccine safety and adverse events</a>. We followed this path and analyzed all the adverse events reported to the <a href="https://vaers.hhs.gov/">U.S. Vaccine Adverse Event Reporting System (VAERS)</a>.</p>
<p>We analyzed almost 294,000 reports over eight years from 2011 to 2018. It equals roughly 115 reports per million people, covering 87 vaccine types. The most frequently reported vaccines were those for chickenpox, influenza, pneumococcal bacteria and human pappilomavirus (HPV).</p>
<p>Each VAERS report (representing one incident) involved an average of three adverse events, the most common being rashes, fever, swelling, pain and headaches. Only 5.5 per cent of the reports were marked as serious, resulting in hospitalization, disability, threats to life or death. The top adverse events in this group also include fever, pain, vomiting, headaches and shortness of breath. </p>
<p>We also analyzed the vaccine adverse events reported to <a href="https://www.canada.ca/en/health-canada/services/drugs-health-products/medeffect-canada/canada-vigilance-program.html">Canada Vigilance</a>. Our findings were consistent with those from the VAERS.</p>
<p>We have provided our results in an <a href="https://public.tableau.com/app/profile/aefi/viz/VAERSAdverseEventFollowingImmuinzationAEFIReports2011-2018/Dashboard1">interactive dashboard</a>. Health-care professionals and others involved in vaccine communication can use this dashboard to provide evidence-based information to the public. Research suggests that <a href="https://doi.org/10.1016/j.vaccine.2016.03.087">summarized data is the best format for communicating vaccine safety information</a>, so using this dashboard in vaccination communication can help mitigate vaccine hesitancy and safety concerns, and increase trust in vaccines.</p>
<h2>The role of cognitive biases in vaccine hesitancy</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/430454/original/file-20211105-17-1g2k9jz.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man in camouflage T-shirt and hat holding an anti-vaccine sign in the foreground, with a group of people in the background" src="https://images.theconversation.com/files/430454/original/file-20211105-17-1g2k9jz.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/430454/original/file-20211105-17-1g2k9jz.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=425&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430454/original/file-20211105-17-1g2k9jz.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=425&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430454/original/file-20211105-17-1g2k9jz.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=425&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430454/original/file-20211105-17-1g2k9jz.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=535&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430454/original/file-20211105-17-1g2k9jz.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=535&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430454/original/file-20211105-17-1g2k9jz.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=535&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An anti-vaccine demonstrator in front of a hospital in Montréal in September 2021.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Paul Chiasson</span></span>
</figcaption>
</figure>
<p>In the second part of our study, after addressing concerns about vaccine adverse events, we examined the role of cognitive biases on vaccine hesitancy. We identified cognitive biases that might affect vaccine communication and decision-making. </p>
<p>As mentioned earlier, vaccines are administrated to healthy people. When people are making decisions about vaccination, they might feel some degrees of risk, ambiguity and uncertainty about the results, which can instigate cognitive biases in the decision-making process. Such cognitive biases might <a href="https://doi.org/10.1016/j.vaccine.2015.03.048">nudge people toward vaccine hesitancy</a>.</p>
<p>For example, contrary to the positive effect of providing people with summarized vaccine safety information that increases vaccine trust, detailed vaccine adverse event reports will decrease trust because of two cognitive biases. </p>
<p>First, when vaccine hesitant people read a detailed report about a vaccine adverse event, it gives them the chance to see what they want to see. It is an example of confirmation bias, which is the <a href="https://doi.org/10.1037/1089-2680.2.2.175">tendency to recall and interpret information that confirms our existing beliefs</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/430452/original/file-20211105-23-1m8sflu.JPG?ixlib=rb-1.1.0&rect=89%2C40%2C2748%2C1859&q=45&auto=format&w=1000&fit=clip"><img alt="An upper arm bearing a heart tattoo and a small round bandage over an injection site" src="https://images.theconversation.com/files/430452/original/file-20211105-23-1m8sflu.JPG?ixlib=rb-1.1.0&rect=89%2C40%2C2748%2C1859&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/430452/original/file-20211105-23-1m8sflu.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430452/original/file-20211105-23-1m8sflu.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430452/original/file-20211105-23-1m8sflu.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430452/original/file-20211105-23-1m8sflu.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430452/original/file-20211105-23-1m8sflu.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430452/original/file-20211105-23-1m8sflu.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Research suggests that summarized vaccine safety information is the best format for increasing trust in vaccines.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Kayle Neis</span></span>
</figcaption>
</figure>
<p>Second, a detailed adverse event report will also increase the event’s vividness, making it easier to recall the next time there is a decision to be made about taking a vaccine. That is the effect of availability bias, <a href="https://doi.org/10.1016/0010-0285(73)90033-9">the tendency to attribute more weight to factors that are easier to recall</a>.</p>
<p>We identified 15 cognitive biases in the vaccine decision-making process and categorized them into three groups:</p>
<ul>
<li><p><strong>Cognitive biases triggered by processing vaccine-related information</strong> include availability bias, as in the above example, as well as framing effect, base rate neglect, availability bias, anchoring effect and authority bias.</p></li>
<li><p><strong>Cognitive biases triggered in vaccination decision-making</strong> include omission bias, which is when the results of not taking an action are viewed as less damaging than the results of taking action, even when this is not the case. Others include ambiguity aversion, optimism bias, present bias and protected values. </p></li>
<li><p><strong>Cognitive biases triggered by prior beliefs regarding vaccination</strong> include confirmation bias such as the one in the example, as well as belief bias, shared information bias and false consensus effect.</p></li>
</ul>
<p>The <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-11745-1/tables/1">full list of cognitive biases affecting vaccination decision-making and their examples is available here</a>. Public health officials and practitioners can use this list and customize their plans, interventions and other forms of vaccine communication to decrease vaccine hesitancy. </p>
<p>You also can check the list and see if these biases have influenced your own vaccination decisions.</p>
<p><em>Do you have a question about COVID-19 vaccines? Email us at <a href="mailto:ca-vaccination@theconversation.com">ca-vaccination@theconversation.com</a> and vaccine experts will answer questions in upcoming articles.</em></p><img src="https://counter.theconversation.com/content/170911/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>To help increase trust in vaccines, researchers analyzed data on adverse events to address safety concerns, and then used cognitive science to show how cognitive biases feed vaccine hesitancy.Hossein Azarpanah, PhD Candidate in Business Technology Management, Concordia UniversityLouise Pilote, Professor of Medicine, James McGill Chair, McGill UniversityMohsen Farhadloo, Assistant professor, John Molson School of Business, Concordia UniversityRustam Vahidov, Professor, Dept. of Supply Chain & Business Technology Management, Concordia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1705112021-11-10T16:18:43Z2021-11-10T16:18:43ZHow an online quiz became the best tool to convince 18- to 30-year-olds to get the COVID-19 vaccine<figure><img src="https://images.theconversation.com/files/430902/original/file-20211108-23-1wszpkt.png?ixlib=rb-1.1.0&rect=29%2C14%2C1355%2C668&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The "Which Virus Are You" website was a fun and informative way to talk to young people about the benefits of the COVID-19 vaccines.</span> <span class="attribution"><span class="source">(Marion Cossin)</span>, <span class="license">Author provided</span></span></figcaption></figure><p>A lot of false information is spread on social media, which means that using social media to provide reliable scientific data on COVID-19 is not an easy task. The danger is all the greater for young people, who get a lot of their information from social media. </p>
<p>People aged 18 to 29 are among the least vaccinated in Québec. As of Sept. 17, <a href="https://mobile.inspq.qc.ca/sites/default/files/covid/vaccination/vigie-vaccination-20210917.pdf">72.9 per cent</a> had received two doses, compared to 89 per cent of 50- to 59-year-olds and 73.8 per cent of 12- to 17-year-olds. Many are concerned about vaccination.</p>
<p>To respond to this group’s unease, we wanted to find an effective tool we could use to reach them and answer their questions.</p>
<p>So, we created the “<a href="https://www.quelvirusestu.com/home-page">Which Virus Are You</a>” website, which explains COVID-19 in an interactive and entertaining way with the help of experts. It took off and became very popular within weeks after being launched. Here’s how it all started.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
</figcaption>
</figure>
<p>When Québec’s research agency Fonds de Recherche du Québec launched a call for projects <a href="https://frq.gouv.qc.ca/jeunes-covid/">“Jeunes dans la lutte contre la Covid-19” (Youth fighting COVID-19</a>, we, a group of science communicators, thought about submitting an idea right away. The goal of the competition was to help students create innovative and creative digital communication projects that would address the COVID-19 concerns of people between 18 and 30.</p>
<p>Before the call went out for projects, our small team of PhD students had already had some science communication projects under out belt, including <a href="https://www.comsciconqc.com/">ComSciCon-QC</a>. So, the ideas started flowing right away. </p>
<p>We quickly saw that while there were already many information sources about COVID-19, what was missing was a tool that made information attractive to young people, one that would make it possible for them to exchange and share ideas. </p>
<h2>Two-way communication</h2>
<p>From the outset we wanted to “think interactive,” to get out of the straitjacket of the printed word and traditional reading, and actively involve the user. The other principle that was important to us was to have two-way communication: to listen, and not just provide information. We felt that traditional communication approaches around COVID-19 lacked reciprocity.</p>
<hr>
<p>
<em>
<strong>
À lire aussi :
<a href="https://theconversation.com/covid-19-vaccine-hesitancy-can-be-overcome-through-relatable-stories-and-accessible-information-169221">COVID-19 vaccine hesitancy can be overcome through relatable stories and accessible information</a>
</strong>
</em>
</p>
<hr>
<p>Yet how do you get young people to share their feelings without generating an unmanageable amount of data? We knew an open forum would require hours of time to moderate and could potentially open the door to abuse. Direct virtual interaction with experts could only be sporadic and limited.</p>
<p>After a few hours of brainstorming, we came up with the idea of a multiple choice quiz. Quizzes are entertaining and can be fun. Most of us like to test our knowledge and share our opinions. It’s hard to resist a quiz like “Which Disney princess are you?” or “Which Hogwarts house do you belong to?”</p>
<h2>Four virus avatars</h2>
<p>The plan was clear: to design a question-and-answer quiz that would assign each user a “virus avatar” that represented their feelings about the COVID-19 pandemic. The next challenge was to build characters that represented the diversity of people taking the quiz while avoiding being judgmental. After doing preliminary research in media reports, and thinking about our own experiences and those of our family and friends, we came up with four “pandemic behaviours” that would be represented by our avatars: the super-informed, the worried, the skeptic and the detached.</p>
<p>In addition to the quiz, we also had to provide quality information to our audience. To do this, we needed the help of scientific experts on the subjects we wanted to cover. Under the leadership of <a href="https://www.chumontreal.qc.ca/en/crchum/researchers/nathalie-grandvaux">Nathalie Grandvaux</a>, director of the Host Response to Viral Infections Laboratory at the CHUM hospital’s research centre, our team of experts wrote the material and provided us with reliable up-to-date sources.</p>
<hr>
<p>
<em>
<strong>
À lire aussi :
<a href="https://theconversation.com/the-9-psychological-barriers-that-lead-to-covid-19-vaccine-hesitancy-and-refusal-168643">The 9 psychological barriers that lead to COVID-19 vaccine hesitancy and refusal</a>
</strong>
</em>
</p>
<hr>
<p>It took a lot of work to synthesize and popularize this information to create accessible infographics. We then handed the material over to Impakt Scientifik to design the <a href="https://www.quelvirusestu.com/tell-me-more">10 infographics</a>. For each of the avatars presented at the end of the quiz, we provide three fact sheets to answer users’ questions. The idea was to use the quiz as a fun tool to lure young people to the site, then suggest that they learn more by exploring the rest of the content.</p>
<figure class="align-center ">
<img alt="A cartoon character in glasses and reading." src="https://images.theconversation.com/files/430904/original/file-20211108-23-1vwxq1b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/430904/original/file-20211108-23-1vwxq1b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430904/original/file-20211108-23-1vwxq1b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430904/original/file-20211108-23-1vwxq1b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430904/original/file-20211108-23-1vwxq1b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430904/original/file-20211108-23-1vwxq1b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430904/original/file-20211108-23-1vwxq1b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The super-informed individual is always on the lookout for additional reliable information.</span>
<span class="attribution"><span class="source">(Marion Cossin)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Opening the dialogue on vaccination</h2>
<p>We launched the website on July 16 and set up a social media strategy to reach a wide audience of young people who would have very different opinions than our own. To do so, we had to know their codes and the tools they were using. We were very active on our social networks all summer, posting every day. We received more comments than we were expecting on our posts.</p>
<p>The posts generated over 20,000 interactions (reactions, shares and comments), with some users questioning our content and others jumping in to defend it. The comments we got on the Facebook page were more aggressive or based on false information from dubious sources, which meant we had to spend time moderating them.</p>
<p>The platform allowed conversations about vaccines to happen between individuals with opposing views. It also allowed information to be shared between populations that do not generally interact. That convinced us we had chosen the right approach.</p>
<h2>A formula that works</h2>
<p>To date, our project has reached over 265,000 people through a combination of social networks (Twitter, Instagram and Facebook) and our website. The majority of users were between the ages of 18 and 34 and located in Québec, but our geographic reach was very wide and included other Canadian provinces, Europe and French-speaking Africa. We also got very positive feedback from science communication professionals. Some important institutions offered to help spread the word about our project.</p>
<p>While access to scientific information is an essential condition to get people to adopt public health behaviours, misinformation is rampant on social networks and confuses people. So it is essential to provide quality scientific information in an accessible and attractive format. In this way, we can stimulate young people’s interest in science and reduce the distance that still exists between experts and the public.</p>
<p>Important messages will only get across if you create a climate of trust and mutual listening, giving young people the tools they need to make good decisions and become the citizens of tomorrow’s society. The question that remains is how to encourage scientists to use these new forms of communication and give them the tools they need to do so.</p>
<p><em>Alexandra Gellé, a chemistry student at McGill University, and Émilie Dubois, founder <a href="https://www.impaktsci.co/">IMPAKT Scientifik</a>, contributed to this project.</em></p>
<hr>
<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/170511/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marion Cossin received funding from the Fonds de Recherche du Québec for her PhD and for the "Which Virus Are You" project.</span></em></p><p class="fine-print"><em><span>Alexia Ostrolenk received funding from the Fonds de Recherche du Québec for her PhD and for the "Which Virus Are You" project.. </span></em></p>To convince 18- to 30-year-olds to get vaccinated, three doctoral students designed an innovative, fun, non-judgmental quiz.Marion Cossin, Étudiante au doctorat et ingénieure de recherche en cirque au Centre de recherche d’innovation et de transfert en Art du Cirque (CRITAC), Université de MontréalAlexia Ostrolenk, Candidate au PhD en Sciences Psychiatriques / Communicatrice Scientifique, Université de MontréalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1710012021-11-05T15:00:55Z2021-11-05T15:00:55ZI’m an infectious disease doctor. Yes, I’m vaccinating our 5-year-old against COVID-19. Here is why you should too.<figure><img src="https://images.theconversation.com/files/430390/original/file-20211104-25-12ufquc.jpg?ixlib=rb-1.1.0&rect=684%2C14%2C3414%2C2195&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Carter Giglio, 8, joined by service dog Barney of Hero Dogs, shows off the bandage over his injection site after being vaccinated at Children's National Hospital in Washington.
</span> <span class="attribution"><span class="source">(AP Photo/Carolyn Kaster)</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/i-m-an-infectious-disease-doctor--yes--i-m-vaccinating-our-5-year-old-against-covid-19--here-is-why-you-should-too-" width="100%" height="400"></iframe>
<p>I am an infectious disease physician. When it is our turn to vaccinate our five-year-old son against COVID-19, I will do so with confidence and without hesitation. I am encouraging every parent with eligible children between ages five and 11 to do the same. Here is why.</p>
<p>The U.S. Food and Drug Administration (FDA) <a href="https://www.cbc.ca/news/world/fda-approves-pfizer-children-1.6229798">recently authorized the Pfizer-BioNTech vaccine for children between five and 11 years of age</a>. Subsequently, <a href="https://www.cbc.ca/news/health/children-covid-19-vaccine-pfizer-cdc-advisory-panel-1.6234568">members of the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices voted unanimously to recommend vaccination for all children ages five to 11</a>, a recommendation quickly endorsed by CDC director Dr. Rochelle Walensky. </p>
<p>The rush to vaccinate children in this age group in the United States has now begun.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
</figcaption>
</figure>
<p><a href="https://www.cbc.ca/news/health/pfizer-seeks-kids-covid-vaccine-approval-health-canada-1.6215547">Health Canada</a> is reviewing a similar submission from Pfizer to allow its vaccine to be used in children aged five to 11. Approval is expected in the coming weeks. The National Advisory Committee on Immunization (NACI) will then provide guidance for its use in Canada, after which we expect to have the vaccine authorized for all children in Canada in this age group.</p>
<h2>Reviewing the evidence</h2>
<p><a href="https://www.theglobeandmail.com/canada/article-parents-more-hesitant-to-vaccinate-kids-than-themselves-researcher/">Many parents in Canada have indicated hesitancy to vaccinate their children</a>, and understandably all parents have questions about weighing the risks and benefits. Let’s review the evidence.</p>
<p>Pfizer’s clinical trial conducted in the United States in kids aged five to 11 began early in 2021, and a significant surge of COVID-19 occurred soon after as the highly contagious Delta variant swept across the country. The data reported from the clinical trial thus far is encouraging. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ethical-decisions-weighing-risks-and-benefits-of-approving-covid-19-vaccination-in-children-ages-5-11-169820">Ethical decisions: Weighing risks and benefits of approving COVID-19 vaccination in children ages 5-11</a>
</strong>
</em>
</p>
<hr>
<p>The antibody responses <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-announce-positive-topline-results">in children aged five to 11 with two 10-microgram doses, given three weeks apart, were comparable to those in persons aged 16 to 25 who were given two 30-microgram doses three weeks apart</a>. Being fully vaccinated <a href="https://www.npr.org/sections/health-shots/2021/10/22/1048334791/pfizer-biontech-covid-vaccine-appears-more-than-90-effective-in-kids-5-to-11">reduced the chances of being infected with COVID-19 by over 90 per cent, an impressive number especially amidst the Delta surge</a>. </p>
<p>No concerning safety events were identified in over 3,000 children who received the vaccine, although followup intervals were short.</p>
<h2>Why vaccinate kids against COVID-19?</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/430173/original/file-20211104-17-3uuo0i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A vial of Pfizer-BioNTech COVID-19 vaccine for children, with a tag indicating it is for ages five to 11" src="https://images.theconversation.com/files/430173/original/file-20211104-17-3uuo0i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/430173/original/file-20211104-17-3uuo0i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430173/original/file-20211104-17-3uuo0i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430173/original/file-20211104-17-3uuo0i.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430173/original/file-20211104-17-3uuo0i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430173/original/file-20211104-17-3uuo0i.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430173/original/file-20211104-17-3uuo0i.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">Data from Pfizer’s clinical trial in children, conducted in the U.S., is encouraging.</span>
<span class="attribution"><span class="source">(AP Photo/Mary Altaffer)</span></span>
</figcaption>
</figure>
<p>A question commonly asked by parents is this: “Kids don’t generally get very sick or die from COVID-19 compared to adults, right? So why vaccinate them if their risk is so low?”</p>
<p>Yes, the risk of children getting very sick or dying with COVID-19 is low, but the relative risk of severe outcomes and death that kids face when they acquire COVID-19 is extremely high. <a href="https://www.fda.gov/media/153508/download">COVID-19 was the sixth highest cause of death from disease in children ages five to 11 in the U.S. in 2020, comparable to rates of death seen in children with heart or lung disease</a>. If there were a way to prevent death in children with heart or lung disease as simple as a safe two-dose vaccine, there would be very little hesitation from parents to take advantage of it.</p>
<p>Besides hospitalization and death, COVID-19 infection poses other significant risks for children, including the risk of multisystem inflammatory syndrome in children (MIS-C) and longer-term post-COVID-19 complications (“long COVID”) similar to adults. <a href="http://doi.org/10.1001/jama.2021.2091">MIS-C can occur two to six weeks after COVID-19 infection, nearly two-thirds of affected children will require critical care support, and between one and two per cent of affected children will die</a>.</p>
<p><a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk/1april2021">About seven per cent of children in the United Kingdom who recovered from COVID-19 infection reported ongoing symptoms 12 weeks after being diagnosed</a>, which affected various aspects of their quality of life: missing school, being less able to perform physical activity and mental health concerns.</p>
<p>MIS-C and long COVID in children are best avoided through prevention of COVID-19 infection by being fully vaccinated.</p>
<h2>Concerns about side-effects</h2>
<p>The primary side-effect of concern in young children receiving the COVID-19 vaccine is myocarditis, or inflammation of the heart muscle. <a href="https://doi.org/10.1056/NEJMoa2110737">In one recent Israeli study</a>, the risk of myocarditis was highest in male patients between ages 16 and 29 after a second dose of an mRNA vaccine, at roughly 11 out of every 100,000 males. <a href="https://doi.org/10.1056/NEJMoa2109730">A second Israeli study identified males between ages 16 and 19 as being at greatest risk</a>. The risk of myocarditis in females across all age groups was negligible in both studies. Deaths due to vaccine-induced myocarditis are extremely rare, and nearly all cases recover fully.</p>
<figure class="align-center ">
<img alt="A Black woman in a face mask holds her son's hand as a health-care worker gives him an injection" src="https://images.theconversation.com/files/430165/original/file-20211104-19-1wgjf9f.jpg?ixlib=rb-1.1.0&rect=216%2C86%2C5483%2C3529&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/430165/original/file-20211104-19-1wgjf9f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430165/original/file-20211104-19-1wgjf9f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430165/original/file-20211104-19-1wgjf9f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430165/original/file-20211104-19-1wgjf9f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430165/original/file-20211104-19-1wgjf9f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430165/original/file-20211104-19-1wgjf9f.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">A seven-year-old gets the Pfizer-BioNTech COVID-19 vaccine in Bronx, N.Y. The United States has approved the vaccine in children ages five to 11, and Canada is expected to follow suit.</span>
<span class="attribution"><span class="source">(AP Photo/Mary Altaffer)</span></span>
</figcaption>
</figure>
<p>In Pfizer’s clinical trial of children between ages five and 11, no cases of myocarditis have been detected, but ongoing surveillance will be necessary as cases of myocarditis in children of this age group are expected to be extremely rare, given that myocarditis is typically a post-pubertal phenomenon. Also, since the vaccine dose being given to children aged five to 11 is one-third the dose given to persons over 12, an even greater reduction in vaccine-induced myocarditis is likely in this younger age group.</p>
<p>The risk of <a href="http://doi.org/10.1001/jama.2021.0107">damage to the heart from infection with SARS-CoV-2</a> is statistically much higher than the risk of vaccine-induced myocarditis. COVID-19 infection can lead to a variety of complications of the heart, some serious. Such complications include damage to heart muscle from myocarditis itself, as well as inflammation of blood vessels supplying the heart muscle caused by the virus. </p>
<p>Many parents worry about the possible effects of COVID-19 vaccine on fertility and future pregnancies. No evidence exists right now to demonstrate any concerns with COVID-19 vaccine and fertility, pregnancy or breast-feeding. <a href="https://doi.org/10.1056/NEJMoa2104983">Tens of thousands of women have received vaccine while being pregnant, and no safety signals have been identified</a>. </p>
<p>Parents are concerned about the lack of long-term safety data available for the mRNA vaccines. No reasonable scientific basis exists to indicate that long-term side effects of mRNA vaccination will occur. mRNA is <a href="https://www.nebraskamed.com/COVID/where-mrna-vaccines-and-spike-proteins-go">degraded in the body very quickly</a>, which is why we would typically expect to see vaccine side effects like myocarditis within the first two months of vaccine administration, or not at all. Billions of doses of COVID-19 vaccine have been administered worldwide with no long-term side effects identified, providing further evidence for the long-term safety of mRNA vaccines.</p>
<h2>Benefits of vaccination far exceed potential risks</h2>
<p>Unfortunately, SARS-CoV-2 is not going to ever go away. Our best-case scenario is <a href="https://ottawacitizen.com/news/local-news/what-does-it-mean-if">endemicity</a>, and even that reality is unpredictable given the potential emergence of new viral variants. We cannot expect our children to live in “bubbles” forever. We must prepare them as best as we can to safely navigate this new reality.</p>
<figure class="align-center ">
<img alt="A syringe with a label reading 'PEDIATRIC Pfizer' in the foreground, held by a person in a mask, out of focus in the background" src="https://images.theconversation.com/files/430353/original/file-20211104-21-1egyto7.jpg?ixlib=rb-1.1.0&rect=176%2C109%2C4808%2C3623&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/430353/original/file-20211104-21-1egyto7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430353/original/file-20211104-21-1egyto7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430353/original/file-20211104-21-1egyto7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430353/original/file-20211104-21-1egyto7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430353/original/file-20211104-21-1egyto7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430353/original/file-20211104-21-1egyto7.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">Based on the scientific evidence at hand, the benefits of vaccination for five-to-11-year-olds far exceed any potential risk.</span>
<span class="attribution"><span class="source">(AP Photo/David Zalubowski)</span></span>
</figcaption>
</figure>
<p>Based on the scientific evidence at hand, the benefits of vaccination for my five-year-old son far exceeds any potential risk. That is why he will be vaccinated as soon as he is eligible, and also why practically every expert group on child health across the world has come out in favour of universal vaccination of children, including the <a href="https://www.aappublications.org/news/2021/10/26/fda-pfizer-covid-vaccine-children-102621">American Academy of Pediatrics</a>. We have not even brought up the significant societal benefit of moving closer toward herd immunity through universal vaccination of eligible children.</p>
<p>Navigating the COVID-19 pandemic has been difficult and disruptive for children and their families. We now give routine childhood vaccines to our kids without hesitation, and they have dramatically improved the quality of life and life expectancy of children worldwide. Getting every child between ages five and 11 fully vaccinated against COVID-19 helps bring us all one step closer towards normalcy and protects our children from severe outcomes of COVID-19 infection. </p>
<p>That is why I am going to vaccinate our five-year-old son with confidence, and why I will strongly encourage all parents to do the same.</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/171001/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr. Alexander Wong has previously consulted for Pfizer with regards to its vaccines to prevent pneumococcal infection, and received honoraria from Pfizer for leading scientific discussions for healthcare professionals on pneumococcal vaccines.</span></em></p>An infectious diseases doctor reviews the evidence, discusses hesitancy and concerns about side-effects and explains the overwhelming case for vaccinating five-to-11-year-olds, including his own son.Alexander Wong, Associate Professor, Infectious Diseases, University of SaskatchewanLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1698202021-11-01T16:26:59Z2021-11-01T16:26:59ZEthical decisions: Weighing risks and benefits of approving COVID-19 vaccination in children ages 5-11<figure><img src="https://images.theconversation.com/files/429411/original/file-20211029-23-1u7vp0d.jpg?ixlib=rb-1.1.0&rect=257%2C74%2C4082%2C2809&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ethics are important to vaccination decisions because while science can clarify some of the costs and benefits, it cannot tell us which costs and benefits matter most to us.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Frank Gunn </span></span></figcaption></figure><iframe style="width: 100%; height: 175px; border: none; position: relative; z-index: 1;" allowtransparency="" src="https://narrations.ad-auris.com/widget/the-conversation-canada/ethical-decisions--weighing-risks-and-benefits-of-approving-covid-19-vaccination-in-children-ages-5-11" width="100%" height="400"></iframe>
<p>The U.S. Food and Drug Administration has approved <a href="https://www.cbc.ca/news/world/fda-approves-pfizer-children-1.6229798">Pfizer’s COVID-19 vaccine for use in children ages five to 11</a>. Pfizer’s <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-announce-positive-topline-results">clinical trial results</a> indicate the vaccine is safe and effective in this age group. </p>
<p>This is an important development. <a href="https://globalnews.ca/news/8250271/covid-19-bc-modelling-data-children/">COVID-19 infections</a> <a href="https://www.cbc.ca/news/canada/calgary/covid-alberta-kids-1.6208827">are on the rise</a> <a href="https://www.cbc.ca/news/canada/saskatchewan/covid-19-saskatchewan-october-9-1.6206509">in children</a> <a href="https://www.thestar.com/politics/provincial/2021/09/28/ontarios-new-covid-19-cases-could-drop-to-200-a-day-or-rise-to-5000-latest-modelling-projects.html">across</a> <a href="https://www.cbc.ca/news/canada/new-brunswick/new-brunswick-school-covid-19-1.6202893">Canada</a>.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
</figcaption>
</figure>
<p>It is now up to <a href="https://www.cbc.ca/news/health/pfizer-seeks-kids-covid-vaccine-approval-health-canada-1.6215547">Health Canada</a> to consider the data and to decide whether to authorize this COVID-19 vaccine for children. Once it is authorized in Canada, the <a href="https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci.html">National Advisory Committee on Immunization</a> (NACI) will have to decide whether to recommend vaccination for all children in this age group. </p>
<p>This raises the question of how this decision ought to be made.</p>
<h2>Making an ethical decision</h2>
<p>As a moral philosopher who has <a href="http://blog.practicalethics.ox.ac.uk/2021/08/we-should-vaccinate-children-in-high-income-countries-against-covid-19-too/">collaboratively researched</a> <a href="https://doi.org/10.1136/bmj.n1687">ethical issues relating to the vaccination of children</a>, I believe it is important to answer this question, for two reasons. </p>
<p>First, whatever the decision, the principles on which it is based — and should be based — must be clear and transparent. </p>
<p>Second, surprisingly little attention has been paid to this issue in Canada, despite the decision to vaccinate children being a matter <a href="https://www.politico.eu/article/coronavirus-vaccine-children-ethics-science/">of science and ethics</a>. Science can clarify some of the costs and benefits of vaccination, but it cannot tell us which costs and benefits matter and when a cost-benefit ratio is favourable.</p>
<p>Fortunately, there is no need to generate a decision-making procedure from scratch. The procedure used by the <a href="https://www.gov.uk/government/groups/joint-committee-on-vaccination-and-immunisation">United Kingdom’s Joint Committee on Vaccination and Immunisation</a> (JCVI) in deciding whether to vaccinate healthy children aged 12-15 in the U.K. can provide important lessons about what not to do.</p>
<h2>Risks and benefits</h2>
<p>The most important factor is whether the benefits of vaccination outweigh its risks, and the degree to which the benefits outweigh the risks. In weighing these, the JCVI relied on what it called the “health perspective.” </p>
<p>Reasoning from this perspective, the JCVI held (in a <a href="https://www.gov.uk/government/publications/covid-19-vaccination-of-children-and-young-people-aged-12-to-17-years-jcvi-statement/jvci-statement-on-covid-19-vaccination-of-children-and-young-people-aged-12-to-17-years-15-july-2021">series</a> of <a href="https://www.gov.uk/government/publications/jcvi-statement-august-2021-covid-19-vaccination-of-children-and-young-people-aged-12-to-17-years/jcvi-statement-on-covid-19-vaccination-of-children-and-young-people-aged-12-to-17-years-4-august-2021">public</a> <a href="https://www.gov.uk/government/publications/jcvi-statement-september-2021-covid-19-vaccination-of-children-aged-12-to-15-years/jcvi-statement-on-covid-19-vaccination-of-children-aged-12-to-15-years-3-september-2021">statements</a>) that the chief benefits of vaccination against COVID-19 were the prevention of death, hospitalization, intensive care unit (ICU) admissions and pediatric inflammatory multisystem syndrome (PIMS) or multisystem inflammatory syndrome (MIS-C). </p>
<p>The chief harms of vaccination were myocarditis, or inflammation of the heart, and pericarditis, inflammation of the thin sack surrounding the heart, though it said these were rare and “typically self-limiting and resolved within a short time.”</p>
<p>The JCVI argued that the benefits of vaccination in this age group are only “marginally greater” than the harms and that therefore vaccination would not be offered to all members of this group.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/429412/original/file-20211029-25-1xe05b5.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A boy wearing a face mask getting an injection" src="https://images.theconversation.com/files/429412/original/file-20211029-25-1xe05b5.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/429412/original/file-20211029-25-1xe05b5.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/429412/original/file-20211029-25-1xe05b5.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/429412/original/file-20211029-25-1xe05b5.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/429412/original/file-20211029-25-1xe05b5.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/429412/original/file-20211029-25-1xe05b5.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/429412/original/file-20211029-25-1xe05b5.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Twelve-year-old Sam Hallett got his shot at the Aboriginal Health and Wellness Centre in Winnipeg shortly after Health Canada approved COVID-19 vaccination in his age group in May.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Winnipeg Free Press-Mike Deal</span></span>
</figcaption>
</figure>
<p><a href="https://www.canada.ca/en/public-health/services/immunization/national-advisory-committee-on-immunization-naci/recommendations-use-covid-19-vaccines/mrna-adolescents.html">NACI disagreed</a>, but did not outline the ethical principles it relied on in recommending vaccination for children ages 12-17.</p>
<p>JCVI’s decision not to offer all children vaccination against COVID-19 was flawed in numerous respects. (It was later <a href="https://www.gov.uk/government/publications/universal-vaccination-of-children-and-young-people-aged-12-to-15-years-against-covid-19/universal-vaccination-of-children-and-young-people-aged-12-to-15-years-against-covid-19">overruled by the chief medical officers of the U.K.’s four nations</a>.) NACI will do well to avoid these mistakes in making its decision about vaccinating children ages five to 11.</p>
<p>The Independent Scientific Advisory Group for Emergencies (Independent SAGE, a group of British scientists offering independent scientific advice on the prevention of COVID-19) <a href="https://www.independentsage.org/wp-content/uploads/2021/10/Independent-SAGE-JCVI-statement_transparency_final.pdf">has raised a number of concerns about the JCVI’s decision-making process</a>. </p>
<p>One concern is the way in which the JCVI calculated the benefits of vaccination, basing these calculations on risk to the population of all children of death, hospitalization, ICU admission and so on from COVID-19 infection, rather than the risks of these to children with a confirmed infection of COVID-19.</p>
<p>Another concern Independent SAGE raised was that the JCVI did not state which vaccine it considered when it examined the risks, a relevant concern <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/heart-inflammation-rates-higher-after-moderna-covid-19-shot-than-pfizer-vaccine-2021-10-01/">since heart inflammation rates appear to be higher after the Moderna vaccine than after the Pfizer</a> vaccine.</p>
<h2>Direct and indirect benefits</h2>
<p>Some of JVCI’s other mistakes related to value judgments, relying on the health perspective to make its decision. However, the JCVI was not consistent on what this included. </p>
<p>As noted, the JCVI mentioned the prevention of death, hospitalization, ICU admission and PIMS or MIS-C. These are not the only health benefits of vaccination against COVID-19. Some direct and indirect health benefits of vaccination were not clearly included.</p>
<p>The direct benefits include the prevention of <a href="https://www.who.int/publications/i/item/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1">long COVID</a> — a condition affecting anywhere <a href="https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(21)00198-X/fulltext">from two</a> <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/english-study-finds-long-covid-affects-up-1-7-children-months-after-infection-2021-09-01/">to 14</a> per cent of children infected with COVID-19 — and potential neurological and cognitive deficits caused by COVID-19 infection. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/429418/original/file-20211029-21-1rwklhi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A group of adolescents near a schoolyard play structure" src="https://images.theconversation.com/files/429418/original/file-20211029-21-1rwklhi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/429418/original/file-20211029-21-1rwklhi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=422&fit=crop&dpr=1 600w, https://images.theconversation.com/files/429418/original/file-20211029-21-1rwklhi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=422&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/429418/original/file-20211029-21-1rwklhi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=422&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/429418/original/file-20211029-21-1rwklhi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=530&fit=crop&dpr=1 754w, https://images.theconversation.com/files/429418/original/file-20211029-21-1rwklhi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=530&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/429418/original/file-20211029-21-1rwklhi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=530&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Families and youth aged 12 and older line up for a COVID-19 vaccine at a Toronto school in May.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span>
</figcaption>
</figure>
<p>Preventing the <a href="https://doi.org/10.1136/bmj.n2052">negative mental and physical health effects</a> associated with school closures, limits on sporting and other such activities and physical distancing requirements are among the indirect benefits (though these were rightly noted by NACI in its recommendation to vaccinate adolescents). These health effects are important when deciding whether to vaccinate.</p>
<p>These are the known risks and benefits. However, the JCVI’s refusal to recommend vaccination to all children aged 12-15 was due to the uncertainties “regarding the magnitude of the potential harms” of vaccination, including myocarditis. </p>
<p>Although it gave considerable weight to unknown harms or uncertainties of vaccination, the JVCI did not consider potential unknown benefits of vaccination, or uncertainties about benefits. There was no reason to rule these out. Uncertainties about benefits seem to be of as much importance in thinking about the risk benefit profile of COVID-19 vaccination as uncertainties about risks. These, again, matter greatly to this decision.</p>
<p>The JCVI made another ethical error when it said the harms of vaccination should be given greater weight (relatively speaking) than the benefits. </p>
<p>There is no good reason to place a higher relative value on harms compared to benefits. Harms caused by vaccines are not worse than harms caused by COVID-19. It does not appear to be true that the rare and typically mild pericarditis or the myocarditis caused by vaccination is any worse than the pericarditis or the myocarditis caused (at <a href="https://www.newscientist.com/article/mg25133462-800-myocarditis-is-more-common-after-covid-19-infection-than-vaccination/">greater</a> <a href="https://www.nytimes.com/2021/10/06/health/covid-vaccine-children-dose.html?smid=tw-share">frequency</a>) by COVID-19 infection. This is not in line with other treatments considered for children, for which harms are not typically weighed more heavily than benefits.</p>
<h2>The well-being perspective</h2>
<p>It was a mistake for JCVI to make the decision about vaccination against COVID-19 in children purely on the basis of the health perspective. Health is important. But it is not the only value in the lives of children. Health is a priority because without it many other important benefits — enjoying friends, connecting with relatives, absorbing oneself in homework or music lessons — become much more difficult, if not impossible.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/429417/original/file-20211029-27-7g7pj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A 12-year-old girl wearing a face mask with a sticker reading 'I got vaccinated'" src="https://images.theconversation.com/files/429417/original/file-20211029-27-7g7pj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/429417/original/file-20211029-27-7g7pj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/429417/original/file-20211029-27-7g7pj5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/429417/original/file-20211029-27-7g7pj5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/429417/original/file-20211029-27-7g7pj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=565&fit=crop&dpr=1 754w, https://images.theconversation.com/files/429417/original/file-20211029-27-7g7pj5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=565&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/429417/original/file-20211029-27-7g7pj5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=565&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sound ethics and sound science show that vaccinating children is, all things considered, beneficial.</span>
<span class="attribution"><span class="source">(AP Photo/Angie Wang)</span></span>
</figcaption>
</figure>
<p>The JCVI mentioned the beneficial effects of vaccination on education. But it did not factor these benefits into the decision relating to vaccinating children against COVID-19. </p>
<p>Educational and other benefits afforded to children by vaccination matter greatly and must be factored into this decision. Moving beyond the health perspective into the well-being perspective encompasses a larger range of benefits and protections from vaccination, including safe and stable learning environments, time with extended family, sport, music performances and the many other things that make life happy and meaningful for children.</p>
<p>When making the decision whether to vaccinate children aged five to 11 against COVID-19, regulators in Canada must rely on both sound science and sound ethics. They must in particular consider all the health and well-being impacts of vaccination more generally; they must consider the uncertain harms and benefits of vaccination; and they must treat benefits and harms symmetrically.</p>
<p>Doing so will show that vaccinating children is, all things considered, beneficial.</p>
<p><em>Do you have a question about COVID-19 vaccines? Email us at <a href="mailto:ca-vaccination@theconversation.com">ca-vaccination@theconversation.com</a> and vaccine experts will answer questions in upcoming articles.</em></p><img src="https://counter.theconversation.com/content/169820/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anthony Skelton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>When making the decision whether to vaccinate children aged five to 11 against COVID-19, regulators in Canada must rely on sound ethics as well as sound science.Anthony Skelton, Associate Professor of Philosophy and Core Member of the Rotman Institute of Philosophy, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1701622021-10-26T15:18:04Z2021-10-26T15:18:04ZFinancial insecurity and right-wing beliefs drive COVID-19 vaccine hesitancy among Albertans<figure><img src="https://images.theconversation.com/files/428305/original/file-20211025-27-w35w4i.JPG?ixlib=rb-1.1.0&rect=11%2C0%2C3982%2C2473&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Even if Alberta was motivated to increase vaccination rates through direct government intervention, the measures may not succeed given conservatives’ lack of faith in the province, the premier and the cabinet.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Jeff McIntosh </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/financial-insecurity-and-right-wing-beliefs-drive-covid-19-vaccine-hesitancy-among-albertans" width="100%" height="400"></iframe>
<p>It is <a href="https://www.factcheck.org/2021/09/covid-19-the-unvaccinated-pose-a-risk-to-the-vaccinated/">dangerous to be unvaccinated</a> right now — especially in Alberta, where vaccination rates are almost 10 percentage points lower than the <a href="https://health-infobase.canada.ca/covid-19/vaccination-coverage/">national average</a>. </p>
<p>Despite making up just over a third of the population (including kids under 12), unvaccinated — or diagnosed within two weeks from the first immunization date — people made up almost 85 per cent of cases, 85 per cent of hospitalized cases and 77 per cent of COVID-19 deaths in the province <a href="https://www.alberta.ca/stats/covid-19-alberta-statistics.htm#vaccine-outcomes">since Jan. 1, 2021</a>. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
</figcaption>
</figure>
<p>Unvaccinated Albertans were more than 12 times as likely to die from COVID-19 over the last four months than <a href="https://www.alberta.ca/stats/covid-19-alberta-statistics.htm#vaccine-outcomes">fully vaccinated Albertans</a>. Real world vaccine data indicates that two doses of the approved vaccines are <a href="https://www.alberta.ca/stats/covid-19-alberta-statistics.htm#vaccine-outcomes">90 per cent effective</a> at preventing infection. </p>
<p>Since the beginning of 2021, less than one per cent of fully vaccinated Albertans <a href="https://www.alberta.ca/stats/covid-19-alberta-statistics.htm#vaccine-outcomes">have been diagnosed with COVID-19</a> 14 days after the second immunization date. Vaccines work. Yet not everyone in the province seems convinced.</p>
<h2>Why won’t people in Alberta get vaccinated?</h2>
<p>For one answer as to why Albertans won’t get vaccinated, we can look to the government and lack of provincial leadership in fighting COVID-19. Despite a strong initial response in March 2020, Alberta has fallen behind other provinces in its <a href="https://centre.irpp.org/data/covid-19-provincial-policies/">implementation of social distancing measures</a>. </p>
<p>This culminated with the provincial government’s “<a href="https://www.cbc.ca/news/canada/edmonton/jason-kenney-deena-hinshaw-covid-reopening-update-1.6070925">Open for Summer</a>” plan, which removed most COVID-19 restrictions and left many residents with the impression that the pandemic was over <a href="https://calgary.ctvnews.ca/kenney-says-calgary-stampede-going-ahead-has-a-lot-to-do-with-morale-1.5448301">just in time for the Calgary Stampede</a>. </p>
<p>The government justified these moves, in part, by promoting personal responsibility and civic freedoms above social responsibility and government restrictions. Opposition to the latter has been driven by <a href="https://doi.org/10.3389/fpos.2021.648646">misinformation campaigns</a>, supported by traditional and social media posts from Canada, the United States and abroad. </p>
<figure class="align-center ">
<img alt="Men unveil a sign that reads 'open for summer July 1'" src="https://images.theconversation.com/files/427618/original/file-20211020-59949-dnm7i.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427618/original/file-20211020-59949-dnm7i.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=415&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427618/original/file-20211020-59949-dnm7i.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=415&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427618/original/file-20211020-59949-dnm7i.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=415&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427618/original/file-20211020-59949-dnm7i.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=521&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427618/original/file-20211020-59949-dnm7i.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=521&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427618/original/file-20211020-59949-dnm7i.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=521&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Albert Health Minister Tyler Shandro and Alberta Premier Jason Kenney unveiled an opening sign after speaking about the ‘Open for Summer’ plan.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Jason Franson</span></span>
</figcaption>
</figure>
<p>If we want to understand the impact of the government’s approach and the influence of misinformation, we need to talk to the unvaccinated. This is what our team did in <a href="https://www.commongroundpolitics.ca/covid-19-vaccine-ab">the September 2021 Viewpoint Alberta Survey</a>. </p>
<p>As part of the <a href="https://www.commongroundpolitics.ca/">Common Ground</a> initiative at the University of Alberta, our team has been fielding surveys with thousands of Albertans for the past two years. Our most recent survey asked 1,204 Alberta residents about their vaccination status and their views on COVID-19 vaccines and policies that support vaccinations. </p>
<h2>Survey results</h2>
<p>Most respondents (86 per cent) were vaccinated, but we found certain groups were less likely to be vaccinated than others. Two factors stood out — economic hardship and political affiliation. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/427600/original/file-20211020-15-c5itgt.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Figure is a bar graph showing vaccination rates across income groups, whether respondents reported being able to meet their expenses over the past few months, and whether they could cover an emergency expense with their savings." src="https://images.theconversation.com/files/427600/original/file-20211020-15-c5itgt.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427600/original/file-20211020-15-c5itgt.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=500&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427600/original/file-20211020-15-c5itgt.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=500&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427600/original/file-20211020-15-c5itgt.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=500&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427600/original/file-20211020-15-c5itgt.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=628&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427600/original/file-20211020-15-c5itgt.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=628&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427600/original/file-20211020-15-c5itgt.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=628&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Graph details vaccination rates across income groups. (Notes: Estimates and 95 per cent confidence intervals. Data are weighted, 1,204 respondents.)</span>
<span class="attribution"><span class="source">(Sept. 2021 Viewpoint Alberta Survey)</span></span>
</figcaption>
</figure>
<p>People who earn less than $40,000 per year, are less able to pay monthly expenses and do not have savings to cover emergency expenses are less likely to be vaccinated than higher earners and people in more stable financial situations.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/427601/original/file-20211020-16-1gava4u.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Figure is a bar graph showing vaccination rates as related to political party affiliation and alignment across the left-right political spectrum." src="https://images.theconversation.com/files/427601/original/file-20211020-16-1gava4u.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427601/original/file-20211020-16-1gava4u.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=500&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427601/original/file-20211020-16-1gava4u.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=500&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427601/original/file-20211020-16-1gava4u.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=500&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427601/original/file-20211020-16-1gava4u.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=628&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427601/original/file-20211020-16-1gava4u.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=628&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427601/original/file-20211020-16-1gava4u.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=628&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Graph details vaccination rates related to political party affiliation. (Notes: Estimates and 95 per cent confidence intervals. Data are weighted, 1,204 respondents.)</span>
<span class="attribution"><span class="source">(Sept. 2021 Viewpoint Alberta Survey)</span></span>
</figcaption>
</figure>
<p>Vaccine hesitancy also varied among Albertans with different political views. The lowest vaccination rates were present among respondents who reported that they would vote for <a href="https://wildrosenation.com/">the Wildrose Independence Party</a> if a provincial election were held today. Only 61 per cent of these respondents were vaccinated. </p>
<p>More broadly, placement on the political spectrum was also related to vaccination rates. Only 71 per cent of people who identified towards the far right end of the spectrum were vaccinated compared to 98 per cent of people on the far left.</p>
<p>Our data show that unvaccinated respondents were primarily concerned about the safety of the vaccines. Approximately 62 per cent of unvaccinated respondents were worried about the vaccine’s side effects and 45 per cent believed that the vaccine was unsafe. Other respondents also cited a lack of trust in government and the pharmaceutical industry. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/427602/original/file-20211020-21-195l8k1.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Figure is a bar graph indicating the percentage of unvaccinated respondents who reported different reasons for not getting vaccinated." src="https://images.theconversation.com/files/427602/original/file-20211020-21-195l8k1.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427602/original/file-20211020-21-195l8k1.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=554&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427602/original/file-20211020-21-195l8k1.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=554&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427602/original/file-20211020-21-195l8k1.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=554&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427602/original/file-20211020-21-195l8k1.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=696&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427602/original/file-20211020-21-195l8k1.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=696&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427602/original/file-20211020-21-195l8k1.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=696&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Graph details unvaccinated respondents reasons for not getting vaccinated. (Notes: Estimates and 95 per cent confidence intervals. Data are weighted, 154 unvaccinated respondents.)</span>
<span class="attribution"><span class="source">(Sept. 2021 Viewpoint Alberta Survey)</span></span>
</figcaption>
</figure>
<h2>What should we do now?</h2>
<p>Our research shows that financial insecurity and right-wing beliefs are leading drivers of vaccine hesitancy in Alberta. And these factors don’t lend themselves to easy solutions — this is particularly true when we consider the deep <a href="https://angusreid.org/premiers-approval-october-2021/">unpopularity of the United Conservative Party government</a>. </p>
<p>Even if the provincial government was motivated to increase vaccination rates through more direct government intervention, the measures may not succeed given conservatives’ lack of faith in the province, the premier and the cabinet.</p>
<p>Take, for instance, the Alberta government’s two primary interventions to increase vaccination rates this summer. First, the government introduced a series of financial incentives — <a href="https://www.alberta.ca/open-for-summer-lottery.aspx">a million-dollar lottery</a> and <a href="https://www.alberta.ca/vaccine-debit-card.aspx">$100 gift card program</a> — to encourage Albertans to get the shot. Neither of these initiatives had a noticeable effect on vaccination rates. </p>
<p>Another — the government’s <a href="https://www.alberta.ca/covid-19-public-health-actions.aspx">“restriction exemption” program</a> — proved more effective by imposing restrictions on certain non-essential businesses who chose not to enforce a vaccine passport system. </p>
<p>In general, we find that Albertans were much more supportive of the restriction-exemption program than they were of the financial incentives. This suggests the government’s use of “carrots,” while aligning with their conservative approach, was not nearly as popular or effective as one based on government restrictions. </p>
<p>More importantly, it creates opportunity for the provincial government to extend and enhance their restriction-exemption approach to include more businesses and more stringent guidelines associated with conventional vaccine passport systems.</p>
<p>Of the more than 56 million doses administered in Canada, <a href="https://health-infobase.canada.ca/covid-19/vaccine-safety/">0.034 per cent of all doses</a> have resulted in an adverse event. If you are someone who has not yet been vaccinated, now is the time.</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/170162/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Maroto receives funding from that Social Sciences and Humanities Research Council of Canada (SSHRC). </span></em></p><p class="fine-print"><em><span>Feo Snagovsky receives funding from the Social Sciences and Humanities Research Council of Canada (SSHRC). </span></em></p><p class="fine-print"><em><span>Jared Wesley receives funding from the Social Sciences and Humanities Research Council of Canada (SSHRC), the Kule Institute for Advanced Studies (KIAS), and the Alberta Teachers' Association (ATA).</span></em></p>We surveyed Albertans, and while most were vaccinated, we found certain groups were less likely to be vaccinated than others. Those being people facing economic hardship and political affiliation.Michelle Maroto, Associate Professor of Sociology, University of AlbertaFeo Snagovsky, Assistant Professor, Political Science, University of AlbertaJared Wesley, Professor, Political Science, University of AlbertaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1673412021-10-17T11:56:27Z2021-10-17T11:56:27ZHow the puzzle of viral vector vaccines was solved, leading to today’s COVID-19 shots<figure><img src="https://images.theconversation.com/files/424929/original/file-20211006-23-hxcce4.jpg?ixlib=rb-1.1.0&rect=479%2C52%2C3543%2C2616&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A mural in Rome depicts a white dove parachuting vials of COVID-19 vaccine. Several COVID-19 vaccines are based on a viral vector developed by Canadian Frank Graham decades ago.</span> <span class="attribution"><span class="source">(AP Photo/Gregorio Borgia)</span></span></figcaption></figure><p>How would you go about solving a puzzle if you didn’t know what pieces to use, how many you would need, how it was supposed to look when you were done or what possible function it would serve? </p>
<p>Such a challenge faced Frank Graham in 1969 when he was a Canadian post-doctoral researcher in the lab of molecular biologist Alex Van der Eb in the Netherlands, working with human adenovirus 5 (Ad5). When he returned to Canada in 1973, he continued his work on Ad5 in the Cancer Research Group in the biology and pathology departments at McMaster University. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
</figcaption>
</figure>
<p>The enduring technology he developed would go on to serve humanity in many ways. Some of them are still emerging today, but one stands out above the rest: Graham’s Ad5 vector would serve as a world-wide platform for vaccines for COVID-19, including the AstraZeneca and Johnson & Johnson vaccines approved in Canada.</p>
<h2>Viral vectors</h2>
<p>The puzzle Graham solved was making a valuable viral vector: a microscopic Trojan horse that can be easily assembled, cheaply manufactured in bulk and remains stable at regular refrigerator temperatures. Most importantly, it is efficient at transferring foreign DNA into mammalian cells — including human cells. </p>
<p>Viral vectors are modified viruses that can trigger the body to generate protective responses without causing infections. These virus-like entities, which are usually rendered incapable of replicating, can <a href="https://www.gavi.org/vaccineswork/what-are-viral-vector-based-vaccines-and-how-could-they-be-used-against-covid-19">achieve what natural, intact viruses can, but without the infectious destruction</a>. They can enter human cells and instruct the machinery of those cells to express the genes carried by the vector, causing the cell to make and export the proteins encoded by those genes — all without permanently modifying the host cell.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/426034/original/file-20211012-27-53fdjg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Illustration of how a viral vector vaccine works by inserting genetic material from a target virus into an adenovirus." src="https://images.theconversation.com/files/426034/original/file-20211012-27-53fdjg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/426034/original/file-20211012-27-53fdjg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=417&fit=crop&dpr=1 600w, https://images.theconversation.com/files/426034/original/file-20211012-27-53fdjg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=417&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/426034/original/file-20211012-27-53fdjg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=417&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/426034/original/file-20211012-27-53fdjg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=525&fit=crop&dpr=1 754w, https://images.theconversation.com/files/426034/original/file-20211012-27-53fdjg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=525&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/426034/original/file-20211012-27-53fdjg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=525&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Viral vector vaccines vaccine use a safe virus to insert pathogen genes in the cell to produce an immune response.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>That means that once a viral vector vaccine for COVID-19 is administered, it can express the COVID-19 spike protein that is engineered into the vector’s genome. This allows the affected cells to present the COVID-19 protein antigen to the human immune system and stimulate immune defences against a COVID-19 infection. </p>
<p>Viral vectors induce a very potent immune response. They generate both a neutralizing antibody to prevent infection, and killer T cells (cytotoxic T cells or CTL) to destroy COVID-19-infected cells. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/revealed-the-protein-spike-that-lets-the-2019-ncov-coronavirus-pierce-and-invade-human-cells-132183">Revealed: the protein 'spike' that lets the 2019-nCoV coronavirus pierce and invade human cells</a>
</strong>
</em>
</p>
<hr>
<p>Several recognized, non-replicating viral vectors have been <a href="https://dx.doi.org/10.3390%2Fvaccines2030624">developed for vaccines</a>. These include those based on adenovirus, adeno-associated virus, herpes virus (such as cytomegalovirus) and vaccinia virus, along with retrovirus-based vectors, including Moloney murine leukemia virus and others based on modified lentivirus (HIV). All have been used in clinical trials of both gene therapy and vaccine delivery with varied success. </p>
<p>However, for effective wide-scale use as safe vaccines, viral vectors based on adenovirus (infamous for <a href="https://www.cdc.gov/adenovirus/index.html">causing the common cold</a>) or vaccinia virus are preferred. In the COVID-19 vaccine arena, <a href="https://doi.org/10.1038/s41541-021-00356-x">the ones that stand out most are based on adenovirus vectors</a>. This is where Graham’s discoveries come into play.</p>
<h2>The puzzle pieces</h2>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/424943/original/file-20211006-14-zdu8v7.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Black and white illustration of an adenovirus" src="https://images.theconversation.com/files/424943/original/file-20211006-14-zdu8v7.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/424943/original/file-20211006-14-zdu8v7.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/424943/original/file-20211006-14-zdu8v7.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/424943/original/file-20211006-14-zdu8v7.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/424943/original/file-20211006-14-zdu8v7.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/424943/original/file-20211006-14-zdu8v7.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/424943/original/file-20211006-14-zdu8v7.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"></a>
<figcaption>
<span class="caption">Frank Graham developed a vector from human adenovirus 5 that now serves as a worldwide platform for COVID-19 vaccines.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
</figcaption>
</figure>
<p>As the first piece of the puzzle, Graham developed a method to transfer foreign DNA (in this case pieces of the genome of human adenovirus subtype 5) into a cell. </p>
<p><a href="https://doi.org/10.1016/0042-6822(73)90341-3">The article describing this technique</a> has been cited by more than 10,000 investigators since it was published, making it one of modern science’s greatest hits. </p>
<p>Because viral vectors are usually non-replicating, expansion (replication) of the vector for manufacture and vaccine production presented a challenge. Vectors need living cells to host them and do the vectors’ bidding, allowing them to reproduce. What was needed was a self-perpetuating line of cells implanted with a modifiable virus, or vector.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/424912/original/file-20211006-23-1fj5a76.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two people inspecting a large crate covered in netting, with a plane in the background." src="https://images.theconversation.com/files/424912/original/file-20211006-23-1fj5a76.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/424912/original/file-20211006-23-1fj5a76.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/424912/original/file-20211006-23-1fj5a76.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/424912/original/file-20211006-23-1fj5a76.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/424912/original/file-20211006-23-1fj5a76.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/424912/original/file-20211006-23-1fj5a76.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/424912/original/file-20211006-23-1fj5a76.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">UNICEF workers check a shipment of 1.4 million doses of Johnson & Johnson’s COVID-19 vaccine donated by the United States, at the Hamid Karzai International Airport, in Kabul, Afghanistan. Viral vector vaccines only require regular refrigeration, not ultra-cold storage like some mRNA vaccines.</span>
<span class="attribution"><span class="source">(AP Photo/Mariam Zuhaib)</span></span>
</figcaption>
</figure>
<p>This was solved by Graham’s second approach. At McMaster University, he used his DNA transfer technique to establish a stable, easy to grow and readily manipulated human cell line called HEK293 cells, which permanently contained the genes required to allow a replication-deficient vector to grow. <a href="https://doi.org/10.1099/0022-1317-36-1-59">Graham’s article on this cell line is another classic, with more than 6,000 citations</a>. </p>
<p><a href="https://www.canada.ca/en/national-research-council/news/2020/09/recognizing-the-scientific-impact-of-dr-frank-grahams-hek-293-cell-line.html">The HEK293 cell line and its derivatives are now used around the world</a>, in industry and both university and government research laboratories, to manufacture vaccines and many other biologics. </p>
<p>As a third approach, Graham prepared stable and robust molecular biology tools to allow <a href="https://doi.org/10.1073/pnas.91.19.8802">easy creation of stable adenovirus vectors with foreign gene insertions</a> that could accommodate up to 8,000 base pairs (individual units of genetic code) of foreign genetic information — which is enough data to produce most useful proteins. This is used both for gene transfer and expression (in gene therapy) and for vaccine delivery, as we have seen with the COVID-19 vaccines.</p>
<p>For vaccines, the process made it possible to take a virus that causes cold symptoms, remove the genes that enable it to reproduce and replace them with genes from an infectious agent, such as a different virus, that is a vaccine’s ultimate target. Those added genes trigger the production of a harmless element of the target virus. The body then recognizes and attacks this element, generating immunity. In the case of the COVID-19 virus, this element is the <a href="https://theconversation.com/revealed-the-protein-spike-that-lets-the-2019-ncov-coronavirus-pierce-and-invade-human-cells-132183">protein spike</a>. </p>
<h2>Putting the puzzle together</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/424934/original/file-20211006-19-6cfdd4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman climbs a curved staircase with an ornamental bannister. In the background is a vaccine clinic in a large open space with arches along the sides." src="https://images.theconversation.com/files/424934/original/file-20211006-19-6cfdd4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/424934/original/file-20211006-19-6cfdd4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/424934/original/file-20211006-19-6cfdd4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/424934/original/file-20211006-19-6cfdd4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/424934/original/file-20211006-19-6cfdd4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/424934/original/file-20211006-19-6cfdd4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/424934/original/file-20211006-19-6cfdd4.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">A woman climbs the stairs to queue for the Sputnik V COVID-19 vaccine at a vaccination centre in Gostiny Dvor, a huge exhibition centre in Moscow, Russia. The banner reads ‘We will defeat COVID-19 together!’</span>
<span class="attribution"><span class="source">(AP Photo/Alexander Zemlianichenko)</span></span>
</figcaption>
</figure>
<p><a href="https://www.biospace.com/article/comparing-covid-19-vaccines-pfizer-biontech-moderna-astrazeneca-oxford-j-and-j-russia-s-sputnik-v/">These advances were accomplished with human adenovirus 5</a> and were applied directly in the COVID-19 vaccines developed by CanSino in China and the Sputnik V vaccine in Russia. The process has also been adapted to other adenovirus subtypes for COVID-19 vaccines. These include the chimpanzee adenovirus vector vaccine developed by Oxford University and AstraZeneca, and the human adenovirus 26 vector vaccine developed by Johnson & Johnson. </p>
<p>Graham, now retired and living in Italy, certainly knew how to put a puzzle together. Today, half a century after his first successes in building viral vectors, billions of people around the world have him to thank for protecting them from the pandemic virus.</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/167341/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jack Gauldie received funding from Canadian Institutes for Health Research. </span></em></p>Viral vectors are modified viruses that trigger an immune response without causing infection. The vector that’s used in several COVID-19 vaccines was created decades ago by Canadian Frank Graham.Jack Gauldie, Distinguished University Professor, Department of Pathology and Molecular Medicine, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1692212021-10-11T13:15:20Z2021-10-11T13:15:20ZCOVID-19 vaccine hesitancy can be overcome through relatable stories and accessible information<figure><img src="https://images.theconversation.com/files/425052/original/file-20211006-27-1bpw8rh.jpg?ixlib=rb-1.1.0&rect=17%2C0%2C2968%2C2178&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In Montréal, people protested the Québec government's measures to help stop the spread of COVID-19.</span> <span class="attribution"><span class="source">(The Canadian Press/Graham Hughes)</span></span></figcaption></figure><p>People who are opposed to vaccination aren’t swayed by numbers or statistics. Among those refusing to get vaccinated — about 15 per cent of the population — many reject any discussion that involves science. </p>
<p>Doctors, journalists and politicians claim to be reporting strictly scientific facts that speak for themselves, particularly when it comes to the effectiveness of vaccines in protecting against <a href="https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html">severe forms of COVID-19</a>. Those who resist the vaccine, however, have a different viewpoint. To them, science is political.</p>
<p>They believe these spokespeople have dubious motives and that they are presenting and manipulating the facts to serve their own personal agendas. To understand vaccine hesitancy or resistance, we need to understand how people interpret certain scientific issues including vaccination.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
</figcaption>
</figure>
<p>Recent articles <a href="https://theconversation.com/a-researchers-view-on-covid-19-vaccine-hesitancy-the-scientific-process-needs-to-be-better-explained-167681">have highlighted the importance of explaining the scientific process of manufacturing vaccines</a> and showing their efficacy rates and <a href="https://www.canada.ca/en/health-canada/services/video/ask-experts-covid-19-vaccines.html#a3">their side effects</a>. </p>
<p>We would add that it is important to make this information accessible, both as new knowledge and as experience that is shared with the rest of the population.</p>
<p>To do this, as communications researchers, we draw on our knowledge of the social and narrative dimensions of meaning-making. Indeed, well-established research in the field of communications — for example, <a href="https://doi.org/10.1111/jcom.12007">examining how patients understood information about cancer</a> — shows that our understanding is shaped by how we identify with the people in the stories we hear. Since <a href="https://doi.org/10.1215/03616878-3632230">identities and the histories that shape them are numerous and varied</a>, our interpretation of scientific facts can also be diverse. Our understanding can then take on a political dimension and lead to rigid positions.</p>
<h2>It’s the experience that counts</h2>
<p>According to the sense-making and narrativity theories developed by organizational theorist <a href="https://us.sagepub.com/en-us/nam/sensemaking-in-organizations/book4988">Karl E. Weick</a> and communication theorist <a href="https://doi.org/10.1080/03637758409390180">Walter R. Fisher</a> respectively, people first evaluate facts in the light of their own experiences and those of their relatives. These experiences are recounted and exchanged in the form of stories in which people see themselves reflected and with which they identify.</p>
<p>These stories are most effective when they present the listener as having control over their lives. For example, for many people, a story in which a family member made a wise choice about medical treatment will be more convincing than a scientific presentation.</p>
<p>When we look at conversations about vaccines on social media, we see that sharing personal stories remains one of the predominant ways in which people form their opinions about the reliability and safety of vaccines.</p>
<p>People retell their experiences as stories, so they can share and compare but also reassure each other that they are able to make their own decisions.</p>
<h2>Disconnected scientific facts</h2>
<p>While most people understand vaccination through personal experience, scientific facts are often reported in statistical form without relating them to the experience of their audience — for example the hospitalization rates of COVID-19 patients. These hospitalizations, because they are experienced by others, may not affect those who are resisting vaccination.</p>
<figure class="align-center ">
<img alt="Two people hold signs" src="https://images.theconversation.com/files/423894/original/file-20210929-18-1oa9aw9.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/423894/original/file-20210929-18-1oa9aw9.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=391&fit=crop&dpr=1 600w, https://images.theconversation.com/files/423894/original/file-20210929-18-1oa9aw9.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=391&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/423894/original/file-20210929-18-1oa9aw9.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=391&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/423894/original/file-20210929-18-1oa9aw9.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=491&fit=crop&dpr=1 754w, https://images.theconversation.com/files/423894/original/file-20210929-18-1oa9aw9.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=491&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/423894/original/file-20210929-18-1oa9aw9.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=491&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Anti-vaccine protesters outside a Montréal hospital. They are deaf to the scientific arguments used to encourage them to get vaccinated.</span>
<span class="attribution"><span class="source">The Canadian Press/Paul Chiasson</span></span>
</figcaption>
</figure>
<p>Facts are often presented from the perspective of the scientists who produced them, or from media or government representatives, so believing them requires <a href="https://www.oecd.org/coronavirus/policy-responses/transparency-communication-and-trust-the-role-of-public-communication-in-responding-to-the-wave-of-disinformation-about-the-new-coronavirus-bef7ad6e/">trust in these institutions</a>. A decline in trust may trigger a feeling in some people that the authorities want to take away the control they have over their own lives.</p>
<p>This crisis of confidence is partly due to the fact that a majority of people have no direct experience with institutions such as medical research, journalistic enquiry or political decision-making. So when stories are presented to those who are vaccine hesitant, it feels like they are being expected to let outsiders guide them without getting any opportunity to ask questions.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-ensuring-trust-is-important-in-reducing-covid-19-vaccine-hesitancy-168167">Why ensuring trust is important in reducing COVID-19 vaccine hesitancy</a>
</strong>
</em>
</p>
<hr>
<h2>Scientific facts and personal stories</h2>
<p>Based on these findings, two recommendations can be made. The first would be to include more non-scientists in reports on scientific research so that audiences can better understand the issues and feel like they are participating in the debate. For example, with the impending approval of COVID-19 vaccines for five to 11 year olds, parents of children who have participated in clinical trials of these vaccines could be used to demystify the scientific research process and provide stories that other parents can relate to.</p>
<p>Or, as the media is doing at the moment, sharing <a href="https://montreal.ctvnews.ca/young-quebecer-who-died-of-covid-19-pleaded-with-people-to-get-vaccinated-1.5603115">the stories of relatives of unvaccinated young people who died of COVID-19</a> may have an impact on those who are reluctant to get the vaccine. Some people may relate to the hesitations these people had about vaccination: “He was worried about the vaccine, yes, but all he wanted to do was to see how people would react to it to make sure it was safe for him and his family before he encouraged them to get vaccinated.”</p>
<p>In the same vein, we should ensure that those who dissect the data in the media have a scientific background and are able to present the figures in an accessible way. For example, it is possible to compare the <a href="https://www.cbc.ca/news/health/covid-vaccines-illness-death-risk-1.6171958">number of hospitalizations of vaccinated people</a> to those of unvaccinated people using high school math.</p>
<p>The second recommendation would be to have more public discussions about the kinds of situations people who are worried are experiencing. Those who dare to express doubts today are <a href="https://www.theguardian.com/commentisfree/2019/apr/28/anti-vaxxers-are-wrong-but-ridicule-is-no-way-to-win-them-over">too quickly removed from the debate and relegated to the status of pariahs</a>. More examples should be presented of people who overcame their doubts, including the process through which they did so.</p>
<p>Some people who refuse vaccination see themselves as informed citizens or concerned parents. For them, this is an act of resistance that allows them to maintain control over their own lives. While it is important to ensure that scientific facts are reported, no one should downplay the importance of these legitimate concerns. </p>
<p>Publishing daily statistics on infections, hospitalizations and deaths is necessary, but is unlikely to be enough to raise awareness among hardcore vaccine resisters. To convince them, scientific facts should contextualized and made relatable to be understood as elements of a human experience.</p>
<hr>
<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/169221/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>People who oppose vaccination won’t be swayed by statistics. To convince them, it is necessary to share real-life experiences and stories with which they will identify.Joelle Basque, Assistant Professor, Département Sciences humaines, Lettres et Communications, Université TÉLUQ Nicolas Bencherki, Associate Professor, organizational communication, Université TÉLUQ Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1681672021-10-07T16:24:52Z2021-10-07T16:24:52ZWhy ensuring trust is important in reducing COVID-19 vaccine hesitancy<figure><img src="https://images.theconversation.com/files/424856/original/file-20211005-17-ekf448.JPG?ixlib=rb-1.1.0&rect=0%2C0%2C5515%2C3574&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An anti-vaccine protester and a vaccine supporter demonstrate in from of a Montréal hospital in September, 2021.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Paul Chiasson </span></span></figcaption></figure><p><a href="https://www.macleans.ca/society/typical-vaccine-hesitant-person-is-a-42-year-old-ontario-woman-who-votes-liberal-abacus-polling/">Polling data</a> from this summer showed that 2.1 million Canadians (seven per cent of the adult population) were hesitant to get a COVID-19 vaccine. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
</figcaption>
</figure>
<p>Most of these adults lack trust in the government and vaccines. They worry about <a href="https://www.cbc.ca/news/canada/toronto/vaccine-hesitant-changed-minds-1.6022537">vaccine safety</a>, a lack of <a href="https://theconversation.com/a-researchers-view-on-covid-19-vaccine-hesitancy-the-scientific-process-needs-to-be-better-explained-167681">communication about the process underlying vaccine development</a> and a lack of <a href="https://www.vox.com/recode/22330018/covid-vaccine-hesitancy-misinformation-carnegie-mellon-facebook-survey">transparency about vaccine trials and side-effects</a>.</p>
<p>Their experience illustrates how trust is embedded in safeguarding <a href="https://theconversation.com/why-trust-is-vital-to-public-health-strategy-149674">public health</a>. And what’s crucial for public health is widespread vaccination uptake. We need to understand how trust can be developed and, in many cases, rebuilt. To address this question, we draw on our research on trust. </p>
<h2>Trust and society</h2>
<p>A trusting person relinquishes control over what they do in return for security and comfort. When we trust each other, we accept what others bring into our lives, even if we do not understand what they bring. </p>
<p>When we get vaccinated based on public health recommendations, we trust these recommendations; we do not need to check up on them. When trust is absent, we ignore the recommendations and find our own information (or disinformation).</p>
<p>Trust is thus necessary for the social fabric of society: it reduces the uncertainty and complexity inherent in social relations. Accordingly, trust maintains <a href="https://doi.org/10.1177/S0038038501000190">social order</a>, <a href="https://doi.org/10.1017/CBO9780511921452.017">civic engagement</a> and <a href="https://doi.org/10.1016/j.aos.2018.05.006">co-operation</a>. </p>
<figure class="align-center ">
<img alt="A gloved hand holds up a needle, blurred in the background a woman stands with her hand up, holding a baby" src="https://images.theconversation.com/files/424863/original/file-20211005-25-6i3sl0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/424863/original/file-20211005-25-6i3sl0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/424863/original/file-20211005-25-6i3sl0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/424863/original/file-20211005-25-6i3sl0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/424863/original/file-20211005-25-6i3sl0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/424863/original/file-20211005-25-6i3sl0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/424863/original/file-20211005-25-6i3sl0.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">Transparency builds trust.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Trust: Cognitions and emotions</h2>
<p>In our research, we show how <a href="https://doi.org/10.1016/j.cpa.2021.102328">trust has two crucial building blocks</a>. First, trust involves what we know; it relates to our cognitions (like how we perceive vaccines). We trust someone more when we know them better. We derive this knowledge from various sources, such as interactions and observations (like social media). </p>
<p>Second, trust involves what we feel; it implicates our emotions (like how we feel about vaccines). We trust someone more when we feel better about them. Our emotions are built through goodwill, motivations, shared values and a sense of belonging. </p>
<p>Since trust has two components, we need to be attentive to each of them when we wish to enhance trust. We need to think about how we can strengthen what we know and how we feel. </p>
<h2>Organizational transparency and trust</h2>
<p><a href="https://theconversation.com/how-pharma-can-build-trust-in-covid-19-vaccines-transparency-on-trials-and-side-effects-150270">Transparency builds trust</a>. Transparency appeals to the cognitive side of trust. </p>
<p>When pharmaceutical companies are more transparent, like disclosing vaccine development protocols and allowing third-party reviewers, we know more about vaccines and trust them more. </p>
<p>Transparency also engages the emotional side of trust. When pharmaceutical companies are more transparent, we sense that they are intrinsically motivated by their concern for public health, enabling an emotional bond to form. We feel that they care about us, and we trust the vaccine more.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1390679403206782980"}"></div></p>
<h2>Government communication and trust</h2>
<p>Enhanced communication builds trust. When governments disclose vaccination plans, we know more about public health strategies targeting the pandemic. We feel that governments care about us and create the conditions that enable us to live our lives. </p>
<p>Decisions like that of <a href="https://www.theglobeandmail.com/politics/article-conservatives-wont-disclose-candidate-vaccination-rate-despite-setting/">the Conservative Party to not disclose its candidates’ vaccination rates</a> do the opposite. They prevent us from accessing relevant information and suggest that containing the pandemic is not a priority. They damage emotional bonds around shared communal responses against the virus. </p>
<h2>Recent measures: vaccine lotteries</h2>
<p>As vaccination uptake in Canada levelled off, governments started to deploy various measures to boost vaccination, <a href="https://cdn-contenu.quebec.ca/cdn-contenu/sante/documents/Problemes_de_sante/covid-19/reglement_concours_vaccination_anglais.pdf?1630417274">like lotteries</a>, <a href="https://www.canada.ca/en/transport-canada/news/2021/10/mandatory-covid-19-vaccination-requirements-for-federally-regulated-transportation-employees-and-travellers.html">mandatory vaccinations</a> and <a href="https://www.quebec.ca/sante/problemes-de-sante/a-z/coronavirus-2019/deroulement-vaccination-contre-la-covid-19/passeport-de-vaccination-covid-19">vaccination passports</a>.</p>
<p>Take lotteries for example — our two-dimensional approach to trust suggests that they are problematic. They fail to involve the cognitive side of trust: lotteries provide little if any new information, and may damage emotional bonds. Although they suggest that governments care about public health, we might question why lotteries, in particular, were chosen. </p>
<p>Lotteries <a href="https://www.cbc.ca/news/canada/edmonton/alberta-vaccine-lottery-1.6166369">had little effect on vaccination rates</a>, and some people felt that lotteries unfairly penalized those vaccinated early on and compensated late adopters who may have already exposed others to the virus. Nevertheless, the case illustrates how public health measures need to be examined for how they affect trust, if they don’t work or, worse, backfire. </p>
<h2>Recommendations on how to enhance trust</h2>
<p>Governments and public health organizations need to speak to the cognitive and emotional sides of trust through their communications and practices — they need to explain vaccines and other public health measures while also speaking to the broader purpose of caring for the community we belong to and depend on. </p>
<p>A Montréal-led <a href="https://www.concordia.ca/news/stories/2021/08/31/new-data-from-a-montreal-led-global-study-helps-explain-vaccination-rates-and-vaccine-hesitancy.html">global survey</a> shows that people get vaccinated for altruistic reasons, like believing that it is good for the general population.</p>
<p>Coercive <a href="https://mbmc-cmcm.ca/covid19/research/stats/">measures like vaccination passports</a> need to be approached carefully because they <a href="https://theconversation.com/why-trust-is-vital-to-public-health-strategy-149674">threaten individual autonomy</a>. Autonomy appeals to the emotional side of trust by motivating us to make decisions like adhering to rules and its cognitive side by enabling us to access information that helps us make informed decisions. </p>
<p>Coercive measures need to be accompanied with explanations, like why are they required, and outreach that highlights mutual care. Otherwise they can backfire and lead to vaccine resistance.</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/168167/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nelson Duenas receives funding from Fonds de recherche du Québec – Société et culture (FRQSC). </span></em></p><p class="fine-print"><em><span>Claudine Mangen receives funding from the Social Sciences and Humanities Research Council of Canada.</span></em></p>Trust is needed to curb vaccine hesitancy. Governments need to explain vaccines and other public health measures, while also speaking to the broader purpose of caring for the community we belong to.Nelson Duenas, PhD Candidate in Accounting, Concordia UniversityClaudine Mangen, RBC Professor in Responsible Organizations and Associate Professor, Concordia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1686432021-09-29T16:01:58Z2021-09-29T16:01:58ZThe 9 psychological barriers that lead to COVID-19 vaccine hesitancy and refusal<figure><img src="https://images.theconversation.com/files/423409/original/file-20210927-21-1vzipkt.JPG?ixlib=rb-1.1.0&rect=49%2C67%2C4039%2C2649&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People wait in line at a mass vaccination and testing clinic in Moncton, N.B., in September 2021.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Christopher Katsarov </span></span></figcaption></figure><p>The fourth wave of the COVID-19 pandemic is putting pressure on hospital networks, upsetting many and making vaccine refusals seem foolish. To better understand what leads someone refuse or delay vaccination, it is important to <a href="https://dx.doi.org/10.1073%2Fpnas.0403823101">identify the psychological barriers that underlie the decision</a>.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
</figcaption>
</figure>
<p>As a clinical psychologist who works mainly with adults suffering from personality, anxiety and mood disorders, I have a front-row seat for observing the distress, frustration and unease of those at the heart of this pandemic. Behind the refusal to be vaccinated, <a href="https://doi.org/10.1016/j.socscimed.2014.04.018">there is a complex emotional spectrum that colours each person’s behaviour and choices</a>.</p>
<p>Apart from religious and cultural reasons or health conditions that justify not receiving the vaccine, the choice to refuse vaccination can be explained by a range of other factors. The following nine factors provide a good picture of the complexity of the situation.</p>
<h2>Misunderstanding and lack of information</h2>
<p>A first barrier is lack of understanding about the vaccine or misunderstanding the necessity of vaccination.</p>
<p>Faced with contradictory opinions and a lack of information, some people are perplexed: Why should you get vaccinated if you can still catch the virus and transmit it? Why vaccinate young people if they are less vulnerable to the virus? </p>
<p><a href="https://doi.org/10.1016/j.vaccine.2021.08.037">Not finding satisfactory answers to these questions can paralyze someone’s thinking and reduce their willingness to take action</a>.</p>
<hr>
<p>
<em>
<strong>
À lire aussi :
<a href="https://theconversation.com/a-researchers-view-on-covid-19-vaccine-hesitancy-the-scientific-process-needs-to-be-better-explained-167681">A researcher's view on COVID-19 vaccine hesitancy: The scientific process needs to be better explained</a>
</strong>
</em>
</p>
<hr>
<h2>Fear of needles … and vaccines</h2>
<p><a href="https://doi.org/10.1016/j.vaccine.2012.04.066">Some people have a strong fear of needles or the pain related to vaccination</a>. Although this fear may seem irrational to others, it is something the sufferer feels intensely.</p>
<p><a href="https://dx.doi.org/10.1017%2FS0033291721002609">Apprehension about needles or pain is sometimes so anxiety-producing</a> that it can lead a person to avoid any situation that involves vaccination. Sometimes just seeing images of vaccination can provoke anxiety.</p>
<hr>
<p>
<em>
<strong>
À lire aussi :
<a href="https://theconversation.com/needle-fears-can-cause-covid-19-vaccine-hesitancy-but-these-strategies-can-manage-pain-and-fear-165009">Needle fears can cause COVID-19 vaccine hesitancy, but these strategies can manage pain and fear</a>
</strong>
</em>
</p>
<hr>
<p>In other cases, the fear is related to the possible side effects of the vaccine. Some people may not refuse to be vaccinated, but will wait until more people have been vaccinated so they can see if there are any long-term side effects.</p>
<figure class="align-center ">
<img alt="A man in a mask holds a dog in front of a young woman, also wearing the mask" src="https://images.theconversation.com/files/421994/original/file-20210919-15-16szdl6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/421994/original/file-20210919-15-16szdl6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=447&fit=crop&dpr=1 600w, https://images.theconversation.com/files/421994/original/file-20210919-15-16szdl6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=447&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/421994/original/file-20210919-15-16szdl6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=447&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/421994/original/file-20210919-15-16szdl6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=561&fit=crop&dpr=1 754w, https://images.theconversation.com/files/421994/original/file-20210919-15-16szdl6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=561&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/421994/original/file-20210919-15-16szdl6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=561&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Zootherapist Sylvain Gonthier and his dog Bidule comfort Divine Nsabimana as she waits for her dose of COVID-19 vaccine, in Montréal, on August 26, 2021.</span>
<span class="attribution"><span class="source">The Canadian Press/Graham Hughes</span></span>
</figcaption>
</figure>
<h2>Feelings of helplessness</h2>
<p>A further psychological barrier comes from the feelings of helplessness and discouragement in response to the possibility that the pandemic will continue, despite vaccination efforts, especially given the detection of new variants.</p>
<p><a href="https://apps.who.int/iris/bitstream/handle/10665/335820/WHO-EURO-2020-1160-40906-55390-eng.pdf">The term “pandemic fatigue”</a> reflects the weary and demotivated feeling that arises during a time of crisis when events appear to repeat themselves. <a href="https://doi.org/10.3390/vaccines9080900">Resignation and loss of hope can lead to reduced motivation</a>, and an unwillingness to follow recommendations, including vaccination. </p>
<h2>Aware but not concerned</h2>
<p>Other people are aware of the impact of the pandemic, but do not feel personally concerned: “I’m healthy, so that protects me.” </p>
<p>These individuals often lack knowledge about the disease and vaccination, so <a href="https://doi.org/10.1016/j.vaccine.2009.09.099">they are not particularly concerned about the harmful effects of the virus on their health or the risks of transmission</a> to others. It’s worth noting that these people are not actually be opposed to the vaccine.</p>
<h2>Mistrust of ingredients</h2>
<p>Some people pay close attention to what goes into their bodies and may be concerned about the ingredients of the COVID-19 vaccine. They experience visceral discomfort at the idea getting a vaccination, and may perceive the COVID-19 vaccine as an intrusion, contamination or aggression. </p>
<p>Not knowing about the <a href="https://www.cbc.ca/news/canada/manitoba/covid-19-vaccine-myths-dispelled-1.6014067">ingredients of the vaccine</a>, they may be <a href="https://doi.org/10.1111/cts.13077">reluctant or even opposed to receiving it</a>.</p>
<h2>Anxiety and denial</h2>
<p>Everyone reacts differently to anxiety-provoking situations. Some will jump into action and look for solutions, others will confide in loved ones <a href="https://doi.org/10.7202/1040167ar">or feel emotionally overwhelmed</a>.</p>
<p>Still others will go <a href="https://doi.org/10.3390/vaccines9080822">into denial</a>. Denial is an automatic, unconscious reflex that works as a Band-Aid to control anxiety. In the pandemic context, this may be expressed as denial of the seriousness of the disease, denial of one’s own vulnerability to contracting the virus, or even denial of the existence of the virus itself.</p>
<h2>Sense of rejection and exclusion</h2>
<p>As social beings, we are extremely sensitive to rejection. Rejection may be more common and painful for some than for others. These people feel more excluded from society and do not recognize themselves in the official discourse or the norms being proposed in response to the pandemic.</p>
<p>When health measures are announced, these people may find them controlling. When one feels neither represented nor listened to by the authorities, or when one is parodied or criticized by other groups in society, <a href="https://doi.org/10.1007/s10902-021-00398-x">the wounds of a past marked by rejection are reactivated and replayed</a>.</p>
<p>These people will also feel <a href="https://doi.org/10.3389/fpsyg.2021.682931">excluded and less likely to follow recommendations</a>. They are also more likely to feel <a href="https://doi.org/10.1080/0960085X.2021.1895682">better understood by alternative and refractory voices that make them feel heard at last</a>.</p>
<h2>Dependency and conflict avoidance</h2>
<p>Some people are more dependent on the opinions of those closest to them. The dynamics of the relationship are such that the person doubts themselves, relies on the other person to make day-to-day decisions for them and idealizes the other person or seeks to minimize conflicts with them.</p>
<p>In these cases, the person’s position and choice will be influenced by the fact that their peer does not consider vaccination to be important.</p>
<h2>Crisis of confidence</h2>
<p>The previously mentioned factors, such as mistrust of what goes into the body, denial and rejection, may crystallize into a <a href="https://www.eurosurveillance.org/content/10.2807/ese.14.49.19437-en">greater distrust of government sources, health authorities and the pharmaceutical industry</a>. This can also turn into a <a href="https://doi.org/10.1016/j.socscimed.2014.04.018">crisis of confidence and distrust of public health recommendations</a>. </p>
<p>Belief in conspiracy theories and the rejection of authority can shape one’s thinking and identity. That in turn creates a danger of polarization.</p>
<figure class="align-center ">
<img alt="A man holds a sign" src="https://images.theconversation.com/files/421993/original/file-20210919-15-i3ickh.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/421993/original/file-20210919-15-i3ickh.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=425&fit=crop&dpr=1 600w, https://images.theconversation.com/files/421993/original/file-20210919-15-i3ickh.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=425&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/421993/original/file-20210919-15-i3ickh.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=425&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/421993/original/file-20210919-15-i3ickh.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=535&fit=crop&dpr=1 754w, https://images.theconversation.com/files/421993/original/file-20210919-15-i3ickh.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=535&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/421993/original/file-20210919-15-i3ickh.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=535&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">An anti-vaccine protester in front of a Montréal hospital.</span>
<span class="attribution"><span class="source">The Canadian Press/Paul Chiasson</span></span>
</figcaption>
</figure>
<p>Other factors could be added to this list of what contributes to vaccine hesitancy and refusal. As a psychologist, I consider it essential to understand why a person refuses to be vaccinated. The measures and solutions to encourage vaccination reach people in different ways, depending on how they process information in the first place. </p>
<p>Some people will need explanations, others will need to be accompanied when they get vaccinated, and still others will need to be in a space where they feel listened to and feel that their irritation is accepted. Finally, to avoid feeling “controlled” some people will prefer following alternative recommendations, such as getting regular screening tests.</p>
<p>In order to offer relevant solutions and move forward collectively in this pandemic crisis, we need to better understand each other’s reactions. I believe that this understanding will better guide authorities in communicating information and how to both decide on and present public health measures. For any measure to be respected, we must know the underlying reasons people reject it.</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/168643/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Geneviève Beaulieu-Pelletier received funding from SSHRC for her work on activism and radicalization.</span></em></p>The decision not to get the COVID-19 vaccine comes from a complex set of psychological factors.Geneviève Beaulieu-Pelletier, Psychologue, conférencière et professeure associée, Université du Québec à Montréal (UQAM)Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1676812021-09-15T23:01:00Z2021-09-15T23:01:00ZA researcher’s view on COVID-19 vaccine hesitancy: The scientific process needs to be better explained<figure><img src="https://images.theconversation.com/files/420655/original/file-20210912-27-1x5nmgm.jpg?ixlib=rb-1.1.0&rect=0%2C45%2C3798%2C2644&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In the reluctance to vaccinate, there is a lack of trust and understanding of the scientific process. Better communication would help rebuild bridges. </span> <span class="attribution"><span class="source">The Canadian Press/Paul Chiasson</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/a-researcher’s-view-on-covid-19-vaccine-hesitancy--the-scientific-process-needs-to-be-better-explained" width="100%" height="400"></iframe>
<p><a href="https://theconversation.com/what-scientists-are-doing-to-develop-a-vaccine-for-the-new-coronavirus-131255">When I first wrote about the arrival of SARS-CoV-2</a> in early March 2020, the question was whether or not the new virus would become a pandemic. At the time, most experts believed that we had already reached the point of no return.</p>
<p>Today, 18 months later, the answer is clear. You don’t need to be a scientist to know it. This pandemic is the worst public health emergency of international concern that our modern society has faced. To date, <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019?adgroupsurvey=%7Badgroupsurvey%7D&gclid=EAIaIQobChMIyfmOzMHy8gIVkYjICh3I8wo5EAAYAiAAEgKQ3_D_BwE">more than 215 million cases have been confirmed and 4.5 million deaths have been reported globally</a>.</p>
<p>These are just the reported cases. In reality, the number of cases is higher, and for a variety of reasons: lack of diagnostic capacity, infection without symptoms, unwillingness or inability to be tested or to visit a health facility, etc. The number of deaths due to COVID-19 is probably underestimated, both <a href="https://www.cp24.com/mobile/news/death-certificates-don-t-accurately-reflect-the-toll-of-the-pandemic-experts-say-1.5326970?cache=/7.363087">in Canada</a> and <a href="https://www.who.int/data/stories/the-true-death-toll-of-covid-19-estimating-global-excess-mortality">worldwide</a>.</p>
<p>In addition to changing the way we live our daily lives, the pandemic has brought scientific processes to public attention. Researchers, used to working in the shadows, now had to provide solutions — and explanations — to a very real threat, and they have been doing this under the watchful eye of the public.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
</figcaption>
</figure>
<p>One of these solutions, vaccination, is far from new. Yet no matter what the context, <a href="https://timesofsandiego.com/opinion/2021/09/08/anti-vax-movement-has-a-long-deadly-history-from-smallpox-to-covid/">it has always generated news</a>. So where are we now?</p>
<p>Still in our laboratories! I recently completed my PhD in microbiology-immunology at Laval University, research that I conducted under the supervision of <a href="https://ipolitics.ca/2020/09/21/leading-vaccine-developer-walks-out-on-federal-vaccine-task-force/">Professor Gary Kobigner</a>, who is known for co-developing an effective vaccine and treatment for Ebola. This fall, I will begin a postdoctoral fellowship at the Galveston National Laboratory in Texas, where I will continue my work on the transmission of, and vaccine development against, severe pathogens.</p>
<h2>Relevant questions</h2>
<p>The World Health Organization (WHO) currently lists <a href="https://www.who.int/news-room/q-a-detail/coronavirus-disease-covid-19">13 available COVID-19 vaccines, based on four different platforms, including mRNA vaccines and viral vector vaccines</a>. Globally, more than five billion doses of vaccines have been administered. In Canada, five of these vaccines are currently approved for use: <a href="https://health-infobase.canada.ca/covid-19/vaccine-administration/">Pfizer-BioNTech, Moderna, AstraZeneca, COVISHIELD and Janssen</a>, with <a href="https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/prevention-risks/covid-19-vaccine-treatment/vaccine-rollout.html#a4">Pfizer-BioNTech, Moderna and AstraZeneca</a> in wide distribution. Combined, these vaccines have been administered to approximately <a href="https://health-infobase.canada.ca/covid-19/vaccination-coverage/">70 per cent</a> of Canadians.</p>
<figure class="align-center ">
<img alt="A woman administers a vaccine to another woman, seated, from behind" src="https://images.theconversation.com/files/420137/original/file-20210909-23-1miromd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/420137/original/file-20210909-23-1miromd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=396&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420137/original/file-20210909-23-1miromd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=396&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420137/original/file-20210909-23-1miromd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=396&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420137/original/file-20210909-23-1miromd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=497&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420137/original/file-20210909-23-1miromd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=497&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420137/original/file-20210909-23-1miromd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=497&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A woman receives her COVID-19 vaccine at Olympic Stadium in Montréal. Five vaccines have been approved in Canada and about 70 per cent of the population is doubly vaccinated.</span>
<span class="attribution"><span class="source">The Canadian Press/Paul Chiasson</span></span>
</figcaption>
</figure>
<p>However, <a href="https://theconversation.com/i-work-at-a-covid-19-vaccine-clinic-heres-what-people-ask-me-when-theyre-getting-their-shot-and-what-i-tell-them-167046">many people have raised questions about these vaccines</a>. And it is fair to do so! The unknown has always been a source of anxiety for human beings, it is normal to <a href="https://theconversation.com/astrazeneca-covid-19-vaccine-faq-why-do-the-age-recommendations-keep-changing-does-it-cause-vipit-blood-clots-is-it-effective-against-variants-158302">ask questions</a>.</p>
<p>So, after working tirelessly to develop vaccines against COVID-19, what are scientists and doctors doing now?</p>
<p>They are doing what they have always done: Practising the best science they can within the limits of current knowledge. This scientific practice means continuing to evaluate the effectiveness of these vaccines <a href="https://www.who.int/en/activities/tracking-SARS-CoV-2-variants/">against new variants</a> in labs, as the virus continues to mutate. </p>
<p>It means continuing to record who has experienced side-effects (serious or not) from vaccination and continuing to investigate the potential links between these side-effects and the vaccine. The science they are practising involves studying the virus day and night to understand how it makes people sick, how we can prevent infection and what our options are for getting rid of it as quickly as possible.</p>
<p>The term “current knowledge” is very important here. It is possible that more side-effects related to vaccination will be discovered much later. Here’s why.</p>
<h2>The scientific method</h2>
<p>When vaccines are initially developed in the laboratory and tested on animals, it is normal that <em>not</em> all side-effects are identified. A mouse is not a human, after all, and models cannot account for all the variables that can be found in a human. Humans live in a complex environment and society where individuals each have their own genetics, immunity and lifestyle (exercise, smoking, nutrition).</p>
<p>Furthermore, the more people are vaccinated, the greater the likelihood of detecting a serious side-effect. Clinical trials, where <a href="https://theconversation.com/explainer-how-clinical-trials-test-covid-19-vaccines-146061">drugs and vaccines are evaluated in a small group of individuals</a> before being made available to the general population, are designed to be safe. Volunteers are usually healthy adults, without serious <a href="https://www.inspq.qc.ca/en/publications/3082-impact-comorbidities-risk-death-covid19">pre-existing medical conditions</a>.</p>
<hr>
<p>
<em>
<strong>
À lire aussi :
<a href="https://theconversation.com/explainer-how-clinical-trials-test-covid-19-vaccines-146061">Explainer: How clinical trials test COVID-19 vaccines</a>
</strong>
</em>
</p>
<hr>
<p>Vaccination is now widespread in many countries. It is therefore statistically normal that rarer effects (for example, ones that one in a million people develop) are now being observed. These effects are too rare to have been detected in a clinical trial of 10,000 people. This is the case for rare side-effects such as <a href="https://www.forbes.com/sites/siladityaray/2021/09/09/european-medicines-agency-lists-nerve-disorder-as-very-rare-side-effect-of-astrazeneca-covid-19-vaccine/?sh=5fd603e61a7b">Guillain-Barré syndrome</a> and <a href="https://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2021/76203a-eng.php">Bell’s palsy</a>.</p>
<p>The <a href="https://www.sciencebuddies.org/science-fair-projects/science-fair/steps-of-the-scientific-method">scientific method</a> requires that the following process is followed: Observe a problem, formulate a hypothesis about its possible causes, evaluate it experimentally by controlling the variables, interpret the results and draw a conclusion.</p>
<p>It can turn out that our initial hypothesis is wrong, and that is equally acceptable. This is how science was designed. I think that before the pandemic, people considered science infallible. Opening up research to the general public has greatly changed this perception, especially as science quickly became embroiled in politics, particularly over <a href="https://www.who.int/health-topics/coronavirus/origins-of-the-virus">the question of the origin of the pandemic</a>.</p>
<figure class="align-center ">
<img alt="Justin Trudeau is surrounded by scientists, in a lab" src="https://images.theconversation.com/files/420138/original/file-20210909-21-17ccvfk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/420138/original/file-20210909-21-17ccvfk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=436&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420138/original/file-20210909-21-17ccvfk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=436&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420138/original/file-20210909-21-17ccvfk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=436&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420138/original/file-20210909-21-17ccvfk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=548&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420138/original/file-20210909-21-17ccvfk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=548&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420138/original/file-20210909-21-17ccvfk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=548&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Prime Minister Justin Trudeau with scientists during a visit to the National Research Council of Canada (NRC), in Montréal, August 2020. The scientific method makes it possible to observe a problem, formulate a hypothesis about its causes, evaluate it experimentally by controlling the variables, interpret the results and draw a conclusion.</span>
<span class="attribution"><span class="source">The Canadian Press/Graham Hughes</span></span>
</figcaption>
</figure>
<h2>Knowing how to communicate</h2>
<p>And that’s where the problem comes from, among other things. <a href="https://doi.org/10.1038/d41586-020-00452-3">The key to effective scientific communication is not the science. It’s the communication</a>. The results of laboratory experiments and clinical trials are what they are. Either the vaccine or drug works to reduce mortality, or it doesn’t work, and we go back to the drawing board.</p>
<p>So where does the reluctance about vaccines come from? One of the main problems is not the lack of information about the safety of the vaccine. Almost everyone has access to this information on internet. The problem is the lack of trust in institutions, <a href="https://www.cairn-int.info/journal-revue-internationale-de-politique-comparee-2003-3-page-433.htm">which has been growing globally in recent years</a>.</p>
<hr>
<p>
<em>
<strong>
À lire aussi :
<a href="https://theconversation.com/how-better-conversations-can-help-reduce-vaccine-hesitancy-for-covid-19-and-other-shots-159321">How better conversations can help reduce vaccine hesitancy for COVID-19 and other shots</a>
</strong>
</em>
</p>
<hr>
<p>But this trust can be earned — or regained. It just takes time, respect and empathy. A study by researchers at the <a href="https://doi.org/10.1080/21645515.2018.1549451">Centre Hospitalier Universitaire de Sherbrooke</a> shows that an educational session about immunization that used motivational interviewing techniques with parents of infants resulted in a nine per cent increase in immunization rates compared with families who did not receive the sessions.</p>
<h2>Finding the right answer to a question</h2>
<p>Ultimately, the goal of science is to find the right answer to a question.</p>
<p>Of course, human nature being what it is, we are not immune to conflicts of interest. We need to ensure transparency about things like funding and links between scientists and potential investors. This is especially important since we are all responsible for funding research, whether through federal subsidies, which are partly derived from taxes paid by citizens, or through the ordinary purchase of drugs in pharmacies.</p>
<p>Since this concerns everyone, it is high time that the public became more involved. After all, scientific discoveries and health measures are everybody’s business. For example, few citizens are familiar with “<a href="https://www.ncbi.nlm.nih.gov/books/NBK285579/">gain-of-function research</a>.” These studies can involve a level of risk ranging from very low to very high. For example, producing a drug from a bacterium carries little risk and much benefit. However, increasing the virulence or transmissibility of a virus such as Ebola or Influenza could carry a lot of risk if such research were carried out by individuals with bad intentions, or in poorly secured laboratories.</p>
<hr>
<p>
<em>
<strong>
À lire aussi :
<a href="https://theconversation.com/origins-of-sars-cov-2-why-the-lab-leak-idea-is-being-considered-again-161947">Origins of SARS-CoV-2: Why the lab-leak idea is being considered again</a>
</strong>
</em>
</p>
<hr>
<p>As with any aspect of science, a risk-benefit analysis must be carried out. Note that in the vast majority of institutions where research is done, the committees assessing whether or not a study is worth doing are not only composed of scientists and students, but also members of the public.</p>
<p>Now each side just has to do its part. Scientists need to do a better job of communicating their results and the interpretation of them, as well as specifically answering questions of interest to the public and regaining their trust. They need to listen and stop hiding behind mountains of data, complicated words and scientific articles that are not easily accessible to the general public.</p>
<p>To those who are hesitant about vaccination, scientists should ask: “What data would make you change your mind?”, “Why do you think the current data are insufficient?”, “Why do you trust this individual, but not another or the institutions?” This is how constructive dialogue can be initiated and more in-depth reflection can begin.</p>
<p>For their part, citizens can adopt better practices when it comes to getting information and not only consider information that fits into their personal narrative. It is also important to avoid falling into a spiral of conspiracy theories and trust in false experts. It is important to not be afraid to doubt, to find other sources to confirm or refute what you have just read and to ask trusted experts around you what they think.</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/167681/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marc-Antoine De La Vega ne travaille pas, ne conseille pas, ne possède pas de parts, ne reçoit pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'a déclaré aucune autre affiliation que son organisme de recherche.</span></em></p>Before the pandemic, the public perceived science as infallible and inaccessible. But the opening up of research to the general public has changed that perception.Marc-Antoine De La Vega, PhD Student in Microbiology-Immunology, Université LavalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1670462021-09-01T22:54:49Z2021-09-01T22:54:49ZI work at a COVID-19 vaccine clinic. Here’s what people ask me when they’re getting their shot — and what I tell them<figure><img src="https://images.theconversation.com/files/418799/original/file-20210901-17-5618xv.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3647%2C2528&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People getting vaccinated may still have questions about COVID-19 vaccines, like why it takes two doses — and then two weeks — to take full effect.
</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Ryan Remiorz </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/i-work-at-a-covid-19-vaccine-clinic--here-s-what-people-ask-me-when-they-re-getting-their-shot---and-what-i-tell-them" width="100%" height="400"></iframe>
<p>As a medical student working with Alberta Health Services to vaccinate people against COVID-19, I have been asked my fair share of questions about the COVID-19 vaccines — from the need for booster doses to rare side effects.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
</figcaption>
</figure>
<p>A few days ago, I told an individual who was about to receive her second dose of the Moderna vaccine, “We are expecting about 95 per cent immunity two weeks from today.” She paused and asked, “What does that even mean?” </p>
<p>That scenario has repeated itself a few more times since then. I usually respond with, “It means you have 95 per cent less chance of developing COVID-19 two weeks after you have been vaccinated with the second dose of an mRNA vaccine.” </p>
<p>But what’s the long story behind that?</p>
<h2>mRNA vaccines</h2>
<p>There are multiple vaccines against COVID-19. I’ll focus on the Moderna and Pfizer-BioNTech mRNA vaccines used in Canada. They both received emergency use authorization from the <a href="https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-vaccines">U.S. Food and Drug Administration (FDA)</a> and <a href="https://covid-vaccine.canada.ca/">Health Canada</a> in December 2020. The Pfizer-BioNTech vaccine also <a href="https://www.fda.gov/news-events/press-announcements/fda-approves-first-covid-19-vaccine">received full FDA approval in August 2021</a>. Now that it is fully approved, the Pfizer-BioNTech vaccine is also known by a brand name — Comirnaty — but it’s the exact same vaccine that’s been in use since December 2020. </p>
<p>Both the Moderna and Pfizer-BioNTech vaccines require two doses given at least three to four weeks apart. The mRNA (or messenger RNA) in the vaccines contains the instructions for how to make the now-well-known <a href="https://theconversation.com/know-your-target-fundamental-science-will-lead-us-to-coronavirus-vaccines-136952">spike protein</a> on the surface of SARS-CoV-2, the virus that causes COVID-19. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/418805/original/file-20210901-19-1tpc2kl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An arm getting an injection" src="https://images.theconversation.com/files/418805/original/file-20210901-19-1tpc2kl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/418805/original/file-20210901-19-1tpc2kl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/418805/original/file-20210901-19-1tpc2kl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/418805/original/file-20210901-19-1tpc2kl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/418805/original/file-20210901-19-1tpc2kl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/418805/original/file-20210901-19-1tpc2kl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/418805/original/file-20210901-19-1tpc2kl.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">Once the mRNA vaccine is injected, it carries instructions to cells for how to make the SARS-CoV-2 virus’s spike protein, so the immune system can learn to recognize it and build an immune response to it.</span>
<span class="attribution"><span class="source">(AP Photo/Rogelio V. Solis)</span></span>
</figcaption>
</figure>
<p>Once it is injected into a muscle in the upper arm, this mRNA gives the muscle’s cells the instructions to make the spike protein. The immune system practises combating this protein and learns how to react when it recognizes something that has that spike protein on it. </p>
<p>Down the line, if we are exposed to the actual SARS-CoV-2 virus, our body knows how to defend against the virus because it has built immunity by making antibodies against the spike protein on the surface of the virus. These antibodies are our bodies’ protective proteins against SARS-CoV-2.</p>
<h2>Efficacy vs. effectiveness</h2>
<p>The Pfizer-BioNTech and the Moderna vaccines are extremely efficacious and effective against COVID-19. But what do efficacious and effective mean in the context of a vaccine? </p>
<p>Vaccine efficacy is defined as the reduction in the rate of developing disease in vaccinated people compared to unvaccinated people. First, we would calculate the difference in cases between the two groups and then divide it by the rate of unvaccinated cases. For example, if eight out of 21,830 vaccinated people and 162 out of 21,830 unvaccinated people develop the disease, the efficacy of that vaccine would be calculated as:</p>
<blockquote>
<p>(162 / 21830 - 8 / 21830) / (162 / 21830) = 95 per cent </p>
</blockquote>
<p>These numbers are the actual numbers out of <a href="https://www.nytimes.com/2020/12/13/learning/what-does-95-effective-mean-teaching-the-math-of-vaccine-efficacy.html">the Pfizer-BioNTech trial</a>, which reported <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-conclude-phase-3-study-covid-19-vaccine">95 per cent efficacy</a> in its clinical trials. Moderna reported a <a href="https://investors.modernatx.com/news-releases/news-release-details/modernas-covid-19-vaccine-candidate-meets-its-primary-efficacy">similar number (94.5 per cent efficacy)</a> in its trials. </p>
<p>Vaccine efficacy is usually measured under specific controlled environments and in the setting of double-blind <a href="https://theconversation.com/how-effective-are-covid-19-vaccines-heres-what-the-stats-mean-and-what-they-dont-164755">randomized controlled trials</a> (RCTs). A double-blind RCT is a study in which the participants are randomly assigned to either a placebo (no vaccine) or intervention (vaccine) group and neither the researchers nor the participants are aware which group they are assigned to. This setting reduces bias and increases the accuracy of the studies. </p>
<p>Now that we know how efficacy is measured, let’s see what 95 per cent efficacy really means. In simple terms, 95 per cent efficacy means that vaccinated people have a 95 per cent lower chance of developing COVID-19. So, if out of 10,000 unvaccinated people, 100 people get the disease, out of 10,000 vaccinated people, only five people might get the disease.</p>
<h2>Real-world effectiveness</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/418809/original/file-20210901-21-11tx0j.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="People getting vaccinated at an arena set up as a mass vaccination clinic" src="https://images.theconversation.com/files/418809/original/file-20210901-21-11tx0j.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/418809/original/file-20210901-21-11tx0j.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/418809/original/file-20210901-21-11tx0j.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/418809/original/file-20210901-21-11tx0j.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/418809/original/file-20210901-21-11tx0j.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/418809/original/file-20210901-21-11tx0j.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/418809/original/file-20210901-21-11tx0j.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">People receive a dose of the COVID-19 vaccine at a mass vaccination clinic at Scotiabank Arena in Toronto on June 27, 2021. For those getting a second dose, the vaccine would take full effect two weeks later.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Cole Burston</span></span>
</figcaption>
</figure>
<p>Vaccine effectiveness, however, is different from efficacy. Effectiveness is how well a vaccine works in reducing the rate of disease in vaccinated people compared to unvaccinated people under real-world conditions.</p>
<p>It’s worth noting that most studies have defined developing disease as testing positive for COVID-19 and having at least one symptom. The efficacy numbers can change based on the circumstances under which the vaccines are tested. For example, the location of testing, the method of testing, the presence of specific strains or variants of a disease-causing virus and the diversity of the participants can affect the efficacy numbers. That’s why demographic information is collected in clinical trials, <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/Moderna.html">including Moderna</a>’s and <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/Pfizer-BioNTech.html">Pfizer-BioNTech</a>’s vaccine trials. </p>
<p>This means we can’t directly compare the efficacy of one vaccine to another if they have not been tested under the exact same conditions.</p>
<h2>How well are the mRNA vaccines working?</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/418810/original/file-20210901-19-1fkk48n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Empty vials of Moderna's COVID-19 vaccine" src="https://images.theconversation.com/files/418810/original/file-20210901-19-1fkk48n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/418810/original/file-20210901-19-1fkk48n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/418810/original/file-20210901-19-1fkk48n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/418810/original/file-20210901-19-1fkk48n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/418810/original/file-20210901-19-1fkk48n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/418810/original/file-20210901-19-1fkk48n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/418810/original/file-20210901-19-1fkk48n.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">Preliminary studies suggest mRNA vaccines are about 90 per cent effective under real-world circumstances.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Lars Hagberg</span></span>
</figcaption>
</figure>
<p>With <a href="https://ourworldindata.org/covid-vaccinations">more than five billion doses</a> administered around the world, we are at a point where we can also look at the effectiveness of the COVID-19 vaccines. <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/effectiveness.html">Preliminary studies</a> have shown that both mRNA vaccines are about 90 per cent effective in the real world against COVID-19. <a href="https://edmonton.ctvnews.ca/here-s-how-effective-covid-19-vaccines-have-been-in-alberta-1.5456656">The Alberta government has reported</a> 93 per cent effectiveness from the Moderna and 90 per cent effectiveness from the Pfizer-BioNTech vaccine.</p>
<p>And why does it take two weeks to develop that level of immunity? The process of a vaccine making our bodies immune against a disease has <a href="https://theconversation.com/covid-19-vaccines-how-pfizers-and-modernas-95-effective-mrna-shots-work-149957">multiple steps</a>. Remember the protective proteins called antibodies? One of the last steps in the immunity process is making those antibodies. </p>
<p><a href="https://www.theatlantic.com/health/archive/2021/03/how-long-wait-fully-vaccinated/618303/">Based on the studies done by the vaccine makers</a>, at around 14 days after the second dose, our bodies have made enough antibodies to recognize and fight SARS-CoV-2, hence the two-week rule before you are considered fully vaccinated.</p>
<p>One important statistic that needs to be mentioned is that both mRNA vaccines have been shown to prevent hospitalizations and deaths. This means that even in the rare case of a vaccinated individual developing COVID-19, the likelihood of them being hospitalized or dying is very much lower than if they hadn’t been vaccinated.</p>
<h2>How do COVID-19 vaccines compare to others?</h2>
<p>Another question I’ve been asked is how the effectiveness from the COVID-19 vaccines compares to the vaccines made for other diseases. Well, the MMR vaccine is <a href="https://www.cdc.gov/vaccines/vpd/mmr/public/index.html">97 per cent effective against measles and rubella and 88 per cent against mumps</a>. The effectiveness of the DTaP vaccine (diphtheria, tetanus, acellular pertussis) is between <a href="https://www.immunize.org/askexperts/experts_per.asp">80-85 per cent</a>. The effectiveness of the flu vaccine hovers <a href="https://www.cdc.gov/flu/vaccines-work/past-seasons-estimates.html">between 10-60 per cent</a> depending on the year, the strains the vaccine protects against each year and the actual strains causing influenza and influenza-like diseases.</p>
<p>These numbers all reflect the reduction in the rate of disease between vaccinated and unvaccinated people. So next time you hear a vaccine is 95 per cent effective, that doesn’t mean five per cent of the people who got the vaccine will develop the disease; it means that vaccinated people have 95 per cent less chance of developing the disease compared to unvaccinated people.</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/167046/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ehsan Misaghi 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>A medical student answers questions he gets asked at a COVID-19 vaccine clinic: Efficacy versus real-world effectiveness, immune response and how the mRNA vaccines compare to vaccines already in wide use.Ehsan Misaghi, Clinician-Scientist Trainee, Faculty of Medicine & Dentistry and Faculty of Science, University of AlbertaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1667092021-08-26T21:39:32Z2021-08-26T21:39:32ZPfizer’s COVID-19 vaccine now has full FDA approval. Here’s what that means for unvaccinated people, organizations and pharma<figure><img src="https://images.theconversation.com/files/418126/original/file-20210826-547-ksvhwl.jpg?ixlib=rb-1.1.0&rect=299%2C80%2C4664%2C3338&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">FDA approval of Pfizer's COVID-19 vaccine may boost vaccination rates among those who have been hesitant to get the shot.</span> <span class="attribution"><span class="source"> (AP Photo/Jessica Hill) </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/pfizer-s-covid-19-vaccine-now-has-full-fda-approval--here-s-what-that-means-for-unvaccinated-people--organizations-and-pharma" width="100%" height="400"></iframe>
<p>The <a href="https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/comirnaty-and-pfizer-biontech-covid-19-vaccine">U.S. Food and Drug Administration approved</a> the Pfizer-BioNTech coronavirus vaccine for use in people 16 and older on Aug. 23. Describing FDA approval as “the gold standard,” <a href="https://www.whitehouse.gov/briefing-room/speeches-remarks/2021/08/23/remarks-by-president-biden-on-the-covid-19-response-and-the-vaccination-program-7/">U.S. President Joe Biden</a>, heralded the moment as “a key milestone in our nation’s fight against COVID.”</p>
<p>This milestone was achieved as a result of the unprecedented pace of <a href="https://theconversation.com/explainer-how-clinical-trials-test-covid-19-vaccines-146061">vaccine development</a>. The <a href="https://www.nytimes.com/interactive/2020/science/coronavirus-vaccine-tracker.html?action=click&module=Top%20Stories&pgtype=Homepage#pfizer">Pfizer-BioNTech vaccine</a> moved from concept to pivotal clinical trial to the FDA granting an emergency use authorization in record time. Since Dec. 11, 2020, <a href="https://www.statista.com/statistics/1198516/covid-19-vaccinations-administered-us-by-company/#statisticContainer">205 million doses</a> of the vaccine have been administered in the U.S., and <a href="https://health-infobase.canada.ca/covid-19/vaccination-coverage/#a6">more than 26 million</a> in Canada.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
</figcaption>
</figure>
<p>But what’s the difference between an FDA emergency use authorization and full approval? And what impact is FDA approval likely to have on unvaccinated people, doctors, organizations and the pharmaceutical industry?</p>
<p>With surging numbers of cases and hospitalizations driven by the <a href="https://theconversation.com/covid-19-delta-variant-in-canada-faq-on-origins-hotspots-and-vaccine-protection-162653">Delta variant</a>, the hope is that FDA approval will provide a timely boost to vaccination rates.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/UD0K7D3ieYc?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">President Biden urges unvaccinated Americans to get the Pfizer COVID-19 now that it has full FDA approval.</span></figcaption>
</figure>
<p><a href="https://www.whitehouse.gov/briefing-room/speeches-remarks/2021/08/23/remarks-by-president-biden-on-the-covid-19-response-and-the-vaccination-program-7/">President Biden</a> appealed directly to those yet to receive the vaccine: “If you are one of the millions of Americans who said that they will not get the shot until it has full and final approval of the FDA, it has now happened. The moment you have been waiting for is here. It is time for you to go and get your vaccination.”</p>
<h2>What is emergency use authorization?</h2>
<p>In the event of a public health emergency, an <a href="https://www.fda.gov/emergency-preparedness-and-response/mcm-legal-regulatory-and-policy-framework/emergency-use-authorization">emergency use authorization</a> allows the FDA to make an unapproved medical product available for use. The <a href="https://www.fda.gov/regulatory-information/search-fda-guidance-documents/emergency-use-authorization-medical-products-and-related-authorities">FDA may grant such authorization</a> provided the available evidence makes it “reasonable to believe that the product may be effective” and there is “no adequate, approved and available alternative.” Importantly, the authorization is limited to the duration of the health emergency.</p>
<p>Recognizing that COVID-19 vaccines would be administered to millions of healthy people, the FDA set a <a href="https://blog.petrieflom.law.harvard.edu/2021/06/15/whats-the-difference-between-vaccine-approval-bla-and-authorization-eua/">high evidentiary bar for authorization</a>. Evidence supporting the vaccine’s safety and efficacy from a well-conducted clinical trial with at least two months of followup is required.</p>
<p>The FDA’s emergency use authorization of the Pfizer-BioNTech vaccine was based on review of a clinical trial with 44,000 people, half of whom had received the vaccine and half the placebo. The trial demonstrated the vaccine prevents 95 per cent of symptomatic COVID-19.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/iGkwaESsGBQ?wmode=transparent&start=100" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Under emergency use authorization, the FDA can provide more timely access to urgently needed drugs and medical products.</span></figcaption>
</figure>
<h2>What does FDA approval add?</h2>
<p><a href="https://blog.petrieflom.law.harvard.edu/2021/06/15/whats-the-difference-between-vaccine-approval-bla-and-authorization-eua/">FDA approval</a> is based on review of a biologics license application, the standard mechanism for the review of novel drugs and vaccines. The product must be demonstrated to be “safe, pure and potent.” For coronavirus vaccines, this means completion of well-conducted clinical trials with six months of followup as well as review of the manufacturing process.</p>
<p>For the Pfizer-BioNTech vaccine, <a href="https://www.wsj.com/articles/the-fda-covid-vaccine-sprint-pfizer-full-approval-11629752800">the FDA reviewed 340,000 pages of data</a> supporting the vaccine’s safety and efficacy — about three times the amount of data contained in the application for emergency use. Additionally, the FDA inspected manufacturing facilities and negotiated the labelling information.</p>
<p>The FDA’s approval of the vaccine will likely affect unvaccinated people, organizations, doctors and the pharmaceutical industry.</p>
<h2>Unvaccinated people</h2>
<figure class="align-right ">
<img alt="A hand preparing a dose of Pfizer's COVID-19 vaccine" src="https://images.theconversation.com/files/418138/original/file-20210826-4978-dxlwt1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/418138/original/file-20210826-4978-dxlwt1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=738&fit=crop&dpr=1 600w, https://images.theconversation.com/files/418138/original/file-20210826-4978-dxlwt1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=738&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/418138/original/file-20210826-4978-dxlwt1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=738&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/418138/original/file-20210826-4978-dxlwt1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=927&fit=crop&dpr=1 754w, https://images.theconversation.com/files/418138/original/file-20210826-4978-dxlwt1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=927&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/418138/original/file-20210826-4978-dxlwt1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=927&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">FDA approval sends a clear message that the COVID-19 vaccine is safe and effective.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Jonathan Hayward</span></span>
</figcaption>
</figure>
<p>FDA approval has sent a clear message that the Pfizer-BioNTech vaccine is both safe and effective. Evidence from clinical trials and surveillance of roughly 92 million vaccinated Americans provide a robust foundation for this claim. </p>
<p>The hope is that FDA approval will entice some of the <a href="https://www.nytimes.com/2021/08/23/health/pfizer-vaccine-approval-fda.html">85 million eligible but unvaccinated Americans to get the shot</a>. Maryland School of Public Health <a href="https://www.washingtonpost.com/health/2021/08/23/pfizer-vaccine-full-approval/">professor Sandra C. Quinn</a> explains that “full approval takes away that ‘Oh, it’s experimental’ kind of language. For some people, it might make a difference. They will feel more confident and comfortable.”</p>
<p>How much of a difference might FDA approval make? A June 2021 poll conducted by the <a href="https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-june-2021/">Kaiser Family Foundation COVID-19 Vaccine Monitor</a> found “three in 10 unvaccinated adults, rising to about half of those in the ‘wait and see’ group, say they would be more likely to get vaccinated if one of the vaccines … were to receive full approval from the FDA.”</p>
<h2>Physicians</h2>
<p>What impact does FDA approval have on doctors? The main difference is that once a drug or vaccine is approved for use, physicians are free to prescribe it for off-label indications, which are uses other than those specifically approved. </p>
<p>Dr. Eric Topol, professor of molecular medicine at non-profit Scripps Research, <a href="https://www.mercurynews.com/2021/08/23/how-fda-approval-will-change-covid-19-vaccinations/">worries that FDA approval</a> of the Pfizer-BioNTech vaccine “will usher in millions of prescriptions by doctors.” Booster shots for fully vaccinated healthy adults would run ahead of FDA’s review of boosters expected in September.</p>
<p><a href="https://www.nytimes.com/2021/08/23/health/pfizer-vaccine-approval-fda.html">Acting FDA Commissioner Janet Woodcock describes</a> the prospect of physicians prescribing vaccine to children as “of great concern.” The proper dose of vaccine and its safety in children under 12 has yet to be established, and widespread prescribing may undermine ongoing clinical trials.</p>
<h2>Organizations</h2>
<figure class="align-right ">
<img alt="A sign outside a restaurant stating " src="https://images.theconversation.com/files/418137/original/file-20210826-13-1qr8joa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/418137/original/file-20210826-13-1qr8joa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/418137/original/file-20210826-13-1qr8joa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/418137/original/file-20210826-13-1qr8joa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/418137/original/file-20210826-13-1qr8joa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/418137/original/file-20210826-13-1qr8joa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/418137/original/file-20210826-13-1qr8joa.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">FDA approval of Pfizer’s COVID-19 vaccine may result in more organizations requiring vaccination.</span>
<span class="attribution"><span class="source">(AP Photo/Haven Daley)</span></span>
</figcaption>
</figure>
<p>FDA approval of the Pfizer-BioNTech vaccine has green-lighted vaccine mandates across government and the private sector. Although FDA approval <a href="https://blog.petrieflom.law.harvard.edu/2021/06/15/whats-the-difference-between-vaccine-approval-bla-and-authorization-eua/">may not be legally required for vaccine mandates</a>, cautious employers put potential mandates on hold awaiting approval. </p>
<p>Monday’s announcement thus triggered a wave of vaccine mandates. The <a href="https://www.nytimes.com/2021/08/23/us/pfizer-vaccine-mandates.html">Pentagon announced</a> that it is “moving ahead with plans to require all active-duty troops to be vaccinated.” New York City’s <a href="https://www.nytimes.com/2021/08/23/nyregion/nyc-schools-employee-vaccine-mandate.html">Department of Education will now require</a> all employees to be vaccinated. Oil producer <a href="https://www.nytimes.com/2021/08/23/business/chevron-coronavirus-vaccine-mandate.html">Chevron will mandate</a> vaccination for all field workers.</p>
<h2>Pharma industry</h2>
<p>FDA approval allows a drug company to market a drug or vaccine for approved indications. Further, unlike an emergency use authorization that is time limited, approval is open-ended. </p>
<p>The short-term impact of approval for the Pfizer-BioNTech vaccine is likely to be minor simply because it is already in use globally. Pfizer-BioNTech currently has contracts with the United States for <a href="https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-provide-us-government-additional-200">one billion doses</a> and the European Union for <a href="https://ec.europa.eu/commission/presscorner/detail/en/ip_21_2548">1.8 billion doses</a>. Canada’s agreement with Pfizer guarantees <a href="https://www.canada.ca/en/public-services-procurement/services/procuring-vaccines-covid19.html">65 million doses over the next two years</a>. </p>
<p>FDA approval of the Pfizer-BioNTech vaccine does, however, make it <a href="https://blog.petrieflom.law.harvard.edu/2021/06/15/whats-the-difference-between-vaccine-approval-bla-and-authorization-eua/">more difficult for a new vaccine to be granted an emergency use authorization</a>. Recall that such an authorization requires that there be no approved alternative. Any new vaccine will be unable to meet this requirement, and this will give existing approved or authorized vaccine makers a strategic advantage.</p>
<p>Finally, FDA approval is an endorsement of the novel messenger RNA vaccine platform. <a href="https://theconversation.com/3-mrna-vaccines-researchers-are-working-on-that-arent-covid-157858">Novel mRNA vaccines against influenza, malaria and even cancer</a> are currently in development. In the long term, this may be the greatest boon for pharma companies using this technology. </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/166709/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charles Weijer receives consulting income from Cardialen, Eli Lilly & Company, and Research Triangle Institute International.</span></em></p>The U.S. FDA has approved the first COVID-19 vaccine. How is approval different from emergency use authorization, and what difference will it make to a vaccine that’s already in global use?Charles Weijer, Professor of medicine, epidemiology & biostatistics, and philosophy, Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1652292021-08-24T14:32:20Z2021-08-24T14:32:20ZIndigenous children’s book ‘Little Louis’ aims to curb COVID-19 vaccine hesitancy with a culturally relevant story<figure><img src="https://images.theconversation.com/files/417088/original/file-20210819-23-o3wag8.jpg?ixlib=rb-1.1.0&rect=6%2C0%2C802%2C1079&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The children's book, Little Louis, tells the story of a young boy preparing for his COVID-19 vaccination.</span> <span class="attribution"><span class="source">(Morning Star Lodge)</span>, <span class="license">Author provided</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/indigenous-children-s-book--little-louis--aims-to-curb-covid-19-vaccine-hesitancy-with-a-culturally-relevant-story" width="100%" height="400"></iframe>
<p>The COVID-19 pandemic has been difficult for everyone. But communities are different, and so are <a href="http://dx.doi.org/10.1136/jech-2020-214401">their pandemic experiences</a>. After more than a year of uncertainty and frustration, <a href="https://www.sciencemag.org/news/2021/02/how-soon-will-covid-19-vaccines-return-life-normal">vaccines have brought many a sense that a return to normal</a> is on the horizon. However, health and research communities now face a new challenge: vaccine hesitancy. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
</figcaption>
</figure>
<p>While there are countless reasons to be vaccine hesitant, we must acknowledge the numerous legitimate reasons for hesitancy. </p>
<p>For example, if a community has experienced an exhausting history of <a href="https://doi.org/10.1353/his.2013.0015">medical experimentation</a>, <a href="https://www.cbc.ca/radio/thecurrent/the-current-for-november-13-2018-1.4902679/indigenous-women-kept-from-seeing-their-newborn-babies-until-agreeing-to-sterilization-says-lawyer-1.4902693">forced or coerced sterilization</a> and breaches of trust by the very institutions presenting the vaccine, their hesitancy is based on <a href="https://doi.org/10.4161/hv.24657">cultural or historical factors</a> and entirely distinct from the <a href="https://theconversation.com/the-inherent-racism-of-anti-vaxx-movements-163456">“anti-vaxx” movement</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/nutrition-researchers-saw-malnourished-children-at-indian-residential-schools-as-perfect-test-subjects-162986">Nutrition researchers saw malnourished children at Indian Residential Schools as perfect test subjects</a>
</strong>
</em>
</p>
<hr>
<p>This is the daunting reality for <a href="https://doi.org/10.1503/cmaj.210112">many Indigenous communities</a> across the country. As a result, there is an urgent need to repair trust and promote vaccine confidence through evidence-based knowledge.</p>
<p>At <a href="https://www.indigenoushealthlab.com/">Morning Star Lodge</a>, we are part of a partnership between the community research advisory committee at <a href="https://fhqtc.com/star-blanket/">Star Blanket Cree Nation</a> and <a href="https://kidsinpain.ca/">Solutions for Kids in Pain (SKIP)</a>. Together we have collaborated to promote vaccine confidence while demonstrating the importance of community-led research.</p>
<h2>Reflecting culture</h2>
<p>We entered into this partnership to promote vaccine uptake under the direction of Indigenous communities. Through our discussions, we came to solutions about ways we could promote COVID-19 vaccination information — like booklets <a href="https://tinyurl.com/AllAboutMeKids">for Indigenous children</a> <a href="https://tinyurl.com/AllAboutMeAdults">and adults</a>. After coming up with several solutions, Star Blanket Cree Nation’s research advisory committee members pointed towards an additional need: A children’s book, and in came <em>Little Louis</em>. </p>
<p>Many Indigenous Peoples grew up without medical information that respected or reflected their culture, the CRAC recognized the need to reverse this trend. A children’s book that reflects the identities of Indigenous children is important for making information accessible to all.</p>
<p>SKIP, Morning Star Lodge and Indigenous community members began to prepare a children’s book that is engaging, educational and relevant for Indigenous children experiencing needle fear or vaccine hesitancy — seeing their culture reflected in a children’s book can make all the difference when it comes to getting the jab. Needle fear or hesitation <a href="https://doi.org/10.1503/cmaj.150391">is a common feeling</a> and there is minimal children’s literature on the topic, especially literature that is culturally relevant. </p>
<p>The Star Blanket Cree Nation’s cultural, community and <a href="http://mediacentre.maramatanga.ac.nz/system/files/NPM%20Conference%20Proceedings%202012.pdf#page=32">storytelling</a> expertise far exceeds that of SKIP or Morning Star Lodge. The community research advisory committee members live in, and are from, the communities we serve, <a href="https://www.ictinc.ca/blog/what-does-indigenous-knowledge-mean">their Indigenous Knowledge adds depth and relevance to all of our projects</a>. Their guidance and leadership ensures that developments, like <em>Little Louis</em>, directly reflect community needs. </p>
<h2>Indigenous Peoples expertise, guidance and leadership</h2>
<p><em>Little Louis</em> talks about how to prepare for getting a vaccine, what vaccines feel like and what parents and children can do in order to be supported. The intention is that <em>Little Louis</em> will evolve into several different stories that will target different audiences and address different issues as time goes on and different issues arise. This sort of flexibility is a requisite to working with dynamic communities.</p>
<p>Inflexible research was and is often the norm. <a href="https://irb.cherokee.org/media/rkknqeww/helicopter-research.pdf">“Helicopter” research</a> (where researchers enter communities, collect data and leave, never to be heard from again) was and is still practised. This entirely one-sided interaction always benefits researchers but rarely, if ever, benefits communities. It frequently misrepresents realities for Indigenous communities and <a href="http://doi.org/10.3233/SJI-180478">actively creates negative stereotypes</a> that have been used to justify systemic racism. </p>
<p>Historically, research with Indigenous Peoples was not conducted “<a href="https://caan.ca/tools-and-resources/resource/doing-research-in-a-good-way">in a good way</a>.” Today, researchers can be guided to correct the errors of the past through principles like <a href="https://fnigc.ca/ocap-training/">OCAP (ownership, control, access and possession)</a> and the <a href="https://www.gida-global.org/care">CARE and FAIR principles for Indigenous data governance</a>. Further, researchers can learn about <a href="https://www.indigenoushealthlab.com/courses">ethical engagement and cultural safety</a> to ensure their research is truly ethical and upholds community perspectives.</p>
<p><a href="https://ethics.gc.ca/eng/tcps2-eptc2_2018_chapter9-chapitre9.html">In practice, this means Indigenous Peoples should be at the helm</a> of any research that may impact them or is about them. Doing so can prevent harmful misrepresentations, promote self-determination and contribute to solutions Indigenous communities actually need — like a children’s book that addresses vaccine hesitancy.</p>
<p><em>The following is a synopsis of “Little Louis.” Check the <a href="https://www.indigenoushealthlab.com/blog">Morning Star Lodge blog for updates on publication</a>.</em></p>
<h2>Meet <em>Little Louis</em></h2>
<p><em>Little Louis</em> tells the story of Louis, a young boy preparing for his COVID-19 vaccination. Louis starts by sharing his fears and frustrations with safety restrictions and the vaccine. His family listens and tells him how brave he is for making the decision to keep himself and the community safe. </p>
<p>Still nervous and hesitant about the vaccine, Louis’ family has an idea to create a “little” Louis, out of paper, which he can bring to the vaccination clinic during his appointment. Louis’ family also shares the story of a <a href="http://www.metismuseum.ca/media/db/06280">brave Métis leader named Gabriel Dumont</a> and his rifle, <em>le petit</em> (little one). </p>
<p>The night before the vaccination appointment, Louis dreams of going on a fishing adventure with Little Louis where they reel in what they think is a fish but it turns out to be a big needle! Louis and Little Louis both bravely face the needle, reeling it in until it turns into the big catch they hoped for. The next morning Louis shares his dream with his family. They tell him that he was brave for facing his fears. </p>
<p>Finally, Louis goes to his vaccine appointment with Little Louis by his side. The doctor asks to see Little Louis to give him the vaccine first. Observing that Little Louis was brave and didn’t get scared, Louis is ready and the doctor gives Louis his vaccine. Both Louis and Little Louis are now protected from COVID-19! </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/165229/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Patrick Sullivan is directly employed by Morning Star Lodge and, by extension, indirectly employed by the communities Morning Star Lodge serves. Therefore, Patrick has an interest in promoting the methodologies utilized by Morning Star Lodge and the priorities identified by community members. </span></em></p><p class="fine-print"><em><span>Heather O'Watch 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>There is an urgent need to combat historically fuelled vaccine hesitancy within Indigenous communities. The best way to do this is through evidence-based knowledge and community-led work.Patrick Sullivan, Sr. Research Assistant, Morning Star Lodge, University of SaskatchewanHeather O'Watch, Research Assistant, Morning Star Lodge, University of SaskatchewanLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1650092021-08-17T13:43:59Z2021-08-17T13:43:59ZNeedle fears can cause COVID-19 vaccine hesitancy, but these strategies can manage pain and fear<figure><img src="https://images.theconversation.com/files/416135/original/file-20210813-17-1n0y7ff.jpg?ixlib=rb-1.1.0&rect=0%2C220%2C4608%2C3131&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Unmanaged needle fear is very distressing for those affected and can influence health-care choices. Science-backed methods can help people manage their phobia and get vaccinated.</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/needle-fears-can-cause-covid-19-vaccine-hesitancy--but-these-strategies-can-manage-pain-and-fear" width="100%" height="400"></iframe>
<p>Think of the last time you were really afraid — and I mean terrified: Cold sweats, trembling, pounding heart. Now think about what it would be like to have that reaction if you saw a needle or even heard people talking about COVID-19 vaccines. </p>
<p>For about <a href="https://doi.org/10.1097/ajp.0000000000000272">1 in 10 people</a>, this is their reality, and it matters for COVID-19 vaccine campaigns. First, when we are highly anxious about something, we tend to avoid or delay it. Second, experiencing high fear and a stress response can lead to escape behaviour (like leaving or acting aggressively), enduring the procedure under immense distress and experiencing symptoms of <a href="https://www.who.int/publications/i/item/10665330277">immunization stress-related responses</a>, such as <a href="http://dx.doi.org/10.15585/mmwr.mm7018e3">feeling dizzy or fainting</a>. Third, needle fears can, in turn, be increased by experiencing or hearing about an immunization stress-related responses from others. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410911/original/file-20210712-19-geybnm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://theconversation.com/ca/topics/vaccine-confidence-in-canada-107061">Click here for more articles in our series about vaccine confidence.</a></span>
</figcaption>
</figure>
<p>The critical thing to know is that these immunization stress-related responses do not result from something being wrong with the vaccine itself. Instead, they can occur <a href="https://doi.org/10.14745/ccdr.v46i06a10">before, during and after</a> injections due to a stress response. Nonetheless, they can disrupt vaccination campaigns.</p>
<p>The good news: there are science-backed strategies to help.</p>
<h2>Needle fear and vaccine hesitancy</h2>
<p>Vaccine hesitancy is complex because people delay or refuse vaccination for many reasons. A <a href="https://kidsinpain.ca/wp-content/uploads/2021/06/Vaccine-Hesitancy-Survey-Executive-Summary-SKIP-and-HEC-2021.pdf">COVID-19 poll</a> showed that of Canadians who did not plan on being vaccinated or were not sure, six to seven per cent had delayed previous vaccinations because of needle fear.</p>
<p>As a clinical psychologist, I have researched and worked with individuals with different levels of needle fear from mild to extreme. Some degree of fear of needles is common and occurs in <a href="https://doi.org/10.1111/jan.13818">most children, up to half of adolescents, and 20 to 30 per cent of people aged 20 to 40</a>. Much of my work focuses on children for three reasons: </p>
<ol>
<li>They experience frequent needles due to recommended vaccination schedules;</li>
<li>They are vulnerable to negative experiences from undermanaged pain; and </li>
<li>These negative experiences can have lasting effects. In fact, most adults with high levels of needle fear report a <a href="https://doi.org/10.1016/0005-7967(94)90161-9">negative previous experience</a>.</li>
</ol>
<p>Needles are to some degree painful, and pain is subjective. There have been huge <a href="https://itdoesnthavetohurt.ca/">campaigns to get evidence-based pain management strategies to the public</a>. In 2015, we conducted a <a href="https://journals.lww.com/clinicalpain/toc/2015/10001">series of rigorous reviews</a> to <a href="https://doi.org/10.1503/cmaj.150391">make recommendations</a> on the best ways to make vaccinations comfortable. </p>
<h2>Science-backed strategies</h2>
<p>The Comfort, Ask, Relax, Distract (CARD) system can <a href="https://dx.doi.org/10.14745%2Fccdr.v47i01a12">help clinics</a>, <a href="https://immunize.ca/card-adults">individuals</a> and <a href="https://www.immunize.ca/card-parents">parents make</a> the vaccination experience as comfortable as possible. If you are mildly to moderately fearful of needles and concerned about pain associated with COVID-19 vaccinations, you will want to make a coping plan for before, during and after the injections. </p>
<ul>
<li>What will you wear for easy access to your upper arms? </li>
<li>What will you do while waiting at the clinic (read, listen to music, play a video game)? </li>
<li>Do you need to purchase a topical anesthetic to numb your skin at the injection site? </li>
<li>How do you want the clinician to indicate they are starting, such as “One, two, three, here we go”? </li>
<li>During the injection, decide if you want to look at it or away and tell the clinician what you need. </li>
<li>During the procedure, do you want to talk about something else, play on your phone or listen to guided imagery? </li>
<li>Afterwards, how will you reward yourself and remember what helped? You could take a short video describing what went well to help you next time.</li>
</ul>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/416126/original/file-20210813-19-1me0ywh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A young man looking upward while getting an injection" src="https://images.theconversation.com/files/416126/original/file-20210813-19-1me0ywh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/416126/original/file-20210813-19-1me0ywh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=438&fit=crop&dpr=1 600w, https://images.theconversation.com/files/416126/original/file-20210813-19-1me0ywh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=438&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/416126/original/file-20210813-19-1me0ywh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=438&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/416126/original/file-20210813-19-1me0ywh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=550&fit=crop&dpr=1 754w, https://images.theconversation.com/files/416126/original/file-20210813-19-1me0ywh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=550&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/416126/original/file-20210813-19-1me0ywh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=550&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Deciding in advance whether to watch the injection or look away is one step in managing needle fears.</span>
<span class="attribution"><span class="source">(AP Photo/Phil Long)</span></span>
</figcaption>
</figure>
<p>Individuals who are extremely fearful of needles will need more than the strategies described above, intended to manage pain and lower levels of fear closer to the time of the needles. Essentially, these individuals need to gain confidence that what they are most afraid of won’t happen, or if it does, they can survive it. This is the essence of exposure-based treatment for fears that are out of proportion to the danger posed. </p>
<p><a href="https://doi.org/10.1016/j.cpr.2006.10.002">Exposure-based therapy is considered the gold standard approach for “specific phobias,”</a> which is what extreme needle fear falls under within the Diagnostic and Statistical Manual of Mental Disorders. The technical term is “specific phobia, blood injection injury subtype,” estimated to occur in about 3.5 per cent of people. </p>
<p><a href="https://doi.org/10.1080/16506073.2016.1157204">I have argued elsewhere</a> that we need to care about the approximately 10 per cent who have high fear, whether or not they have a mental health diagnosis related to needles. This is because <a href="https://doi.org/10.1155/2014/471340">up to 94 per cent</a> of affected people won’t go to a professional to get that diagnosis, but are still suffering and in need of help.</p>
<p>Exposure therapy can occur in person or through imagining the feared situation. <a href="https://rsc-src.ca/en/voices/high-needle-fear-and-covid-19-vaccines">Here’s an overview</a>: </p>
<p>First, an individual is asked to create a list of all of the situations and aspects related to getting a needle that make them afraid: Is it about seeing blood? Feeling the needle enter the body? The pain? Feeling dizzy? Or something else? </p>
<figure class="align-center ">
<img alt="A roll of pink stickers reading 'I got my COVID-19 shot!'" src="https://images.theconversation.com/files/416127/original/file-20210813-17-oqqzsw.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/416127/original/file-20210813-17-oqqzsw.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/416127/original/file-20210813-17-oqqzsw.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/416127/original/file-20210813-17-oqqzsw.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/416127/original/file-20210813-17-oqqzsw.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/416127/original/file-20210813-17-oqqzsw.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/416127/original/file-20210813-17-oqqzsw.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">Managing needle-related pain and fear can help increase COVID-19 vaccinations, but also maximize comfort and confidence in all needle procedures.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Lars Hagberg</span></span>
</figcaption>
</figure>
<p>Then the individual rates their fear for each of these situations and creates a fear hierarchy which starts with the least feared situation (for example, looking at pictures of needles) and moves in small increments to the most feared (for example, vaccine injection). The person practises each step until their fear comes down before moving to the next one.</p>
<p>Some individuals feel dizzy or faint during needles. This is more common in individuals with high levels of fear. A strategy called <a href="https://immunize.ca/sites/default/files/Resource%20and%20Product%20Uploads%20(PDFs)/COVID-19/fainting-muscle-%20tension-resource-AODA-compliant-e.pdf">muscle tension</a> — a technique of tensing and releasing muscles — can help avoid the sudden drop in blood pressure that leads to dizziness and fainting. Someone with high needle fear can practise doing muscle tension when completing their fear hierarchy steps.</p>
<h2>Maximizing comfort and confidence</h2>
<p>You can imagine how much motivation and bravery is required for an individual to willingly face their fears and this affects how <a href="https://doi.org/10.1016/j.cpr.2006.10.002">acceptable the treatment is</a>. With my colleagues, I am working on creating more accessible exposure-based interventions for high levels of needle fear. <a href="https://doi.org/10.12688/f1000research.20082.1">Other treatments that may be promising</a>, such as eye movement desensitization and reprocessing, also warrant investigation by researchers.</p>
<p>Unmanaged needle fear is very distressing for those affected and can influence health-care choices. But it’s not their choice to be afraid. The COVID-19 pandemic has brought needle fear into the spotlight like nothing before. Yet, even outside COVID-19, needles are a common part of health care for prevention, diagnosis and treatment. </p>
<p>Ignoring needle fear doesn’t make it go away — in fact, for the person with the fear, avoidance just makes it worse. By consistently managing needle-related pain and fear, we have an opportunity to not only increase COVID-19 vaccinations, but also maximize comfort and confidence in health-care interactions and needle procedures more broadly. </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/165009/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Meghan McMurtry has received funding from the Canadian Institutes of Health Research, the Public Health Agency of Canada, the Canadian Foundation for Innovation, and the Ministry of Research and Innovation. She was a member of the working group on Immunization Stress-Related Responses for the Global Advisory Committee on Vaccine Safety for the World Health Organization and a member of the Royal Society of Canada's COVID-19 working group on Vaccine Acceptance. </span></em></p>For the one in 10 people with a significant fear of needles, getting a vaccination is distressing. This can disrupt vaccination campaigns, but there are effective ways to manage pain and fear.Meghan McMurtry, Associate Professor in Psychology, University of GuelphLicensed as Creative Commons – attribution, no derivatives.