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COVID-19 Wrap: Exploring milestones, vaccine inequity, hesitancy and communications

Introduction by Croakey: To date, Australia’s vaccine promotion efforts “have not been particularly engaging”, perhaps due to an over-reliance on consulting firms over vaccine social science researchers, according to a timely analysis at The Conversation.

The Government could learn also from the vaccination promotions from other countries that public health researcher Alison Barrett has tracked down for the latest edition of the COVID-19 Wrap, which also investigates what’s best needed to communicate a health emergency. Plus much more, as always.


Alison Barrett writes:

It is now six months since the first COVID-19 vaccine worldwide was administered to a grandmother in the United Kingdom on 8 December 2020.

Since then, 2.36 billion doses of vaccine have been administered (as at 12 June), and 495.5 million people are considered fully vaccinated (either by receiving two doses, or in the case of the Johnson and Johnson vaccine, one dose).

Sourced from Our World in Data,12 June 2021, under Creative Commons License.

With high vaccination rates compared to other countries, the United States and UK have reached positive milestones in recent weeks.

Last week, the US recorded its lowest seven-day average of COVID-19 cases since 29 March 2020, and the UK recorded zero deaths from COVID-19 on 1 June 2021, for the first time since March 2020. However, the UK is currently experiencing an increase in cases, resulting from the Delta variant of the virus.

Last week the World Health Organization’s Director-General Dr Tedros Adhanom Ghebreyesus said: “Increasingly, we see a two-track pandemic. Many countries still face an extremely dangerous situation, while some of those with the highest vaccination rates are starting to talk about ending restrictions.”

As highlighted in the map below, administration of vaccines globally is unequal. Many countries in Africa and South East Asia are lagging behind the US, Canada, China and Western Europe.

Sourced from Our World in Data, 12 June 2021, under Creative Commons License.

As of 14 June 2021, Australia had administered 5.77 million single doses (20 percent of the population), and 2.7 percent of the population has been fully vaccinated.

Additional to tracking global vaccine data on Our World in Data, Australia’s vaccine rollout numbers can be tracked on The Guardian.


Vaccine promotion videos from across the globe

The following is not an exhaustive compilation of COVID-19 vaccine promotion videos being rolled out across the globe, but highlights some examples.

I have been unable to date to find videos for countries in Africa or South America, so if you see any, please share them with me (via Twitter at @alisonsbarrett). I would love to see them and pass them on.

France: Solidarity and Health Minister Olivier Veran shared this new vaccine video on Twitter on 9 June 2021, with the message, “With each vaccination, life begins again. Let’s all get vaccinated now.”

Germany: The German Federal Ministry of Health has enlisted David Hasselhoff, who is of German descent, to promote COVID-19 vaccines in a video shared also via Twitter. In case you missed It, Germany also produced a great tongue-in-cheek video clip during pandemic restrictions, urging young Germans to do their patriotic duty in the war against coronavirus by just staying at home.

Canada: The Federal Government’s campaign, ‘We can all help by getting vaccinated,’ has been running since 14 May 2021, with links to information about the different vaccines and vaccination data, and shareable resources available in multiple languages. It also has a series of animations explaining key concepts of vaccine development and safety. ‘Hope is Stronger than Fear’ is a COVID-19 vaccine message from the Manitoba Keewatinowi Okimakanak, First Nations people in Manitoba.

China: The Sichuan province’s ‘Get jabbed quick’ rap song encourages COVID-19 vaccinations.

United Kingdom: Sirs Elton John and Michael Caine encourage people to get a COVID-19 vaccine for the UK’s National Health Service.

Northern Ireland: The Public Health Agency’s message is that “Every vaccination brings us closer together.”

Singapore: Its catchy ‘Get your shot!’ video has been viewed 1.4 million times via YouTube since being published on 2 May 2021.

New Zealand: Ka kite, COVID’ (‘see you, COVID’), by NZ’s Ministry of Health, shares reasons why people are getting vaccinated against COVID.

One Campaign: One Campaign, co-founded by U2’s Bono, has launched a campaign to raise awareness about the inequitable distribution of vaccines and limited access faced by lower-middle income countries, saying: “If this vaccine isn’t everywhere, then this pandemic isn’t going anywhere.” View all seven videos in the Pandemica Series One here.

Australia: The Federal Department of Health has developed a series of animated explainer videos,  and video resources for Aboriginal and Torres Strait Islander people. More COVID-19 vaccine resources for Aboriginal and Torres Strait Islander people are available on the Aboriginal Health and Medical Research Council of NSW website.


Communicating about vaccine safety

Publication: Communicating with patients and the public about COVID-19 vaccine safety: recommendations from the Collaboration on Social Science in Immunisation. Leask, J, et al., 17 May 2021, Medical Journal of Australia

Risk communication about COVID-19 vaccine safety has been impacted by the decision to make the Pfizer vaccine the preferred vaccine for Australians under 50 years.

The Australian Technical Advisory Group on Immunisation (ATAGI) announced this decision on 8 April 2021 in light of evidence that the AstraZeneca (AZ) vaccine causes a rare, but serious, clotting condition, thrombosis with thrombocytopenia syndrome (TTS). While little is known about risk factors for the condition, it has been found to occur more in those under 50 years.

The Collaboration on Social Science in Immunisation, a network of researchers, immunisation policy makers and healthcare professionals, developed recommendations for communicating risk in both the clinic setting and general public.

Recommendations for risk communication in the clinic setting:

  • Support valid consent by an individual, after they have received sufficient, reliable and appropriate information about potential benefits and risks.
  • Help people to weigh risks and benefits of a vaccine. Page 10 of this PDF outlines some suggestions for structuring a risk-benefit conversation with a 55-year-old female concerned about receiving the AZ vaccine. Resources for aiding vaccine decision making are also available on the Ask, Share, Now website for GPs.

Recommendations for public risk communication:

  • Communicate frequently about process and outcomes. Transparency is important. For example, the authors wrote, “The ATAGI recommendation was timely and detailed. It included their various considerations, using clear and empathic language. Moreover, it acknowledged inevitable trade-offs, such as an impact on confidence.”
  • Make values explicit to enable decisions about the acceptability of a risk to someone’s family, economic, social life and individual health.
  • Use clear, accurate and actionable messages. As the COVID-19 situation is ever-changing and complex, confusion is likely. It is important that communications are clear and considerate of differing levels of health literacy.
  • Promote vaccination but don’t over-reassure.
  • Diversify communication channels and platforms. The authors have found in their research that people don’t know where to find reliable information about their specific questions. Government vaccine information should be easy to find and access. Multiple dissemination methods are needed to reach people, including social media, radio, and TV.
  • Identify and address misinformation by proactively debunking myths about the vaccines.
  • Prioritise key groups for communication.
  • Utilise credible spokespeople. The authors research has identified that people trust health professionals and advisory bodies more than politicians when communicating about adverse events from vaccinations.
  • Sustain trust. Public trust in the Government may impact trust in the vaccine rollout. It is important for the Australian Government to be transparent and show concerted efforts to maintain and rebuild trust.
  • Use data to inform action. “Data showing a decline in vaccination coverage does not disentangle the reasons for it to occur,” the authors wrote. Barriers other than vaccine hesitancy, such as access, or difficulty booking appointment, may exist and should be appropriately addressed.
  • Monitor and evaluate. Communication efforts should be continually monitored and evaluated to determine effectiveness.

In conclusion, the authors wrote:

Good risk communication and support for providers and citizens to make decisions about vaccination is essential as we can work towards protecting all Australians, opening our borders, and continuing to live optimally with SARS-CoV-2.”


WHO conference on communicating in health emergencies

Public opening session, 7 June 2021

The World Health Organization (WHO) is in the midst of a two-week long global conference on communicating science during health emergencies, and the opening and closing sessions are accessible to the public.

The opening session held on 7 June included a panel of five communication experts, who shared their expertise, knowledge and lessons learned about communicating science during the COVID-19 pandemic.

In short, they said communicating scientific evidence during a health emergency is a challenge, as we have particularly seen during the COVID-19 pandemic, with overabundance of rapidly changing information.

They each presented ways in which some of these challenges can be overcome, which are notably in-line with the risk communication strategies outlined by Leask and colleagues, and include building trust and community engagement, considering context and how the message is best delivered, and being clear, consistent and transparent.

WHO’s Director General, Dr Tedros Adhanom Ghebreyesus, opened the session by highlighting the importance of high-quality communication in tackling vaccine hesitancy, misinformation and the overabundance of scientific research that has been produced in the last 18 months.

Speaking next, Dr Shamila Nair-Bedouelle Assistant Director General for Natural Sciences at UNESCO and Dr K ‘Vish’ Viswanath, Professor of Health Communication at the Harvard School of Public Health, both emphasised the important role that journalists play in pandemic communications.

Due to the vast amount of research being published, journalists are essentially gatekeepers to important information read by the general public, health professionals, and politicians, they said.

Nair-Bedouelle’s key takeaways were that quality science communication should be trustworthy and based on rigorous science, clearly presented, and must connect with society by being purposeful and relatable to the target audience.

UNESCO, in collaboration with WHO and the Office of the United Nations High Commissioner for Human Rights are advocating for open access to science, not just for the COVID-19 pandemic, but for the future, to enable equitable and prompt access to evidence.

Viswanath outlined four main challenges to communicating science during a pandemic, and some recommendations to overcome them:

  1. As well as a rapid increase in information, there’s been a rapid increase in platforms that disseminate information, such as social media, streaming services and Internet search engines. A multitude of information is available to us, almost whenever we want it, often without review.
  2. Information about science and health r is produced by mass media, health systems, activist groups and private systems. Given their social networking function, user-generated content on social media platforms is also very common, again, often without review.
  3. “Information is not confirmation”, Viswanath said. Just because information is available, it does not necessarily mean that it is accurate or that the person reading it or disseminating it, understands it. Misinformation can result from the overwhelming abundance of information or low health or research literacy levels.
  4. Inequalities in health and communication exist. Communication inequalities may be in the form of unequal distribution of health information between groups or differences in accessing and processing health information. This is likely to impact an individual or community’s ability to respond to the information, and therefore, impact health outcomes.

Recommendations:

  • Consider how you say what you need to say. For example, is using fear and sensationalist reporting the right approach to get the message across? Can the message be framed another way?
  • Engage stakeholders and empower them to be part of the solution, especially in underserved communities. Viswanath recommended that community engagement should be ongoing, prior to the next health emergency, to enable trust and rapport between communicators and communities.

Also in the session, Dr Siouxsie Wiles, an Associate Professor at the University of Auckland, discussed her popular collaboration with illustrator Toby Morris to create engaging, easy to read and informative infographics and animations to communicate evidence-based information COVID-19.

She has spent the previous decade developing her science communication skills by writing a science blog, speaking on a weekly Radio New Zealand science show, working with graphic designers, and also with her daughter on children’s education videos. She said these experiences were invaluable to building skills and learning how to communicate with different audiences in different formats.

When COVID-19 hit, she saw a need for different types of communication and was prepared to do it, engaging Morris to draw the illustrations.

Wiles and Morris released their work under a creative commons license, enabling people to share and adapt it to make it relevant to their audience or language. Their infographics have been shared worldwide, including by the WHO.

Wiles also reiterated that science communication was as important when we’re not in a pandemic as when we are. “Science/research doesn’t end with a journal publication”, she said, suggesting more support was required for science communications in academia.

You can access all of their infographics and animations on The Spinoff website, an independent online NZ magazine, covering pop culture, politics and current affairs.

Sourced from The Spinoff, under creative commons license.

Dr Alex Freeman, from the Winton Centre for Risk and Evidence Communication at the University of Cambridge, outlined three evidence-based strategies for delivering trustworthy and useful communication to individuals and policy makers.

  1. Provide balanced evidence – “don’t ignore inconvenient evidence or cherry-pick” what you will present. Provide appropriate context — for example, in advising risk from COVID-19 (i.e. severity of symptoms, death), instead of advising the chance for any one person to acquire severe-COVID-19 or die from the virus, advise what their risk might be in relation to other people’s risk or other causes of death.
  2. Be open about uncertainty. Advise what is unknown as well as what is known, and also if further research is being conducted to find out more. Especially relevant to the current pandemic and constantly changing evidence, be honest that advice may change (and how it will be communicated if/when it does).
  3. Critique and communicate the quality of the evidence. Some evidence may only be relevant to some populations, or studies may be conducted with low quality methods.

Freeman also discussed recent Winton Centre research that found that trustworthiness matters the most to people who are initially sceptical.

She has publicly shared their ‘Evidence communication tick-list,’ which is a useful guide for planning your communication.

The final presentation of the session was by Brazilian Dr Atila Iamarino, who, similar to Wiles, has spent the previous decade building his science communication skills and audience by writing science blogs, podcasts and YouTube videos.

Again, like Wiles, when the pandemic hit Brazil, he saw a need to counter some of the misinformation and fake news about COVID-19.

Iamarino highlighted the importance of researching where the target audience consumed science so that messages can be developed and delivered appropriately. For example, he found that 15-24 year olds mostly consumed science on Google, YouTube, WhatsApp and Facebook, and that due to low literacy levels, media is mostly consumed via video. So, he created videos for his YouTube channel and shared them via WhatsApp, Telegram, a secure messaging app, Facebook and Instagram.

Some of the lessons he shared include allowing time to build communities and that, as Viswanath discussed, this should be ongoing, beyond current health emergencies. He also reiterated that consistency is important and that time is required to develop messages for different platforms that demand a specific format.

The slides for the five opening presentations can be viewed from the links below.

Science journalism needed now, Shamila Nair-Bedouelle, Assistant Director General for Natural Sciences, UNESCO

Communication of science & risk during a pandemic, Dr Kasisomayajula Viswanath, Harvard School of Public Health

Demystifying science, Associate Professor Siouxsie Wiles, The University of Auckland

Trustworthy & useful evidence communication, Dr Alex Freeman, University of Cambridge

When social media shapes the public discourse, Dr Atila Iamarino

You can register to watch the conference closing panel on 25 June here.


Australia and COVID-19 — Successes and failures

La Trobe University Ideas & Society Webcast, 10 June 2021

More than one thousand people registered to watch La Trobe University’s Ideas and Society recent webinar about Australia’s successes and failures in managing the COVID-19 pandemic, moderated by Dr Deb Gleeson, Associate Professor from La Trobe University, who co-convenes the Political Economy of Health Special Interest Group of the Public Health Association of Australia (PHAA).

Panel members were:

  • Professor Stephen Duckett, director of the Health Program at the Grattan Institute
  • Dr Norman Swan, ABC broadcaster, from Radio National’s Health Report and Coronacast Podcast
  • Professor Raina MacIntyre, head of the Kirby Institute’s Biosecurity Program, and
  • Professor Michael Toole, from the Burnet Institute.

Main takeaways

Opening up: While acknowledging that Australia has been more successful than most other countries in preventing the spread of COVID-19 largely by controlling our borders, the panel agreed hotel quarantine is not fit-for-purpose and new quarantine systems and high vaccination rates are required for us to open our borders and enable stranded Australians to return home.

Hotel quarantine: New quarantine systems are required to increase capacity, and also to lower the risk of breaches into the community, with a breach occurring in Australia every 11 days since November (Toole). However, even though the Federal Government and Victoria have reached an agreement about a new quarantine facility in or near Melbourne, the panellists warned it will still be months before one is ready.

Vaccination: The panel attributed the blame for the slow vaccine rollout largely due to procurement, supply and poor communications, including that Federal Government decisions meant we have had access to only two COVID-19 vaccines, AstraZeneca and Pfizer-BioNTech.

Having the AstraZeneca vaccine manufactured in Australia by pharmaceutical company CSL means we have continuous supply, but the unforeseen side effects of the AZ vaccine have increased vaccine hesitancy and lowered demand. We are currently receiving just 100,000 doses per week of Pfizer, which is manufactured overseas and subject to high worldwide demand.

The Federal Government has pre-purchased two other vaccines, Moderna and Novavax. However, these are not available until at least the end of 2021, most likely early 2022.

Communications: Another challenge with the vaccine rollout is the lack of an engaging, national vaccine campaign (see above).

Professor MacIntyre suggested three things are required for Australia to successfully manage the pandemic moving forward:

  1. Acknowledge that a lot of the problems in solving the pandemic are not health problems. Engineers, logistics, aerosol scientists and manufacturing experts should all be engaged in decision making.
  2. Empower the States and Territories to manage the operational health tasks, such as vaccine rollout.
  3. Given quarantine is a federal responsibility, start thinking about how this pandemic situation would be managed in the future.

To watch the recording of the webcast, you can register here.


In the news

Ed Yong, a writer for The Atlantic and one of the writers I have followed throughout the pandemic, has won the 2021 Pulitzer Prize for explanatory reporting during the pandemic.

Below are two of his most recent pieces about the pandemic. You can read more of his work here.

What happens when Americans can finally exhale, 20 May 2021

“The COVID-19 pandemic has been a singular disaster—a recurring series of traumatic events that have eroded the very social trust and connections that allow communities to recover from catastrophes”, wrote Yong about the emotional trauma of the pandemic.

The fundamental question of the pandemic is shifting, 9 June 2021

“The pandemic, meanwhile, is still just that—a pandemic, which is raging furiously around much of the world, and which still threatens large swaths of highly vaccinated countries, including some of their most vulnerable citizens. It is still a collective problem, whether or not Americans are willing to treat it as such”, Yong wrote, discussing the discord between individual choice and public health.


Resources

AusVaxSafety: Australia’s active vaccine safety system

COVID-19 vaccine safety data are being collected via a survey sent to Australians three times after they receive a vaccination. Surveys, sent on Days 3, 8 and six weeks after the vaccine, ask if side effects from the vaccine have been experienced.

As at the latest update on 6 June 2021, 740,489 surveys had been completed on the third day after immunisation of either the Pfizer or AZ vaccine.

Half of the people reported no side effects, 49.7 percent reported a side effect, and 1.1 percent of participants reported visiting an emergency department or doctor from the side effect.

The most common side effects for both vaccines include pain at injection site, fatigue, headache, muscle and body aches.

It is important to note that the side effects are self-reported, not clinically verified and may be due to other causes. However, the events reported on the AusVaxSafety survey for both vaccines are similar to those reported in the clinical trials for both AZ and Pfizer, and the UK’s vaccine surveillance.

More detailed results can be viewed here.

The Therapeutic Goods Administration monitor the side effects closely and publish a weekly safety report, which can be viewed here.


COVID-19 Health Literacy Project

A set of COVID-19 resources that have been created, reviewed by faculty members of Harvard Medical School, and translated into more than 40 different languages.

Resources include fact sheets about preventing COVID-19, managing the virus if infected with it, and advice for different age groups.


Tracking SARS-CoV-2 variants

The WHO have been monitoring and evaluating the evolution of the SARS-CoV-2 virus since the pandemic began, including the emergence of variants of interest and concern.

On 31 May 2021, WHO announced a simpler way of naming the key variants of the virus by letters of the Greek alphabet.

Media outlets and national authorities are encouraged to use the new labels, which can be found here. And also reported at Croakey.


Alison Barrett is a Masters by Research candidate and research assistant at University of South Australia, with interests in public health, rural health and health inequities. Follow on Twitter: @AlisonSBarrett. Croakey thanks her for providing this column as a probono service to our readers.

See previous editions of the COVID wrap.


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Comments 1

  1. Aine Healy says:

    Such an important and super useful article. Thank you!

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