Gordon Campbell on the messaging to the vaccine hesitants

ad23f8a93b37dfa9a5dfWhile the recent surge in vaccinations has been welcome, we’re still in the low hanging fruit phase of the journey towards 80-90% rates of protection. Previous polling suggested that the hardcore anti-vaxxers and vaccine “hesitants” used to comprise about a third of the population. Although the “hesitants” and the “wait and watch” crowd may be shrinking in number, we’re still barely in the foothills of engaging with this part of the community. The messaging to them remains a work in progress.

For example: Among the hesitants are some people who fear needles. That being so, the readiness of print media and television to illustrate their Covid stories with images of needles going into arms probably isn’t being helpful. At a more complex level, there is also a downside in lecturing the vaccine hesitants that (a) the likelihood of serious side effects from the vaccines is vanishingly low (b) the health risks from the vaccines are less severe than the risk of catching Covid and (c) the risks from being vaccinated are therefore justified for the greater good.

All of which is true. And no doubt, the people lecturing the vaccine hesitants along those lines feel pretty satisfied with the cogency of their own arguments. Unfortunately, they’re preaching to the converted. Such lectures don’t empathise or engage with the underlying fear. It is like telling people afraid of flying that hey, the risks of a plane crash are low, you’d be statistically at more risk in a car, so get on that plane. That approach tends to have a pretty high failure rate.

IMO, what the process of engaging with the hesitant has to begin with is an acknowledgement that their fear is real. Just as people buy Lotto tickets in the statistically unlikely hope that they will hold the winning ticket, there is a comparable fear that they – or their loved ones – might draw one of the statistically rare but fatal side effect tickets after receiving the vaccine. IMO, the process of converting the vaccine hesitant has to begin by acknowledging that their fears are genuine – at least to the extent that deaths and serious side effects have indeed been linked to almost all of the Covid vaccines. (Luckily, the Pfizer vaccine seems the best of the bunch.) No doubt, getting Covid is worse, and more statistically likely. Yet at this point for most of us, Covid is still something of a hypothetical, while having a vaccine injection is a tangible event. There’s a cognitive difference between having a bigger risk out there somewhere and choosing to put oneself directly in the path of a smaller level of risk.

I’m not disagreeing with the content of the message. Just saying that the message of reassurance hasn’t much hope of being successful if it hectors or belittles the target audience, many of whom have sound historical reasons for holding sceptical attitudes towards authority. Rather than deny or dismiss vaccination fears, we should concede that yes, vaccination does carry a risk. And in the very next sentence, we shouldn’t then dismiss it. From overseas evidence, the best hope of getting the hesitant on board is not via top down messaging, but through encouragement from other authority figures (ministers, elite sports people or artists, friends and family) who can sympathetically encourage the hesitant to transcend any of the fears they may have, if only for the sake of their loved ones. Social media, unfortunately, isn’t a good vehicle for conveying messages of empathy. It probably has to be done face to face.

At an even more basic level, there needs to be a wider recognition that class differences, ethnic differences and gender differences all come into play when we talk about overcoming vaccine hesitancy. Some of the vaccine hesitant are low income workers who feel they cannot afford to risk being off work (and taking an income hit) as a result of vaccine side effects. There’s an obvious response. More generous sick leave provisions are going to be needed anyway, if we are going to be “living with Covid” in future. It would be helpful if those provisions could be put at the forefront of the vaccination drive. But will the corporate leaders clamouring for NZ to open its borders declare themselves willing to embrace more generous sick leave entitlements in future? For the greater good?

The track record of distrust between Maori/Pasifika communities is being recognised. As has been suggested, the government has to do more to bring the vaccination effort to Maori communities – or to local, trusted GPs – rather than to expect Maori communities to come to the usual vaccination centres. The greater risk to women – especially to young women – from vaccine side effects will become a bigger issue if the Ardern government chooses to deploy either of the main adenovirus vector vaccines ( Johnson & Johnson, AstraZeneca) to augment its exclusive reliance to date on the Pfizer vaccine.

The J&J vaccine

The current lockdowns – and the surge in demand for vaccinations they have triggered – has led the government to at least consider using the J&J vaccine as a back-up option. If the surge continues at its current rate, the stocks of the Pfizer vaccine could come under pressure in the month before late October, until a scheduled major shipment of the Pfizer vaccine is expected to resolve any supply problems.

The J& J vaccine is also known as the Janssen vaccine, because it was developed by Janssen Laboratories, a J& J subsidiary. It offers some advantages. Unlike the Pfizer vaccine, it requires only one shot. It can be more easily stored and shipped, because it needs only to be refrigerated, and not kept constantly at super cold temperatures. It would therefore be easier to deploy in the more remote parts of New Zealand. As mentioned, it is a so-called adenovirus vector vaccine, which is a more familiar vaccine technology than the trail-blazing mRNA approach used to create the Pfizer and Moderna vaccines..

In early July, Medsafe approved the use in New Zealand of the J& J vaccine for those aged 18 and over. Later in July, Medsafe also finally approved the Oxford AstraZenca vaccine for use in New Zealand. This regulatory move on AstraZeneca was a pre-requisite before shipments to this country could begin of the first of the 7.6 million AstraZeneca doses (enough for 3.8 million treatments) that we purchased late last year, before some of the AstraZeneca vaccine’s more troubling side effects came to light.

Mindful of the extensive media coverage of those serioous side effects, the New Zealand government has been reluctant to tap into a supply of AstraZeneca, even though it is being manufactured just across the Tasman. (Our Pfizer supplies by contrast, have come from a Pfizer plant in Germany.) So far, the immediate benefit of the Medsafe seal of approval has been that New Zealand can now funnel circa 500,000 doses of this unwanted-by-us vaccine into the Covax international distribution programme, initially to help Fiji to shore up its Covid defences.

Footnote: The trial data from the two shot Novovaxx adenovirus vaccine – which has yet to be authorised for use here- is holding some promise of being a better performer than the J&J vaccine. Early trial results suggest it may be capable of efficacy levels comparable to the mRNA vaccines. Late last year, New Zealand reportedly ordered 5.36 million Novovaxx doses and this vaccine could eventually become New Zealand’s best back-up/booster shot option.

Efficacy

Some useful comparisons between the two main mRNA vaccines and the J&J adenovirus vector vaccine can be found here. The efficacy rates for the J&J vaccine are the least impressive of the three. While the Pfizer and Moderna vaccines deliver significantly higher levels of protection against infection than the J& J vaccine – we’re talking 85-95% rates for the mRNA vaccines versus 66% for J&J – the protection rates against serious illness hospitalisation and death seem roughly comparable. According to data released by the company itself, the efficacy rate (85%) in preventing the death, hospitalisation and long Covid that Delta and other variants can cause to the unvaccinated looks pretty good.

Side effects

The serious side effects with the J& J vaccine are rare, and yes, they are far outweighed by the serious health risks from getting a Covid infection. As with some other Covid vaccines, the J&J vaccine has been associated with rare cases of anaphylactic shock, a side effect that is can be readily reversed by alert nursing staff. More worryingly, the J&J vaccine has been associated with the rare incidence of blood clots, a side effect also previously associated with the AstraZeneca vaccine. In Australia, six deaths have been associated with blood clots apparently caused by the AstraZeneca vaccine. In the UK, the death of 44 year old BBC presenter Lisa Shaw has been attributed by a coroner to a blood clot caused by the AstraZeneca vaccine.

Similarly, the J&J vaccine has been associated with the risk of thrombosis, via a rare blood clot condition called thrombocytopenia syndrome (TTS). The TTS effect has been most often observed in females between the ages of 18 and 48. After US health authorities requested a brief pause to review the TTS risk, J&J vaccinations resumed in the United States after it was concluded that the benefits of the vaccine outweighed this risk, and others. The US Center for Disease Control has estimated that the risk of TTS incidence via the J& J vaccine is 7 per million among females under 50. Here’s its judgement: choose a different vaccine, if you can:

The Advisory Committee on Immunization Practices (ACIP) and CDC recommended vaccination with the J&J/Janssen COVID-19 Vaccine resume among people 18 years and older. However, women younger than 50 years old especially should be aware of the rare but increased risk of TTS, a serious condition that involves blood clots with low platelets. There are other available COVID-19 vaccine options for which this risk has not been seen.

Sounds reasonable. If you can avoid/minimise the risk, do so. That’s the approach that’s been taken by the Ardern government which went – early, hard and exclusively – for the Pfizer option, with the aim of keeping everyone as safe as possible. As an aside, it would be interesting to know the relative costs per dose of the Pfizer, AstraZeneca, J& J and Novovaxx vaccines. It would be commercially sensitive information, of course. Yet once we get past the initial “loss leader” phase of vaccine supply by the big pharmaceutical companies, those costs are going to mount, and the cost differentials could become a factor if and when Pharmac gets entrusted with managing the purchasing process. Put it this way: the “booster” shots are likely to become more expensive. (Not that this year has been too bad for Big Pharma. Pfizer has just reported $33billion in profits this year from its Covid vaccine.)

Back to the risk factor. As Werewolf pointed out in July, the focus of the vaccination drive is now shifting from the old and the vulnerable into the younger age groups where – for users of the J&J vaccine – the (rare) blood clot risk is known to be higher. The Maori population – a lagging community in the vaccination drive – is also relatively younger than the general population, and would therefore be at a slightly higher risk overall if J& J and/or the AstraZeneca vaccine were ever brought into play here. Even if they were, it bears repeating : the relatively rare risk of vaccine-induced serious side effects has to be weighed against the serious and far more likely health risks of not being vaccinated at all, and then getting a Covid infection.

But as mentioned at the outset, that message of re-assurance needs to be more sensitively conveyed than it has been to date. If we’ve learned anything from the past decade or so of the culture wars, information that contradicts deeply held convictions rarely results in a conversion to the new mindset. Its not a matter of education, either. On the evidence, higher education merely gives people a better vocabulary with which to defend their entrenched beliefs.

Footnote: Booster shots. While the government has been pushing the need for vaccination, there has been little effort put into explaining how long the Pfizer vaccine is likely to offer significant protection against infection. (Answer: eight months, roughly.) Last week, Johnson and Johnson also reported that its one shot vaccine would provide protection for eight months, after which time a second “booster” shot would be needed.

Armed with interim results from two phase 1/2a studies, Johnson & Johnson on Wednesday said a follow-up dose of its vaccine prompted a “rapid and robust” increase in spike-binding antibodies. The increase was more than nine times higher than results observed 28 days after primary vaccination, the company said in a release. Investigators observed “significant” antibody boosts in patients between the ages of 18 to 55, as well as in patients ages 65 and up, the company said. For the study, investigators gave recipients boosters eight months after their original vaccination.

This release from J&J came a week after the White House unveiled its plan for a “booster shot” regime for the mRNA vaccines. The likely time to elapse before the need for a booster shot will kick in ? Again, some eight months after “full” vaccination.

The U.S. aims to make a third mRNA dose available to Americans ages 18 and older eight months after their second Pfizer-BioNTech or Moderna shot, health officials said during a White House press briefing Wednesday. The government plans to roll out its program the week of Sept. 20, assuming the boosters pass muster with the FDA and the Centers for Disease Control and Prevention’s (CDC’s) Advisory Committee on Immunization Practices, Surgeon General Vivek Murthy, M.D., said during the conference.

In other words, eight months seems the ‘use by’ date for the current vaccination round. Even the people currently lining up for their second shot of the Pfizer vaccine sometime this month, probably need to keep in mind that they will almost certainly be needing another “booster” vaccination by about May of next year. And so on, for the foreseeable. Meaning : “living with Covid” is going to mean more ( not less) government intervention and public health funding… That’s if we aim to ensure that the security provided by the current Covid vaccination effort gets sustained, year after year.

Abba, meet Johnny Marr

Mamma mia. After a lapse of 40 years, we’re being promised new Abba singles and a new Abba album by year’s end, the prospect of Abba holograms dancing onstage sometime next year. Let’s hope the new album doesn’t prove to be their Waterloo. Talking of old school, ancient pop hooks, guitar rock meets EDM and the kind of video that used to be quite the MTV rage 40 years ago, here’s where Johnny Marr (formerly of the Smiths and later of Modest Mouse) is at these days. Trapped in a time tunnel, evidently…