argumentative essay against covid 19 vaccine

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An Overview of the Vaccine Debate

Looking at Both Sides of the Argument

There is a wealth of research demonstrating the efficacy and safety of vaccines —including how some have virtually eradicated infectious diseases that once killed millions. However, this has done little to sway those who believe that untold harms are being hidden from the American public.

The vaccine debate—including the argument as to whether vaccines are safe, effective, or could cause conditions like autism —has received a lot of attention from the media in recent years. With so much conflicting information being publicized, it can be a challenge to discern what is true and what is not. Therefore, it is important to learn the facts before making health decisions.

Claims and Controversy

Those who are part of the anti-vaccination movement include not only non-medical professionals but several scientists and healthcare providers who hold alternative views about vaccines and vaccination in general.

Some notable examples include:

• British healthcare provider Andrew Wakefield, who in 1998 published research linking the MMR vaccine and autism . That study has since been retracted, and he was later removed from the medical registry in the United Kingdom for falsifying scientific data.
• Pediatrician Bob Sears, who wrote the bestseller "The Vaccine Book: Making the Right Decision for your Child ," which suggested that many essential childhood vaccines were "optional." However, he was subsequently put on probation by the Medical Review Board of California in 2018 for alleged medical negligence and the inappropriate writing of medical exemptions for vaccinations.
• Dr. Jane M. Orient, director of the Association of American Healthcare Providers and Surgeons, who was among the leading opponents of the COVID-19 vaccine and one of the leading proponents of using hydroxychloroquine to treat COVID-19 during the pandemic.

These opposing views and claims, along with other information promoted by the news and social media, have led some people to question whether they know everything they need to know about vaccines.

Common Concerns Regarding Vaccines

The arguments made against vaccines are not new and have been made well before the first vaccine was developed for smallpox back in the 18th century.

The following are some of the common arguments against vaccines:

• Vaccines contain "toxic" ingredients that can lead to an assortment of chronic health conditions such as autism.
• Vaccines are a tool of "Big Pharma," in which manufacturers are willing to profit off of harm to children.
• Governments are "pharma shills," meaning they are bought off by pharmaceutical companies to hide cures or approve drugs that are not safe.
• A child’s immune system is too immature to handle vaccines , leading the immune system to become overwhelmed and trigger an array of abnormal health conditions.
• Natural immunity is best , suggesting that a natural infection that causes disease is "better" than receiving a vaccine that may cause mild side effects.
• Vaccines are not tested properly , suggesting a (highly unethical) approach in which one group of people is given a vaccine, another group is not, and both are intentionally inoculated with the same virus or bacteria.
• Infectious diseases have declined due in part to improved hygiene and sanitation , suggesting that hand-washing and other sanitary interventions are all that are needed to prevent epidemics.
• Vaccines cause the body to "shed" virus , a claim that is medically true, although the amount of shed virus is rarely enough to cause infection.

The impact of anti-vaccination claims has been profound. For example, it has led to a resurgence of measles in the United States and Europe, despite the fact that the disease was declared eliminated in the U.S. back in 2000.

Studies have suggested that the anti-vaccination movement has cast doubt on the importance of childhood vaccinations among large sectors of the population. The added burden of the COVID-19 pandemic has led to further declines in vaccination rates.

There is also concern that the same repercussions may affect COVID-19 vaccination rates—both domestically and abroad. Ultimately, vaccine rates must be high for herd immunity to be effective.

According to a study from the Centers for Disease Control and Prevention (CDC), the rate of complete recommended vaccination among babies age 5 months has declined from 66.6% in 2016 to 49.7% by May 2020. Declines in vaccination coverage were seen in other age groups as well.

Benefits of Vaccination

Of the vaccines recommended by the CDC, the benefits of immunization are seen to overwhelmingly outweigh the potential risks. While there are some people who may need to avoid certain vaccines due to underlying health conditions, the vast majority can do so safely.

According to the U.S. Department of Health and Human Services, there are five important reasons why your child should get the recommended vaccines:

• Immunizations can save your child’s life . Consider that polio once killed up to 30% of those who developed paralytic symptoms. Due to polio vaccination, the disease is no longer a public health concern in the United States.
• Vaccination is very safe and effective . Injection site pain and mild, flu-like symptoms may occur with vaccine shots. However, serious side effects , such as a severe allergic reaction, are very rare.
• Immunization protects others . Because respiratory viruses can spread easily among children, getting your child vaccinated not only protects your child but prevents the further spread of disease.
• Immunizations can save you time and money . According to the non-profit Borgen Project, the average cost of a measles vaccination around the world is roughly $1.76, whereas the average cost of treating measles is $307. In the end, the cost of prevention is invariably smaller than the cost of treatment.
• Immunization protects future generations . Smallpox vaccinations have led to the eradication of smallpox . Rubella (German measles) vaccinations have helped eliminate birth defects caused by infection of pregnant mothers in the developed world. With persistence and increased community uptake, measles could one day be declared eliminated (again) as well.

A Word From Verywell

If you have any questions or concerns about vaccinations, do not hesitate to speak with your healthcare provider or your child's pediatrician.

If a vaccine on the immunization schedule has been missed, speak to a healthcare provider before seeking the vaccination on your own (such as at a pharmacy or clinic). In some cases, additional doses may be needed.

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Eggerton L.  Lancet retracts 12-year-old article linking autism to MMR vaccines .  CMAJ . 2010 Mar 9; 182(4):e199-200. doi:10.1503/cmaj.109-3179

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By Vincent Iannelli, MD  Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years. 

Should COVID-19 vaccines be mandatory? Two experts discuss

Senior Research Fellow, Oxford Uehiro Centre for Practical Ethics, University of Oxford

NIHR Academic Clinical Fellow in Public Health Medicine, UCL

Disclosure statement

Alberto Giubilini receives funding from the Arts and Humanities Research Council/UK Research and Innovation (AHRC/UKRI) and has previously received funding from the Wellcome Trust.

Vageesh Jain is affiliated with Public Health England under an honorary contract as a speciality registrar.

University College London provides funding as a founding partner of The Conversation UK.

University of Oxford provides funding as a member of The Conversation UK.

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To be properly protective, COVID-19 vaccines need to be given to most people worldwide. Only through widespread vaccination will we reach herd immunity – where enough people are immune to stop the disease from spreading freely. To achieve this, some have suggested vaccines should be made compulsory , though the UK government has ruled this out . But with high rates of COVID-19 vaccine hesitancy in the UK and elsewhere , is this the right call? Here, two experts to make the case for and against mandatory COVID-19 vaccines.

Alberto Giubilini, Senior Research Fellow, Oxford Uehiro Centre for Practical Ethics, University of Oxford

COVID-19 vaccination should be mandatory – at least for certain groups. This means there would be penalties for failure to vaccinate, such as fines or limitations on freedom of movement.

The less burdensome it is for an individual to do something that prevents harm to others, and the greater the harm prevented, the stronger the ethical reason for mandating it.

Being vaccinated dramatically reduces the risk of seriously harming or killing others. Vaccines such as the Pfizer , AstraZeneca or Moderna ones with 90-95% efficacy at preventing people from getting sick are also likely to be effective at stopping the virus from spreading, though possibly to a lower degree. Such benefits would come at a very minimal cost to individuals.

Lockdown is mandatory. Exactly like mandatory vaccination, it protects vulnerable people from COVID-19. But, as I have argued in detail elsewhere, unlike mandatory vaccination, lockdown entails very large individual and societal costs. It is inconsistent to accept mandatory lockdown but reject mandatory vaccination. The latter can achieve a much greater good at a much smaller cost.

Also, mandatory vaccination ensures that the risks and burdens of reaching herd immunity are distributed evenly across the population. Because herd immunity benefits society collectively, it’s only fair that the responsibility of reaching it is shared evenly among society’s individual members.

Of course, we might achieve herd immunity through less restrictive alternatives than making vaccination mandatory – such as information campaigns to encourage people to be vaccinated. But even if we reach herd immunity, the higher the uptake of vaccines, the lower the risk of falling below the herd immunity threshold at a later time. We should do everything we can to prevent that emergency from happening – especially when the cost of doing so is low.

Fostering trust and driving uptake by making people more informed is a nice narrative, but it’s risky. Merely giving people information on vaccines does not always result in increased willingness to vaccinate and might actually lower confidence in vaccines. On the other hand, we’ve seen mandatory vaccination policies in Italy recently successfully boost vaccine uptake for other diseases.

Mandatory seatbelt policies have proven very successful in reducing deaths from car accidents, and are now widely endorsed despite the (very small) risks that seatbelts entail. We should see vaccines as seatbelts against COVID-19. In fact, as very special seatbelts, which protect ourselves and protect others.

Vageesh Jain, NIHR Academic Clinical Fellow in Public Health Medicine, UCL

Mandatory vaccination does not automatically increase vaccine uptake. An EU-funded project on epidemics and pandemics, which took place several years before COVID-19, found no evidence to support this notion. Looking at Baltic and Scandinavian countries, the project’s report noted that countries “where a vaccination is mandatory do not usually reach better coverage than neighbour or similar countries where there is no legal obligation”.

According to the Nuffield Council of Bioethics, mandatory vaccination may be justified for highly contagious and serious diseases. But although contagious, Public Health England does not classify COVID-19 as a high-consequence infectious disease due to its relatively low case fatality rate.

COVID-19 severity is strongly linked with age, dividing individual perceptions of vulnerability within populations. The death rate is estimated at 7.8% in people aged over 80, but at just 0.0016% in children aged nine and under. In a liberal democracy, forcing the vaccination of millions of young and healthy citizens who perceive themselves to be at an acceptably low risk from COVID-19 will be ethically disputed and is politically risky.

Public apprehensions for a novel vaccine produced at breakneck speed are wholly legitimate. A UK survey of 70,000 people found 49% were “very likely” to get a COVID-19 vaccine once available. US surveys are similar . This is not because the majority are anti-vaxxers.

Despite promising headlines, the trials and pharmaceutical processes surrounding them have not yet been scrutinised. With the first trials only beginning in April , there is limited data on long-term safety and efficacy. We don’t know how long immunity lasts for. None of the trials were designed to tell us if the vaccine prevents serious disease or virus transmission.

To disregard these ubiquitous concerns would be counterproductive. As a tool for combating anti-vaxxers – estimated at around 58 million globally and making up a small minority of those not getting vaccinated – mandatory vaccines are also problematic. The forces driving scientific and political populism are the same . Anti-vaxxers do not trust experts, industry and especially not the government. A government mandate will not just be met with unshakeable defiance, but will also be weaponised to recruit others to the anti-vaxxer cause.

In the early 1990s, polio was endemic in India , with between 500 and 1,000 children getting paralysed daily. By 2011, the virus was eliminated. This was not achieved through legislation. It was down to a consolidated effort to involve communities, target high-need groups, understand concerns, inform, educate, remove barriers, invest in local delivery systems and link with political and religious leaders.

Mandatory vaccination is rarely justified. The successful roll-out of novel COVID-19 vaccines will require time, communication and trust. We have come too far, too fast, to lose our nerve now.

• Mandatory vaccination
• Coronavirus
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What arguments against covid-19 vaccines run on facebook in poland: content analysis of comments.

1. Introduction

1.1. background, 2. materials and methods, 2.1. data collection, 2.2. themes of comments, 2.3. data analysis, 3.1. data overview, 3.2. research question 1, 3.3. research question 2, 3.4. research question 3, 4. discussion, 4.1. overview, 4.2. main topics of anti-vaccine comments, 4.3. changes in content over time, 5. conclusions, author contributions, institutional review board statement, informed consent statement, data availability statement, acknowledgments, conflicts of interest.

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Wawrzuta, D.; Jaworski, M.; Gotlib, J.; Panczyk, M. What Arguments against COVID-19 Vaccines Run on Facebook in Poland: Content Analysis of Comments. Vaccines 2021 , 9 , 481. https://doi.org/10.3390/vaccines9050481

Wawrzuta D, Jaworski M, Gotlib J, Panczyk M. What Arguments against COVID-19 Vaccines Run on Facebook in Poland: Content Analysis of Comments. Vaccines . 2021; 9(5):481. https://doi.org/10.3390/vaccines9050481

Wawrzuta, Dominik, Mariusz Jaworski, Joanna Gotlib, and Mariusz Panczyk. 2021. "What Arguments against COVID-19 Vaccines Run on Facebook in Poland: Content Analysis of Comments" Vaccines 9, no. 5: 481. https://doi.org/10.3390/vaccines9050481

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The Covid vaccine is safe, whatever anti-vaxxers say. Here's why we can trust it.

I've researched autism for more than a decade. Specifically, I've investigated how some antibodies in expecting mothers could complicate fetal development and lead to the condition. Through all my research and that of my colleagues, one thing is clear: Vaccines are not the cause of autism. And yet, that connection is on the tip of many tongues.

None of the claims have proven to be true when it comes to autism, and there's no reason to think they are any more valid with the Covid-19 vaccines.

Unfortunately, the fabricated link between autism and vaccines has made all vaccines suspect in the eyes of some skeptics. Now that Covid-19 vaccines are finally rolling out, the disinformation is clouding the science and adding fuel to the vaccine hesitancy fire.

A recent Pew Research Center poll reports that 39 percent of people say they definitely or probably wouldn't get a coronavirus vaccination. This endangers more than the people who don't get shots; we need a large though as-yet-undetermined percentage of people to be vaccinated before we see a slowdown in the virus's spread and with it the indirect protection known as herd immunity. Meanwhile, vulnerable groups whose immune systems are too compromised to be vaccinated are unprotected.

"Vaccine scares" have existed ever since the first smallpox vaccine was developed. Religious beliefs and distrust in medicine dissuaded some from inoculations; others believed they violated their personal liberty. Legally mandating vaccines in the mid-19 century galvanized these objectors into anti-vaccine movements , members of which claimed the right to make their own decisions about their children's bodies and their own.

Opinion Toxic Christian ideology is infecting the Covid debate. And that's bad for everyone.

The autism variant of these historical conspiracy theories started in 1998 with a report in a prestigious medical journal suggesting that 12 children developed autism shortly after they received the measles, mumps and rubella, or MMR, vaccine. But the findings were plagued with problems : The research of the lead scientist was funded by a lawyer suing a vaccine manufacturer , while the researcher himself held a patent for a new MMR vaccine . He altered the children's medical histories to boot. Since then, scores of medical research findings have invalidated the report, and the researcher's license was revoked .

Yet anti-vaxxers continue to cling to this infamous mythology, resulting in U.S. outbreaks of life-threatening diseases, such as whooping cough and measles , thought to be well-controlled and even eradicated. Today, so-called vaccine truthers continue to claim that vaccines overwhelm the infant immune system, that natural immunization is better than vaccination and that vaccines themselves contain toxins or actually give you the disease.

None of the claims have proven to be true when it comes to autism, and there's no reason to think they are any more valid with the Covid-19 vaccines. With the stakes so high, it's important to understand just how and why vaccine doubters are wrong.

It's true that the Covid-19 vaccine went through an unprecedentedly rapid process — for which we should all be grateful, given the urgency. And while there's concern that the Covid-19 vaccines were rushed and that that means they haven't been properly vetted or that their safety is otherwise in question, it's simply not the case.

Opinion We want to hear what you THINK. Please submit a letter to the editor.

A chief reason for the speedy turnaround was a decision the federal government made to expedite delivery of the vaccine — which has nothing to do with the scientific validity of the drug itself. The government allowed the drugmakers to mass-produce the vaccine while still conducting clinical trials. This was a gamble: If the Food and Drug Administration deemed the vaccines not safe and effective, those doses would be no better than trash. But it's a bet that seems to have paid off.

Another concern stems from the talk that the medical technology involved is "novel." Other vaccines, like that for the flu, use forms of inactivated or weakened viruses. In contrast, the Covid-19 vaccines by Pfizer-BioNTech and Moderna deliver a small snippet of messenger RNA into the body. Messenger RNA, or mRNA, is a genetic coding material the body uses as instructions to make specific proteins. Once a protein is made, it is displayed on the surface of the cell. The body then recognizes the foreign protein and develops an immune response to fend off future infection.

It's the first time such a vaccine technique has been authorized, but that doesn't mean it's unknown . In fact, RNA-based platforms to deliver vaccines have been researched since the 1990s . Having this technology and know-how in place allowed for speedy development during a pandemic and should be applauded.

The coronavirus vaccines do have side effects — but that doesn't mean they're harmful. It actually means they're working. We know from Pfizer's clinical trials that short-term side effects occurred within 24 to 48 hours, especially after the second dose. Sixteen percent of people ages 18 to 55 and 11 percent of people over 55 reported fevers after the second dose . Even more people reported having fatigue, headaches and joint pain. (The Covid-19 vaccine hasn't yet been approved for children under 16.)

While such symptoms can be unpleasant, they are transient and not dangerous. They don't mean you're sick with Covid-19; they mean the vaccine has triggered your immune response to create the "bodyguards" that fight future Covid-19 infection.

A very small number of people have suffered from allergic reactions after vaccination that require medical attention, such as rashes, shortness of breath, racing heart, puffy eyes and lightheadedness. These people received standard medical treatment for allergies and were released from the hospital within a short time. Although that may sound scary, clinics are equipped to deal with such reactions in real time .

In contrast to the hyped-up concerns about what the Covid-19 vaccine might do, we have incontrovertible evidence about the harm that the virus itself really does.

What about long-term effects? At this point, there's no reason to worry about those, either. While we don't have a full two years of safety data to confirm the lack of unexpected long-term side effects, severe or extreme side effects have appeared within weeks rather than years of previous vaccines' being given. It has been over 14 weeks since the completion of the second dose in Pfizer clinical trials , while the nation has been vaccinating for more than two weeks and we have not seen those responses, though monitoring systems are in place to follow up after vaccination.

I've also heard of concerns that the vaccine may cause cancer in the long term, particularly from anti-vaxxers worried about what other ingredients in the vaccines can do. First, unlike non-mRNA-based vaccines , Covid-19 vaccines don't contain other components. Second, mRNA-based vaccines can't make changes to the human genome and therefore are extremely unlikely to induce new genetic mutations in the cells of the kind that lead to cancer.

In contrast to the hyped-up concerns about what the Covid-19 vaccine might do, we have incontrovertible evidence about the harm that the virus itself really does. So far in the U.S., 345,000 people have died, while countless others are still suffering from health complications. Millions of people have lost their jobs and businesses and homes. It is our responsibility as a society not to believe misinformation so that we may leave 2020 behind us.

Lior Brimberg, PhD, is an assistant professor at the Feinstein Institutes for Medical Research. Her research focuses on the role of the in utero environment in autism.

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• Published: 14 May 2021

Public attitudes toward COVID-19 vaccination: The role of vaccine attributes, incentives, and misinformation

• Sarah Kreps 1 ,
• Nabarun Dasgupta 2 ,
• John S. Brownstein 3 , 4 ,
• Yulin Hswen 5 &
• Douglas L. Kriner   ORCID: orcid.org/0000-0002-9353-2334 1  

npj Vaccines volume  6 , Article number:  73 ( 2021 ) Cite this article

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While efficacious vaccines have been developed to inoculate against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; also known as COVID-19), public vaccine hesitancy could still undermine efforts to combat the pandemic. Employing a survey of 1096 adult Americans recruited via the Lucid platform, we examined the relationships between vaccine attributes, proposed policy interventions such as financial incentives, and misinformation on public vaccination preferences. Higher degrees of vaccine efficacy significantly increased individuals’ willingness to receive a COVID-19 vaccine, while a high incidence of minor side effects, a co-pay, and Emergency Use Authorization to fast-track the vaccine decreased willingness. The vaccine manufacturer had no influence on public willingness to vaccinate. We also found no evidence that belief in misinformation about COVID-19 treatments was positively associated with vaccine hesitancy. The findings have implications for public health strategies intending to increase levels of community vaccination.

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Measuring the impact of COVID-19 vaccine misinformation on vaccination intent in the UK and USA

Vaccine hesitancy and monetary incentives

Providing normative information increases intentions to accept a COVID-19 vaccine

Introduction.

In less than a year, an array of vaccines was developed to bring an end to the SARS-CoV-2 pandemic. As impressive as the speed of development was the efficacy of vaccines such as Moderna and Pfizer, which are over 90%. Despite the growing availability and efficacy, however, vaccine hesitancy remains a potential impediment to widespread community uptake. While previous surveys indicate that overall levels of vaccine acceptance may be around 70% in the United States 1 , the case of Israel may offer a cautionary tale about self-reported preferences and vaccination in practice. Prospective studies 2 of vaccine acceptance in Israel showed that about 75% of the Israeli population would vaccinate, but Israel’s initial vaccination surge stalled around 42%. The government, which then augmented its vaccination efforts with incentive programs, attributed unexpected resistance to online misinformation 3 .

Research on vaccine hesitancy in the context of viruses such as influenza and measles, mumps, and rubella, suggests that misinformation surrounding vaccines is prevalent 4 , 5 . Emerging research on COVID-19 vaccine preferences, however, points to vaccine attributes as dominant determinants of attitudes toward vaccination. Higher efficacy is associated with greater likelihood of vaccinating 6 , 7 , whereas an FDA Emergency Use Authorization 6 or politicized approval timing 8 is associated with more hesitancy. Whether COVID-19 misinformation contributes to vaccine preferences or whether these attributes or policy interventions such as incentives play a larger role has not been studied. Further, while previous research has focused on a set of attributes that was relevant at one particular point in time, the evidence and context about the available vaccines has continued to shift in ways that could shape public willingness to accept the vaccine. For example, governments, employers, and economists have begun to think about or even devise ways to incentivize monetarily COVID-19 vaccine uptake, but researchers have not yet studied whether paying people to receive the COVID-19 vaccine would actually affect likely behavior. As supply problems wane and hesitancy becomes a limiting factor, understanding whether financial incentives can overcome hesitancy becomes a crucial question for public health. Further, as new vaccines such as Johnson and Johnson are authorized, knowing whether the vaccine manufacturer name elicits or deters interest in individuals is also important, as are the corresponding efficacy rates of different vaccines and the extent to which those affect vaccine preferences. The purpose of this study is to examine how information about vaccine attributes such as efficacy rates, the incidence of side effects, the nature of the governmental approval process, identity of the manufacturers, and policy interventions, including economic incentives, affect intention to vaccinate, and to examine the association between belief in an important category of misinformation—false claims concerning COVID-19 treatments—and willingness to vaccinate.

General characteristics of study population

Table 1 presents sample demographics, which largely reflect those of the US population as a whole. Of the 1335 US adults recruited for the study, a convenience sample of 1100 participants consented to begin the survey, and 1096 completed the full questionnaire. The sample was 51% female; 75% white; and had a median age of 43 with an interquartile range of 31–58. Comparisons of the sample demographics to those of other prominent social science surveys and U.S. Census figures are shown in Supplementary Table 1 .

Vaccination preferences

Each subject was asked to evaluate a series of seven hypothetical vaccines. For each hypothetical vaccine, our conjoint experiment randomly assigned values of five different vaccine attributes—efficacy, the incidence of minor side effects, government approval process, manufacturer, and cost/financial inducement. Descriptions of each attribute and the specific levels used in the experiment are summarized in Table 2 . After seeing the profile of each vaccine, the subject was asked whether she would choose to receive the vaccine described, or whether she would choose not to be vaccinated. Finally, subjects were asked to indicate how likely they would be to take the vaccine on a seven-point likert scale.

Across all choice sets, in 4419 cases (58%) subjects said they would choose the vaccine described in the profile rather than not being vaccinated. As shown in Fig. 1 , several characteristics of the vaccine significantly influenced willingness to vaccinate.

Circles present the estimated effect of each attribute level on the probability of a subject accepting vaccination from the attribute’s baseline level. Horizontal lines through points indicate 95% confidence intervals. Points without error bars denote the baseline value for each attribute. The average marginal component effects (AMCEs) are the regression coefficients reported in model 1 of Table 3 .

Efficacy had the largest effect on individual vaccine preferences. An efficacy rate of 90% increased uptake by about 20% relative to the baseline at 50% efficacy. Even a high incidence of minor side effects (1 in 2) had only a modest negative effect (about 5%) on willingness to vaccinate. Whether the vaccine went through full FDA approval or received an Emergency Use Authorization (EUA), an authority that allows the Food and Drug Administration mechanisms to accelerate the availability and use of treatments or medicines during medical emergencies 9 , significantly influenced willingness to vaccinate. An EUA decreased the likelihood of vaccination by 7% compared to a full FDA authorization; such a decline would translate into about 23 million Americans. While a $20 co-pay reduced the likelihood of vaccination relative to a no-cost baseline, financial incentives did not increase willingness to vaccinate. Lastly, the manufacturer had no effect on vaccination attitudes, despite the public pause of the AstraZeneca trial and prominence of Johnson & Johnson as a household name (our experiment was fielded before the pause in the administration of the Johnson & Johnson shot in the United States).

Model 2 of Table 3 presents an expanded model specification to investigate the association between misinformation and willingness to vaccinate. The primary additional independent variable of interest is a misinformation index that captures the extent to which each subject believes or rejects eight claims (five false; three true) about COVID-19 treatments. Additional analyses using alternate operationalizations of the misinformation index yield substantively similar results (Supplementary Table 4 ). This model also includes a number of demographic control variables, including indicators for political partisanship, gender, educational attainment, age, and race/ethnicity, all of which are also associated with belief in misinformation about the vaccine (Supplementary Table 2 ). Finally, the model also controls for subjects’ health insurance status, past experience vaccinating against seasonal influenza, attitudes toward the pharmaceutical industry, and beliefs about vaccine safety generally.

Greater levels of belief in misinformation about COVID-19 treatments were not associated with greater vaccine hesitancy. Instead, the relevant coefficient is positive and statistically significant, indicating that, all else being equal, individuals who scored higher on our index of misinformation about COVID-19 treatments were more willing to vaccinate than those who were less susceptible to believing false claims.

Strong beliefs that vaccines are safe generally was positively associated with willingness to accept a COVID-19 vaccine, as were past histories of frequent influenza vaccination and favorable attitudes toward the pharmaceutical industry. Women and older subjects were significantly less likely to report willingness to vaccinate than men and younger subjects, all else equal. Education was positively associated with willingness to vaccinate.

This research offers a comprehensive examination of attitudes toward COVID-19 vaccination, particularly the role of vaccine attributes, potential policy interventions, and misinformation. Several previous studies have analyzed the effects of vaccine characteristics on willingness to vaccinate, but the modal approach is to gauge willingness to accept a generic COVID-19 vaccine 10 , 11 . Large volumes of research show, however, that vaccine preferences hinge on specific vaccine attributes. Recent research considering the influence of attributes such as efficacy, side effects, and country of origin take a step toward understanding how properties affect individuals’ intentions to vaccinate 6 , 7 , 8 , 12 , 13 , but evidence about the attributes of actual vaccines, debates about how to promote vaccination within the population, and questions about the influence of misinformation have moved quickly 14 .

Our conjoint experiment therefore examined the influence of five vaccine attributes on vaccination willingness. The first category of attributes involved aspects of the vaccine itself. Since efficacy is one of the most common determinants of vaccine acceptance, we considered different levels of efficacy, 50%, 70%, and 90%, levels that are common in the literature 7 , 15 . Evidence from Phase III trials suggests that even the 90% efficacy level in our design, which is well above the 50% threshold from the FDA Guidance for minimal effectiveness for Emergency Use Authorization 16 , has been exceeded by both Pfizer’s and Moderna’s vaccines 17 , 18 . The 70% efficacy threshold is closer to the initial reports of the efficacy of the Johnson & Johnson vaccine, whose efficacy varied across regions 19 . Our analysis suggests that efficacy levels associated with recent mRNA vaccine trials increases public vaccine uptake by 20% over a baseline of a vaccine with 50% efficacy. A 70% efficacy rate increases public willingness to vaccinate by 13% over a baseline vaccine with 50% efficacy.

An additional set of epidemiological attributes consisted of the frequency of minor side effects. While severe side effects were plausible going into early clinical trials, evidence clearly suggests that minor side effects are more common, ranging from 10% to 100% of people vaccinated depending on the number of doses and the dose group (25–250 mcg) 20 . Since the 100 mcg dose was supported in Phase III trials 21 , we include the highest adverse event probability—approximating 60% as 1 in 2—and 1 in 10 as the lowest likelihood, approximating the number of people who experienced mild arthralgia 20 . Our findings suggest that a the prevalence of minor side effects associated with recent trials (i.e. a 1 in 2 chance), intention to vaccinate decreased by about 5% versus a 1 in 10 chance of minor side effects baseline. However, at a 25% rate of minor side effects, respondents did not indicate any lower likelihood of vaccination compared to the 10% baseline. Public communications about how to reduce well-known side effects, such as pain at the injection site, could contribute to improved acceptance of the vaccine, as it is unlikely that development of vaccine-related minor side effects will change.

We then considered the effect of EUA versus full FDA approval. The influenza H1N1 virus brought the process of EUA into public discourse 22 , and the COVID-19 virus has again raised the debate about whether and how to use EUA. Compared to recent studies also employing conjoint experimental designs that showed just a 3% decline in support conditional on EUA 6 , we found decreases in support of more than twice that with an EUA compared to full FDA approval. Statements made by the Trump administration promising an intensely rapid roll-out or isolated adverse events from vaccination in the UK may have exacerbated concerns about EUA versus full approval 8 , 23 , 24 , 25 . This negative effect is even greater among some subsets of the population. As shown in additional analyses reported in the Supplementary Information (Supplementary Fig. 5 ), the negative effects are greatest among those who believe vaccines are generally safe. Among those who believe vaccines generally are extremely safe, the EUA decreased willingness to vaccinate by 11%, all else equal. This suggests that outreach campaigns seeking to assure those troubled by the authorization process used for currently available vaccines should target their efforts on those who are generally predisposed to believe vaccines are safe.

Next, we compared receptiveness as a function of the manufacturer: Moderna, Pfizer, Johnson and Johnson, and AstraZeneca, all firms at advanced stages of vaccine development. Vaccine manufacturers in the US have not yet attempted to use trade names to differentiate their vaccines, instead relying on the association with manufacturer reputation. In other countries, vaccine brand names have been more intentionally publicized, such as Bharat Biotech’s Covaxin in India and Gamaleya Research Institute of Epidemiology and Microbiology Sputnik V in Russia. We found that manufacturer names had no impact on willingness to vaccinate. As with hepatitis and H. influenzae vaccines 26 , 27 , interchangeability has been an active topic of debate with coronavirus mRNA vaccines which require a second shot for full immunity. Our research suggests that at least as far as public receptiveness goes, interchangeability would not introduce concerns. We found no significant differences in vaccination uptake across any of the manufacturer treatments. Future research should investigate if a manufacturer preference develops as new evidence about efficacy and side effects becomes available, particularly depending on whether future booster shots, if needed, are deemed interchangeable with the initial vaccination.

Taking up the question of how cost and financial incentives shape behavior, we looked at paying and being paid to vaccinate. While existing research suggests that individuals are often willing to pay for vaccines 28 , 29 , some economists have proposed that the government pay individuals up to $1,000 to take the COVID-19 vaccine 30 . However, because a cost of $300 billion to vaccinate the population may be prohibitive, we posed a more modest $100 incentive. We also compared this with a $10 incentive, which previous studies suggest is sufficient for actions that do not require individuals to change behavior on a sustained basis 31 . While having to pay a $20 co-pay for the vaccine did deter individuals, the additional economic incentives had no positive effect although they did not discourage vaccination 32 . Consistent with past research 31 , 33 , further analysis shows that the negative effect of the $20 co-pay was concentrated among low-income earners (Supplementary Fig. 7 ). Financial incentives failed to increase vaccination willingness across income levels.

Our study also yields important insights into the relationship between one prominent category of COVID-19 misinformation and vaccination preferences. We find that susceptibility to misinformation about COVID-19 treatments—based on whether individuals can distinguish between factual and false information about efforts to combat COVID-19—is considerable. A quarter of subjects scored no higher on our misinformation index than random guessing or uniform abstention/unsure responses (for the full distribution, see Supplementary Fig. 2 ). However, subjects who scored higher on our misinformation index did not exhibit greater vaccination hesitancy. These subjects actually were more likely to believe in vaccine safety more generally and to accept a COVID-19 vaccine, all else being equal. These results run counter to recent findings of public opinion in France where greater conspiracy beliefs were negatively correlated with willingness to vaccinate against COVID-19 34 and in Korea where greater misinformation exposure and belief were negatively correlated with taking preventative actions 35 . Nevertheless, the results are robust to alternate operationalizations of belief in misinformation (i.e., constructing the index only using false claims, or measuring misinformation beliefs as the number of false claims believed: see Supplementary Table 4 ).

We recommend further study to understand the observed positive relationship between beliefs in COVID-19 misinformation about fake treatments and willingness to receive the COVID-19 vaccine. To be clear, we do not posit a causal relationship between the two. Rather, we suspect that belief in misinformation may be correlated with an omitted factor related to concerns about contracting COVID-19. For example, those who believe COVID-19 misinformation may have a higher perception of risk of COVID-19, and therefore be more willing to take a vaccine, all else equal 36 . Additional analyses reported in the Supplementary Information (Supplementary Fig. 6 ) show that the negative effect of an EUA on willingness to vaccinate was concentrated among those who scored low on the misinformation index. An EUA had little effect on the vaccination preferences of subjects most susceptible to misinformation. This pattern is consistent with the possibility that these subjects were more concerned with the disease and therefore more likely to vaccinate, regardless of the process through which the vaccine was brought to market.

We also observe that skepticism toward vaccines in general does not correlate perfectly with skepticism toward the COVID-19 vaccine. Therefore, it is important not to conflate people who are wary of the COVID-19 vaccine and those who are anti-vaccination, as even medically informed individuals may be hesitant because of the speed at which the COVID-19 vaccine was developed. For example, older people are more likely to believe vaccines are safe but less willing to receive the COVID-19 vaccine in our survey, perhaps following the high rates of vaccine skepticism among medical staff expressing concerns regarding the safety of a rapidly-developed vaccine 2 . This inverse relationship between age and willingness to vaccinate is also surprising. Most opinion surveys find older adults are more likely to vaccinate than younger adults 37 . However, most of these survey questions ask about willingness to take a generic vaccine. Two prior studies, both recruiting subjects from the Lucid platform and employing conjoint experiments to examine the effects of vaccine attributes on public willingness to vaccinate, also find greater vaccine hesitancy among older Americans 6 , 7 . Future research could explore whether these divergent results are a product of the characteristics of the sample or of the methodological design in which subjects have much more information about the vaccines when indicating their vaccination preferences.

An important limitation of our study is that it necessarily offers a snapshot in time, specifically prior to both the election and vaccine roll-out. We recommend further study to understand more how vaccine perceptions evolve both in terms of the perceived political ownership of the vaccine—now that President Biden is in office—and as evidence has emerged from the millions of people who have been vaccinated. Similarly, researchers should consider analyzing vaccine preferences in the context of online vaccine controversies that have been framed in terms of patient autonomy and right to refuse 38 , 39 . Vaccination mandates may evoke feelings of powerlessness, which may be exacerbated by misinformation about the vaccines themselves. Further, researchers should more fully consider how individual attributes such as political ideology and race intersect with vaccine preferences. Our study registered increased vaccine hesitancy among Blacks, but did not find that skepticism was directly related to misinformation. Perceptions and realities of race-based maltreatment could also be moderating factors worth exploring in future analyses 40 , 41 .

Overall, we found that the most important factor influencing vaccine preferences is vaccine efficacy, consistent with a number of previous studies about attitudes toward a range of vaccines 6 , 42 , 43 . Other attributes offer potential cautionary flags and opportunities for public outreach. The prospect of a 50% likelihood of mild side effects, consistent with the evidence about current COVID-19 vaccines being employed, dampens likelihood of uptake. Public health officials should reinforce the relatively mild nature of the side effects—pain at the injection site and fatigue being the most common 44 —and especially the temporary nature of these effects to assuage public concerns. Additionally, in considering policy interventions, public health authorities should recognize that a $20 co-pay will likely discourage uptake while financial incentives are unlikely to have a significant positive effect. Lastly, belief in misinformation about COVID-19 does not appear to be a strong predictor of vaccine hesitancy; belief in misinformation and willingness to vaccinate were positively correlated in our data. Future research should explore the possibility that exposure to and belief in misinformation is correlated with other factors associated with vaccine preferences.

Survey sample and procedures

This study was approved by the Cornell Institutional Review Board for Human Participant Research (protocol ID 2004009569). We conducted the study on October 29–30, 2020, prior to vaccine approval, which means we captured sentiments prospectively rather than based on information emerging from an ongoing vaccination campaign. We recruited a sample of 1096 adult Americans via the Lucid platform, which uses quota sampling to produce samples matched to the demographics of the U.S. population on age, gender, ethnicity, and geographic region. Research has shown that experimental effects observed in Lucid samples largely mirror those found using probability-based samples 45 . Supplementary Table 1 presents the demographics of our sample and comparisons to both the U.S. Census American Community Survey and the demographics of prominent social science surveys.

After providing informed consent on the first screen of the online survey, participants turned to a choice-based conjoint experiment that varied five attributes of the COVID-19 vaccine. Conjoint analyses are often used in marketing to research how different aspects of a product or service affect consumer choice. We build on public health studies that have analyzed the influence of vaccine characteristics on uptake within the population 42 , 46 .

Conjoint experiment

We first designed a choice-based conjoint experiment that allowed us to evaluate the relative influence of a range of vaccine attributes on respondents’ vaccine preferences. We examined five attributes summarized in Table 2 . Past research has shown that the first two attributes, efficacy and the incidence of side effects, are significant drivers of public preferences on a range of vaccines 47 , 48 , 49 , including COVID-19 6 , 7 , 13 , 50 . In this study, we increased the expected incidence of minor side effects from previous research 6 to reflect emerging evidence from Phase III trials. The third attribute, whether the vaccine received full FDA approval or an EUA, examines whether the speed of the approval process affects public vaccination preferences 6 . The fourth attribute, the manufacturer of the vaccine, allows us to examine whether the highly public pause in the AstraZeneca trial following an adverse event, and the significant differences in brand familiarity between smaller and less broadly known companies like Moderna and household name Johnson & Johnson affects public willingness to vaccinate. The fifth attribute examines the influence of a policy tool—offsetting the costs of vaccination or even incentivizing it financially—on public willingness to vaccinate.

Attribute levels and attribute order were randomly assigned across participants. A sample choice set is presented in Supplementary Fig. 1 . After viewing each profile individually, subjects were asked: “If you had to choose, would you choose to get this vaccine, or would you choose not to be vaccinated?” Subjects then made a binary choice, responding either that they “would choose to get this vaccine” or that they “would choose not to be vaccinated.” This is the dependent variable for the regression analyses in Table 3 . After making a binary choice to take the vaccine or not be vaccinated, we also asked subjects “how likely or unlikely would you be to get the vaccine described above?” Subjects indicated their vaccination preference on a seven-point scale ranging from “extremely likely” to “extremely unlikely.” Additional analyses using this ordinal dependent variable reported in Supplementary Table 3 yield substantively similar results to those presented in Table 3 .

To determine the effect of each attribute-level on willingness to vaccinate, we followed Hainmueller, Hopkins, and Yamamoto and employed an ordinary least squares (OLS) regression with standard errors clustered on respondent to estimate the average marginal component effects (AMCEs) for each attribute 51 . The AMCE represents the average difference in a subject choosing a vaccine when comparing two different attribute values—for example, 50% efficacy vs. 90% efficacy—averaged across all possible combinations of the other vaccine attribute values. The AMCEs are nonparametrically identified under a modest set of assumptions, many of which (such as randomization of attribute levels) are guaranteed by design. Model 1 in Table 3 estimates the AMCEs for each attribute. These AMCEs are illustrated in Fig. 1 .

Analyzing additional correlates of vaccine acceptance

To explore the association between respondents’ embrace of misinformation about COVID-19 treatments and vaccination willingness, the survey included an additional question battery. To measure the extent of belief in COVID-19 misinformation, we constructed a list of both accurate and inaccurate headlines about the coronavirus. We focused on treatments, relying on the World Health Organization’s list of myths, such as “Hand dryers are effective in killing the new coronavirus” and true headlines such as “Avoiding shaking hands can help limit the spread of the new coronavirus 52 .” Complete wording for each claim is provided in Supplementary Appendix 1 . Individuals read three true headlines and five myths, and then responded whether they believed each headline was true or false, or whether they were unsure. We coded responses to each headline so that an incorrect accuracy assessment yielded a 1; a correct accuracy assessment a -1; and a response of unsure was coded as 0. From this, we created an additive index of belief in misinformation that ranged from -8 to 8. The distribution of the misinformation index is presented in Supplementary Fig. 2 . A possible limitation of this measure is that because the survey was conducted online, some individuals could have searched for the answers to the questions before responding. However, the median misinformation index score for subjects in the top quartile in terms of time spent taking the survey was identical to the median for all other respondents. This may suggest that systematic searching for correct answers is unlikely.

To ensure that any association observed between belief in misinformation and willingness to vaccinate is not an artifact of how we operationalized susceptibility to misinformation, we also constructed two alternate measures of belief in misinformation. These measures are described in detail in the Supplementary Information (see Supplementary Figs. 3 and 4 ). Additional regression analyses using these alternate measures of misinformation beliefs yield substantively similar results (see Supplementary Table 4 ). Additional analyses examining whether belief in misinformation moderates the effect of efficacy and an FDA EUA on vaccine acceptance are presented in Supplementary Fig. 6 .

Finally, model 2 of Table 3 includes a range of additional control variables. Following past research, it includes a number of demographic variables, including indicator variables identifying subjects who identify as Democrats or Republicans; an indicator variable identifying females; a continuous variable measuring age (alternate analyses employing a categorical variable yield substantively similar results); an eight-point measure of educational attainment; and indicator variables identifying subjects who self-identify as Black or Latinx. Following previous research 6 , the model also controlled for three additional factors often associated with willingness to vaccinate: an indicator variable identifying whether each subject had health insurance; a variable measuring past frequency of influenza vaccination on a four-point scale ranging from “never” to “every year”; beliefs about the general safety of vaccines measured on a four-point scale ranging from “not at all safe” to “extremely safe”; and a measure of attitudes toward the pharmaceutical industry ranging from “very positive” to “very negative.”

Reporting summary

Further information on research design is available in the Nature Research Reporting Summary linked to this article.

Data availability

All data and statistical code to reproduce the tables and figures in the manuscript and Supplementary Information are published at the Harvard Dataverse via this link: 10.7910/DVN/ZYU6CO.

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Acknowledgements

S.K. and D.K. would like to thank the Cornell Atkinson Center for Sustainability for financial support.

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Sarah Kreps & Douglas L. Kriner

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Kreps, S., Dasgupta, N., Brownstein, J.S. et al. Public attitudes toward COVID-19 vaccination: The role of vaccine attributes, incentives, and misinformation. npj Vaccines 6 , 73 (2021). https://doi.org/10.1038/s41541-021-00335-2

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February 17, 2021

COVID Vaccines Are Safe and Effective—What the Research Says

As more coronavirus vaccines are rolled out, researchers are learning about the extent and nature of side effects

By Ariana Remmel & Nature magazine

A healthcare worker administers a dose of the Pfizer-BioNTech Covid-19 vaccine at the Sun City Anthem Community Center vaccination site in Henderson, Nevada, U.S., on Thursday, Feb. 11, 2021.

Roger Kisby Getty Images

As people around the world receive COVID-19 vaccines, reports of temporary side effects such as headaches and fevers are rolling in. Much of this was expected—clinical-trial data for the vaccines authorized so far suggested as much. But now that millions of people are vaccinated, compared with the thousands enrolled in early studies, reports of some rare, allergic reactions are surfacing, and questions are arising about whether any deaths are linked to the shots.

There is no question that the current vaccines are effective and safe. The risk of severe reaction to a COVID-19 jab, say researchers, is outweighed by the protection it offers against the deadly coronavirus.  Nature  looks at what scientists are learning about the frequency and nature of side effects as huge numbers of people report their reactions to physicians and through safety-monitoring systems, such as smartphone apps.

How many people experience common side effects from COVID-19 vaccines?

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For the two available messenger RNA (mRNA) vaccines—one made by Moderna at Cambridge, Massachusetts, and the other developed through a collaboration between Pfizer in New York City and BioNTech in Mainz, Germany—a significant portion of people experience non-serious reactions, such as injection-site pain, headache and fatigue. These vaccines deliver bits of RNA that code for coronavirus proteins, which the body mounts a response against.

According to data  from the US Vaccine Adverse Event Reporting System (VAERS), about 372 out of every million administered doses of the mRNA vaccines lead to a non-serious reaction report. This number is lower than would be expected from clinical-trial data, which indicated that at least 80% of people would experience injection-site pain. Researchers running trials monitor patients closely and record every reaction. VAERS, meanwhile, relies on health-care workers and vaccinated individuals to self-report side effects.

So far, reactions to the mRNA vaccines are similar. These vaccines are administered in a two-dose regimen: the first shot triggers an immune reaction, and the second is a ‘booster’ that strengthens the body’s ability to fight the coronavirus. For the Pfizer–BioNTech vaccine, which has been in use longer than the Moderna vaccine and therefore has generated more data, side effects increase with the second dose.

In the United Kingdom, three million doses of another vaccine, developed by the University of Oxford and pharmaceutical firm AstraZeneca, have been doled out. This vaccine, which also requires a two-dose regimen, contains a inactivated cold-causing adenovirus with genetic instructions for making coronavirus proteins to trigger immunity.  According to UK safety-monitoring system  the Yellow Card Scheme, about 4,000 doses out of every million administered lead to adverse reactions. Again,  clinical-trial data suggest  that a higher frequency is more accurate: around 50% of participants had injection-site pain, headache or fatigue, according to data reported to the European Medicines Agency (EMA).

Few people have received a second dose of the Oxford–AstraZeneca vaccine because  the United Kingdom used its supplies  to administer a first dose to as many people as possible, but clinical-trial data presented to the EMA suggest that side effects of the second shot are milder than those caused by the first.

Safety data for shots rolling out in other parts of the world, such as the COVID-19 vaccines in China, are harder to come by. Preliminary data from clinical trials of the adenovirus-based Sputnik V vaccine in Russia suggest its most common side effects include flu-like symptoms and injection-site reactions.

How does that compare with side effects from an annual flu shot?

At least for the mRNA vaccines, physicians are seeing more side effects than for flu shots, says Helen Chu, an infectious-disease specialist at the University of Washington School of Medicine in Seattle, who directs the Seattle Flu Study. In clinical trials for the Pfizer–BioNTech vaccine, for instance, 75% of  participants reported  a ‘systemic reaction’, such as headache, fever or chills. In a clinical trial for the common influenza vaccine Flubok Quadravalent, around 34% of participants aged 18–49 had a systemic reaction. Side effects were even less frequent in study participants who were at least 50 years old.

Chu says the mRNA COVID-19 vaccines generate a particularly strong immune response that increases the risk of side effects, although this also means that the vaccines are working. She notes that her second dose of the Pfizer–BioNTech vaccine made her ill. “I got the vaccine, and 6 hours later, I had chills, a high fever, muscle aches and I went to bed for 24 hours,” she says. “Then by 36 hours later, it was totally over and I was back to normal.” But Chu would rather be temporarily ill from a vaccine than deal with COVID-19, “a potentially mortal disease that could kill me”, she says.

Have investigations linked any deaths to a COVID-19 vaccine?

Although some have questioned whether the vaccines have led to deaths, none have been directly attributed to a COVID-19 jab. After 33 elderly care-home residents in Norway died within 6 days of receiving the Pfizer–BioNTech vaccine, investigations by both the Norwegian Medicines Agency and  the World Health Organization  concluded that these deaths were in line with normal death rates in this age group and that the vaccine is still safe for older people. India's Ministry of Health and Family Welfare  reported 27 deaths  in the country, but none of these have been linked directly to a COVID-19 vaccine either.

It is “extremely difficult” to definitively link a death to the vaccine itself, says Hilda Bastian, a writer and scientist who specializes in validating evidence-based health claims. That is partially because the deaths reported so far have occurred days or weeks after an injection, making it hard to rule out other circumstances. Another reason is that, right now, clinicians are prioritizing vaccines largely for a population of older people with underlying health conditions. Most of those who have died after vaccination have been in this group, according to reports from the  United Kingdom  and the  United States .

What do researchers know about the rare, but severe, allergic reactions to the vaccines?

The Moderna vaccine elicits about three anaphylactic reactions per million doses administered, and the Pfizer–BioNTech vaccine triggers five reactions per million doses,  according to VAERS data . This is a higher rate than most other vaccines—including annual flu shots, which trigger anaphylaxis for only one out of every million doses administered. For the Oxford–AstraZeneca vaccine, 30 cases of anaphylaxis have been confirmed overall so far, out of a little more than 3 million administered doses. Vaccine specialists expect that these rates might change as more shots are administered.

Although some people have required hospitalization, all have fully recovered. Public-health officials advise people with a history of allergies to any of the vaccines’ ingredients not to get a COVID-19 jab.

Unlike COVID-19, anaphylaxis is treatable with drugs such as epinephrine if caught quickly, says Paul Offit, a vaccine and infectious-disease specialist at the Children’s Hospital of Philadelphia in Pennsylvania, who participated in the US Food and Drug Administration advisory-committee meetings that led the agency to authorize both mRNA vaccines. “I wish that SARS-CoV-2 could be immediately treated with a shot of epinephrine!” he says.

Most of the people who experienced anaphylaxis had reacted to other substances before: about 80% of people who reacted to the Pfizer–BioNTech vaccine, and 86% to the Moderna vaccine, had a history of allergies, according to the US Centers for Disease Control and Prevention.

The specific cause of the anaphylactic reactions remains unknown, but the US National Institute of Allergy and Infectious Diseases told  Nature  in an e-mail that the agency has designed a clinical trial to determine the underlying mechanism, but did not specify when the trial would begin.

What could be causing the allergic reactions?

Some researchers have had their eye on polyethylene glycol (PEG) as the anaphylaxis-causing agent in the mRNA vaccines. The Moderna and Pfizer–BioNTech vaccines use hollow lipid nanoparticles to store and then deliver their mRNA payload to cells. PEG is linked to the lipids in these particles and, under normal circumstances, helps them to sneak by the immune system. Although PEG-linked molecules are found in a variety of products, such as laxatives and gout medicines, they have been known to cause allergic reactions.

Follow-up studies in people who experienced anaphylaxis could help to determine whether PEG is the culprit, says Samuel Lai, a pharmaco-engineer at the University of North Carolina at Chapel Hill. If blood samples from these people contain anti-PEG antibodies, it could be an indicator, says Lai, but it is as yet unclear how long these proteins remain in the bloodstream after anaphylaxis.

Vaccines that don’t use PEG—such as the not-yet-authorized shot from Johnson & Johnson, which also uses an adenovirus to trigger immunity to the coronavirus—might be a way to vaccinate people with a sensitivity to the polymer, he adds.

Because mRNA vaccines have shown such promise, Ulrich Schubert, a polymer scientist at the University of Jena in Germany, thinks now is the time to invest in developing vaccine-compatible polymers that don’t cause allergic reactions. At the German Research Foundation-funded collaborative research center PolyTarget, where Schubert works, these studies are already in progress. “If we want to be ready for the next pandemic—which will come—we have to start now,” he says.

This article is reproduced with permission and was first published on February 16 2021.

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Evidence does not justify mandatory vaccines - everyone should have the right to informed choice

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Evidence is insufficient to back mandatory NHS staff vaccination, says House of Lords committee

Read our latest coverage of the coronavirus pandemic.

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Rapid Response:

Dear Editor,

As doctors and health professionals, many of whom work in the NHS, we would like to express our opposition to anti-SARS-CoV-2 vaccination being mandated for any group of people, including health and care workers. We agree with the House of Lords committee that the evidence is insufficient to justify this measure, but the government and Parliament do not appear to be listening and mandatory vaccines for NHS staff looks likely to be passed into law this week.

We do not dispute that covid-19 can be and has been a dangerous infection, and we agree that vaccines are effective in many situations. However, there is considerable uncertainty about the effectiveness of the covid vaccines, some serious short-term complications and a lack of data on long-term harms. In this situation, it is imperative that people are able to make a fully-informed choice about whether to have the vaccine or not.

It is widely accepted that randomised controlled trials are the only means of providing robust data on the efficacy of medical interventions because observational data is subject to uncontrolled biases. Yet the randomised trials of the covid vaccines lasted for a very short time and were only powered to provide definitive statistical evidence on preventing ‘symptomatic infections’, not on preventing infection per se, hospitalisation or death. The trials also provided no data on whether the vaccines reduce transmission or not—things we have had to learn the hard way, through real world evidence like the rapid spread of the Delta and now Omicron variants.

Results from the randomised vaccine trials published so far suggested the vaccines were effective in reducing symptomatic infections for a few weeks. The average duration of follow-up for people in the first report from the Pfizer trial, on which licensing was based, was only 46 days, for example. [1] The recent report on data from people who had been in the trial for up to 6 months revealed that the mean total duration of follow-up for the primary outcome of the double-blind trial was 3.6 months for those who received the vaccine and 3.5 months for those allocated to placebo. [2] Moreover, only 7% of participants actually remained in the double blind trial for 6 months. [3] Real-world data are not consistent with the trial results, with high case numbers in doubly vaccinated individuals reported from the UK [4] and Israel [5], for example. This suggests either that effects of vaccines wear off quickly, and/or that some bias crept into original trial procedures, possibly due to unblinding caused by vaccine reactions [6] or other procedural irregularities. [7] The same observational data suggests the vaccines may reduce hospital admission and death due to covid infection, but, in the absence of data from randomised trials it is difficult to be certain, since unknown factors may bias the data in either direction.

More alarmingly, third and fourth ‘booster’ shots have not been tested in any randomised trials, and other data on the efficacy and safety of administering further doses are scanty.

In other words, data on the only outcome properly tested in randomised trials, the prevention of cases by two vaccinations, appear unreliable, possibly due to rapidly waning effects or other factors, and other outcomes and procedures have not been investigated in randomised trials, meaning there is no secure evidence either way.

As far as the safety of the vaccines is concerned, it is clear that rare but serious, and potentially fatal adverse effects occur, such as thrombosis and myocarditis, [8] and that these took months to identify. Long-term harms will be difficult to detect due to the short duration of the randomised trials, and will only become apparent in coming years.

There are also no data on groups who might be particularly adversely affected by the vaccine, such as those with, or at risk of autoimmune disorders, and there is little data on adverse effects of booster shots, which is significant since there have long been safety concerns about repeated exposure to mRNA technology. [9] Repeated booster vaccines therefore represent cumulative risk for untested benefit.

For young age groups, in whom covid-related morbidity and mortality is low, and for those who have had covid 19 infection already, and appear to have longstanding immunological memory, [10] the harms of taking a vaccine are almost certain to outweigh the benefits to the individual, and the goal of reducing transmission to other people at higher risk has not been demonstrated securely. [11]

Respecting people’s autonomy and bodily integrity is at the heart of human rights and medical ethics and the data currently available on the vaccines by no means justify over-riding these important principles. More good quality research and access to existing data from the vaccine trials are required for people to make fully-informed decisions about whether to take these vaccines or not. [12] Coercing people to have a covid vaccine, either through the threat of legal sanctions or, in the case of mandates for occupational groups, by depriving people of their livelihoods and careers, is not justified due to the prevailing uncertainty about the overall benefits of the vaccines, the unfavourable risk-benefit ratio for many groups, and, not least, the lack of data on long-term harms.

1. Polack FP, Thomas SJ, Kitchin N, et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med 2020;383(27):2603-15. doi: 10.1056/NEJMoa2034577 [published Online First: 2020/12/11] 2. Thomas SJ, Moreira ED, Jr., Kitchin N, et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine through 6 Months. N Engl J Med 2021;385(19):1761-73. doi: 10.1056/NEJMoa2110345 [published Online First: 2021/09/16] 3. Doshi P. Does the FDA think these data justify the first full approval of a covid-19 vaccine? British Medical Journal 2021 23rd Aug 2021. https://blogs.bmj.com/bmj/2021/08/23/does-the-fda-think-these-data-justi... . 4. UK Health Security Agemcy. COVID-19 vaccine surveillance report: Week 48. 2021 5. Goldberg Y, Mandel M, Bar-On YM, et al. Waning Immunity after the BNT162b2 Vaccine in Israel. New England Journal of Medicine 2021;385:e85. doi: DOI: 10.1056/NEJMoa2114228 6. Doshi P. Pfizer and Moderna’s “95% effective” vaccines—we need more details and the raw data. British Medical Journal 2021 4th Jan 2021. https://blogs.bmj.com/bmj/2021/01/04/peter-doshi-pfizer-and-modernas-95-... (accessed 10th Dec 2021). 7. Thacker PD. Covid-19: Researcher blows the whistle on data integrity issues in Pfizer’s vaccine trial. British Medical Journal 2021;375:n2635. doi: doi.org/10.1136/bmj.n2635 8. Mevorach D, Anis E, Cedar N, et al. Myocarditis after BNT162b2 mRNA Vaccine against Covid-19 in Israel. New England Journal of Medicine 2021;385:2140-49. doi: 10.1056/NEJMoa2109730 9. Garde D. Lavishly funded Moderna hits safety problems in bold bid to revolutionize medicine. STAT News 2017 10th Jan 2017. https://www.statnews.com/2017/01/10/moderna-trouble-mrna/ (accessed 12th Dec 2021). 10. Dan JM, Mateus J, Cato Y, et al. Immunological memory to SARS-CoV-2 assessed for up to 8 months after infection. Science 2021;371:(6529):eabf4063. doi: 10.1126/science.abf4063 11. Singanayagam A, Hakki S, Dunning J, et al. Community transmission and viral load kinetics of the SARS-CoV-2 delta (B.1.617.2) variant in vaccinated and unvaccinated individuals in the UK: a prospective, longitudinal, cohort study. Lancet Infect Dis 2021 doi: 10.1016/S1473-3099(21)00648-4 [published Online First: 2021/11/11] 12. Tanveer S, Rowhani-Farid A, Hong K, et al. Transparency of COVID-19 vaccine trials: decisions without data. BMJ Evid Based Med 2021 doi: 10.1136/bmjebm-2021-111735 [published Online First: 2021/08/11]

Competing interests: No competing interests

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Getting the COVID-19 Vaccine

This article is part of a series of explainers on vaccine development and distribution. Learn more about vaccines – from how they work and how they’re made to ensuring safety and equitable access – in WHO’s Vaccines Explained series.

Vaccines are a critical tool in the battle against COVID-19, and getting vaccinated is one of the best ways to protect yourself and others from COVID-19.

Getting vaccinated is safer than getting infected 

Vaccines train our immune system to recognize the targeted virus and create antibodies to fight off the disease without getting the disease itself. After vaccination, the body is ready to fight the virus if it is later exposed to it, thereby preventing illness.

Most people who are infected with SARS-CoV-2, the virus that causes COVID-19, develop an immune response within the first few weeks, but we are still learning how strong and lasting that immune response is, and how it varies between different people.

People who have already been infected with SARS-CoV-2 should still get vaccinated unless told otherwise by their health care provider. Even if you’ve had a previous infection, the vaccine acts as a booster that strengthens the immune response. There have also been some instances of people infected with SARS-CoV-2 a second time, which makes getting vaccinated even more important.

What to expect during vaccination

Medical professionals can best advise individuals on whether or not, and when, they should receive a vaccine. A health worker will administer the vaccine, and the person receiving it will be asked to wait for 15–30 minutes before leaving the vaccination site. This is so that health workers can observe individuals for any unexpected reactions following vaccination.

Like any vaccine, COVID-19 vaccines can cause mild-to-moderate side effects, such as a low-grade fever or pain or redness at the injection site. These should go away on their own within a few days. See WHO’s Safety of COVID-19 Vaccines explainer and Vaccines Safety Q&A to learn more about common side effects and find out who should consult with a doctor before vaccination.

Vaccine doses

For some COVID-19 vaccines, two doses are required . It’s important to get the second dose if the vaccine requires two doses.

For vaccines that require two doses, the first dose presents antigens – proteins that stimulate the production of antibodies – to the immune system for the first time. Scientists call this priming the immune response. The second dose acts as a booster, ensuring the immune system develops a memory response to fight off the virus if it encounters it again.

Because of the urgent need for a COVID-19 vaccine, initial clinical trials of vaccine candidates were performed with the shortest possible duration between doses. Therefore an interval of 21–28 days (3–4 weeks) between doses is recommended by WHO. Depending on the vaccine, the interval may be extended for up to 42 days – or even up to 12 weeks for some vaccines – on the basis of current evidence.

There are many COVID-19 vaccines being developed and produced by different manufacturers around the world. WHO recommends that a vaccine from the same manufacturer be used for both doses if you require two doses. This recommendation may be updated as further information becomes available.

Safety against infection and transmission after vaccination

Available clinical trials have shown COVID-19 vaccines to be safe and highly effective at preventing severe disease. Given how new COVID-19 is, researchers are still looking into how long a vaccinated person is likely to be protected from infection, and whether vaccinated people can still transmit the virus to others. As the vaccine rollout expands, WHO will continue to monitor the data alongside regulatory authorities.

Safe and effective vaccines are making a significant contribution to preventing severe disease and death from COVID-19. As vaccines are rolling out and immunity is building, it is important to continue to follow all of the recommended measures that reduce the spread of SARS-CoV-2. This includes physically distancing yourself from others; wearing a mask, especially in crowded and poorly ventilated settings; cleaning your hands frequently; covering any cough or sneeze in your bent elbow; and opening windows when indoors.

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• Volume 107, Issue 3
• Should children be vaccinated against COVID-19?
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• http://orcid.org/0000-0002-2388-4318 Petra Zimmermann 1 , 2 , 3 ,
• http://orcid.org/0000-0002-2395-4574 Laure F Pittet 3 , 4 , 5 ,
• http://orcid.org/0000-0003-1756-5668 Adam Finn 6 , 7 ,
• http://orcid.org/0000-0001-7361-719X Andrew J Pollard 8 , 9 ,
• http://orcid.org/0000-0003-3446-4594 Nigel Curtis 3 , 4 , 10
• 1 Faculty of Science and Medicine , University of Fribourg , Fribourg , Switzerland
• 2 Department of Paediatrics , Fribourg Hospital HFR , Fribourg , Switzerland
• 3 Infectious Diseases Research Group , Murdoch Children’s Research Institute , Parkville , Victoria , Australia
• 4 Department of Paediatrics , The University of Melbourne , Parkville , Victoria , Australia
• 5 Pediatric Infectious Diseases Unit , Geneva University Hospitals and Faculty of Medicine , Geneva , Switzerland
• 6 Bristol Vaccine Centre, School of Clinical Sciences and School of Cellular & Molecular Medicine , University of Bristol , Bristol , UK
• 7 Bristol Royal Hospital for Children , University Hospitals Bristol NHS Foundation Trust , Bristol , UK
• 8 Oxford Vaccine Group, Department of Paediatrics , University of Oxford , Oxford , UK
• 9 NIHR Oxford Biomedical Research Centre , Oxford , UK
• 10 Infectious Diseases Unit , The Royal Children’s Hospital Melbourne , Parkville , Victoria , Australia
• Correspondence to Dr Petra Zimmermann, Faculty of Science and Medicine, University of Fribourg, Fribourg 1700, Switzerland; petra.zimmermann{at}unifr.ch

Whether all children under 12 years of age should be vaccinated against COVID-19 remains an ongoing debate. The relatively low risk posed by acute COVID-19 in children, and uncertainty about the relative harms from vaccination and disease mean that the balance of risk and benefit of vaccination in this age group is more complex. One of the key arguments for vaccinating healthy children is to protect them from long-term consequences. Other considerations include population-level factors, such as reducing community transmission, vaccine supply, cost, and the avoidance of quarantine, school closures and other lockdown measures. The emergence of new variants of concern necessitates continual re-evaluation of the risks and benefits. In this review, we do not argue for or against vaccinating children against COVID-19 but rather outline the points to consider and highlight the complexity of policy decisions on COVID-19 vaccination in this age group.

• child health
• communicable diseases
• epidemiology

Data availability statement

No data are available. N/A.

https://doi.org/10.1136/archdischild-2021-323040

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What is already known on this topic?

COVID-19 is generally asymptomatic or mild in children, but can be more severe in those with certain comorbidities.

There is no consensus on whether all healthy children less than 12 years of age should be vaccinated against COVID-19.

Data from COVID-19 vaccine use in this age group will become available in the near future.

What this study adds?

The balance of risks and benefits of COVID-19 vaccination in children is more complex than in adults as the relative harms from vaccination and disease are less well established in this age group.

One of the key arguments for vaccinating children less than 12 years of age, apart from reducing acute illness, is to protect them from long-term consequences of COVID-19; other considerations include population-level factors.

The risks and benefits need continual re-evaluation with the emergence of new variants of concern, and new data on effectiveness and adverse effects.

Introduction

Whether all children should be offered vaccination against SARS-CoV-2 has been controversial in children aged 12–15 years old, and remains so for those under 12 years of age, partly because the balance of risk and benefit in this age group is more complex (see figure 1 ).

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Summary of benefits and risks of vaccinating children against COVID-19. PIMS-TS, paediatric inflammatory multisystem syndrome-temporally associated with SARS-CoV-2.

The risk of severe acute COVID-19 in healthy children infected with SARS-CoV-2 is much lower than in adults. 1–10 Two longer term consequences of SARS-CoV-2 infection might therefore be more of a concern in this age group. The first is ‘paediatric inflammatory multisystem syndrome-temporally associated with SARS-CoV-2 (PIMS-TS)’, also known as ‘multisystem inflammatory syndrome in children’, an immune-mediated disease that occurs in a small proportion of children 2–6 weeks after being infected with SARS-CoV-2. 11–20 The second is long COVID-19, the persistence of symptoms following SARS-CoV-2 infection, a heterogeneous group of conditions. 21

Aside from potential long-term consequences, other considerations in deciding on COVID-19 vaccine policy for children include safety (both common reactions and rare serious side effects), population-level factors, such as reducing community transmission, vaccine supply, cost of vaccination, the avoidance of quarantine, school closures and other lockdown measures, and the potential impact on routine immunisation programmes.

In this review, we do not argue for or against vaccinating children against COVID-19 but rather outline the points to consider to highlight the complexity of policy decisions on COVID-19 vaccination in this age group.

Benefits and risks of vaccinating children against COVID-19

The main question for implementing any vaccine is ‘do the benefits of the vaccine in preventing the harms of the disease outweigh any known or potential risks associated with vaccination?’ To date, two COVID-19 vaccines have been shown to be effective in children aged 12–17 years, and have been authorised for emergency use and subsequently recommended for this age group in many countries. 22–26 Both vaccines are currently being evaluated in children aged 6 months–12 years and it is likely that emergency authorisation will be sought in this age group soon. Nevertheless, COVID-19 vaccine trials in adolescents so far include less than 4000 participants and appropriately focus on efficacy, immunogenicity and rates of common reactions. 25 26 A phase 2/3 trial in children 5–12 years of age recently reported that a messenger RNA (mRNA) vaccine was safe, well tolerated and induced robust neutralising antibodies. 27 Results from the same trial in children under 5 years of age are expected by the end of 2021. Rare adverse effects are difficult to detect with such sample sizes, and are often seen only after large-scale use. Outside clinical trials, millions of adolescents between 12 and 18 years of age have been vaccinated, including 13 million in the USA. 28 Arguments for and against vaccinating children against COVID-19 are summarised in table 1 .

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Arguments for and against vaccinating children against COVID-19

Potential benefits of vaccinating children

Protection against covid-19.

COVID-19 is generally a mild disease in children with less than 2% of symptomatic children requiring hospital admission. 1–10 The rate of intensive care admission of hospitalised children ranges between 2% and 13%. 1 7 8 29 30 Higher rates (10%–25%, 31 32 up to 33% in some studies 33 34 ) are reported from the USA. However, these numbers often include children who are hospitalised with COVID-19 and not because of COVID-19, and therefore overestimate the severity. In children and adolescents, the risk of death from SARS-CoV-2 infection is 0.005%, 35 and in those who are hospitalised with COVID-19 it is 0%–0.7%. 1 7 8 29 30 33 34 However, again, these numbers often include children who died with a SARS-CoV-2 infection and not because of it (a recent population-based study showed that only 41% of child deaths reported from SARS-CoV-2 infections were from COVID-19). 35 Therefore, the prevention of SARS-CoV-2 infection is not as strong an argument for vaccinating all healthy children as it is for adults. Nevertheless, this might change if new variants emerge which cause more severe disease in otherwise healthy children.

There are insufficient data to estimate the risk of myocarditis in children and adolescents with COVID-19, although one report from the USA suggested a risk of 876 cases per million. 36 Another study reported an adjusted risk ratio for myocarditis from patients with COVID-19 compared with patients without COVID-19 of 36.8 in children less than 16 years of age and 7.4 in adolescents 16–24 years of age. 37 A third study reported an 8.2-fold increase in myocarditis admissions during the pandemic, but no cases among the 1371 children and adolescents less than 18 years of age. 38 Information on the long-term outcome of myocarditis resulting from SARS-CoV-2 infection (e.g., progression to fibrosis) is currently lacking.

In the USA, with the emergence of the more transmissible Delta variant, a recent rise in infections in children has led to overcrowded hospital and intensive care units. 39 For hospitalised children, intensive care admission and mortality rates are currently stable at 23% and 0.4% 29 – 1.8%, 30 respectively. Of note, this has occurred in settings with low vaccine coverage in adults and suboptimal preventive measures in place. There are no reports indicating an increase in the severity of COVID-19 in children since the Delta variant has become dominant.

At this time, COVID-19 vaccines only have ‘emergency use authorisation’ in children between 12 and 16 years of age, which is for interventions that address a serious or life-threatening condition. It has been argued that, unless children are at high risk of severe COVID-19 because of an underlying condition, it is unclear whether the benefits to the individual outweigh the risks in this age group, and approval through the standard regulatory process should be awaited. 40

There are good reasons to consider offering vaccination to children and adolescents at higher risk of being hospitalised or becoming severely unwell from a SARS-CoV-2 infection, as, in their case, the risk of harm from vaccination is estimated to be lower than the risk of harm from COVID-19. This includes children with neurodisabilities, Down’s syndrome, immunodeficiencies, malignancies, some cardiac, respiratory and renal diseases, obesity and poorly controlled diabetes. 41

The low risk of hospitalisation and death from COVID-19 might not be a good argument against vaccinating against this disease as the risk is similar or even higher than that for other diseases for which vaccines are routinely given, such as varicella, rubella, hepatitis A and influenza. 42 In addition, if a high proportion of children are infected, even a very low rate of severe illness might translate to a high absolute number of cases. Moreover, in low/middle-income countries (LMICs), the impact of COVID-19 in children may be greater due to comorbidities that impact immunity, including diarrhoea, dengue fever, tuberculosis, malnutrition, stunting and anaemia. 33 Similary, in high-income countries, children from deprived and ethnic minority groups are more frequently infected with SARS-CoV-2, which might be due to a greater likelihood of living with unvaccinated adults or in multigenerational and overcrowded households. 43 44 These children have also been reported to have more severe COVID-19 and to more frequently suffer from PIMS-TS. 45–47

Protection against PIMS-TS

The risk of PIMS-TS is low, affecting less than 0.1% of SARS-CoV-2-infected children. Although up to 70% of children with PIMS-TS are admitted to intensive care units, 48 49 almost all patients recover without sequelae. 11–20 48 50 51 Between 79% and 100% of abnormal cardiac findings are reported to resolve within 14–30 days after hospital discharge. 48 52 53 Six months after discharge, 96% of children have a normal echocardiography, and renal, haematological, otolaryngological and neurological abnormalities have largely resolved. 45 However, the long-term consequences of PIMS-TS remain uncertain and the death rate from PIMS-TS is estimated to be 1%–2%. 48 49 There is no evidence to date on whether vaccination protects against PIMS-TS: although by protecting against SARS-CoV-2 infection it may well also protect against post-infectious sequelae; data are needed to confirm this. Since the pathogenesis of PIMS-TS remains unclear, there is also a theoretical risk that antibodies induced by COVID-19 vaccination could cause PIMS-TS, though there is no evidence of this to date.

Protection against long COVID-19

While vaccination prevents infection with SARS-CoV-2 to a degree and thus, presumably, persistent symptoms following the infection, more data are needed to determine accurately the incidence of long COVID-19 in children. 21 Studies to date report a prevalence ranging from 1.2% to 66%. 54–64 However, most of these studies have substantial limitations, including a lack of a clear case definition, the absence of a control group without infection, inclusion of children without laboratory-confirmed SARS-CoV-2 infection, follow-up at arbitrary time points and high non-responder bias. 54–63 65–68 Of the five studies to date that have included controls, 55 59 61 65 two did not find a difference in the prevalence of persistent symptoms between infected and uninfected children. 61 65 This highlights the difficulty of separating COVID-19-related symptoms from those attributable to other factors associated with the pandemic, such as lockdowns and school closures. The three that did find a difference had significant limitations, including potential selection bias due to a high non-responder rate, that could lead to an overestimate of the risk of long COVID-19. 55 59

Prevention of community transmission

Another advantage of vaccinating children is helping decrease transmission and thus reducing severe cases in adults and the risk of new virus variants emerging. As well as reducing disease, COVID-19 vaccines also reduce infection. Initial studies reported that vaccinated individuals who become infected are less likely to transmit the virus due to decreased viral load and duration of virus shedding 69 70 and as a consequence, transmission from vaccinated individual to household contacts is significantly lower 71 (by 50% in one study 69 ). However, more recent studies done since the Delta variant became dominant show similar viral loads in vaccinated and unvaccinated individuals. 72–75

Children, including young children, can transmit SARS-CoV-2. 76 Nonetheless, even though transmission in schools can contribute to the circulation of SARS-CoV-2, 77 the rate of transmission in educational settings is low and index cases are often adults. 78–81 The risk of infection in schools correlates strongly with local community infection rates, which can be reduced by vaccinating older age groups. Nevertheless, the risk of transmission in different age groups and settings might change with the emergence of new virus variants of concern. For the Delta variant, it has been suggested that infected fully vaccinated individuals are as likely to transmit SARS-CoV-2 as infected unvaccinated individuals, although for shorter duration. 82 83 However, recent data from Australia reported a low risk of transmission in educational settings with protection measurements in place, even with the Delta variant (the transmission rate from adults to children was 8%, from children to adults 1.3% and from children to other children 1.8%). 84

Earlier in the pandemic, it was reported that index cases in households were more likely to be a parent or adolescent than a young child. 6 85–87 However, one study suggests that children and adolescents are more likely to infect others. 88 Another study reported that household transmission was more common from children aged 0–3 years than from children aged 14–17 years. 89 However, this might change with the Delta or other new variants. In a population with low numbers of vaccinated adults, infected children transmitted the Delta variant to 70% of households (in 57% of households all members became infected). 84 Nevertheless, once a large proportion of the adult population is vaccinated, preventing transmission to them from unvaccinated children becomes less important. There is a stronger argument for vaccinating children and adolescents who live with immunosuppressed or other high-risk household members, not only for the protection of the latter but also to benefit the mental health of the former. Also, in LMICs children under 12 years of age form a larger proportion of the population and might therefore have a larger role in tranmission.

Another consideration is that, once SARS-CoV-2 becomes endemic, primary SARS-CoV-2 infection in early childhood, when COVID-19 is mild, with subsequent boosting from ongoing exposure at older ages, may bring about population immunity, as seen with common circulating coronaviruses, more effectively than mass immunisation. 90

Avoidance of indirect (population-level) harms

Vaccinating children and adolescents might help reduce the indirect harms caused by quarantine, lockdowns, repeat testing, school exclusion and closures, and other policies aimed at reducing community transmission, although the extent to which mass vaccination is necessary to achieve this remains unclear. Also, if the purpose of lockdowns and school closures is to protect adults, the incremental benefit of vaccinating children will be minimal once most adults are protected through vaccination. The possibility that vaccination might become a requirement for children for international travel is another consideration.

Potential risks of vaccinating children

Risk of adverse effects.

As with any vaccine, there are potential rare adverse effects of COVID-19 vaccines. The development of myocarditis or pericarditis after mRNA vaccines has been a recent concern, 91 92 particularly in male adolescents (studies reporting 6.3–6.7 cases per 100 000 second vaccine doses in males aged 12–17 years, 91 93 and 15.1 cases per 100 000 second vaccine doses in males aged 16–19 years 94 ). Another study reported an incidence of 10.7 cases per 100 000 persons in males aged 16–29 years. 95 Of these patients, approximately 6% required intensive care admission. 96 However, most recovered without sequelae (86% had resolution of symptoms after mean duration of 35 days). 97 98 Importantly, even in this age group, recent reports suggest the risk of myocarditis associated with COVID-19 is higher (see above).

The risk of thrombosis after viral vector vaccines observed rarely in adults also needs to be considered. The thrombotic risk in children or adolescents is less 99 and no cases have been reported to date in this age group. However, since the pathogenesis underlying thrombosis associated with COVID-19 vaccines is thought to differ from that for clots from other causes, such as stasis and the contraceptive pill, further data from children are necessary. As thrombotic events have either not been observed or appear to be very rare in Asia, Africa and Latin America, some countries are considering these vaccines as an option. The theoretical risk of COVID-19 vaccines triggering PIMS-TS has been raised but there are no reports of this to date. 100

Long-term safety

The lack of long-term safety data is another consideration. Longer term follow-up of myocarditis cases is needed to exclude any possibility of myocardial fibrosis and associated dysfunction or arrhythmia risk. Two studies showed a high prevalence of late gadolinium enhancement in MRIs in patients suffering from post-vaccine myocarditis. 97 101 Further studies are needed to establish whether this resolves or evolves into fibrosis. As discussed above, information on this risk is also needed for myocarditis resulting from SARS-CoV-2 infection.

Although the majority of adverse vaccine effects occur early after vaccination, any unforeseen adverse effects could undermine vaccine confidence and reduce vaccination rates against other diseases. 102

Vaccine supply

The currently limited global COVID-19 vaccine supply is another factor to consider. To date, many LMICs have only been able to vaccinate less than 5% of their population despite the COVAX programme. At this time, available supplies might be better prioritised for vaccinating adults with a higher risk of severe COVID-19 and death, including healthcare workers. 103 Another consideration is the higher immunogenicity of mRNA vaccines in children, meaning that one dose or a reduced dose might be sufficient to protect this age group. 25 On the other hand, the infrastructure to upscale the production of COVID-19 vaccines already exists and strategies for boosting global supply have been outlined. 104

Since the risks of intensive care admission or death in children are so low, the cost–benefit ratio of COVID-19 vaccination in children is higher. However, the emergence of new variants might change this if these variants cause more frequent or more severe disease in children. 105 The cost of vaccination also needs to be balanced against the reduction in community transmission that might be achieved through vaccinating children, which would enable a faster return to pre-pandemic economic stability with associated benefits to children.

Other immunisation programmes

Routine immunisation programmes for children and adolescents have been disrupted by the pandemic. 106 107 Implementing a universal COVID-19 vaccine programme for these age groups runs the risk of causing further delays by using up existing delivery resources and personnel. This in turn may harm children by resulting in more cases of vaccine-preventable infections and diseases such as cervical cancer, meningitis, measles and pertussis. However, if COVID-19 vaccination is combined with the administration of other routine vaccines, this problem might be reduced.

Concluding remarks

In summary, the case for vaccinating all healthy children against COVID-19 is more difficult than for adults as the balance of risks and benefits is more nuanced. If COVID-19 remains a generally mild disease in children and in vaccinated adults, it may not be necessary to vaccinate all children. 90 108 In addition, it is important to consider different age groups separately; the balance of risk and benefit of vaccination is likely to differ between infants, young children and adolescents. Children under 5 years of age are likely to need separate consideration to those 5–11 years of age. Continued monitoring of disease severity across all age groups is crucial. If a variant of concern emerges with increased severity in children (as is, for example, the case for Middle East respiratory syndrome-related coronavirus), this would alter the risk–benefit equation. 90 In LMICs, where the burden of COVID-19 is higher in the paediatric population as a result of comorbidities, there may be a lower threshold for vaccinating children. A one-dose schedule (as now recommended in the UK and Norway) 109 110 or a reduced-dose vaccine might be an option for this age group; this might also reduce the risk of myocarditis with the second dose of mRNA vaccines. Although mass COVID-19 vaccination of all ages, including children under 12 years of age, may become the general approach globally in the future, it seems wise at present to weigh up the risks and benefits with caution and to proceed with care.

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Twitter @Dr_Petzi, @PittetLaure, @adamhfinn, @ajpollard1, @nigeltwitt

Contributors PZ drafted the initial manuscript. All authors critically revised the manuscript and approved the final manuscript as submitted.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Disclaimer The views expressed in this article do not necessarily represent the views of the DHSC, JCVI, NIHR or WHO.

Competing interests AJP is chair of UK Department of Health and Social Care’s (DHSC) Joint Committee on Vaccination & Immunisation (JCVI), but does not participate in policy decisions on COVID-19 vaccine. He is a member of the WHO’s SAGE. AJP is chief investigator on clinical trials of Oxford University’s COVID-19 vaccine funded by NIHR. Oxford University has entered a joint COVID-19 vaccine development partnership with AstraZeneca. AF is an investigator in trials and studies of COVID-19 vaccines manufactured by Pfizer-BioNTech, AstraZeneca, Janssen, Valneva and Sanofi but receives no personal remuneration or benefits for this work. He is a member of the UK Joint Committee on Vaccination and Immunisation and chairs the WHO Euro Regional Technical Advisory Group of Experts (ETAGE) on immunisation.

Provenance and peer review Not commissioned; externally peer reviewed.

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Vaccine equity: A fundamental imperative in the fight against COVID-19

* E-mail: [email protected]

Affiliation Public Library of Science, San Francisco, California, United States of America and Cambridge, United Kingdom

• The PLOS Medicine Editors

Published: February 22, 2022

• https://doi.org/10.1371/journal.pmed.1003948
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Citation: The PLOS Medicine Editors (2022) Vaccine equity: A fundamental imperative in the fight against COVID-19. PLoS Med 19(2): e1003948. https://doi.org/10.1371/journal.pmed.1003948

Copyright: © 2022 The PLOS Medicine Editors. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: The authors are each paid a salary by the Public Library of Science, and they wrote this editorial during their salaried time.

Competing interests: The authors’ individual competing interests are at http://journals.plos.org/plosmedicine/s/competing-interests-of-the-plos-medicine-editors . PLOS is funded partly through manuscript publication charges, but the PLOS Medicine Editors are paid a fixed salary (their salaries are not linked to the number of papers published in the journal).

Provenance: Written by editorial staff; not externally peer reviewed.

The PLOS Medicine Editors are Raffaella Bosurgi, Callam Davidson, Louise Gaynor-Brook, Caitlin Moyer, Beryne Odeny, and Richard Turner.

On March 11, 2020, WHO declared the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a global pandemic. Now, almost 2 years on, COVID-19 continues to cause widespread morbidity, mortality, and disruption, both directly and indirectly, on a global scale. The speed at which multiple effective vaccines were developed is a remarkable achievement and testament to scientific advances and collaboration. However, numerous barriers to global vaccination efforts have left 47% of the world’s population unvaccinated or only partially vaccinated to date, with huge disparities between countries in the proportion of fully vaccinated individuals ranging from 0% to 95% [ 1 ]. Barriers such as vaccine hesitancy and anti-vaccine movements have hindered the progress of vaccination efforts, and have been perpetuated by fears over vaccine safety and the spread of misinformation and disinformation, despite the wealth of evidence supporting the benefits of vaccination. Adding to the evidence on vaccine safety, in this issue of PLOS Medicine , William Whiteley [ 2 ] and Steven Kerr [ 3 ] and respective colleagues have shown in large-scale observational studies that the Oxford-AstraZeneca vaccine is associated with no more than a small elevated risk of intracranial venous thrombosis and cerebral venous sinus thrombosis, respectively. The risks of cerebral venous thromboses are far greater following COVID-19 infection [ 4 ], further underlining the demonstrated benefits of vaccination.

Inequity of access to vaccines has posed a significant barrier to vaccination in low- and middle-income countries (LMICs), despite calls for action to achieve equitable distribution and production of COVID vaccines from WHO [ 5 ] and the UN Development Programme [ 6 ]. In addition to the health risks to unvaccinated individuals of contracting COVID-19, greater opportunities for infections and viral mutations [ 7 ] leave the world vulnerable to the emergence of new variants which threaten to evade our defences and undo progress made. Most recently, this has been seen in the emergence of the Omicron variant of concern. It is without doubt that vaccination rollout must be equitable and fair on a global scale. Despite tireless efforts by public health experts to extol the benefits of vaccine equity throughout the pandemic, global vaccination rates remain woefully unequal. As of February 1, 2022, approximately 183 COVID-19 vaccine doses had been administered per 100 people in high-income countries, compared to just 14 doses per 100 people in LMICs [ 8 ]. The COVID-19 Vaccines Global Access (COVAX) initiative was launched in April 2020 with the intention of addressing this imbalance through accelerated development, production and equitable distribution of vaccines. Yet, by December 30, 2021, only 7 African countries had achieved their target 40% vaccination rates [ 9 ], which leaves us with the question of how vaccine inequity can be tackled and what can be done to overcome barriers to vaccination.

To begin untangling this complex issue, we must first consider what a country needs to successfully vaccinate its population. A reliable supply of vaccines is the first step. The COVID Global Accountability Platform (COVID GAP) reported that in November 2021, just 20% of the doses pledged by G7 countries had been shipped to LMICs and there are additional reports of vaccines arriving close to their expiration dates, rendering them unusable [ 10 ]. Equally essential to vaccine rollout are health infrastructure, trained medical personnel, appropriate vaccine storage facilities, accessible vaccination sites, health literacy, and public willingness to take vaccines. Furthermore, limited supplies of vital equipment such as syringes risk derailing vaccination efforts [ 11 ], with shortfalls of between one and two billion syringes projected by the end of 2022 [ 12 ]. Scientists, academics and public health experts have collaborated to publish open letters to governments in high-income countries, recommending increased financial and operational support, and a temporary waiver of intellectual property rules to expand capacity for vaccine manufacture in LMICs themselves [ 13 , 14 ]. Of particular relevance is the World Trade Organisation (WTO) Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which sets the minimum standards for regulation of different forms of intellectual property applicable to WTO member nations. In May 2021, delegations from WTO members representing multiple LMICs issued a communication proposing a waiver from certain provisions of the TRIPS agreement [ 15 ] to facilitate ‘the prevention, containment and treatment of COVID-19’. At the time of writing, a decision regarding the proposal is yet to be reached.

Expanding vaccine manufacturing capacity in LMICs offers an opportunity to bring the current pandemic under control and to enable a more coordinated, rapid global response to the current and future pandemics. Currently, Africa imports 99% of its vaccines [ 16 ], but the Africa Centre for Disease Control and Prevention (Africa CDC) launched the Partnership for African Vaccine Manufacturing in April 2021, with ‘the proposed ambition to manufacture 60% of Africa’s routine immunisation needs on the continent by 2040’ [ 17 ]. With this independence comes the potential to tailor vaccines to the needs of local populations, such as in outbreak situations, and to maintain the efficacy of vaccines through improved management of the vaccine cold chain. Such an ambition will only be possible with international cooperation, including from the pharmaceutical companies that own the intellectual rights to the vaccines. Progress is being made towards increasing production of COVID-19 vaccines in Africa [ 18 , 19 ]; however, the projected annual manufacturing rates fall short of meeting the needs of the continent’s 1.3 billion inhabitants [ 16 ], particularly when factoring in the multi-dose regimen for COVID vaccines. Given that 120 pharmaceutical companies have been identified as meeting the technical and quality standards required for manufacturing sterile injectables across Asia, Africa and South America [ 20 ], there is significant potential for introducing geographic diversity in vaccine manufacture. The right support from pharmaceutical companies, medicines regulatory authorities and national governments is essential.

Achieving vaccine equity presents an essential, but substantial and highly complex, policy challenge. Beyond fundamental issues such as health infrastructure and the availability of trained personnel and medical equipment, unreliable supply and distribution of vaccines in LMICs must be addressed as a matter of urgency, and must happen alongside public health campaigns to challenge misconceptions and address vaccine concerns. Empowering LMICs to develop and/or expand their own vaccine manufacturing capabilities provides a longer-term and more sustainable solution to achieving global vaccination coverage, for COVID-19 and many other infectious diseases. Achieving this necessitates a coordinated effort across multiple agencies, requiring strong national and international leadership and formation of public–private partnerships, as well as scientific and technical expertise and public pressure to instigate change. To surmount this global pandemic, we have a collective responsibility to find a global solution.

• 1. Understanding Vaccination Progress by Country—Johns Hopkins Coronavirus Resource Center. [cited 2022 Feb 15]. Available from: https://coronavirus.jhu.edu/vaccines/international .
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• 5. World Health Organisation. Vaccine Equity Declaration. 2021 Jan [cited 2022 Feb 15]. Available from: https://www.who.int/campaigns/vaccine-equity/vaccine-equity-declaration .
• 6. United Nations Development Programme. Support to Vaccine Equity; Beyond Recovery: Towards 2030. 2021 Jun [cited 2022 Feb 15]. Available from: https://www.undp.org/publications/support-vaccine-equity-beyond-recovery-towards-2030 .
• 9. World Health Organisation. WHO Coronavirus (COVID-19) Dashboard. [cited 2022 Feb 15]. Available from: https://covid19.who.int/ .
• 11. United Nations Development Programme USA. A New Hurdle in the Race to Vaccinate the World: a Syringe Shortage. 2021 Nov [cited 2022 Feb 15]. Available from: https://www.unicefusa.org/stories/new-hurdle-race-vaccinate-world-syringe-shortage/39211 .
• 13. COVID Collaborative. US Emergency Plan for Global COVID-19 Relief. 2021 Aug [cited 2022 Feb 15]. Available from: https://www.covidcollaborative.us/initiatives/us-emergency-plan-for-global-covid-19-relief .
• 14. Letter to the Prime Minister from the scientific community. 2021 [cited 2022 Feb 15]. Available from: https://www.globaljustice.org.uk/wp-content/uploads/2022/01/Letter-to-the-Prime-Minister-from-the-scientific-community.pdf .
• 16. Geddes L. Why Africa needs to manufacture its own vaccines. Gavi, the Vaccine Alliance. 2021 Jul [cited 2022 Feb 15]. Available from: https://www.gavi.org/vaccineswork/why-africa-needs-manufacture-its-own-vaccines .
• 17. Africa Centre for Disease Control and Prevention. African Union and Africa CDC launches Partnerships for African Vaccine Manufacturing (PAVM), framework to achieve it and signs 2 MoUs–Africa CDC. 2021 Apr [cited 2022 Feb 15]. Available from: https://africacdc.org/news-item/african-union-and-africa-cdc-launches-partnerships-for-african-vaccine-manufacturing-pavm-framework-to-achieve-it-and-signs-2-mous/ .

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Here Are Arguments That Can Help Overcome COVID-19 Vaccine Hesitancy

COVID-19 Quarterly Update on All Things Viral: Vaccinations and Treatments for the Winter Respiratory Viruses

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Legalization of recreational use of marijuana in the U.S. Podcast

https://anchor.fm/brenton-gibson/episodes/Legalization-of-recreational-use-of-marijuana-in-the-U-S–Podcast-e1beg51

Legalization of recreational use of Marijuana in the U.S.

Start of Podcast 1. I will input an intro-song, then I will first introduce myself as- Brenton Gibson a student at Georgia State University, and then I will introduce my topic of “Legalization of recreational use of marijuana in the U.S.” a. Hello, everybody my name is Brenton Gibson and I am a freshman at Georgia State University, in today’s podcast I will be discussing the controversy of Legalization of Recreational use of Marijuana in the US, together we will weigh the pros and cons of the subject, analyze an article on the topic of discussion, and lastly I will discuss the subject in relation to Daniel Kahneman’s Thinking Fast and Slow. 2. I will then proceed to weigh the pros and cons of the recreational use of marijuana, asking various questions and then proceed to answer them. -insert video of recreation use of marijuana a. what are some pros of using marijuana recreationally? -relief, to help cope, to enhance everyday activities ^ elaborate through discussion b. what are some cons concerning the recreational use of marijuana? – increase in crime, impaired decision making, and health issues ^ elaborate through discussion as well 3. Discuss scholarly article titled, “Recreational Marijuana Legalization and Adolescent Use of Marijuana, Tobacco, and Alcohol.” and it’s corelation to the topic of discussion. a The scholarly journal article by Rebekah Coley covers major points regarding the debate over wether recreational marijuana should, or shouldn’t be legalized all over the US. -list the points, and my opinion. 4. Discuss Daniel Kahneman’s, “Thinking Fast and Slow.” I will then build a connection between system 1 and system 2 when decision making, and the affect recreational marijuana use has on these systems and decision making as a whole. a.Daniel describes system 1 as… and system 2 as… b. By participating in the recreational use of marijuana both systems are affected. After consumption of marijuana the systems.. ( I am purposely not writing this word for word, to give the podcast a more conversation-like feel, and to not spit facts at my reader) 5. I will then repeat the intro-song as now the outro-song and give my closing remarks. a. I hope you enjoyed my podcast and learned something new be sure to look out for future episodes concerning other social issues in the US. Have a blessed day, and stay safe.

Police Brutality

The term “police brutality” is sometimes used to refer to various human rights violations by police. This might include beatings, racial abuse, unlawful killings, torture, or indiscriminate use of riot control agents at protests. I have gathered 4 sources to better explain the overarching conversation.

The first scholarly article I gathered was titled, “How Reasonable Is the Reasonable Man: Police and Excessive Force”. In the journal article of criminal law criminology by Northwestern University. Geoffrey P. Alpert and William C. Smith wrote specifically wrote on the police and there use of excessive force.They wrote on their belief that the authority of the police to use force represents one of the most misunderstood powers granted to representatives of government.After establishing the foundation for the use of force, the article discusses “reasonableness” and the unrealistic expectation which is placed on police to understand, interpret, and follow the guidelines. It is concluded that, until the expectations and limitations on the use of force are clarified, in behavioral terms, police officers will be required to adhere to the vague standards of the “reasonable person.”

The second scholarly article I gathered was titled, “Police Violence, Use of Force Policies, and Public Health.” In this article authors Osagie K. Obasogie & Zachary Newman discuss how racialized police violence is a recurring issue.The article continues to elaborate on how social movements have re-centered police violence as a subject of public discourse, yet there has been little progress in reducing the number of people killed by police. Therefore without further efforts in research and legal reform, this everyday crisis will continue.

The third source I gathered is a scholarly article titled, “Racial Profiling and Use of Force in Police Stops: How Local Events Trigger Periods of Increased Discrimination.” In this article Joscha Legewie of The University of Chicago Press Journals writes about racial profiling and the disproportionate use of police force are controversial political issues, while also conducting his own experiment to shed light on this injustice. His research reveals a general set of processes where events create intergroup conflict, foreground stereotypes, and trigger discriminatory responses.

The last article I gathered is a scholarly article titled, “Fatal police violence by race and state in the USA.” The article discusses the burden of fatal police violence as an urgent public health crisis in the USA.The authors illustrate how mounting evidence shows that deaths at the hands of the police disproportionately impact people of certain races and ethnicities, pointing to systemic racism in policing.

To ensure perfect MLA page formatting, proper MLA citations, correct grammar/usage, concise style, and effective reading comprehension as the prompt requires I plan on letting my peer’s read and check over my essay, while also paying close attention to the prompt requirements as I construct my essay.

The relevant struggle I am experiencing with major assignment 3 is the 1,000 word-length minimum. I think it’s too small. I feel as if it is going to be hard to fit 4 sources within the essay. Likewise I also struggle with procrastination, and since this essay is 20% of my grade I cannot allow myself, to try and construct the essay last minute, therefore this is another relevant struggle.

Police Brutality Rough Draft

Police brutality is the excessive and unwarranted use of force by law enforcement. It is an extreme form of police misconduct or violence and is a civil rights violation. It also refers to a situation where officers exercise undue or excessive force against a person. Police brutality is a on-going social issue, and many advocates, scholars, and other individuals have spoke out against it, and the effect it has on the community.

Legewie, Joscha, and Yale University “Racial Profiling and Use of Force in Police Stops: How Local Events Trigger Periods of Increased Discrimination1: American Journal of Sociology: Vol 122, No 2.” American Journal of Sociology, 1 Sept. 2016, https://www.journals.uchicago.edu/doi/full/10.1086/687518.

Joscha Legewie of The University of Chicago Press Journals writes about racial profiling and the disproportionate use of police force are controversial political issues.He argues that racial bias in the use of force increases after relevant events such as the shooting of a police officer by a black suspect. To examine this argument, he designed a quasi experiment using data from 3.9 million time and geocoded pedestrian stops in New York City. The findings showed that two fatal shootings of police officers by black suspects increased the use of police force against blacks substantially in the days after the shootings. The use of force against whites and Hispanics, however, remained unchanged, and there is no evidence for an effect of two other police murders by a white and Hispanic suspect. Aside from the importance for the debate on racial profiling and police use of force, this research reveals a general set of processes where events create intergroup conflict, foreground stereotypes, and trigger discriminatory responses.

Newman, Zachary. Police Violence, Use of Force Polocies, and Public Health. https://www.law.berkeley.edu/wp-content/uploads/2018/03/Paper-Obasogie.pdf.

Osagie K. Obasogie & Zachary Newman authors of the American Society of Law & Medical Ethics, also wrote about police violence and the use of force policies.It reads “Racialized police violence is a recurring issue. Recent social movements have re-centered police violence as a subject of public discourse, yet there has been little progress in reducing the number of people killed by police. Without further efforts in research and legal reform, this everyday crisis will continue.Thus, material interventions designed to fundamentally shift police practices away from deadly engagements are greatly needed.” The article proceeds to discuss how these interventions have the potential to disrupt current policing practices that continue to determine which lives which can be lost to police violence.It also includes information about other strategies for addressing police violence that have been proposed. However, the authors argue that the discussions do not fully engage a primary factor in police violence and major barrier to accountability; the use of force policies, which are the policies that codify the rules that govern the levels and types of force that police are permitted to use against citizens, including deadly force.

Smith, William c. How Reasonable Is the Reasonable Man: Police and Excessive … https://scholarlycommons.law.northwestern.edu/cgi/viewcontent.cgi?article=6818&context=jclc.

Lastly, I reviewed an article in the journal of criminal law criminology by Northwestern University. Geoffrey P. Alpert and William C. Smith wrote specifically wrote on the police and there use of excessive force.They wrote on their belief that the authority of the police to use force represents one of the most misunderstood powers granted to representatives of government. They believe police officers are authorized to use both psychological and physical force to apprehend criminals and solve crimes. The article focuses on issues of physical force. After a brief introduction and a review of current legal issues in the use of force, the article presents an assessment of current police policy development. After establishing the foundation for the use of force, the article discusses “reasonableness” and the unrealistic expectation which is placed on police to understand, interpret, and follow the guidelines. It is concluded that, until the expectations and limitations on the use of force are clarified, in behavioral terms, police officers will be required to adhere to the vague standards of the “reasonable person.”

8 Untold Truths Concerning the Covid-19 Vaccine

Coronavirus in the U.S.

Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus. Most people infected with the virus will experience mild to moderate respiratory illness and recover without requiring special treatment. However, some will become seriously ill and require medical attention. There are many cognitives biases that correlate in relation to the coronavirus. The New York Times writes, ” Coronavirus deaths have risen 40 percent in the last two weeks. Around 1,900 deaths are being reported most days in the United States, the most since winter.” I believe that conformation biases is present in statistics and claims like this.  Confirmation bias describes our tendency to interpret and recall information in a way that confirms our existing opinions and beliefs. By already perceiving the Coronavirus as deadly virus many scientists and reporters collect statistics to describe the fatalities concerning the virus, without taking much into consideration the amount of individuals that have survived the virus.

The New York Times also writes, West Virginia which has one of the country’s lowest vaccination rates, leads all states in recent cases per capita. More new infections are being reported now than in any previous surge. After analyzing this section of an article, I can see an anchoring bias start to formulate. In an anchoring bias people, or a group of person(s) rely too heavily on the initial piece of information that is provided to them. West Virginia has already been established as the country’s lowest vaccination rates, and has recently had the most cases, so even if there vaccinations started to rise, and there amount of cases went down, they would probably still be identified as one of the worst states concerning the coronavirus, because of the anchoring bias West Virginia will be judged on there initial statistics concerning the virus.

In contrast, IKEA effect illustrates how we place a higher value on products that we helped to create. The Food and Drug Administration (FDA) approved the Pfizer COVID-19 vaccine and has granted emergency use authorizations for three COVID-19 vaccines. All are safe and effective. Furthermore, the COVID-19 vaccine was founded in the U.S. Because of this, I believe the U.S. advertises and persuades many individuals to obtain the vaccine because its origins are in the U.S. This is an example of the IKEA effect because the U.S. is more keen on promoting the vaccine because, they were the creators of it. BBT explains it as, The Ikea effect – “that labour alone can be sufficient to induce greater liking for the fruits of one’s labour. ”

Self serving Bias refers to one’s tendency to take personal credit for positive outcomes while blaming external factors when things go wrong. Following reading the article on COVID-19 in the U.S. I have come across many examples of self serving biases. In most instances scientists or/and doctors attribute low volumes of covid cases to vaccinations. However,  when covid cases start to flourish in a distinct area doctors credit it to0 poor sanitation and poor social distancing between citizens of the U.S. This a popular trend from articles to article concerning the coronavirus.

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Persuasive messaging to increase COVID-19 vaccine uptake intentions

Erin k. james.

a Yale Institute for Global Health, New Haven, CT, USA

b Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA

Scott E. Bokemper

c Institution for Social and Policy Studies, Yale University, New Haven, CT, USA

d Center for the Study of American Politics, Yale University, New Haven, CT, USA

Alan S. Gerber

e Department of Political Science, Yale University, New Haven, CT, USA

Saad B. Omer

f Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA

g Yale School of Nursing, West Haven, CT, USA

Gregory A. Huber

Associated data.

Widespread vaccination remains the best option for controlling the spread of COVID-19 and ending the pandemic. Despite the considerable disruption the virus has caused to people’s lives, many people are still hesitant to receive a vaccine. Without high rates of uptake, however, the pandemic is likely to be prolonged. Here we use two survey experiments to study how persuasive messaging affects COVID-19 vaccine uptake intentions. In the first experiment, we test a large number of treatment messages. One subgroup of messages draws on the idea that mass vaccination is a collective action problem and highlighting the prosocial benefit of vaccination or the reputational costs that one might incur if one chooses not to vaccinate. Another subgroup of messages built on contemporary concerns about the pandemic, like issues of restricting personal freedom or economic security. We find that persuasive messaging that invokes prosocial vaccination and social image concerns is effective at increasing intended uptake and also the willingness to persuade others and judgments of non-vaccinators. We replicate this result on a nationally representative sample of Americans and observe that prosocial messaging is robust across subgroups, including those who are most hesitant about vaccines generally. The experiments demonstrate how persuasive messaging can induce individuals to be more likely to vaccinate and also create spillover effects to persuade others to do so as well.

The first experiment in this study was registered at clinicaltrials.gov and can be found under the ID number {"type":"clinical-trial","attrs":{"text":"NCT04460703","term_id":"NCT04460703"}} NCT04460703 . This study was registered at Open Science Framework (OSF) at: https://osf.io/qu8nb/?view_only=82f06ecad77f4e54b02e8581a65047d7.

1. Introduction

The global spread of COVID-19 created an urgent need for safe and effective vaccines against the disease. However, even though several successful vaccines have become available, vaccine hesitancy in the general population has the potential to limit the efficacy of vaccines as a tool for ending the pandemic. For instance, in the United States, the public’s willingness to receive a vaccine has declined from 72 % saying they would be likely to get a COVID-19 vaccine in May 2020 to 60 % of people reporting that they would receive a vaccine as of November 2020 [ 1 ]. Given the considerable amount of skepticism about the safety and efficacy of a COVID-19 vaccine, it has become increasingly important to understand how public health communication can play a role in increasing COVID-19 vaccine uptake.

Vaccination is both a self-interested and a prosocial action [ [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] ]. By getting vaccinated, people protect themselves from a disease, but they also reduce the chance that they become a vector through which the disease spreads to others. If enough people receive a vaccine, the population gains protection through herd immunity, but this also creates an incentive for an individual to not get vaccinated because they can forgo vaccination and receive protection from others who do vaccinate. Recent research on vaccination in general has demonstrated that people view vaccination as a social contract and are less willing to cooperate with those who choose not to get inoculated [ 10 ]. This work also implies that highlighting the reputational costs of choosing not to vaccinate could be an effective strategy for increasing uptake. Further, appeals to herd immunity and the prosocial aspect of vaccination have been shown to increase uptake intentions [ [11] , [12] , [13] ], but emphasizing the possibility of free riding on other’s immunity reduces the willingness to get vaccinated [ 14 ].

Focusing specifically on vaccination against COVID-19, recent studies have found that messages that explain herd immunity increase willingness to receive a vaccine [ 15 ] and reduces the time that people would wait to get vaccinated when a vaccine becomes available to them [ 16 ]. However, other work has found that prosocial appeals did not increase average COVID-19 vaccination intentions [ 17 ] and the effect of prosocial concerns was present in sparsely populated places, but absent in more densely populated ones [ 18 ]. Given the current state of evidence, it is unclear whether appealing to getting a COVID-19 vaccine as a way to protect others will increase willingness to vaccinate.

Viewing vaccination through the lens of a collective action problem suggests that in addition to increasing individuals’ intentions to receive a vaccine, effective public health messages would also increase people’s willingness to encourage those close to them to vaccinate and to hold negative judgments of those who do not vaccinate. By encouraging those close to them to vaccinate, people are both promoting compliance with social norms and increasing their own level of protection against the disease. Also, by judging those who do not vaccinate more negatively, they apply social pressure to others to promote cooperative behavior. This would be consistent with theories of cooperation, like indirect reciprocity or partner choice, that rely on free riders being punished or ostracized for their past actions to encourage prosocial outcomes [ [19] , [20] , [21] , [22] , [23] ]. Thus, effective messaging could have outsized effects on promoting vaccination if it both causes people to vaccinate themselves and to encourage those around them to do so.

We conducted two pre-registered experiments to study how different persuasive messages affect intentions to receive a COVID-19 vaccine, willingness to persuade friends and relatives to receive one, and negative judgments of people who choose not to vaccinate. In the first experiment, we tested the efficacy of a large number of messages against an untreated control condition (see Table 1 for full text of messages). A subgroup of the messages in Experiment 1 drew on this collective action framework of vaccination and emphasized who benefits from vaccination or how choosing not to vaccinate hurts one’s social image. A second subgroup drew on contemporary arguments about restrictions on liberty and economic activity during the COVID-19 pandemic. In Experiment 2, we retested the most effective messages from Experiment 1 on a nationally representative sample of American adults. By utilizing this test and re-test design, we guard against false positive results that are observed by chance among the large number of messages tested in Experiment 1. In our analysis of both experiments, we examined whether specific messages were more effective among certain subgroups of the population.

Experimental treatment messages for Experiment 1 and Experiment 2. All messages add the prose in the table to the content of the Baseline informational control. All of the messages in the table were tested in Experiment 1. The messages that are bolded were retested in Experiment 2.

Experiment 1 was fielded in early July 2020. Participants were randomly assigned to either a placebo control condition in which they read a story about the effectiveness of bird feeders or one of eleven treatment messages. The first message is a Baseline informational control condition that describes how it is important to receive a vaccine to reduce your risk of contracting COVID-19 or spreading it to others. Informational messages have been shown to be effective at increasing COVID-19 vaccine uptake intentions [ 24 ]. This message also emphasized that vaccines are safe and estimated to save millions of lives per year. The other messages add additional content to this baseline message.

The subgroup of messages that emphasized collective action varied who would benefit from vaccination or what other people might think of someone who chooses to be a free rider by not vaccinating. Focusing on who benefits from vaccination, the second message invoked Self Interest and reinforced the idea that vaccination is a self-protecting action (“Remember, getting vaccinated against COVID-19 is the single best way to protect yourself from getting sick.”). The third message, Community Interest, instead argued that vaccination is a cooperative action to protect other people (“Stopping COVID-19 is important because it reduces the risk that members of your family and community could get sick and die.”). This message also invoked reciprocity by emphasizing the importance of every-one working together to protect others.

The fourth, fifth, and sixth messages added an invocation of an emotion, Guilt, Embarrassment, or Anger, to the Community Interest message. These messages prompted people to think about how they would feel if they chose not to get vaccinated and spread COVID-19 to someone else in the future. Emotions are thought to play a role in cooperation, either by motivating an individual to take an action because of a feeling that they experience or restraining them from taking an action because of the emotional response it would provoke in others [ [25] , [26] , [27] ]. Further, anticipated emotional states have been shown to promote various health behaviors, like vaccination [ [28] , [29] ].

The seventh and eighth messages evoked concerns about one’s reputation and social image, which influences their attractiveness as a cooperative partner to others. The seventh, a Not Bravery message, reframed the idea that being unafraid of the virus is not a brave action, but instead selfish, and that the way to demonstrate bravery is by getting vaccinated because it shows strength and concern for others (“To show strength get the vaccine so you don’t get sick and take resources from other people who need them more”). The eighth message was a Trust in Science message that highlights that scientists believe a vaccine will be an effective way of limiting the spread of COVID-19. This message suggests that those who do not get vaccinated do not understand science and signal this ignorance to others (“Not getting vaccinated will show people that you are probably the sort of person who doesn’t understand how infection spreads and who ignores or are confused about science.”).

The final three messages drew on concerns about restrictions on freedom and economic activity that were widespread during the COVID-19 pandemic. A pair of messages focused on how vaccination would allow for a restoration of Personal Freedom (“Government policies to prevent the spread of COVID-19 limit our freedom of association and movement”) or Economic Freedom (“Government policies to prevent the spread of COVID-19 have stopped businesses from opening up”). These messages take a value that is commonly invoked in individuals’ decision to not vaccinate [ [30] , [31] ] and reframed vaccination as something that would actually restore freedoms that had been taken away. The final message, Community Economic Benefit, argues that a vaccine will help return people’s financial security and strengthen the economy This message is similar to the Community Interest messages that are described above, but instead focuses on cooperating to restore the economy (“We can all end this outbreak and strengthen the national economy by working together and getting vaccinated”).

2.1. Experiment 1 results

Panel A of Fig. 1 plots the effect of each vaccine message relative to the untreated control group on intention to vaccinate. The intention to vaccinate measure was formed by combining responses to a question about the likelihood of getting a COVID-19 vaccine within the first 3 months that one is available with a question about getting a vaccine within the first year that one is available. Specifically, for respondents who did not answer that they were very likely to vaccinate within the first three months that a vaccine is available to them, we asked how likely they would be to vaccinate within a year. This measure coded those who are very likely in the first three months at the highest value on the scale followed by very likely within a year descending down to very unlikely within the first year. Analyzing the vaccination item separately does not substantively change the results. All outcome variables were scored 0 to 1, with higher values indicating greater willingness to endorse the pro-vaccine action or belief (Underlying regressions appear in Table S1 and unless otherwise noted, all analyses were pre-registered).

Experiment 1. Messages that frame vaccination as a cooperative action to protect others or emphasize how non-vaccination might negatively affect one’s social image increase reported willingness to advise a friend, and judgment of non-vaccinators. Panel A displays treatment effects for the combined measure of intention to vaccinate, Panel B displays the advise a friend outcome, and Panel C displays the judging a non-vaccinator outcome. Treatment effects for both panels were estimated using OLS regression that included covariates. The effects displayed are a comparison against the placebo control baseline and are presented with 95% confidence intervals. The dashed vertical line is the effect of the Baseline informational control for each outcome.

Compared to the untreated control, the Baseline informational message was associated with modest increases in intention to vaccinate by 0.034 units (95 % CI:0.002, 0.065; p < .05). This effect represents an increase of approximately 6 % in the scale score compared to the outcome in the control condition.

By comparison, the Community Interest, Community Interest + Guilt, Embarrassment, or Anger, Not Bravery, Trust in Science and Personal Freedom messages all produce larger effects, at least qualitatively, than the Baseline informational message on the intention to vaccinate outcome. Effects for the Self-Interest, Economic Freedom, and Community Economic benefit messages were not consistently distinguishable from the untreated control group outcomes, and their effects were indistinguishable from the effects of the Baseline informational message.

The most promising messages were the Not Bravery, Community Interest, and Community Interest + Embarrassment messages. These messages were associated with effects that were statistically distinguishable from the untreated control group (Not Bravery: 0.077 units, 95 % CI: 0.035, 0.119; p < .01, Community Interest: 0.090 units, 95 % CI: 0.050, 0.129; p < .01, Community Interest + Embarrassment: 0.094 units, 95 % CI: 0.054, 0.134; p < .01) at p < .01. Moreover, their effects were always more than twice as large as the Baseline informational treatment and these differences were significant at p < .05 (two-tailed tests). The effects of the Trust in Science message and the Personal Freedom message were not statistically significant when compared to the Baseline informational message.

To put the magnitudes of the effects into context, we re-estimated our analysis after dichotomizing the intended vaccine uptake measure such that those who report they were “somewhat” or “very” likely to get the vaccine, either with three months or a year, are coded as 1 and those who do not are coded 0 (this analysis was not pre-registered). This produced a predicted rate of intended vaccination in the control group of 58.2 %. Respondents who read the Baseline informational message were 7.4 percentage points (95 % CI: 2.9 pp, 12.0 pp; p < .01) more likely to receive a vaccine. Among those assigned to the Not Bravery or Community Interest messages it was predicted to increase by 10.4 percentage points and 12.7 percentage points (Not Bravery: 95 % CI: 4.3 pp, 16.4 pp; p < .01, Community Interest: 95 % CI: 6.7 pp, 18.7 pp; p < .01) respectively, while among those assigned to the Community Interest + Embarrassment message it was predicted to increases by 15.9 percentage points (95 % CI: 10.2 pp, 21.6 pp; p < .01). This last difference was substantively large, representing a proportional increase of 27 % (0.159/0.582) compared to the control condition and a 13 % increase compared to the Baseline informational condition (0.159-0.074)/(0.582 + 0.074).

Turning to the other regarding outcomes that focused on spurring action by others, Panel B plots the effects of each vaccine message relative to the untreated control for advising a friend to receive a vaccine and Panel C plots the effects for negatively judging someone who refuses to receive one. Here, the effect of the Baseline informational intervention was modest and statistically insignificant. However, the Not Bravery, Trust in Science, Personal Freedom, Community Interest, Community Interest + Guilt, and Community Interest + Embarrassment messages had larger effects on both outcomes that were statistically distinguishable from the control outcome.

The most promising message was the Community Interest + Embarrassment message for the advise a friend outcome, which was associated with a 0.09 unit increase in the scale outcome (95 % CI: 0.049, 0.132; p < .01 two-tailed test), an effect that represents an increase of 27 % compared to the mean scale score in the control group. The effect was 0.067 units compared to the Baseline informational message (95 % CI: 0.027, 0.105; p = .001, two-tailed test). We conducted a similar exercise to the one describe above to gauge the relative magnitude of these treatment effects. For the Community Interest + Embarrassment message we estimated a 15 percentage point increase (95 % CI: 0.088, 0.209; p < .01, two tailed test,) in a binary intention to advise others to vaccinate outcome, a proportional increase of 27 % compared to the control group baseline of 53 % (0.15/0.53). This effect was also 6 percentage points larger than the effect of the baseline message (95 % CI: 0.008, 0.121; p = .03, two-tailed test).

The most promising outcome for the negative judgment of non-vaccinators was the Not Bravery message, which had an effect of 0.09 scale points (95 % CI: 0.052, 0.126; p < .01, two-tailed test) compared to the untreated control and 0.072 scale points versus the Baseline information (95 % CI: 0.037, 0.106; p < .01 Baseline message, two-tailed tests). This corresponded to a 21 % increase compared to the scale outcome in the control group (0.09/0.43). These are both substantively and statistically meaningful effects. The Community Interest, Community Interest + Guilt, Community Interest + Embarrassment, Trust in Science, and Personal Freedom messages all produced effects that were statistically distinguishable from the control condition.

We also investigated the robustness of these findings to sample restrictions and whether certain subgroups were more responsive to specific treatment messages (reported in Figures S2-S12 ). Results were generally robust to restricting the sample to those who were over the 10th percentile and under the 90th percentile for completion time. For subgroup analyses, those scoring low in liberty endorsement appeared more responsive to the Baseline treatment and to the Not Bravery message than are those who scored high in liberty endorsement. Those who report being less likely to take risks appeared robustly more responsive to the Not Bravery message than those who were high in risk taking. Those who were high in risk taking appear more responsive to the Personal Freedom message with regard to their own behavioral intentions. Certain groups appeared generically easier to persuade (Democrats rather than Republicans, an important divide that has emerged during the pandemic [ 32 ], and Women rather than Men), but there were no clear differences in which treatments appeared most effective across these groups. We explored the robustness of these subgroup differences in Experiment 2.

Taken together, the most successful messages in Experiment 1 were those that were theoretically motivated by viewing vaccination as a collective action problem. Consistent with previous work that demonstrates that prosocial appeals are effective in promoting vaccination, the Community Interest message and Community Interest + Guilt, Embarrassment, or Anger messages increased COVID-19 vaccine uptake intentions. Moving beyond who benefits from vaccination, the Not Bravery and Trust in Science messages that invoked concerns about one’s social image if they choose not to vaccinate also increased uptake intentions. All of the collective action oriented messages increased intentions to advise a friend to vaccinate and negative judgments of those who do not, potentially creating spillover effects that induce others to vaccinate. In addition to this subgroup of messages, we found that reframing vaccination as a way to restore freedom was also effective, though the other messages motivated by contemporary debates about the pandemic were generally no more effective than the Baseline condition.

2.2. Experiment 2 results

Experiment 2 tested the subset of the best performing messages from Experiment 1 on a nationally representative sample in September 2020. Notably, in the several month period between Experiment 1 and Experiment 2, the public had grown increasingly skeptical of a potential COVID-19 vaccine [ 1 ]. Panel A of Fig. 2 plots the effect of each vaccine message, relative to the untreated control group, on the same measure of intention to vaccinate used in Experiment 1. (The model specifications shown in the figure were from our pre-registered specifications, underlying regression appear in Table S2.). Given that we observed the messages from Experiment 1 were effective at increasing vaccine uptake, we pre-registered directional hypotheses for Experiment 2 that tested whether the effects could be replicated on a nationally representative sample. Accordingly, we report one-tailed hypothesis tests and 90 % confidence intervals in the results presented below. Results largely confirmed the patterns observed in Experiment 1.

Experiment 2. The Not Bravery, Community Interest, and Community Interest + Embarrassment messages increase both intentions to vaccinate and other-regarding outcomes. Panel A displays treatment effects for intentions to vaccinate, Panel B displays the advise a friend, and Panel C displays the judging a non-vaccinator outcomes. Treatment effects for both panels were estimated using OLS regression that included covariates. The effects displayed are a comparison against the placebo control baseline and are presented with 90 % confidence intervals. The dashed vertical line is the effect of the Baseline informational control for each outcome.

The Baseline informational treatment was associated with a modest increase, 0.029 units, in intention to vaccinate (90 % CI: 0.011, 0.046; p < .01, one-tailed test). This effect was a 6 % increase of the observed scale outcome in the untreated control group.

The Community Interest and Community Interest + Embarrassment messages were associated with qualitatively larger effects on intended vaccine uptake. These messages were associated with increases of 0.045 units (90 % CI: 0.021, 0.070; p < .01, one-tailed test) and 0.043 units (90 % CI: 0.019, 0.067; p < .01, one-tailed test), respectively. As with Experiment 1, we recoded those who stated they were “somewhat” or “very” likely to receive the vaccine as 1 and those who did not report that they were likely to receive it as 0 (this analysis was not pre-registered: for consistency we report 90 % confidence intervals). This binary measure produced a predicted rate of intended vaccination in the control group of 51.4 %. Intended uptake was 3.3 percentage points higher in the Baseline information condition (90 % CI: 0.5 pp, 6.0 pp; p < .05, one-tailed test), 3.5 percentage points higher in the Community Interest + Embarrassment condition (90 % CI: −0.1 pp, 7.0 pp; p = .06, one-tailed test), and 5 percentage points higher in the Community Interest condition (90 % CI: 1.3 pp, 0.8.7 pp; p < .05, one-tailed test). The latter effect was proportionally large—10 % compared to the baseline predict rate in the control group (0.050/0.514).

On average, the Not Bravery, Trust in Science, and Personal Freedom messages were approximately as effective as the informational content to which they were added in increasing intention to vaccinate, which differs from Experiment 1 where they modestly outperformed the Baseline informational condition.

Turning to other regarding outcomes, Panel B of Fig. 2 plots effects for advice given to others and Panel C does so for negative judgments of non-vaccinators. The Baseline informational treatment was again associated with statistically significant increases in each outcome. For these outcomes, the Not Bravery, Trust in Science, and both Community Interest messages produced effects that were at least descriptively larger than the Baseline treatment. The effects for the Personal Freedom message were smaller than the Baseline informational treatment, a result that again diverged from Experiment 1.

In terms of advising others to vaccinate, the most effective message was the Community Interest + Embarrassment message, which was also the most effective message in Experiment 1. This effect was 0.07 scale points (90 % CI: 0.043, 0.095; p < .01, one-tailed test), an increase of 14 % compared to the control group average scale score of 0.51 (0.07/0.51). This effect was also statistically distinguishable from the effect of the Baseline informational treatment (difference = 0.045; 90 % CI: 0.020, 0.069; p < .01, one-tailed test). When dichotomizing the advise a friend outcome to better describe the magnitude of the effect, we estimated that the Community interest + Embarrassment message was associated with a 10 percentage point increase (90 % CI: 0.064, 0.140; p < .01, one-tailed test) in intention to advise others to vaccinate compared to the control group, a proportional increase of 27 % compared to the control group baseline of 38 % (0.10/0.38). This effect was approximately 6 points larger than the effect of the Baseline message (90 % CI: 0.026, 0.099; p < .01, one-tailed test).

In terms of judging non-vaccinators, the largest effects were for the Not Bravery and Trust in Science messages, with each effect also statistically distinguishable from the Baseline message. Notably, in this sample the Trust in Science message had large effects on beliefs and actions toward others but appeared ineffective in changing an individual’s own intended vaccination behavior. The Not Bravery message was also the most effective message in this regard in Experiment 1.

We examined three pre-registered differences in subgroup treatment effects to test the patterns observed in Experiment 1. First, confirming Experiment 1 we found that those who did not endorse liberty values were more responsive to the Not Bravery message (compared to the baseline message) than those who endorsed liberty values for the three outcome measures. Second, we did not confirm either preregistered prediction with regard to differences in treatment effects by risk taking that were observed in Experiment 1.

The remaining subgroup comparisons were not pre-registered. Beginning with gender, in comparison to the untreated control, women responded more to the Trust in Science and Community Interest + Embarrassment message than did men (all five outcomes), while men responded more to the Not Bravery and Community Interest (without embarrassment) messages. Democrats were more responsive than Republicans across the board to the different treatment messages, while Republicans appeared to react only to the Community Interest and Community Interest + Embarrassment messages (magnitudes similar to those of Democrats). We observed a similar pattern for differences by baseline vaccine confidence, measured pre-treatment with a multi-item battery of questions [ 33 ]. Those high in vaccine confidence responded to all messages, while those low in confidence responded reliably only to the Community Interest messages.

3. Discussion

Overall, the results point both to a set of effective messages and the potential efficacy of specific messages for some particular subgroups. On average, a simple informational intervention is effective, but it is even more effective to add language framing vaccine uptake as protecting others and as a cooperative action. Not only does emphasizing that vaccination is a prosocial action increase uptake, but it also increases people’s willingness to pressure others to do so, both by direct persuasion and negative judgment of non-vaccinators. The latter social pressure effects may be enhanced by highlighting how embarrassing it would be to infect someone else after failing to vaccinate. The Not Bravery and Trust in Science messages had substantial effects on other regarding outcomes and for some subgroups, but do not appear to be as effective as the Community Interest messages in promoting own vaccination behavior. Importantly, in distinct samples fielded several months apart, the Community Interest, Community Interest + Embarrassment, and the Not Bravery messages produced substantively meaningful increases for all outcomes measures relative to the untreated control, and in some instances did so in comparison to the Baseline information condition.

Our findings are consistent with the idea that vaccination is often treated as a social contract in which people are expected to vaccinate and those who do not are sanctioned [ 10 ]. In addition to messages emphasizing the prosocial element of vaccination, we observed that messages that invoked reputational concerns were successful at altering judgment of those who would free ride on the contributions of others. This work could also help explain why social norm effects appear to overwhelm the incentive to free ride when vaccination rates are higher [ [34] , [35] ]. That is, messages that increased intentions to vaccinate also increased the moralization of non-vaccinators suggesting that they are fundamentally linked to one another. These messages will need to be adapted in specific cultural contexts with relevant partners, such as community leaders.

The robust effect of the Community Interest message advances our current understanding of whether public health messaging that deploys prosocial concerns could be effective at increasing COVID-19 vaccine uptake. The results of both experiments presented here support prior work that demonstrated the effectiveness of communication that explains herd immunity on promoting vaccination [ [15] , [16] ]. It also suggests that a detailed explanation of herd immunity may not be necessary to induce prosocial behavior.

Beyond the theoretical contribution, the results have practical implications for vaccine communication strategies for increasing COVID-19 vaccine acceptance. We identified multiple effective messages that provide several evidence-based options to immunization programs as they develop their vaccine communication strategies. Importantly, the insights into differential effectiveness of various messages by subgroup (e.g. men vs women) could inform messaging targeted to specific groups. Understanding heterogeneous treatment effects and the mechanisms that cause differential responses to persuasive messaging strategies requires additional testing and theoretical development. We view this as a promising avenue for future work.

The experiments presented here are not without limitations. First, we measured intentions to vaccinate at a time when a vaccine was not currently available and the effectiveness and side effects of potential vaccines were not known. This also meant that we could not observe actual vaccination behavior, which is ultimately the outcome of interest. While intentions predict behavior in many contexts [ [36] , [37] ] including vaccination [ [38] , [39] , [40] ], past research examining the effect of behavioral nudges on COVID-19 vaccine uptake has produced divergent evidence when testing the effect of the same treatments in the field on behavior and in a survey experiment on a behavioral intention [ 41 ]. This observation highlights the need for field testing messages that have shown to be successful on increasing uptake intentions in survey experiments to ascertain whether they also increase vaccine uptake. It may be that field tests reveal certain messages are particularly less effective than in the survey context, or that messages are uniformly less effective. Second, given the rapidly evolving nature of the COVID-19 pandemic, attitudes about vaccines may have changed since the experiments were fielded which could also change the efficacy of the messages that we tested. Third, we cannot be sure whether, or how long, the effects we observe here persist. Finally, we only tested text-based messages, but public health messaging is delivered through many mediums, like public service announcements, videos, and images. Future work can adapt the successful messaging strategies found here and test their efficacy when delivered in alternative formats.

Efforts to vaccinate individuals against COVID-19 are currently underway in the United States and it remains important to convince the mass public of the safety and efficacy of COVID-19 vaccines to ensure that the threshold for herd immunity is reached. Our experiments provide robust evidence that appealing to protecting others has effects on intentions to get vaccinated and to apply social pressure to others to do so as well.

4. Materials and methods

4.1. ethics statement.

The experiments reported here were fielded under an exemption granted by the Yale University IRB. Informed consent was obtained from participants and they were informed that they could stop the study at any time. Data was collected anonymously and contained no personally identifiable information.

4.2. Experiment 1

Participants and Procedure. Participants were recruited by the vendor Luc.id to take a survey. Of those who were recruited, 4,361 participants completed the survey. An examination of attrition during the survey reveals that attrition was balanced across groups which minimizes concerns that the treatment effects estimated in the main manuscript are affected by attrition. The survey was programmed using the survey software Qualtrics. The survey was fielded between July 3, 2020 and July 8, 2020.

Experimental Design. Participants first completed basic demographic and pre-treatment attitudinal questions and were asked about their experience with COVID-19. After this, participants read a treatment message. They were required to spend at least 20 s on the survey page that contained the message to given them an adequate amount of time to read it. We allocated 2/15 of the sample to the untreated control condition and 1/5 of the sample to the Information baseline condition due to the number of comparisons that would utilize these conditions. Each of the remaining conditions received 1/15 of the sample. The design and analysis were pre-registered at ClinicalTrials.gov (protocol ID: 2000027983).

Outcome Measures. For COVID-19 vaccine uptake intentions, participants were asked “How likely are you to get a COVID-19 vaccine within the first 3 months that it is available to you?” and “How likely are you to get a COVID-19 vaccine in the first year that it is available to you?” Respondents answered this question on a five-point scale with end points of “Extremely unlikely” and “Extremely likely.” The main text describes how these items were combined for analysis. Turning to the likelihood of advising someone to vaccinate, respondents were asked “How likely are you to advise a close friend or relative to get vaccinated against COVID-19 once a vaccine becomes available?” Respondents also answered this question on a five-point scale with end points of “Extremely unlikely” and “Extremely likely.” Finally, for judging someone who chooses not to vaccinate, respondents read “we would like you to think about a friend or relative who chose not to receive a COVID-19 vaccine when it is available. What would you think about this person? Are they…”. This prompt was followed by four traits: trustworthy, selfish, likeable, and competent. The response options were “not at all”, “slightly”, “somewhat”, “mostly”, and “very.”

Analysis. We used OLS regression with robust Huber-White standard errors and indicators for assigned treatment to estimate treatment effects. We use robust standard errors to address the heteroscedasticity observed when estimating our primary analysis models without them. We included covariates as described in the Supplementary Materials . Comparisons across treatments are from linear combination of coefficients tests. For the subgroup analyses, we restricted the sample to the stated criteria and estimate the model specified here on the subsample. For liberty endorsement and risk taking, we determined who was high and low by splitting the sample at the mean.

4.3. Experiment 2

Participants and Procedure. Participants ( n  = 5,014) were recruited by the vendor YouGov/Polimetrix. YouGov provides subjects using a sampling procedure that is designed to match a number of Census demographics. To determine the sample size, we conducted a power analysis to detect effects that were 80 % as large as those observed in Experiment 1. The experiment was fielded between September 9, 2020 and September 22, 2020.

Experimental Design. Participants first completed basic demographic and pre-treatment attitudinal questions and were asked about their experience with COVID-19. Participants were randomly assigned to one of seven conditions: the untreated control, the Information baseline control, Community Interest, Community Interest + Anticipated Embarrassment, Not Bravery, Trust in Science, or Personal Freedom. As in Experiment 1, more participants were assigned to the untreated control condition and the Baseline information control condition, 1/5 and 3/10 of the sample respectively. The remaining five conditions each received 1/10 of the sample. Participants were required to spend at least 30 s on the survey page that had the treatment message. The design and analysis were pre-registered at Open Science Framework.

Outcome Measures. The outcome measurement was the same as described in Experiment 1 with the exception of intelligent being added to the judgment of a non-vaccinator scale.

Analysis. We used the same modeling approach described above to produce the results displayed in Fig. 2 . We included covariates as described in the Supplementary Materials . For subgroup analyses, we estimated OLS regression models with an indicator variable if a person was a member of a subgroup (e.g. high endorsement of liberty) and zero otherwise.

CRediT authorship contribution statement

Erin K. James: Conceptualization, Writing- original draft, Writing- review and editing. Scott E. Bokemper: Conceptualization, Data curation, Formal analyses. Alan S. Gerber: Conceptualization, Writing- review and editing. Saad B. Omer: Conceptualization, Writing- review and editing. Gregory A. Huber: Conceptualization, Data curation, Formal analyses, Writing- original draft, Writing- review and editing.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgments

The authors would like to acknowledge support for the Tobin Center for Economic Policy at Yale University. EKJ and SBO were supported by the Yale Institute for Global Health.

SEB, ASG, and GAH received support from the Institution for Social and Policy Studies and the Center for the Study of American Politics at Yale University.

Appendix A Supplementary data to this article can be found online at https://doi.org/10.1016/j.vaccine.2021.10.039 .

Appendix A. Supplementary material

The following are the Supplementary data to this article:

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Supreme Court Rejects Challenge to Biden Administration’s Contacts With Social Media Companies

The case, one of several this term on how the First Amendment applies to technology platforms, was dismissed on the ground that the plaintiffs lacked standing to sue.

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By Adam Liptak

Reporting from Washington

The Supreme Court handed the Biden administration a major practical victory on Wednesday, rejecting a Republican challenge that sought to prevent the government from contacting social media platforms to combat what it said was misinformation.

The court ruled that the states and users who had challenged those interactions had not suffered the sort of direct injury that gave them standing to sue.

The decision, by a 6-to-3 vote, left for another day fundamental questions about what limits the First Amendment imposes on the government’s power to influence the technology companies that are the main gatekeepers of information in the internet era.

The case arose from a barrage of communications from administration officials urging platforms to take down posts on topics like the coronavirus vaccine and claims of election fraud. The attorneys general of Missouri and Louisiana, both Republicans, sued, along with three doctors, the owner of a right-wing website that frequently traffics in conspiracy theories and an activist concerned that Facebook had suppressed her posts on the supposed side effects of the coronavirus vaccine.

“The plaintiffs, without any concrete link between their injuries and the defendants’ conduct, ask us to conduct a review of the yearslong communications between dozens of federal officials, across different agencies, with different social media platforms, about different topics,” Justice Amy Coney Barrett wrote for the majority. “This court’s standing doctrine prevents us from exercising such general legal oversight of the other branches of government.”

Justice Samuel A. Alito Jr., joined by Justices Clarence Thomas and Neil M. Gorsuch, dissented.

“For months,” Justice Alito wrote, “high-ranking government officials placed unrelenting pressure on Facebook to suppress Americans’ free speech. Because the court unjustifiably refuses to address this serious threat to the First Amendment, I respectfully dissent.”

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