View from The Hill: Voters could wreak vengeance if Scott Morrison can’t get rollout back on track


Mick Tsikas/AAP

Michelle Grattan, University of CanberraLast week, people were falling over themselves to get vaccination appointments and had to be told, by their doctors and their government, to be patient.

Patience is still needed — indeed, more than ever — but now there’s rising vaccination hesitation and the message from the government is people should remain eager for the jab.

Conservative advice from the Australian Technical Advisory Group on Immunisation (ATAGI), recommending against the AstraZeneca vaccine for the under 50s (because of the very small danger of blood clots), has alarmed many people.

The danger is the advice has a knock-on effect, spooking people to whom it doesn’t apply.

Apart from younger frontline workers in health and aged care, those with underlying health conditions, and certain others, under 50s are not presently being vaccinated.

But with changing messages, some of the over 70s — the cohort now at the head of the vaccination queue — might start to have second thoughts, despite being told they shouldn’t.

They may or may not be reassured by Prime Minister Scott Morrison on Friday declaring his mother is lining up for her AstraZeneca shot soon. Or Commonwealth Chief Medical Officer Paul Kelly sharing the fact he’s urging his 86-year-old father to do so.

Thursday’s unwelcome medical advice was just the latest setback to the rollout and the Morrison government.

There have been the blocks and delays imposed on supplies from Europe and CSL production (of AstraZeneca) has been slower than anticipated.

The logistics haven’t all gone smoothly. Despite protestations to the contrary, the Commonwealth’s distribution has been sub-optimal.

Some doctors have complained of getting inadequate supplies; the arrangements for nursing homes have had glitches.

The whole program is running massively behind the original schedule. The government on Friday was celebrating passing one million doses administered, when we should have been well past four million.

We’re marching at a much slower pace than the United States or the United Kingdom. In the UK, incidentally, the authorities are being less conservative about AstraZeneca — it’s the under 30s who are being offered an alternative.

One can only imagine Morrison’s reaction when he was delivered the ATAGI advice, which of course he had to follow (even though some experts disagree with it). As he said, “You don’t get to choose the medical advice that’s provided by the medical experts”.

One guide to the prime ministerial mood is the fact he stresses it’s only advice to avoid AstraZeneca if you are under 50. The decision is up to you, and your doctor (though you will be signing a rigorous consent form if you ignore it).

But that line just contributes to the muddled messaging many people will feel they’re receiving.

With an already disorderly program thrown into further disarray by the medical advice, the government on Thursday night and Friday went into overdrive.

Another 20 million doses of the Pfizer vaccine — now the one for the under 50s — were instantly procured (this is on top of the 20 million already purchased). This is good news, if you are patient. They are not due to land until the last quarter of the year.

Health Minister Greg Hunt says Pfizer doses scheduled to arrive in coming days will ramp up, but details are sketchy.

The government is anxious to say the immediate stage of the vaccination schedule should not be much delayed.

The elderly who are being vaccinated now are good to get AstraZeneca.

As for the health and aged care workers? Determinedly looking on the bright side, Morrison noted many are over 50. Pfizer vaccines will have to be arranged for the younger ones, however, which could involve some scrambling.

But the rollout generally has to be recalibrated and delays are expected to hit in coming months when the program gets to the younger section of the general population.

For these people, vaccination is not as critical in health terms as it is for those older. But for the economy, vaccinating them as soon as can be done is vital.

At one level, Australia is being protected by our previous (and continued) success on the health front, which has left us with little or no community transmission. The rollout problems would be a disaster if we had COVID raging.

But we are riding on our luck. There are no guarantees against serious outbreaks.

Even without those, the longer the rollout drags on, the more we have the disruption of small lockdowns, and the slower the re-opening of Australia’s international border, with all the consequences that brings.

Morrison, who recently talked so confidently about everyone who was eligible and willing receiving one vaccine shot by October, now won’t commit to any date.

It would be a nightmare for him if the rollout wasn’t finished by year’s end, and the international border remained substantially shut.

He’d be only months from an election campaign, and Australians would probably be suffering a bad dose of cabin fever.

Politically, state and territory leaders have reaped rewards in elections from being seen to handle COVID well. A few months ago the pundits predicted Morrison would do the same.

But if they come to believe he has comprehensively mishandled the vaccine rollout, the voters could wreak vengeance.The Conversation

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.

New AstraZeneca advice is a safer path, but it’s damaged vaccine confidence. The government must urgently restore it


Jane E Frawley, University of Technology SydneyThe federal government’s recommendation last week that the Pfizer COVID-19 vaccine is now the preferred vaccine for adults under 50 has shaken public confidence in the COVID-19 vaccine rollout.

The Australian Technical Advisory Group on Immunisation (ATAGI) advised the AstraZeneca vaccine, previously planned as Australia’s main vaccine, will no longer be the preferred vaccine for adults under 50. It came after an extensive review of data from the United Kingdom and Europe which found an association between a very rare type of blood clot and the AstraZeneca vaccine.

Public confusion has already resulted in mass cancellations of vaccine appointments at GP clinics, by adults both over and under 50.

It’s important to remember the Australian government can afford to choose a safer path because we are not in the midst of a large COVID-19 outbreak.

But a decrease in vaccine confidence may be an unintended consequence of this path.

Now, the federal government must urgently restore public confidence in the vaccine rollout. It needs to quickly reassure adults aged over 50 the AstraZeneca vaccine is safe.

It’s essential the government gets this right. Concerns about one vaccine can damage public trust in other vaccines.

Why has a safer approach decreased confidence?

Vaccine confidence can be fickle. There are many recent examples of established vaccine programs that have been undermined by unrelated events or errors. This has led to mass disease outbreak and preventable death. For example, in the Philippines, a new measles outbreak that infected 47,871 people in 2019 and killed 632, mostly children, was fuelled by a drop in measles vaccination spurred by concerns about a dengue fever vaccine.

Vaccine program resilience is an even bigger ask during a new vaccine rollout where rare effects are expected once the vaccine is given to hundreds of millions of people.

Research from the Australian National University published last week found young women are the most likely to avoid vaccination. Women who did not approve of the government’s handling of recent sexual harassment scandals were less likely to accept a COVID vaccine. This demonstrates the importance of trust, and shows a lack of trust in one area of the government’s remit can spill into other areas.

Because the risk of catching COVID-19 is currently so low in Australia, many people are feeling less interested in being vaccinated.

One Australian study, published in September last year, found fewer people were willing to accept a COVID-19 vaccine compared to a similar study done two months earlier. This decrease was evident following a decreased number of new COVID-19 cases in Australia in the time between these two studies. People can change their intention to be vaccinated when they fear the effects from the vaccine more than the disease.

On top of all of this, some members of the community are still concerned COVID-19 vaccines were developed too quickly and without appropriate checks and balances — even though this isn’t true.

Changing recommendations during a vaccine program rollout can compound these concerns.




Read more:
Less than a year to develop a COVID vaccine – here’s why you shouldn’t be alarmed


How can confidence be restored?

While the federal government was quick to accept the recommendation from ATAGI, the confusion has added to the rollout chaos. Public confidence has been damaged, and further vaccine delays are imminent across the board, including for younger health and aged-care workers.




Read more:
4 ways Australia’s COVID vaccine rollout has been bungled


Vaccine program resilience is essential to survive the bumps along the way and the government has not invested enough in understanding public sentiment and developing plain language information resources.

The challenge for public health and the federal government now is to address the understandable concerns and prevent them from contaminating the broader public dialog on COVID-19 vaccination.

With high numbers of Australians needing to be vaccinated to prevent further COVID-19 outbreaks, there’s very little room for vaccine rejection.

The government urgently needs to use clear messaging for all communities and health professionals. This includes communities with diverse cultural and language requirements

These efforts will greatly benefit from multidisciplinary teams of infectious disease, vaccine, social science and communication experts.

We need a compensation scheme

During Australia’s COVID-19 vaccine rollout, so far one man in his 40s has developed blood clots following vaccination with the AstraZeneca vaccine. There’s a 25% death rate following a vaccine-related clot according to ATAGI. Four to six clots are expected per million doses of AstraZeneca vaccine (first dose) and while this reaction is exceedingly rare, it is severe.

This also highlights the importance of a no-fault vaccine injury compensation scheme.

Such a scheme recognises that if the government promotes whole of community vaccination for collective good, then it also accepts the ethical and financial burden for the few people who will sustain a serious injury. The federal government should implement one as a matter of priority.




Read more:
Bad reactions to the COVID vaccine will be rare, but Australians deserve a proper compensation scheme


The Conversation


Jane E Frawley, NHMRC Research Fellow, University of Technology Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

As Australia’s vaccination bungle becomes clear, Morrison’s political pain is only just beginning


Mick Tsikas/AAP

Mark Kenny, Australian National UniversityAmong many surprising things about 2020 was how a novel coronavirus drove an equally novel upending of Australia’s political orthodoxy.

The hackneyed election straightener, “it’s the economy, stupid”, got shoved aside for a refreshing new imperative, “it’s the community, stupid”. Australians unhesitatingly turned to government, embraced expertise, and willingly abided by society-wide deprivations in the interests of the whole.




Read more:
Australian vaccine rollout needs all hands on deck after the latest AstraZeneca news, mass vaccination hubs included


Reluctantly at first, centre-right politicians fell into line. Those who had built their careers on the virtues of small-government and gruff fiscal discipline, flipped to become big spending hyper-Keynesians.

Necessarily, political combat took a back seat to problem-solving. In an atmosphere of policy-not-politics, voters backed incumbent governments, marking them favourably for doing their jobs. Every election since the crisis began has returned the incumbents: in the Northern Territory, ACT, Queensland, and Western Australia. In the latter case, Labor’s Mark McGowan — arguably the country’s most aggressively parochial premier — was endorsed so strongly in March that the Liberal opposition officially ceased to exist.

Federally, Prime Minister Scott Morrison reaped the dividends of Australia’s tandem run of good management and good luck. While our closest allies, the United States and United Kingdom, descended into death and division, Australia closed its international borders early. It then compartmentalised further with the states episodically insulating their own populations and their own hospital systems.

Of course, there were mistakes. But the aggregate impact of these measures, high public trust, and the deliberately consensual mechanism of Morrison’s national cabinet has served the country well.

2021 brings new pressures

But 2021 has been a whole new ball game, and one for which a prime minister not accustomed to pressure, has proved far less equipped.

Prime Minister Scott Morrison, Health Minister Greg Hunt and health authorities at a Canberra press conference.
Prime Minister Scott Morrison and Health Minister Greg Hunt have found themselves in crisis-management mode over the vaccine rollout.
Mick Tsikas/AAP

The vaccine rollout — which remember, started stubbornly late — is in disarray. A promised four million inoculations by the end of March and completion by the end of October proved wildly unrealistic.

As of Sunday, the government says it hopes all Australians could receive at least one dose of vaccine by the end of the year. But as Morrison posted on Facebook, the government has no plans for any new targets because

it is not possible to set such targets given the many uncertainties involved.

Through the second half of last year, as it became clear there would be effective vaccines, Morrison, Health Minister Greg Hunt, and health authorities assured worried Australians the government was up to the global competition. And that Canberra was being sufficiently front-footed about procuring vaccines.

As Morrison boasted in a press statement on August 19,

Australians will be among the first in the world to receive a COVID-19 vaccine, if it proves successful, through an agreement between the Australian Government and UK-based drug company AstraZeneca.

In November, he also said,

Our strategy puts Australia at the head of the queue.

This was always unconvincing. That claimed “agreement” turned out to have been an over-egged letter of intent. Even ordinary observers could see demand from wealthy countries would be strong, and binding contracts would need to be signed quickly if Australia was to secure early adequate supplies.

It is now clear Australia’s risk-averse pandemic management — much of which was driven by premiers — has been followed by an insufficiently risk-aware vaccine contingency, controlled by the Commonwealth. And so we see another bizarre inversion: Australia being trounced by Britain and America, countries that had persistently botched their infection response.

Post-Trump America is now vaccinating three million people a day, and has gone above four million at least once. Covid-ravaged Britain is also roaring ahead. More than half of adults have had their first jab.

Textbook vaccination program?

What is not clear is why Morrison et al insisted the absence of urgency was an advantage because — combined with our judicious “portfolio” approach to multiple acquisitions — our health authorities could plan and execute a textbook public vaccination program.

Trouble is, the states have complained about a lack of genuine cooperation in the rollout, critical supply problems have been obscured, and the much vaunted broad “portfolio” approach has had its narrowness exposed.




Read more:
Blood clot risks: comparing the AstraZeneca vaccine and the contraceptive pill


Clearly, the slow and steady approach failed to build in redundancy for the wholly imaginable interruptions to supply from international competition and technical limitations in production and transporting. Then there is straight-out vaccine nationalism, as has been the cause of a blocked shipment from Italy.

Australia’s approach rather relied initially on two locally producible vaccines primarily with Pfizer (and later Novavax) as a back-up — the University of Queensland one which fell over in December, and AstraZeneca which is now “not preferred” for under 50s. While the AstraZeneca clotting risk is hardly a public health disaster — it has been compared to that of long-haul flights — it is certainly a disaster for an already fractious vaccine confidence.

Morrison now faces multiple, serious threats

Coupled with a poorly managed political crisis over the treatment of women, Morrison’s 2021 has been tin-eared. A sharp decline of public trust in government, in expertise, and in institutional competence looms as a clear and present danger for Morrison’s popularity.

Brittany Higgins walks through the crowd at the women's march in Canberra.
The prime minister has taken a hit to his approval ratings over his recent handling of gender issues.
Lukas Coch/AAP

Business-as-usual politics is already making a comeback with Labor’s Mark Butler toughening up of criticism of the rollout and calling for more transparency and a greater sense of urgency. Labor has little choice. Voters themselves see other countries are surging ahead while Australia inches along, tempting the fate of another outbreak, and delaying the economic recovery dependent on vaccination.

And that’s the next inversion we’re likely to see. Business and Coalition hardliners were outspoken last year against state border closures, lockdowns, and other restrictions, on economic grounds.

Expect to hear those voices too in coming weeks as the penny drops about a whole extra year lost to the pandemic.The Conversation

Mark Kenny, Professor, Australian Studies Institute, Australian National University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

A balancing act between benefits and risks: making sense of the latest vaccine news


Shutterstock

Hassan Vally, La Trobe UniversityLast night, the federal government announced substantially revised plans for the use of the AstraZeneca vaccine in Australia.

Due to concerns about the vaccine’s possible links to a rare blood-clotting disorder, and following advice from the Australian Technical Advisory Group on Immunisation (ATAGI), the Pfizer vaccine is now preferred for people under 50.

These developments raise questions about how authorities and individuals assess risk, and respond. Let’s try to make some sense of it.




Read more:
New setback for vaccine rollout, with AstraZeneca not advised for people under 50


What’s happened?

Reports about rare blood clots possibly associated with the AstraZeneca vaccine have been floating around for a few weeks now.

So why has it taken so long for the government to clarify this relationship and make the recommendations? Authorities haven’t been keeping us in the dark.

When you have a new condition like this, and experts are examining data in real time, it takes a while to understand exactly what’s going on: to develop a clear case definition, to be confident what you’re seeing is a real phenomenon, and importantly, whether it’s likely to be caused by something in particular (in this case, the vaccine). It’s made more difficult when the event is very rare.

After reviewing a wide range of data relating to cases of this rare blood-clotting syndrome predominantly in the United Kingdom and Europe, Australian experts have now reached the threshold of evidence they needed to be satisfied there may well be a causal link between the AstraZeneca vaccine and this condition.

An arm with a bandaid on the upper arm.
The Australian government now recommends the Pfizer vaccine for adults under 50, rather than the AstraZeneca one.
Shutterstock

Understanding risk

It’s important to note every therapeutic agent (a drug or a vaccine, for example) carries the risk of unintended consequences. For most of us, most of the time, this will be minimal. This is a biological reality reflecting the interconnectedness and complexity of the human body.

So like for any other therapeutic agents, there are risks as well as benefits we have to accept in taking COVID vaccines. What we need to do is to weigh up these risks against the benefits.

We make these sorts of calculations every day in all aspects of our lives. When we decide to get in the car, we know there’s a risk associated with driving. But we assess the risks are worth taking as the benefits of getting where we want to go quickly are worth it.

Mostly, we make these calculations without being consciously aware we’re doing it. Sometimes the parameters underlying these calculations are easy to grapple with — but sometimes they’re more nebulous.




Read more:
Australia’s bungled COVID vaccine rollout suffers another setback. Here’s how we can get it back on track


Weighing up the risks and benefits of the AstraZeneca vaccine

We know the vaccine offers near-complete protection against severe disease and death from COVID-19.

We also know severe side effects from the vaccine, in particular vaccine induced prothrombotic immune thrombocytopenia (VIPIT, the blood-clotting disorder in question), are extremely rare. But the condition is serious and around 25% of people have died after developing VIPIT.

There are a range of estimates of how often this syndrome occurs. But it’s generally accepted its incidence is about 4-6 cases per million doses of vaccine.

To put it in perspective, this puts the risk in the same order of magnitude to the average risk of dying if you complete a marathon, go scuba diving, or rock climbing.

It’s also important to note that we’ve started to see a pattern in that those who are at higher risk of this syndrome tend to be younger and tend to be women. We don’t have a clear understanding of why this is, but recognising this is really helpful in terms of making decisions about how to mitigate this risk.

Why the balancing act isn’t so easy

Although we have a pretty good understanding of the rate of severe outcomes from COVID-19, since we have over 12 months’ experience now of this illness, context is important. There are different levels of risk depending on where you live and what the rate of transmission in the community is.

While it’s all well and good in some countries to say you’re more likely to get very sick with or die from COVID than experience a complication from the vaccine, in Australia we have next to no COVID, so the risk of adverse outcomes from COVID is much lower. This needs to be factored into the equation.

We also have different strains of the virus, which can vary in how infectious they are and how sick they might make you. This also needs to be added to the mix.

In acknowledging the difficulty in completing these risk-benefit analyses, it’s really helpful to use a visualisation the University of Cambridge has put together based on UK data, which we’ve adapted here, comparing the risks and benefits of the AstraZeneca vaccine.



It depicts the risk of adverse effects from COVID (being in ICU) against adverse outcomes from the vaccine, based on an assumed incidence of COVID in the community of two in 10,000 people. Although the incidence rate in Australia is lower than this, this visual is extremely useful in conveying the nature of the relationship between the risks and benefits of the AstraZeneca vaccine in Australia.

What this visual shows clearly is that the benefits of the vaccine increase the older you are, because the risk of severe disease is higher the older you get.

It also shows that although the risks of side effects from the vaccine are relatively small regardless of age, the gap between risks and benefits narrows the younger you are. This is in part due to the reduced benefit of the vaccine for younger people who are less likely to have severe symptoms from COVID, and in part due to the increased risk of serious side effects, such as blood clots, for younger adults.

This visual clearly communicates the rationale for the changes announced yesterday. Where the risk-benefit becomes marginal, it makes sense to use other vaccines for younger adults — the Pfizer vaccine and possibly the Novavax vaccine down the track. The recommendations are both cautious and sensible.




Read more:
What you need to know to understand risk estimates


The Conversation


Hassan Vally, Associate Professor, La Trobe University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Australian vaccine rollout needs all hands on deck after the latest AstraZeneca news, mass vaccination hubs included


from www.shutterstock.com

Mark Hanly, UNSW; C Raina MacIntyre, UNSW; Ian Caterson, University of Sydney; Louisa Jorm, UNSW; Oisin Fitzgerald, UNSW, and Timothy Churches, UNSWAustralia’s vaccine rollout is due to be reset after the news last night the AstraZeneca vaccine would not be recommended for people under 50. Instead, this age group will be offered the Pfizer vaccine, with the federal government today announcing it had secured an additional 20 million doses.

Although details of the redesigned rollout have yet to be released, our new modelling, which has yet to be published in a peer-reviewed journal, shows how this might work under a range of scenarios, including the logistical requirements of different vaccines, and different vaccination venues.

Once a steady stream of locally manufactured AstraZeneca vaccine is available in Australia, the bottleneck in the vaccine rollout will shift from supply to administration. That’s when expanded GP vaccination clinics and mass vaccination hubs will be needed to deliver these jabs to nine million people over 50 in phases 1b and 2a of the rollout.




Read more:
New setback for vaccine rollout, with AstraZeneca not advised for people under 50


Here’s what we did and what we found

We used mathematical simulations of waiting in line, known as stochastic queue network models, to model the process of running a vaccination clinic.

Queue models allow us to assess the daily vaccination capacity for different venues, taking into account available staff numbers and estimated times to complete each stage of the vaccination process.

The two key venues we looked at were mass vaccination hubs — which could be large venues such as halls, parks or stadiums — and GP clinics.

Mass vaccination hubs and GP clinics lay out their vaccine clinics differently. Hubs with larger premises and more staff can adopt an assembly line approach to vaccination. They can divide the tasks of registration, clinical assessment, vaccine preparation and administration across a series of stations. Smaller clinics are likely to have fewer people available, each performing multiple tasks. We developed two distinct models to reflect these different set-ups.




Read more:
Australia urgently needs mass COVID vaccination hubs. But we need more vaccines first


We used these models to estimate how many vaccines could be delivered in an eight-hour clinic based on a range of staffing levels, within an average overall waiting time of under an hour.

We estimate a small general practice could administer 100 doses, rising to 300 doses for a large practice. Mass vaccination clinics could deliver 500-1,400 doses in the same period, depending on staff numbers.

We also used our models to test how clinics would perform under service pressures, including increased vaccine availability and staff shortages.

For both delivery modes, sites with more staff were better able to keep waiting times under control as system pressures increased. Unsurprisingly, mass vaccination hubs were more robust compared to GP clinics.




Read more:
4 ways Australia’s COVID vaccine rollout has been bungled


We can test different scenarios

Our models rely on subjective assumptions about the time needed to complete different stages in the vaccination process. In reality, these timings will vary in different contexts.

For instance, the Pfizer vaccine takes longer to prepare than the AstraZeneca vaccine. Our models can account for this by increasing the expected preparation time and seeing how many extra staff would be needed to run a vaccine clinic with the same number of appointments. When the Novavax or other vaccines come on board, we can re-run the model with updated preparation times.

In fact, we have developed an an app that allows anyone to re-run our simulations based on their own assumptions about service times, appointment schedules and staffing availability.

Vaccination simulator
Anyone can use the app to plug in how vaccination might play out under different scenarios.
Author supplied/UNSW

This can support policymakers, individual GPs and community pharmacies to plan vaccination delivery, as the quantity and type of available vaccine varies throughout the rollout.

However, there are some aspects of vaccine rollout our models do not account for. This includes essential support staff, such as administrators, cleaners and marshals.

Neither do our models address the logistics of distributing vaccines to vaccination centres, which is a separate challenge.




Read more:
How the Pfizer COVID vaccine gets from the freezer into your arm


One isn’t ‘better’ than the other. We need both

Our models suggest mass vaccination hubs and GP clinics are equally efficient in terms of the number of doses delivered per staff member. This supports distribution through both modes, provided GPs are enabled to vaccinate at their peak capacity.

These two approaches offer distinct advantages. Older people or clinically vulnerable patients may benefit from attending their local GP, who will be familiar with their medical history.

Younger males, busy working people and marginalised populations are less likely to have a regular GP and may be easier to reach through mass vaccination hubs. The rollout of phase 2 to adults under 50 may require expansion of the hubs, as not all GPs may be able to store the Pfizer vaccine.

A diverse profile of vaccination sites, drawing on the benefits of different distribution modes, will help maximise the daily vaccination rate and vaccinate the Australian population against COVID-19 as quickly as possible.The Conversation

Mark Hanly, Research Fellow, UNSW; C Raina MacIntyre, Professor of Global Biosecurity, NHMRC Principal Research Fellow, Head, Biosecurity Program, Kirby Institute, UNSW; Ian Caterson, Medical Lead, Royal Prince Alfred Hospital COVID Vaccination Clinic, Sydney Local Health District, Boden Professor of Human Nutrition, School of Life and Environmental Sciences, University of Sydney; Louisa Jorm, Director, Centre for Big Data Research in Health, UNSW; Oisin Fitzgerald, PhD Candidate, UNSW, and Timothy Churches, Senior Research Fellow, South Western Sydney Clinical School, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Pictures of COVID injections can scare the pants off people with needle phobias. Use these instead


See, no crying or big needles, just a person of colour showing off his plaster. This image does the job without scaring people and demonstrates diversity.
from www.shutterstock.com

Holly Seale, UNSW and Jessica Kaufman, Murdoch Children’s Research InstituteThis year is shaping up as the year of the COVID-19 vaccination photo, with the pandemic providing seemingly endless photo opportunities. We’ve seen stock photos of people getting vaccinated in news reports, images of the prime minister receiving his shot and health workers posting #vaxxies on social media.

But evidence shows the wrong images can make some people reluctant to get vaccinated. So our well-meaning efforts to use images to help demystify the vaccination process or share our pride in getting a COVID-19 vaccine can backfire.

Here’s what we can all do to choose and share vaccination images responsibly.




Read more:
Posting COVID-19 vaccine selfies on social media can cause anger, frustration


Images are powerful

Communicating public health strategies like vaccination can be challenging. There can be complex and unfamiliar technical terms and health concepts, and not everyone can understand them. So pictures play an essential role.

Pictures can draw attention to the message, help people relate to and remember what is being said, and may nudge people to act on a health recommendation. People also rate brochures with pictures more positively than ones with just text.

Pictures not only provide meaning, they have an emotional impact. Images we see on social media can also shape our perception of social norms (what we believe others are thinking or doing) and our behaviour.




Read more:
Friday essay: COVID in ten photos


But what happens when the picture is a giant needle, or a needle poked into someone’s arm? We have all seen these images to illustrate media articles about COVID-19 vaccination.

In addition to being a bit gruesome, stock photos commonly used in stories about vaccination are often inaccurate. The needle might be in the wrong position, the health worker may be wearing gloves when they are not needed or the liquid inside the needle seems coloured rather then clear.

Do vaccination images really matter?

Yes, vaccination images matter. A study looking at vaccine-related news coverage found nearly one in eight images contained something negative, such as the classic “crying baby”.

This may lead new parents, who have yet to really experience the vaccination process, to become anxious. And this negative photo may override any positive vaccination messages accompanying it.

This issue is especially important because when a photo is of someone’s face, it can trigger an emotional response, making it easier for someone to have a strong reaction to that communication.

Baby crying with vaccine needle
We can still illustrate vaccination without using scary images like this of a crying baby and an oversized needle.
from www.shutterstock.com

We know images can help people remember health messages. But if we use an inappropriate photo, such as the wrong needle size or someone looking anxious, this is the image that can stick with us, not the public health messages or statistics we intended to convey.

For some people, photos of needles are so scary this might put them off vaccination. While we don’t know precisely which types of needle imagery could stimulate such a response, we know needle phobia is a real issue. In fact, one survey found 23% of adults have avoided influenza vaccines due to fear of needles. And we don’t want to risk this happening with COVID-19 vaccines.




Read more:
Fear of needles could be a hurdle to COVID-19 vaccination, but here are ways to overcome it


What can we do about it?

Whether we are choosing images for news articles or for our personal social media, it is important we consider the potential impact of the photos we use. Here are some tips for choosing the right image:

  • focus on positive outcomes. Consider showing a smiling person with a plaster on their arm or someone holding a vaccination card or sticker. Flickr provides free photos that reflect the reality of immunisation and are medically accurate
  • humanise the process. People develop, deliver and receive vaccines. Show these people where possible, instead of disembodied needles
  • depict diversity. Ensure images of vaccination show diversity of ethnicity, gender, age and disability
  • imply rather than illustrate vaccination. Why do we need the needle in the photo? We do not illustrate articles about urinary tract infections in children with photos of urine samples or invasive medical treatments. An image of a health worker speaking to someone with their sleeve rolled up is enough to evoke a mental image of the vaccination process, particularly when it accompanies a story about vaccines
  • highlight the vial not the needle. For stories about vaccine production or rollout with no personal or emotive element, showing the vaccine vial is a neutral option
  • avoid inaccurate images. The emoji of a needle full of blood? Not a great choice to tell your friends and family you have been vaccinated. The plaster emoji is a good alternative. Publications should check any vaccine images with medical professionals for accuracy.



Read more:
5 ways we can prepare the public to accept a COVID-19 vaccine (saying it will be ‘mandatory’ isn’t one)


The Conversation


Holly Seale, Associate professor, UNSW and Jessica Kaufman, Research Fellow, Vaccine Uptake Group, Murdoch Children’s Research Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Australia urgently needs mass COVID vaccination hubs. But we need more vaccines first


Mary-Louise McLaws, UNSWAustralia’s COVID-19 vaccine rollout has been much maligned recently, as it’s become clear we’re way behind schedule.

So far Australia’s average daily rate since the rollout began in late February is around 22,000 doses a day according to my calculations. To achieve herd immunity, I calculate we’ll need to vaccinate 85% of the population, using a combination of the Pfizer and AstraZeneca vaccines. To achieve this by the end of March 2022, I calculate we need to vaccinate at least 133,000 people a day until December 31, and then around 79,000 a day in the first three months of 2022.

One way to achieve this would be to stop relying on small GP and respiratory clinics and urgently move towards using mass vaccination hubs.

However, we don’t yet have enough of the AstraZeneca vaccine to service large vaccination hubs. This I think is one reason why Australian authorities have not yet planned to use them.

What are mass vaccination sites?

Mass vaccination means vaccination on a large scale in a short time. Locations for mass vaccination would include stadiums and sportsgrounds, schools, parks, places of worship, and shopping centres.

This is what’s being done in countries like Israel, the United Kingdom and the United States.

According to the latest data, Israel has given at least one dose to 60% of its population; that figure is 46% in the UK and 32% in the US.




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In Australia we’ve given about 850,000 COVID vaccine doses, which is roughly 4% of the adult population.

As Australia moves into phase 1B of the rollout and beyond, the federal government’s plan has been to rely solely on GP, respiratory clinics and eventually community pharmacies. This plan presumes we’re all middle class and have the ability to access a local GP during work hours or early evenings. But many people who are unemployed, disadvantaged, working multiple part-time jobs, disaffected or can’t get away from work might not be able or willing to visit a GP clinic in their neighbourhood.

Instead, many might be more comfortable going to a mass site. For the placement of mass vaccination facilities to improve uptake of the vaccine, authorities should consult demographers who can identify the location of vaccination hubs to be most effective in attracting the most people.

We can’t rely on small GP clinics alone

Relying on small GP and respiratory clinics means the rollout is progressing very slowly. Local clinics might vaccinate around 50 people per day, depending on the size of their clinic. They also need to ensure physical distancing that allows space for people to wait for 15 minutes after their vaccination while they are monitored for any side effects.

GPs also need to continue to see patients with various health and well-being needs they should not ignore, even in a pandemic.




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Federal Deputy Chief Medical Officer Michael Kidd said mass hubs were “not off the agenda”. And today, the NSW government announced it will be setting up a mass COVID vaccination hub in Homebush, in Sydney’s inner west.

This is a good start but we need many more mass vaccination sites before we can get close to reaching the daily target.

So far there isn’t a formal plan detailing how the federal or state governments will introduce mass vaccination hubs in the COVID vaccine rollout.

Vaccine supply is the crucial issue

Vaccination is a huge logistical challenge amid a global pandemic and there’s an element of authorities learning to build the ship while it’s sailing.

Australian governments may also not yet be able to supply sufficient vaccines for mass vaccination hubs.

The federal government has repeatedly said Melbourne-based biotech company CSL will be producing one million doses of the AstraZeneca vaccine a week. It’s yet to reach that target, and it’s not yet clear exactly when it will.

But let’s look at that target and presume CSL reaches it soon. One million doses divided by seven days a week equals about 142,000 doses a day. This is only just on the cusp of being sufficient to reach our daily vaccination target. But it doesn’t take into account other delays that might occur such as problems with distribution, loss of stock, logistical hurdles, and bottlenecks at vaccination clinics.

In outbreak management you plan for the worst-case scenario. So when setting goals you should plan forward and look backwards to identify weaknesses in the plan, such as not receiving enough vaccine and logistical issues. You must also allow a buffer if things go “pear shaped”.

The fact we’re already behind the federal government’s initial target of vaccinating all Australian adults by the end of October this year suggests its plans were idealistic. It’s difficult to make further assessments without full transparency around vaccine supply and distribution.

There have been issues with Europe blocking and slowing supply. Planning appropriately for the rollout would have included considerations for delays for approval and batch testing. It begs the questions of why 2.5 million doses of the AstraZeneca vaccine are currently waiting for batch testing.

Authorities should be fully transparent about issues relating to vaccine supply, batch testing and distribution, so the public can feel fully informed and engaged in the vaccine rollout.

Great examples of transparency in vaccine rollouts can be seen in New Zealand and Canada. NZ includes weekly adverse reaction reports where people can read about vaccine side effects. Greater transparency like this can reduce anxiety, hesitancy and conspiracy theories.




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The Conversation


Mary-Louise McLaws, Professor of Epidemiology Healthcare Infection and Infectious Diseases Control, UNSW

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Can my boss make me get a COVID vaccination? Yes, but it depends on the job



Bernat Armangue/AP

Cecilia Anthony Das, Edith Cowan University and Kenneth Yin, Edith Cowan University

As Australia prepares to roll out a national vaccination program – aiming for a 95% uptake rate – big questions remain for employers and employees.

Employers have a clear incentive to want employees vaccinated, to protect clients and co-workers as well as to avoid legal liabilities of potential workplace COVID transmissions.

But can an employer insist on vaccination as a condition of employment?

That’s an ambiguous legal question, as indicated by two recent unfair dismissal cases taken to the federal Fair Work Commission. Both involve employers in 2020 making an influenza vaccination a requirement, and employees losing their jobs for refusing.

The bottom line from both cases is that an employer can make vaccination a condition of working – but with significant caveats. It depends on “balancing” the employer’s duty of care to others with the employee’s reason for refusal, and the circumstances of the work they do.

Employers have a duty of care

The first relevant case is the Fair Work Commission’s ruling in November 2020 on an unfair dismissal claim by child-care worker Nicole Arnold against Goodstart Early Learning, Australia’s largest early learning provider.

In April 2020 Goodstart made a flu vaccination a condition of employment, though allowing exceptions on medical grounds. Arnold objected. In correspondence with her employer she cited the Bible, the Nuremberg Principles and the Universal Declaration of Human Rights. But she gave no medical reasons. She was dismissed in August 2020.

The commission dismissed Arnold’s application to have her case heard on the basis Goodstart’s vaccination policy was arguably reasonable to satisfy its duty of care to children, while Arnold’s refusal was arguably unreasonable.

Commissioner Ingrid Asbury ruled:

While I do not go so far as to say that [Arnold’s] case lacks merit, it is my view that it is at least equally arguable that [Goodstart’s] policy requiring mandatory vaccination is lawful and reasonable in the context of its operations which principally involve the care of children, including children who are too young to be vaccinated or unable to be vaccinated for a valid health reason.

It was, Asbury said, a matter of balancing an employer’s duty of care with the needs of employees who may have reasonable grounds to refuse to be vaccinated. She saw no exceptional circumstances to rule Arnold was unfairly dismissed.




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Work circumstances count

The second case involves an unfair dismissal claim by care assistant Maria Glover against Queensland aged and disability care provider Ozcare, for whom she had worked since 2009.

Ozcare provides free flu vaccinations to employees annually. Glover, 64, had previously declined to get the shot due to allergies and her understanding she had an adverse reaction to a flu shot as a child.

In April 2020, Ozcare introduced a policy making influenza vaccinations mandatory for all employees in its residential aged care facilities or having direct client contact in its community care services. Its reason was the risk to clients who caught the flu and then contracted COVID-19.

It required supporting evidence for a medical exemption. Glover did not do so. This resulted in Ozcare no longer rostering her for work from May. She filed her unfair dismissal claim in October.

Aged care worker with elderly man.
Ozcare made influenza vaccinations for workers mandatory due to the risk for clients getting the flu and then COVID-19.
Shutterstock

A final ruling by the Fair Work Commission is still pending. The case was complicated by Ozcare’s lawyers arguing Glover had not been dismissed. But a preliminary decision on January 18 – in which Commissioner Jennifer Hunt ruled Glover had been dismissed – included observations relevant to the merits of future cases involving vaccination refusals.




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Hunt considered a future scenario (in November 2021) when employers of men playing Santa Claus in shopping centres may be required to have a flu vaccination “and if a vaccination for COVID-19 is available, that too”. In such a situation, where social distancing is impossible, a vaccination might become an “inherent requirement” of the job. In the court of public opinion, Hunt said, this might not be considered unreasonable. But a court or tribunal would need to consider the context.

In particular, Commissioner Hunt noted:

In my view, each circumstance of the person’s role is important to consider, and the workplace in which they work in determining whether an employer’s decision to make a vaccination an inherent requirement of the role is a lawful and reasonable direction. Refusal of such may result in termination of employment, regardless of the employee’s reason, whether medical, or based on religious grounds, or simply the person being a conscientious objector.

What this all means

What these two rulings boil down to is that an employer can make a vaccination an inherent requirement of employment, and dismiss a worker for refusing – even if they have a legitimate reason. But it depends on the role and exposure risks.

But if risks to others can be minimised through social distancing and other measures – say, for instance an employee works from home – dismissing an employee for refusing to get vaccinated could be ruled unfair. Particularly if they have a good reason – that is a medical condition, not a pseudo-legal objection. It depends on the balance of the employer’s duty of care to others against the employee’s claims.

So it’s not clear-cut. As things stands it is risky for employers to adopt a blanket policy to make COVID-19 vaccinations compulsory.




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Bringing greater clarity

Employer groups would like a more straightforward legal landscape. As the head of the Council of Small Business Organisations Australia, Peter Strong, has noted:

There is the issue of vaccinated employees refusing to work with non-vaccinated employees. Where does the employer stand, legally and practicably, in that situation? Where does the employee stand?

In the US the Equal Employment Opportunity Commission (which enforces federal laws against workplace discrimination) has ruled employers can require all employees – with some religious or disability-related exemptions – to get vaccinated to enter a workplace.

Australia’s federal industrial relations minister Christian Porter has reportedly told employers the government will not mandate vaccines in workplaces.

That means making the legality of workplace vaccination policies more “black-and-white” will need to come from the state and territory governments, using their regulatory powers under their work health and safety acts.The Conversation

Cecilia Anthony Das, Lecturer, Edith Cowan University and Kenneth Yin, Lecturer in law, Edith Cowan University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Needles are nothing to fear: 5 steps to make vaccinations easier on your kids



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Therese O’Sullivan, Edith Cowan University

The COVID vaccine rollout has placed the issue of vaccination firmly in the spotlight. A successful rollout will depend on a variety of factors, one of which is vaccine acceptance. One potential hurdle to vaccine acceptance is needle fear.

In a study that surveyed parents and children in Canada, 24% of parents and 63% of children reported a fear of needles. About one in 12 children and adults alike said they didn’t get all the vaccinations they needed because of their phobia.

Needle phobia generally begins from around age five, and can last through to adulthood. It can be a barrier to health-care access and treatment.

So it’s important to establish positive attitudes towards needle procedures, particularly vaccination, early in life.

An opportunity

Although there’s no one specific reason why people develop needle phobia, people who are anxious and fearful of needles can often relate their concerns back to one poorly-managed needle experience as a child. A bad experience may result from feelings of powerlessness due to being under-informed or being “tricked” into a vaccination.

In Australia, the National Immunisation Program Schedule includes vaccinations during the first 18 months, again at age four, and then in adolescence.

While it’s important to use a respectful approach at all ages, the four-year-old vaccinations present a particularly valuable opportunity for parents to help children feel comfortable with needle procedures.




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The guide below offers a strategy to help make vaccination a positive experience for your child. It’s based on what’s called the respectful approach to child-centred health care. This focuses on the parent and health-care provider developing a cooperative relationship with the child, rather than using authority or incentives.

The aim is to help the child feel in control and reduce anxiety around needle procedures.

The author's son having his four-year-old vaccinations. He's sitting on his father's knee and receiving it in his thigh.
The author’s son is pictured having his four-year-old vaccinations.
Therese O’Sullivan, Author provided

Five steps

1. Prepare

A few weeks beforehand, briefly introduce the topic of vaccinations and why they’re important.

Expect some resistance. This is normal — there’s no need to argue, just acknowledge your child’s feelings. Let them know adults don’t particularly like getting vaccinations either!

About a week out, mention again that they’ll be having a vaccination, and give some details, such as where they will be going. Another reminder the day before is helpful.

2. Be honest and transparent

It’s important to check if your child has any questions each time you discuss vaccination with them. Answer as honestly as possible. Yes, it will hurt. But not for long — most of the pain will be gone by the time 30 seconds is up, perhaps as long as it takes to run around the house or say the alphabet.




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3. Give choices

Help children feel like they are actively part of the process by giving choices where possible. For example, can they have a choice of day, or morning or afternoon?

Check with your health-care provider in advance whether children can choose the location of the injection – normally the vaccines are administered on the outside of the thigh, or the upper arm.

In the lead up, the child might like to prod themselves with a toothpick to see the difference between how each site feels. They may also have a preference for the left or right side.

Sometimes it helps to yell out when you feel pain. Kids may find this fun if you give them free rein to call out anything they want (even “rude” words) when the injection goes in. Just let your health-care provider know in advance so they’re not taken by surprise.

A little girl receives an injection in her arm.
Let your child watch the injection, if they want to.
Shutterstock

4. Avoid bribes and distractions

Offering a bribe can give the child the impression there’s something terrible about the procedure. As the parent, be confident (or pretend to be confident if you have needle fear yourself). Pain-related beliefs and behaviours can be learnt through observing others, and children are very perceptive.

You can always do a fun activity or have a treat afterwards, but make this a surprise at the end rather than a bribe before the vaccination.

Distractions are common, but can leave the child wondering why they were distracted. “What was going on that was so bad I wasn’t allowed to look at it?”, they might wonder. When children feel they have been deceived, this may erode trust.

Some children may like to watch so they know what’s happening — give them the option. Interestingly, in one study, adults who chose to watch the needle being inserted into their arm reported less pain compared with those who chose to look away.

5. Use mindful parenting

Think of vaccinations as an opportunity to be 100% present, one-on-one with your child. Put aside any multitasking for the morning or afternoon of the vaccination. If you can, take the time off work, turn off your phone, and arrange for any other siblings to be looked after.

Observe your child, aim to listen with your full attention, be compassionate and aware of how you and your child are feeling. All of these things can improve the quality of parent–child relationships and are important for helping children through potentially anxious times.




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Fear of needles could be a hurdle to COVID-19 vaccination, but here are ways to overcome it


The Conversation


Therese O’Sullivan, Associate Professor, Edith Cowan University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Laws making social media firms expose major COVID myths could help Australia’s vaccine rollout



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Tauel Harper, University of Western Australia

With a vaccine rollout impending, key groups have backed calls for the Australian government to force social media platforms to share details about popular coronavirus misinformation.

An open letter was put forth by independent group Reset Australia. It was endorsed by the Doherty Institute, Immunisation Coalition and Immunisation Foundation of Australia, along with the research group I’m working with, Coronavax — which reports community concerns about the COVID-19 vaccination program to government and health workers.

The issue of coronavirus and vaccine-related misinformation should not be understated. That said, big tech companies need to be engaged the right way to help the Australian public avoid what could potentially be a lifetime of health problems.

A leaderboard for COVID myths

We’re living in a dangerous time for both journalism and public education. We don’t have the legal infrastructure or public forums required to address the spread of coronavirus misinformation. Reset’s proposal intends to address these shortcomings, to better regulate this content in Australia.

It states there should be a mandate given to internet service providers to provide more details on the highest trending online posts spreading misinformation about COVID.

These “live lists” would be updated in real time and would let politicians, researchers, medical experts, journalists and the public keep track of which communities are being exposed to coronavirus and vaccine-related lies and what the major stories are.

The proposal suggests the eSafety commissioner should determine how the information is shared publicly to help prevent the potential victimisation of particular individuals.

Conspiracies can slip through the cracks

Many people rely on news (or what they think is news) presented on social media. Unlike traditional journalism, this isn’t fact-checked and has no editorial oversight to ensure accuracy. Moreover, the vast scale of this misinformation extends beyond platforms’ best efforts to curb it.

Since last year, a host of fake coronavirus cures have circulated and been sold illegally on the dark web. Among these was one hoax ‘cure’ in the form of ‘blood’ from supposedly recovered coronavirus patients.
Shutterstock

While social media analytic sites such as CrowdTangle provide some insight for researchers, it’s not enough.

For example, the data CrowdTangle shares from Facebook is limited to public posts in large public pages and groups. We can see engagement for these posts (numbers of likes and comments) but not reach (how many people have seen a particular post).

Reset’s open letter recommends extending access provision to data across the entire social networking site, including (in Facebook’s case) posts on people’s personal profiles (not to be confused with private conversations via Facebook Messenger).

While this does raise privacy concerns, the system would be set up so personal identifiers are removed. Instead of paying social media platforms in exchange for data, we would be putting pressure on them via the law and, at base, their “social license to operate”.

Taking down extremists isn’t the goal

Far-right conspiracy group QAnon has managed to entrench itself in certain pockets in Australia. Its believers claim there is a “deep state” plot against former US President Donald Trump.

This group’s conspiracies have extended to include the bogus claim that COVID is an invention of political elites to ensure compliance from the people and usher in oppressive rules. As the theory goes, the vaccine itself is also a tool for indoctrination and/or population control.




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Public figures have further amplified the conspiracies, with celebrity chef Pete Evans seemingly spearheading the celebrity faction of the QAnon “cause” in Australia.

The real value of Reset’s policy recommendation, however, is not in trying to change these peoples’ views. Rather, what researchers require are more details on trends and levels of engagement with certain types of content.

One focus would be to identify groups of people exposed to misinformation who could potentially be swayed in the direction of conspiracies.

If we can figure out which particular demographics are be more involved in the spreading of misinformation, or perhaps more vulnerable to it, this would help with efforts to engage with these communities.

We already know young people are generally less confident about receiving a COVID vaccine than people over 65, but we’ve less insight on what their concerns are, or whether there are particular rumours circulating online that are making them wary of vaccinations.

Once these are identified, they can be prioritised in the minds of health workers and policy makers, such as by creating educational content in a group’s specific language to help dispel any myths.




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Pressure on platforms is mounting

There is the argument that sharing links to online misinformation could help spread it further. We’ve already seen unscrupulous journalists repeat popular terms from online conspiracists (such as “Dictator Dan”, in reference to Victoria Premier Daniel Andrews) in their own coverage to engage a particular audience.

But ultimately, the information being highlighted is already out there, so it’s better for us to take it on openly and honestly. It’s also not just a matter of monitoring misinformation, but also monitoring legitimate public concern about any vaccine side effects.

The increased visibility of the public’s concerns will force government, researchers, journalists and health professionals to engage more directly with those concerns.

Pfizer vaccine's on conveyor belt
The Therapeutic Goods Administration has granted provisional approval for Pfizer’s coronavirus vaccine to be rolled out in Australia. It’s the first receive regulatory approval.
Shutterstock

The goal now is to invite Facebook, Twitter and Google to help us develop a tool that highlights public issues while also protecting users’ privacy.

Compelled by Australian law, the platforms will likely be concerned about their legal liabilities for any data passed into the public domain. This is understandable, considering the Cambridge Analytica debacle happened because Facebook was too open with users’ data.

Then again, Facebook already has CrowdTangle and Twitter has also been relatively amendable in the fight against COVID misinformation. There are good reasons to suggest these platforms will continue to invest in fighting misinformation, even if just to protect their reputation and profits.

Like it or not, social media have changed the way we discuss issues of public importance — and have certainly changed the game for public communication. What Reset Australia is proposing is an important step in addressing the spread and influence of COVID misinformation in our communities.The Conversation

Tauel Harper, Lecturer, Media and Communication, UWA, University of Western Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.