Vaccine Hesitancy

Why are some unsure about getting the COVID vaccine?
15 June 2021
Presented by Chris Smith, Eva Higginbotham
Production by Eva Higginbotham.


COVID vaccine in gloved hand


We're looking at the world of vaccine hesitancy: why are some folks unsure about getting a COVID vaccine, and how we can help? Plus, in the news, home, or away - should we be able to get away for a holiday abroad this year? Also, 'sea snot' paralyses the Turkish coastline; and how just seeing another ill bird at a distance boosts a canary's immune system.

In this episode

An aircraft in flight

01:00 - How COVID spread through travel in 2020

New research shows how the EU1 variant of coronavirus spread through Europe in 2020 - thanks to travel...

How COVID spread through travel in 2020
Emma Hodcroft, University of Bern

It’s the question on many people’s minds: with the pandemic still ongoing, can I go away on holiday this year? Scientists across the world have been tracking the spread of coronavirus through different countries by looking at the genetic sequences of the virus and building up a sort of virus family tree. Now, scientists doing this detective work at the University of Bern in Switzerland have discovered that, last summer, a coronavirus variant called EU1 spread broadly throughout Western Europe by hopping onto holidaymakers who took it and spread it back home. Eva Higginbotham spoke to lead author Emma Hodcroft about the role travel played in the spread last year, and what that can tell us about how we might think about holidays abroad this year…

Emma - Last summer we were looking at SARS-CoV-2 sequences in Switzerland, and we were particularly interested in seeing if we could tell something about how cases might have been spreading within Switzerland. But when I started to look into this more closely, I found that we had clusters of sequences that were closely related, and not only were spreading in Switzerland but also in Spain and in the UK. And as time went on, I started to see them popping up across Europe. When we first started looking into this, we were really worried that this might be the more transmissible variant that we were all very concerned about at the end of 2020, but actually the more we looked at it, we realised that it seemed to be that travel was the key. And so what we showed in our paper is that this variant, which is called EU1, spread from Spain soon after borders opened last summer after the lockdowns finished, and it was able to basically hop aboard the holidaymakers and travel across Europe. And it became the most prevalent variant circulating in Western Europe by the end of 2020 last year.

Eva - How can you tell that this was spread by travel and not by it being more transmissible? What's the difference there?

Emma - So we did do some lab experiments that allowed us to look at the mutations themselves and see if they had an effect, and we couldn't see that they seem to make any difference in the lab dish. But perhaps even more importantly, what we see in the patterns last summer is that the variant really spread most when travel was the highest, and that instead of continuing to spread in the autumn and kind of taking over - for example like the variant from the UK, the alpha variant, did - it actually just started to plateau after that. And this suggests that its advantage was transient; it didn't last forever. And that matches really well with this idea that it took advantage of travel, but then after the summer holidays and the travel slowed down, it just couldn't really take off anymore.

Eva - So how big a role, would you say, did travel play in the spread of this variant last year?

Emma - So we really think that travel was the key here. We think this variant started to spread in Spain - possibly through some agricultural workers, and as people started to visit family and friends across Spain as the lockdown eased - and then we really start to see it being detected in other countries in Europe only after the borders reopened in Europe. And we can actually look at, for example, the number of people who travelled to Spain and when they were there, and we found that this correlates pretty well with how much EU1 ended up traveling back to that country. So that's a strong indicator that it really was travel that played the real role here.

Eva - And do we know if this sort of travel induced spread of this variant led to worse outcomes in the countries that it got into?

Emma - So we don't think that EU1 necessarily, for example, led to the rise in cases that we saw in September; we think that this was probably more likely to be seasonal. However, it does matter what number of cases you start with. We've learned this in the epidemic. So when you're growing exponentially, you'll get up to higher numbers much faster if you start out with a higher number. And so we do think that the number of cases people brought back from EU1 might have meant that that country's case number started to go up perhaps earlier, or went up a little bit faster. One way of thinking about it is thinking of a lot of sparks. They won't all start a fire, but the more sparks you import, the chances are that fire could take off a little bit sooner.

Eva - So what might this mean for this year, then? Should people not be going on holiday abroad?

Emma - I think one of the things that EU1 can teach us is what mistakes we made last year, and then of course we can think about how we can not make those again. Last summer, we let people continue traveling to Spain even when case numbers were going up. We didn't have really any testing associated with travel. And unfortunately it looks like the test and trace systems didn't catch those EU1 cases when they came back, so they were able to really get a good foothold in the countries where they spread. The situation is different this year. So for one, thankfully the vaccine rollout is going well in most countries, and so the proportion of people who are much less likely to get the virus is going down. And we've also seen that testing is playing a much bigger role in travel this year, with most countries requiring a negative test before you arrive. Those two things I do think will make a big difference in how likely it is that people will bring home SARS-CoV-2. But I think it's also really important for us to remember that those may not always be perfect, and we should always be keeping an eye out on what impact travel might be making on the number of introductions.

Eva - And what's the take home message?

Emma - One of the biggest take home messages for me about EU1 is that it spread so effectively across Europe, despite the fact that it's not more transmissible. So we always want to keep in mind what human behaviours could be impacting the spread of a variant, and what might we be able to do to help cut those transmission chains.

Eva - And one of those things might be not going on holiday abroad just yet?

Emma - One of those things might be not going on holiday, or at least waiting to go on holiday until you're fully vaccinated. And I think another important thing to keep in mind is to just be flexible this holiday season. Maybe think about going somewhere that's less crowded, or spending a little more time on the beach and less time in crowded indoor spaces, and not being afraid to decide if you go somewhere and it seems a little bit more busy, or people aren't adhering to guidelines as much as you'd like, you can always come back another time. It's all small things, but it can make a difference as far as transmission.

A beach in Alanya, Turkey.

07:17 - 'Sea snot' blooms off Turkish coast

A thick jelly-like carpet of ‘sea snot’ is spreading off the coastline of Turkey’s Sea of Marmara...

'Sea snot' blooms off Turkish coast
David Kline, Smithsonian Tropical Research Institute

We recently recognised “World Ocean Day” which, according to the initiative’s mission statement, is all about raising awareness of what’s happening to the marine realm and rallying to restore and protect our blue planet. So the appearance in the sea south of Istanbul, Turkey, of huge floating rafts of thick, viscid, sticky material that’s being dubbed “sea snot”, which is made by explosively growing blooms of algae and suffocates other sea life, is a perfectly timed wake-up call. Charlotte Birkmanis waded into this problem with David Kline, from the Smithsonian Tropical Research Institute...

Charlotte - Whether you're in the Northern Hemisphere and the sun is shining, or you're here in the Southern Hemisphere, and.... well, it's a little more chilly, you decide to start planning your next summer holiday for when we're advised to travel once more. So you first find and blow the dust off the old atlas to glance at the world map. Then you remember it's the 21st Century and you can actually look at photos online! You go to the search engine and start browsing. You want a sight of the exotic while you're away - some baklava with your sun baking perhaps - so Turkey it is. But instead of photos of glorious beaches and happy holidaymakers, you see something very different staring back at you. A thick jelly-like carpet of aptly named 'sea snot' is spreading off the coastline of Turkey's Sea of Marmara. Dense mats of the slimy substance blankets the dark blue waters. Up close it's even less appealing: creamy gelatinous goo. Stinky, too. Now with your holiday plans in disarray, let's find out what's going on.

David - So it's not climate change per se. It's more poor pollution and water management.

Charlotte - That's David Kline from the Smithsonian Tropical Research Institute. The inland sea's record breaking marine bloom stretches from Istanbul, Europe's most populated city, to the tourist hotspot of the Aegean. The thick slimy substance is not only an eyesore, but it can also devastate human health, as well as the environment and the economy of the region.

David - And they basically cause dead zones where no animals are living because the oxygen levels get too low.

Charlotte - The heavily industrialised shoreline of one of the planet's smallest seas is also a source of pollution. Agricultural runoff and ineffective waste disposal, coupled with increasing temperatures in calm waters, have led to high nutrient levels of nitrogen and phosphorus. This is the perfect environment for phytoplankton - tiny floating sea plants or microscopic algae that create oxygen in the oceans. Normally that's a good thing, but with these excess levels of nutrients they grow very quickly, and that's called a plankton bloom. And that also leads to these marine snot outbreaks, which are basically huge rafts of marine microorganisms.

David - These phytoplankton that make the blooms can produce toxins that can make us sick - types of phytoplankton that you don't really want.

Charlotte - These blooms can also harbour bacteria and other toxic microorganisms that are harmful to human health. Now this algae and bacteria is using up all the oxygen, and that causes everything else that needs this oxygen, like fish, crabs, and even corals, to suffocate and die. These animals then rot, and sometimes sink, releasing mucus, causing more bacteria to grow, using more of the oxygen, and so the cycle continues. Yuck! This can quickly create these 'dead zones', damaging not only the ecosystem, but also the economy of the fisheries and others who are dependent on the ocean for their livelihoods - and tourism. And with the looming threat of climate change with increasing ocean temperatures, this could get worse, as everything could be accelerated and amplified. Algae can breed faster; the blooms will increase in size using the available oxygen even more quickly.

David - So climate change and global warming will just make this whole phenomenon even worse.

Charlotte - And this isn't just impacting Turkey.

David -Many other examples around the world, basically anywhere where you have a lot of farming, a lot of fertiliser use. It's happening in many places all around the world.

Charlotte - Cleaning it up is not only messy, but it's also expensive. However, there is something we can do. As well as continuing to develop better ways to manage our waste, and treat our water, and deal with the agricultural runoff before it reaches the ocean, there's some creative solutions floating around.

David - There are groups that are growing algae that local communities can sell. They grow them in rivers that feed into the ocean, and basically act as a natural sponge for the nutrients, while at the same time growing algae that the local communities can sell for fertiliser or for biofuels.

Charlotte - There's also hope for the current outbreak.

David - It's not too late. There's lots of cases showing that if we do something to manage the nutrients... that the ecosystems can usually bounce back.

Charlotte - And the silver lining in all this is that you can see the effects of reducing the nutrients in the water in a matter of weeks to months. Perhaps your Turkish holiday is just on hold for now.

Foot skeleton

14:07 - Bunions: fancy shoes in medieval Cambridge

Archaeological digs in Cambridge reveal that the wealthy regularly got bunions from wearing pointy-toed shoes

Bunions: fancy shoes in medieval Cambridge
Jenna Dittmar, University of Aberdeen

Are you a fan of high heels? If so, you might be unfortunately familiar with bunions - painful bony lumps that can form affect the big toe joint. This deformation, also known as hallux valgus, can be caused by wearing high heels or shoes that put pressure on the big toe. And, it turns out, this condition wouldn’t have been unfamiliar to the medieval residents of Cambridge who enjoyed wearing the incredibly fashionable, at the time, pointy-toed shoes, as Jenna Dittmar, now at the University of Aberdeen, discovered analysing human remains from cemeteries around Cambridge, as she told Chris Smith...

Jenna - So we analyse the bones of the feet. And from looking at these bones, we can see evidence of degenerative changes on the joints. Sometimes you see lipping or evidence of arthritis, and you can tell that during life, the toes would have been malaligned, so kind of stuffed together.

Chris - And how do you link that deformity to what the people were wearing? Because they could have been wearing any old shoes, could they not?

Jenna - Absolutely. But during the 14th century, we see a new type of very pointed shoes that had very long exaggerated tips that become quite fashionable. And the toes of these shoes were so long that they had to be stuffed with wool or moss, so they would keep their shape. And when we were looking at trends through the 11th and 15th century, we see a very clear increase during the 14th and 15th centuries that it coincides exactly with the time that these shoes became popular in England.

Chris - Are those the same sorts of shoes that you see Jesters wearing in a pack of cards?

Jenna - They're very similar. Yes. Only typically the types of shoes we would be talking about would be made of leather.

Chris - And were they fashionable among the upper classes or was everyone walking around in shoes like that?

Jenna - They certainly were the most popular amongst wealthy individuals, but our study looked at individuals from four different archaeological sites, including a hospital specifically for the poor. And we found evidence of hallux valgus in this cemetery as well. So this suggests that this type of footwear was widely adopted by all members of Cambridge society. Even though we did find more evidence of this type of condition in the clergy and in the wealthy patrons that were also buried in an Augustinian priory

Chris - Men and women, or were these shoes chiefly popular with just one sex?

Jenna - We did find evidence in both men and women, but we found higher percentage rates in the men that we looked at. And when we looked at the historical records, we find that the shoes tended to be more exaggerated and pointed in male footwear than they did in female footwear.

Chris - And did anyone actually make the connection between wearing these daft forms of footwear as we now view them and having these negative consequences?

Jenna - That's an excellent question. There are some historical records that talk about foot pain, but it's really difficult to differentiate medical terms in the 13th and 14th century. So it could also mean that they were experiencing foot pain from something completely different. So it's really hard to tell if they made this connection during historic times. Actually we found that the individuals in this study that were over the age of 45 were significantly more likely to have a fracture as the result of a fall than those that did not have hallux valgus. So it suggests that people were paying quite a high price for fashionable footwear.

Chris - So they will literally tripping over their own toes.

Jenna - Yes, exactly.

A medical face mask for oxygen.

17:51 - Laughing gas works against severe depression

Nitrous oxide is a commonly-used anaesthetic - and seems to work against treatment-resistant depression...

Laughing gas works against severe depression
Peter Nagele, University of Chicago

Laughing gas, at high concentrations, is a recreational drug that gives a sense of euphoria. But when mixed with oxygen, it’s one of the oldest drugs that we use in medicine - it’s an anaesthetic, and relieves pain. And now, doctors from the University of Chicago have found a new and surprising use for it in treating mental health. When they gave laughing gas - properly known as nitrous oxide, or nitrous - to people with severe depression, they found some extraordinary results. Anaesthesiologist Peter Nagele told Phil Sansom how they got their hunch...

Peter - Yes it does. And remarkably so. Not every patient does respond to nitrous oxide, but, in most patients it improves depressive symptoms really quickly, so within several hours. And a single inhalation may help patients up to two weeks or longer.

Phil - Wow. Is this just like one big breath in of nitrous oxide that you gave to a bunch of people? Or what is it?

Peter - No. So this is not like the recreational party drug use. It is much more like patients would get it in dentistry or in the emergency room. You know, you'd be in a chair or, you know, a hospital bed and inhaled this for about an hour through the face mask. And of course we always combine nitrous oxide with oxygen and it could be either 50-50 or what we've shown in the study, a lower concentration of 25% nitrous and the rest oxygen has similar efficacy.

Phil - Who were you giving this to? And out of those people, how many did it help?

Peter - These patients have been suffering from depression for close to 20 years and had run out of treatment options. And, you know, four out of five patients had an improvement in depressive symptoms, 'You know, I can see clearer now. The grey has gone out of my life. I'm more energized, I'm happier'. They may describe this within hours of the treatment.

Phil - That's remarkable, isn't it? I mean, these people had untreatable previously depression, 80% of them, you helped get better for weeks.

Peter - Yes. So for some patients, you know, the improvement in their depression lasted much longer. In some patients, you know, it started to come back after a week. It will be interesting to tailor the treatment to the individual patient to see, you know, how often would you need to repeat the treatment. But I agree with you. It is quite remarkable that the mass majority of patients really did see a treatment effect. Yes, I agree.

Phil - How can you be sure that it's not some sort of placebo effect happening?

Peter - Placebo effects are very common in studies or clinical trials in patients with mood disorders like depression, but it has become very apparent that the drug effect is much stronger than a simple placebo effect.

Phil - So is it just that people were blissed out by getting this drug or was something deeper happening?

Peter - When you look at most patients, the response to inhaling nitrous oxide is that basically they fall asleep. But asking what's going on in their brain is actually super important and super interesting. The way we think nitrous oxide works is similar to a drug called ketamine. And the discovery that ketamine has effects as an antidepressant has been considered one of the biggest breakthrough findings in depression research in the last 50 years. There's a receptive system in the human brain, that's called NMDA receptors, that must play a very important part. Now how this interacts is really, I think, one of the hottest areas right now in neuroscience, something must happen in the brain that it's like flipping a switch that will change how the brain operates. Right? And this may last, you know, as I said, for some patients for several weeks, and by that time, of course, nitrous oxide is long gone.

A yellow canary bird.

22:24 - Seeing sick birds boosts canary immune system

Canaries boost their immune system at the mere sight of infected birds.

Seeing sick birds boosts canary immune system
Ashley Love, University of Connecticut

Seeing sick people can make you feel unwell yourself sometimes, but it might also, scientists are showing, augment your own immune system to better defend you should they come too close! That’s certainly the case for canaries at least, as Sally Le Page has been hearing from the University of Connecticut’s Ashley Love...

Ashley - For our experiment we had birds that were sick, so they are infected with this bacterium. And then we had healthy individuals on the other side of a divider. And then across from those two groups, we had birds that were either just staring at healthy neighbours or birds that were staring at sick neighbours so they could see sort of a visual cue of disease.

Sally - What does a sick bird look like?

Ashley - Sick canaries, when they're infected with bacteria, tend to look a little bit fluffed out, so they're a little puffy. They look tired, they don't want to move. Sometimes they just hang out by the food bowl, which I also do when I'm sick. I just sit around with snacks!

Sally - So you've got these healthy canaries that are looking at either sick or healthy birds opposite them in the room. What did you test?

Ashley - We looked at a few different components of innate immunity, which is just a non-specific component of your immune system. We found an increase in a specific cell type called a heterophile, which is similar to neutrophils that humans have, and this cell's really important in early inflammation responses so it's sort of like your first line of defence that goes out to the site of infection. And then the one other thing we looked at was called compliment activity, and this is really important for breaking open foreign cells like bacteria. So yeah, we found that seeing sick individuals was changing the immune system.

Sally - Could these changes make it harder for those birds to get infected?

Ashley - We haven't tested to confirm whether or not this increased immunity actually benefits the birds, but that's something we're working on right now.

Sally - It's astonishing to think that what the birds can see is linked up to such a different part of the body like the immune system. While Ashley's team haven't yet pinned down how that link is happening, it's possible that seeing sick birds is stressful, which triggers stress hormones that amp up the immune system - just like humans watching a horror movie triggers an adrenaline response, which amps up our heart rate. So that might be how the birds are responding to sick individuals, but why are they responding?

Ashley - That's a great question. So we don't know for sure. We think it could be that avoiding individuals obviously can help prevent you from becoming infected. But there's also costs associated with that, so birds aren't getting to engage in social interactions, they might miss out on foraging opportunities. So if there is this little immune boost that they're getting from seeing sick individuals, it might potentially protect them and allow them to still interact with other individuals.

Sally - And how strong is this effect?

Ashley - The response is sort of incredible just because it's happening at all. I don't think it's as strong as say, you know, a vaccine, or I think taking pre-emptive medicines to protect yourself. But I think it's sort of a short-term boost that probably helps a wild organism. I don't know about humans...could give a short burst of immune benefits to humans as well, but not as strong as probably some of the medicines and pre-emptive medicines we give.

Sally - What made you even think of looking at how social interactions can affect the immune system?

Ashley - I've been studying wildlife diseases for a while and I came across this paper that was a study in humans where they showed human participants images of sick people, so coughing and sneezing people with rashes. And what they found was that those participants that were seeing images of sick people had a boost in immune function. So I thought that was super fascinating and was really curious if that was going on in other organisms as well.

Sally - And of all the organisms you could have picked. Why canaries?

Ashley - Well I was currently working with canaries at the time and since I was already working with a disease system that caused these obvious visual signs or symptoms of disease, we thought it would be the perfect system to test these questions in!

Sally - And how many beds do you have in at once?

Ashley - At the time of this experiment we had a little over 40 birds. But now we - well, since we've been studying reproductive effects in mothers we've been breeding birds, I think, we're over a hundred birds now. It's a lot of canaries!

Sally - A swarm of canaries! Oh, that must be amazing.

Ashley - Yeah, the noise that they make carries down the hallway. So I think the other labs that work in our building might be a little bit frustrated with that!

A healthcare worker preparing a needle.

29:17 - Why are some people vaccine hesitant?

What makes some people less likely to get vaccinated?

Why are some people vaccine hesitant?
Mohammed Razai, St George's Hospital, London

With us is Mohammad Razai, a researcher in primary care at St George’s Hospital in London who has been looking into why some peole are vaccinated hesitant, as he told Chris Smith... 

Mohammad - The most common reasons people give, and surveys and studies have shown, is concerns about long-term effects, side effects, and unknown future effects on health. Concerns about the speed of development of COVID-19 vaccines, and concerns about vaccines incompatibility with religious beliefs. There are also concerns about practical issues, such as inconvenient vaccine delivery, time and location. Particularly amongst women they're apprehensions surrounding fertility, pregnancy, and breastfeeding. And of course we have heard quite a lot around the spread of misinformation and some people do believe in conspiracy theories, such as COVID-19 not being real or that vaccines modify DNA. Also in some ethnic minorities, such as some black ethnicities, we see a lack of trust in the pharmaceutical industry, in government, public health bodies, and just generally a low confidence in vaccines and their importance and safety and efficacy. So these are some of the concerns we are seeing consistently in published surveys and research.

Chris - Most of these though, Mohammed, sound like a communication deficit. As in that people are saying those things, are making, to them, quite rational decisions and quite sensible decisions based on a lack of information or a lack of the right sort of information or access to that information.

Mohammad - Absolutely. I mean, recognising barriers to uptake such as the ones I mentioned, it's just really crucial because it will help inform interventions to address them. And because the key with vaccine hesitancy is to build confidence in vaccines, and particularly listening to people's concerns, being respectful of different religious or cultural beliefs, and being aware of some justifiable and understandable historical mistrust among some ethnic minority communities about vaccines. And these are really crucial in vaccine communication.

Chris - Have those stumbling blocks always been there with those groups you just mentioned, snd it's just only when we come to try and vaccinate people en masse against something like coronavirus that we then disclose them, or is this a new thing for coronavirus?

Mohammad - It has been there for a very long time. We know that the key drivers of vaccine hesitancy, and in a way causes of vaccine hesitancy, are actually rooted in lower socioeconomic groups around structural upstream factors like structural racism, access barriers. And we know that lack of trust in government, for example, fear of government is a very, very pertinent, potent symbol of structural racism.

Chris - Not just a problem for the UK though, is it, because if you look at what the World Health Organisation is saying, they are putting vaccine hesitancy and anti-vax on their list of the top 10 of what they regard as global health threats going forward.

Mohammad - Absolutely. I mean, several international surveys have shown that about 40 to 50% of the world population are vaccine hesitant with really wide variations across countries. Internationally, when we look, one of the things we need to bear in mind is vaccine hesitancy is context dependent, it's variable across time, location, and different vaccines. So the same reasons don't apply to every country. What we see in other countries is again around poverty, socio economic status, and mainly access barriers. And also to do with misinformation again, and disinformation and rumours and conspiracy theories are really powerful in the international studies when we have looked and the reasons people have stated why they are vaccine hesitant

Chris - And to give people some context, what do we think the impact of the present status quo is? What sort of a cost is that having in terms of our ability to control and potentially reign in coronavirus going forward?

Mohammad - I think we have said that if you look across the population in the UK, for example, vaccine hesitancy is on the decline, at the moment it's 6%. But if you look at the granular data, we see a lot of vaccine variations across ethnic groups. We see some variation along the age groups. These are really important because it will lead to local outbreaks, and local outbreaks are not good because it drives infection, the spread of infection, and that could cause emergence of new variants as well as putting the rest of the population at risk because of these pockets of unvaccinated people. And also we need to bear in mind that vaccine hesitancy is really high amongst ethnic minorities and it will exacerbate pre-existing health inequalities and inequities in health. So these are really important. We need to address vaccine hesitancy by engaging at the population level and targeting those groups.

Covid vaccine vials

34:19 - Vaccine hesitancy: as old as vaccines

Can we learn useful lessons about COVID vaccine hesitancy from historical vaccine hesitancy?

Vaccine hesitancy: as old as vaccines
Paula Larsson, University of Oxford

Although the coronavirus pandemic is new, vaccine hesitancy is not. The phenomenon has been around for as long as we’ve had vaccines, as Eva Higginbotham heard from the University of Oxford’s Paula Larsson...

Paula -  So I think one of the most really fascinating parts about studying the history of vaccination resistance is the way in which the same arguments are used over and over again for centuries. You have individuals in the mid 1800s who were saying that, first of all, that the disease itself was not such a problem. They would minimise the threat of disease quite significantly and say, "smallpox epidemic, maybe it wasn't happening". "Maybe it wasn't as bad as it was reported". And we see those same arguments today with COVID.

You also have people say that the vaccine itself is what's making people sick. They used to say in the past that vaccination would give you tuberculosis, syphilis, blood poisoning was quite often thrown around. And over the next hundred years, you saw consistent resistance throughout the UK, America and Canada. Those resistance movements would repeat those exact same arguments again, it's just that maybe in the 1800s, they'd say blood poisoning, but by 1920, they would say cancer. And by 1976, you see autism thrown in there.

Eva - And is it the same groups historically who tend to be nervous about vaccines that are being affected by this rhetoric?

Paula - When it comes to anti-vaccination movements in the past, you do see the same type of people who lead them. They often are led by people who are wealthy, middle-class and white. Usually individuals who have something to gain from a movement financially, as well as reputationally.

In, for instance, 1885, there was a really big anti-vaccination movement in Canada. And that was led by Dr. Alexander Ross, who was a homeopath, but also a medical physician. And he really wanted to fight against the vaccinators because he wanted to really change his reputation. He viewed himself as like a white knight crusader, and he had a stake in it, personally. The father of naturopathy, for instance, which really took off in 19th century North America, Benedict Lust, he had a lot to gain professionally from it because his practice of naturopathy was being pushed out and regulated from the profession of medicine.

And so there were reasons why naturopaths and homeopaths wanted to have anti-vaccination movements take place because it gave them more prominence in the medical field at a time when they were being pushed out of it. When they were being called cranks and quacks and not being given licence to practise their trade. So there were lots of financial and lots of personal reasons that people could lead these movements, but they're almost exclusively always movements that begin and are led by individuals that are white, upper-middle class likely, and usually are trying to gain something from them.

Eva - And what about the people who are vulnerable to these sorts of messages? Do they tend to be the same sort of people in terms of demographics over the course of history?

Paula - That is, I think the most complex part of this. The people who listen or who buy into anti-vaccination arguments are a diverse group and they usually pick up on parts of different arguments and only certain aspects of it. There's been many individuals who would, for instance, be against vaccination in the past because it was compulsory, not because they're actually the practice itself, but they just didn't want it to be compulsory. There were people who would be against vaccination because they believed it was a conspiracy of some sort. That was another argument that was repeated since the mid 1800s over and over again. And there'll be some people who believe that the vaccines themselves are dangerous and some individuals too will just believe that perhaps they're nervous or uncomfortable.

One vaccine, for instance, smallpox vaccine was compulsory for a long time and had many different adverse reactions associated with it. So there's a reason why we discontinued using it in 1971. So there could be a fear of just one vaccine, which kind of bleeds over into other vaccinations. In the 1980s, we saw a fear of just the pertussis vaccine come forward, the pertussis component for whooping cough. And there was suspicion that it could be linked to adverse reactions that could cause brain damage. And that led to a large anti-vax movement led by parents of children, who they perceived had been vaccine injured.

So people who follow or who listened to the anti-vax rhetoric, they often pick and parcel the ones that are actually informing their own identity and their own experiences. And that can change depending on which group or community they belong to.

Eva - And is there anything we can learn from history, how people previously managed to encourage people to take different vaccines? Is there anything we can learn from that in how we operate now to try to encourage people to take the COVID-19 vaccine?

Paula - So I think the most telling part of history have been the successes and the successes come forward when communities are directly included in decisions about policy. There's always a question about compulsion and that's been of course coming up over and over again as well. Compulsory policies have always been the worst for vaccine initiative and uptake in trust. Every time a compulsory policy comes forward, it's usually led to a large resistance movement and an expansion of hesitancy, almost exclusively every single time. So compulsion is usually not the way.

The best way that it's historically always worked, is working with community members, community leaders in different communities. So it's usually religious leaders or physicians of colour if you're working with a community of colour. And working with people they trust who will listen to their concerns and would not be coming from the establishment that has historically been an oppressing force for them. So working directly with communities is really key and important and listening to those individual concerns for hesitancy itself.

Because anti-vaccination movements and anti-vaccination narratives are only a small piece of why people actually are hesitant historically. That's the loudest piece we hear and they're very visible, but there's always a number of personal individual reasons as well. And so when that personal conversation happens is when hesitancy itself can really be addressed.

A smartphone screen displaying social media applications

40:26 - Vaccine misinformation and social media

How do social media platforms affect public opinion and trust in vaccines?

Vaccine misinformation and social media
Yotam Ophir, University of Buffalo

Although vaccine hesitancy has been around in various forms for centuries, modern technologies like smartphones and social media that allow uncurated communication have moved the goalposts on a massive scale, allowing the mass proliferation of what is sometimes highly misleading information. Yotam Ophir is from the University of Buffalo where he studies how these platforms can affect public opinion and trust in science and medicine, and he spoke with Eva Higginbotham...

Yotam - On average, both in the United Kingdom and in the US, trust in science remains actually high relatively to other institutions. In fact, in the United Kingdom, surveys indicated that there is some increase in trust in science during COVID. However, and it's important, averages can be misleading. Part of the reason why we don't see changes in trust of science is a movement towards political polarisation in trust. So here in the United States, for example, we see an increase in trust among Democrats, but also a worrisome decrease in trust among Republicans. That's polarisation.

We might pay a heavy price for it in the future when we need to cope with other challenges such as global warming and so on. So even if on average trust in science remains relatively high, I believe our focus should be directed to sub-populations, political or otherwise, where misinformation and this trust is actually on the rise.

Eva - And on that note, what can we actually do to try and increase public trust?

Yotam - So my own research suggests that to increase trust in science, we need to educate the public, but by educating, we do not mean teaching people scientific facts, for example, that the world is warming up. Those were found consistently in recent years to be ineffective. Instead, what we found is that explaining to people how science works, what is the nature and values of science, could increase trust in science and allow people to better understand why they should trust science and why science is a reliable way of learning about the world.

Eva - I see, so it's not so much about learning this fact, it's about learning how that fact was discovered. How we decided as a community of scientists that this is the truth. You've done some research into the role of the media in particular, in creating or damaging public trust in science. What have you found is helpful in that scenario for the media to do?

Yotam - So in my work with Kathleen Hall Jamieson, we found that one problem with how the media discussed science is that they tend to focus too much on individual achievements and failures. So most times media coverage of science focuses on the hero scientists who made a breakthrough or the villain scientist who committed a fraud. Now we believe that a more accurate depiction of science should focus on the scientific community and its values, the consistent skeptic search for the truth and the ability of science as a community project to self-correct itself and identify mistakes when they are made.

A good example for this is the Johnson and Johnson vaccine that was put on hold in the United States after some reports of blood clots among females. This could be depicted by the media as a crisis, as, as a sign that science doesn't work. But we believe that it's a sign that science is actually healthy, that science is doing what it needs to be doing. Even after you approve something, you keep testing it, you keep being skeptic about it. The Johnson and Johnson vaccine was put on hold, was retested, was found to be safe and then was redeployed.

Eva - And the thing underlying a lot of this is social media. Lots of people, I mean, everyone's on something, Twitter, Facebook, whatever it is. Why does misinformation about things like vaccines spread so well on social media?

Yotam - Right? So it's easy and tempting to blame us, to blame the people for spreading misinformation. But in my view, the biggest problem with social media is not the people who use it, but the algorithms working behind the scenes. What we call the 'newsfeed' in Twitter or Facebook is actually programmed to keep users engaged for as long as possible in order to increase profits by those private companies. So basically social media show us what we want to see. It shows us what they believe is engaging content that's going to keep us engaged for as long as possible. That content is often misleading. That's because the truth is often much more boring than conspiracy theories. And so social media algorithms are pushing misinformation to the top of our feeds to keep us engaged, to increase profits. Now because of those algorithms, in part, those who distrust science managed to remain a very, very loud minority that can influence others online as well.

Eva - So it seems like a lot of social media is kind of almost bound to be perpetuating this negative stuff, this misinformation. Is there any way that we can harness the power of social media though, to spread helpful stories and narratives and facts about science and about the vaccines.

Yotam - So health organisations and science communicators do their best to harness social media for the benefit of society. But in my opinion, they often do so without following the science of science communication. Again, as I said earlier, just providing facts doesn't work. So if science communicators should get better at creating engaging content that matters, content that takes into consideration the values and characteristics of the audience and relies on engaging messages in order to make the point about, for example, the safety of vaccines. So social media do offer a prominence for science communication, but it will require us to get better at working in this platform.

Woman speaking on a mobile phone over coffee

46:43 - How to talk about vaccines with loved ones

What can you do if you have a loved one who doesn't want to get the Covid vaccine?

How to talk about vaccines with loved ones
Farzana Hussain, The Project Surgery

What can you do if you have a loved one who doesn’t want to get the vaccine? Farzana Hussain is a GP in London. In February, she made it her mission to personally call up as many eligible patients as she could who hadn’t yet signed up to get their covid vaccines, to talk them through it. Chris Smith spoke with Farzana about how she reached out to her patients...

Farzana - Yes, it was Chris. When the vaccine program rolled out, I found that within about two, three weeks, I could see that around the country, there was great uptake, but amongst my patients, only 50% of my over 65s, which was the open cohort at that time, were attending. And it was fascinating for me because I run quite a small practice. I've been there 18 years. I know my patients quite well, and I could see that the 50% that weren't attending Chris, were mainly from various BAME communities. And the 50% that did attend were all Caucasian. And I really found this fascinating, because Newham had the highest COVID death rates in the country in the first wave. So I took it upon myself to ring my patients, having been very fortunate, having that relationship with many of my elderly patients as well, to try and find out what it was, what was causing the lack of wanting to go.

Chris - And what did they say?

Farzana - In Newham we’re very diverse, ethnically, very rich little world, 74% BAME. If I was to put it into three categories, and which I know is huge generalization, my South Asian patients, particularly my Pakistanis and Bangladeshis, who have been shown to have lower uptake than the Indians, were mainly concerned, as Mohammad said, about animal products, is it safe? Is it halal Islamically? Is it okay, I'm a practicing Hindu. I don't want any animal products in my body. My black Africans and Caribbeans, it was exactly as Paula was talking about, it was a general mistrust of the state. You know, lots of examples of, well, if you're black, then you're more likely to be diagnosed with schizophrenia. Why should we have any faith in this vaccine now, when black people are generally more victimised? So it's a fascinating piece of work for me.

Chris - It does sound like it comes down to what we were hearing just previously with Mohammed, about education and information. There's also a study out. It's in yesterday's Telegraph, this was reported. A study out from Kings college and university of Bristol, 5,000 people quizzed. They showed that actually the number of people who were vaccine hesitant has dramatically changed in a year. Among white communities, 56% are saying they're supportive of vaccines and that's gone up this year to 87%, but as exactly as you're pointing to, 67% of Muslims questioned now express vaccine confidence. But that's up from 23% last year. So a big turnaround. That kind of says, these are not people with rigid ideas that they're just not going to do something. It appears to be a lack of information, or knowledge about a product that's making people sceptical. And it argues your approach of actually talking to people, and then putting them on the right path is the right one.

Farzana - Absolutely, Chris. We've seen a five fold increase in the Bangladeshi community, nationally, taking up their vaccines. A three-fold increase in the Pakistani community. The key to this for me as a GP, I'm a family doctor. I've been a GP for 20 years, and I very much consider myself a family doctor, part of the community. I live in Newham. I work in Newham, I'm a mum to two teenagers in Newham. And I really want to listen to my patients. We talk a lot about education. Education works both ways. It's not just about us telling our patients what to do. We've seen lots of messaging, public health messaging nationally, but the key for me has been to listen to what the concerns are, because every single family and every single individual will have a unique concern. And that's what we need to address with facts, medical facts in an appropriate language, asking people to give us their feedback on what they've heard.

Chris - Well, speaking of listening, let's have a listen to the family that we spoke of at the beginning of the program, they've tried to talk to their son about the vaccine. This is what they said.

Concerned Listener - We just sent him the details and said, look, you're wrong. And here are the reasons why, and that's it. I know we've addressed everything, all the facts, all the supposed facts that he sent us, we've addressed them. And we've tried to explain to them why they're wrong.

Chris - What would be your approach under those circumstances, Farzana?

Farzana - I'd really be going with, what is it? Because I've found that the common theme for whatever the reason people are giving is fear. Whether it's fear of lack of fertility, fear of the state, fear of putting something in that doesn't comply with my religion. That's the key in, that I would take through listening. What's his fear?

Chris - What about friends and family Farzana? Because you know, who we turn to when we want advice, isn't necessarily picking up the phone and talking to your GP. The first people we will almost certainly speak to, as in the family we've been hearing these clips from, are other family members. So is part and parcel of solving this problem about reaching, not just one individual, but reaching the whole network.

Farzana - Yes, definitely, Chris. I think you've hit the nail on the head, and certainly where I am, we see a lot of intergenerational families as well. And I always go back to the old thing: if your mum tells you to put your coat on, you generally put your coat on. So one of the things that I've found really useful is actually speaking to some of the women, and particularly the women who are perhaps mothers, as well as looking after their mother-in-laws and their own parents. Because if they are very pro-vaccine, they can actually influence an awful lot of people in their household, from their younger ones to their husbands, to their relatives.

Chris - It's a bit like sparks coming down and starting lots of little fires isn't it? So you have started the ball rolling. By getting to a few people, there were obviously some influences in there, that then helped to grab other people along the way.

Farzana - Yeah. And I think my biggest success was one of my ladies who I've known very, very well. Over 15 years, I've known her. In her eighties, an African lady. And she said to me; "Oh, but doctor, I'm worried about the long-term side effects." And I know her really well. So I could be a bit cheeky. And I said: "Listen, if you grow a second head because of your vaccine, when you're a hundred, I'll come and cut it off myself." And she was laughing. And I said: "You know, my mum's passed away. My mum died when I was 19." I said: "But my mum would have been exactly your age. She's in her early eighties." And I said: "If my mum was here, I would really want her to have the vaccine to protect her. And I want you to have it." Her son rang our reception three days later and said: "Can you just thank Dr Hussain because I wanted my mum to have it as well." So I did have him on my side, and she said but what Dr Hussain said about her mum, she went and had it.

Chris - A bit of a worry when your GP says I'll chop your second head off! But it can be really hard on families. Let's have a listen to a little bit more of what they told us.

Concerned Listener - I mean, we just don't talk about it, that's all. We talk about other things, but we won't get into that issue because you know, we've learned that every time we've tried, it just doesn't work. And his parting argument is always: "I want to protect you. I want what's best for you, because you're my parents. And obviously I love you. And I want to make sure that you're safe."

Chris - Have you got any advice for people or families that find themselves in this position, where it's almost become an unmentionable subject, like not bringing up politics at a dinner party?

Farzana - Yeah. It was quite sad to hear wasn't it, that they don't talk about it. And actually heart-wrenching to hear that actually, he just wanted to protect his parents and this is how he knew best how. I think in a situation like this, if we can encourage support, so does that family know anybody else in their wider family friend circle that has perhaps had the vaccine? Is there anybody else they can talk to? In Newham we've got what we call COVID Champions. So our council, our public health team, have trained up over a hundred people who are from the community, who have found out about the COVID vaccine, and COVID effects, and they help other members of the community, and come into practices as well with us. Sometimes it's really powerful to just have somebody else, when you've reached that loggerhead yourself, with your family, to have somebody else coming in.

Can of fizzy drink

55:01 - QotW: Will a can in the sea float or be crushed?

Will a can of soda dropped in the ocean sink until it implodes, or float once it reaches equilibrium?

QotW: Will a can in the sea float or be crushed?

This week, Phil Sansom has been thinking deeply - or rather, sinking deeply - about this question from listener Richard. "Will a can of soda dropped in the ocean sink until it implodes, or float once it reaches equilibrium?" Here's the answer, with help from the Cambridge Science Centre's Mia Foulkes...

Richard - Will a can of soda dropped in the ocean sink until it implodes, or float once it reaches equilibrium?

Phil - There’s only one way to find out what happens to a can in the ocean - an experiment! I don’t have an ocean, but I do have a really big pot that I can fill up…

...that’s three litres - so if I add six tablespoons of salt, I think that should make seawater… let’s see what happens when I drop in a can of Coke… floats!

Right there on the surface! Richard, the can’s failed your question at the first hurdle - it would have to be denser than the water to sink, before we can learn whether it would implode or hover at a fixed depth. But that’s not the end of it - says Mia Foulkes, from the Cambridge Science Centre...

Mia - This is a really interesting and deceptively complex question, and depends on which country you’re in! In the UK, fizzy drinks contain less sugar and so the can will always have a lower density than water and float. Other countries will add more sugar, and so their cans of soda will sink.

Phil - The difference even extends to diet vs regular drinks - regular Coke will sink, while Diet Coke will float! So let’s take the sugariest of US fizzy drinks as an example, which will have a density of a little over a gram per millilitre.

Mia - Ocean water is at that density at about 5,000 m below the surface. If our can sank to 5,000 m it would sub-surface float because of equal densities. But, it is unlikely the can would get that deep. At 5,000 m, the water pressure would be around 50,000 kPa.

Phil - That’s 500 times the pressure of the normal atmosphere!

Mia - So, if a can of soda sank in the ocean, it would be crushed before it started floating.

Phil - Halc on the forum speculated on how this might happen. The can is a nice symmetric shape, so it will retain that shape for a while, but eventually the top of the can will begin to bulge inward. Given enough pressure, the can might actually dent somewhere allowing the two pressures to equalise and preventing further deformation. It won't ever completely implode - there’s not enough compressible gas.

Mia - Interestingly enough, the average depth of the ocean is 3,700 m. So, in many places, the can couldn’t possibly get deep enough to float, even if it could survive the trip down.

Phil - Thanks very much to Mia Foulkes for that answer. For now, that’s see you later, alligator - because next time we’re answering this question from one of our younger listeners, Johan...

Johan - Why is a crocodile’s skin bumpy and not smooth?


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