Capital Daily

Can Better Communication Curb Vaccine Hesitancy?

Episode Summary

We analyze how the province has communicated with the public during the vaccine roll-out. We also speak to a public policy expert about how governments should communicate with the public about vaccines.

Episode Notes

We analyze how the province has communicated with the public during the vaccine roll-out. We also speak to a public policy expert about how governments should communicate with the public about vaccines.  


 

Get more stories like this in your inbox every morning by subscribing to our daily newsletter at CapitalDaily.ca 

And subscribe to us on our socials! 

Twitter @CapitalDailyVic  

Instagram @CapitalDaily  

Facebook @CapitalDailyVic

Episode Transcription

Disclaimer: These interviews have been edited for clarity and length. 

Jackie: My name is Jackie Lamport. Today is Wednesday, May 19th. Welcome to the Capital Daily Podcast. Today on the show, We look at how the vaccine rollout is going on Vancouver Island. What kind of challenge is posed by vaccine hesitancy, and how public health communications can combat that. 

Vaccine rollout is ramping up across the province and on Vancouver Island. As of this week, 55% of eligible adults in B.C. have received their first dose of a COVID-19 vaccine, and 3% of eligible adults have had both doses. As we put issues of vaccine supply behind us, a new challenge arises - getting them into the arms of people who are still not convinced they are safe. Vaccine hesitancy overall is low in B.C. A recent Angus Reid poll shows that 11 percent of British Columbians still remain unconvinced - that’s down from 24 percent at the end of January. And of all the demographics, young people are the least likely to have registered to get vaccinated. 

We’ll look at how the vaccine rollout is going on Vancouver Island, what kind of a challenge is posed by vaccine hesitancy, and how public health communications can combat that. We’ll hear first from Dr. Mike Benusic, Medical Health Officer with Island Health, who will provide the latest on the Island’s vaccination campaign.  

After that, we’ll speak with Heidi Tworek, Associate Professor at the School of Public Policy and Global Affairs at the University of British Columbia. We’ll hear from Heidi about the best way that governments, media outlets, and individuals can talk to people who may be on the fence about getting a vaccine. 

Jackie: Mike, thank you so much for joining the podcast today. 

Mike: Thanks for having me. 

Jackie: Let’s start brief. How far along is Vancouver Island’s vaccine rollout?

Mike: We are so far along. It’s so tremendous to see how far we've come. As of today, we have vaccinated 55% of adults within the Island Health region. And we are on track to offer vaccines to anyone who wants it over the age of 18 before the end of June. 

Jackie: That’s incredible. Is that ahead of expectations? 

Mike: Definitely. When we look back into what the original schedule was set in, I guess it was December, and we were expecting that all adults will be offered first doses in BC by about the end of September. So we're definitely months ahead of that. I actually just saw an article today that was saying, as a whole, the province of BC. And I guess, same with Island Health because we have very similar rates is that we're on track to be ahead of the states in terms of first dose coverage within a couple of weeks. So I think back to the criticism, and some of it was very legit criticism about the pace of the rollout in the early months and how that's completely night and day compared to where we are now. Vaccines are getting out fast and furious.

Jackie: What do you think has changed? Why is it different now?

Mike: It's always just been an issue of supply. We’ve been very efficient within Island Health. When we receive vaccines, we use them. And sometimes we have to hold a little bit if we have second dose requirements or if we know we're going to do a whole community approach next week. We hold the vaccines for maybe a week, but that's it. We've planned our system so that we're able to basically scale up to however many vaccines we get in a week we can provide that out. And it's always been a mismatch so far with supply and demand. People aren't really hungry for vaccines on the island, which makes my job a lot easier, and I love it. And now it's just tipping better into a level where the supply is actually meeting the demand. That's the only reason why Island Health, within BC and throughout Canada, had an initial slower pace to our rollout compared to, let's say, the United Kingdom or the US, but we are more than catching up now. 

Jackie: You mentioned that there's a demand for it on Vancouver Island. But there was a comment from Dr. Stanwyck about vaccine hesitancy among younger people, specifically on the island. Is that something that you have actually seen, or is the demand high?

Mike: So it's difficult to I would, I would say that to draw a firm conclusion right now. And the reason for that is because we were not yet into the stage where we're vaccinating, let's say, people who would be considered the EU, of which I heard a definition lately, which is under 30, which is almost me. So I feel flattered to be still considered almost a youth. I'm an elderly youth, I guess. And we right now, on the island this week, were vaccinated people between the ages of 45 and 50. We’re going a little bit slower through our rollout compared to some other health authorities. And the reason for that is one, because, you know, the island has a bit of an older population, so there are more people to go through. And the vaccine uptake among the population so far has just been phenomenal. You know, we're talking about 90% of people over the age of 80 who have been vaccinated. And so that just means it takes a little bit longer before we can start offering it to everyone. Now, when we're at the state where, over the weekend, it was opened up that anyone born in 2003 and earlier can register for a vaccine. And a lot of people are getting booked in within the middle of June for their vaccination. I think we have to wait a little bit till the dust settles about after we’ve kind of done all the first doses to see what the uptake has really been among the youth. Because on the one hand, when we look at just the provincial system, we know that the registration for people, let's say, isn’t as high as other groups between the ages of 18 and 30. But registration to me doesn't necessarily mean that there's going to be less of an uptake. Because I know that being a millennial myself, like I talked to a lot of my colleagues or my agent somewhere younger, you know, they're not that keen on pre-registering the system. They're just like, “Oh, I'll just wait till vaccines become available, and in mid-June, I can go into the system and book immediately.” So there's not necessarily hesitancy; it’s just they don't want to go through that. The hoops and jump jumps with the system. I do want to say that the system is easy to go through. And I encourage everyone to register in advance. But I really think we have to wait until the dust settles till we really see what we're looking at in terms of hesitancy. No, I definitely wouldn't say it's premature. I think that, especially when we look at other jurisdictions like we expect that there's going to be more hesitancy among I would be able to say this, I would be incredibly shocked if there was the same amount of uptake among 18 to 30, that we've seen a plus 80. Like, I do not expect that 90% of people between the ages of 18 and 30 will be vaccinated, which I think makes sense on the one hand because it's very easy for people not to see the risks of them. Because unlike certain things like influenza, for example, which has a bad effect on people who are very young, and people who are very old, COVID-19 has really been shown to have the worst effects on people who are very old. So it makes sense that people who are over the age of 80 are going to be very keen on getting vaccinated to protect themselves. For as in people who are younger they make on see the immediate benefits of being vaccinated. So I think that makes me guarantee that my boss, Dr. Stan, was right that we will see less uptake among that group of people. And exactly what that's going to be is just what will we see after the first dose rollout is complete somewhere in June. 

Jackie: There's some good news. According to Angus Reed, a poll showed that only 11% of British Columbians were vaccine-hesitant compared to and that's compared to 24% at the end of January. Why do you think this has changed?

Mike: I was kind of surprised at that number because it is quite low, very low actually. When we think of traditional like with it with childhood vaccination vaccine hesitancy, and it makes a lot of sense, though, why we would see that number decrease since the rollout is because, in December and January, these are brand new vaccines. The people who receive them in Canada are the first people to have received them in Canada. And so, you know, and even though there have been studies done, of course. It’s been approved by Health Canada, by the BC, the CDC and the Provincial Health Officer. So it’s very natural for people to think like, “I don't want to be the first,” but then as the rollout has happened, and we've provided almost half a million doses within the health region, within Island health, I think people are becoming more comfortable and recently talking to their colleagues and hearing people say, “I got my shot, and I had a sore arm for a couple of days, but then, I felt great. Now, I'm glad I got vaccinated.” And those types of stories are, are very powerful. And, and they're doing, you know, peer pressure is a real thing, sometimes in bad situations. And sometimes it gets situations from my perspective, with vaccines, hearing that 55% of the population of the adult population of Island Health been vaccinated. So I think that people click; it’s like, “oh, well, if everyone else is doing it, I should, too.” And in this situation, that's good. 

Jackie: Canada is kind of going about things in a unique way in comparison to other countries that are similar to us. We are focusing heavily on the first doses. And also, with that, allowing some big gaps between the first and second dose, which the science is still not out on whether or not that is better or worse. Do you know anything about that science? 

Mike: I recently saw a news article that said something to the tune of “Canada's big bets on delaying the second dose may have a big payoff.” As a medical health officer with Island Health, I've been involved in the discussions or, you know, peripheral to the discussions that have been happening, including the timing of doses. And it's never been, it's never been a bet. It's always been based on what we know about vaccines. To me, there’s never been such a preoccupation with the minimum interval to vaccines. Because with all of the vaccines, we're not concerned about if someone's getting a dose too late because it's there's usually no maximum interval when it comes to vaccines. For instance, if someone gets an MMR measles vaccine at age one, it's recommended to get their second dose between four to six years. So there's a five-year interval between those. If someone gets it at when they're seven, it doesn't mean that that that second dose isn't valid. But if someone was to get a too early if they got a measles dose on, let's say, on Monday that they got another dose on the next week, that second dose would be invalid because there hasn't been enough time for the body to develop. And so the whole notion that we have to stick to this minimum timing, and if we provide doses later than that, that that there's going to be this real lack of effectiveness. It just goes against like everything we know about vaccinology. So that in combination with what was seen in other jurisdictions, Quebec actually beat BC in terms of exposure extended the interval and the UK, which combined was the evidence to move forward with this. And there was a recent study that was done. Not a study, there was a presentation done by NACI, the National Advisory Committee on immunizations, that showed how many deaths and hospitalizations and cases have likely been prevented by doing this approach. And it's it to me when I saw that it just hit home that like this was 100%, the right decision. This literally has saved many lives in Canada by extending the doses.

Jackie: This is something that is brand new information, and like a brand new type of information to so many people, but it affects everybody. So we're all getting involved. I know which article you're referring to because that's the one where I read that, and that's the first time I had heard that. I'm no scientist, so when I saw that, I thought, “Oh, that makes more sense.” But do you think that this should have been communicated better? Because what we see right now is there’s a lot of people who are just seeing the manufacturer’s recommendations? Therefore they think that's exactly what's right. And they don't understand that there's science behind the approach. Do you think that we could communicate it better?

Mike: I would like to know what it would have been like to be in the Spanish flu pandemic and to see what impact communications had been. Because I see now that they had people who were vaccine-hesitant people who may have other ideas about the cause and solution to the pandemic, they also didn't have this massive tide of misinformation in social media. And I think communications, in general, are just between such a rock and a hard spot right now with I don't know what could have been done differently to put people at ease with the rationale. In this example, for extending the dose interval. I mean, Dr. Henry was talking about a daily on press conferences, there's, there's information that every Health Authority produces, we meet with how many different organizations to explain this, I have daily conversations about it. I know that all other health officials are too. And I know, there's also been information campaigns about a put-out. But, still, at the end of the day, it's going against that type of information on social media that may be misinformation, or maybe people who say like, “No one's telling me anything, what's the answer here?” And other people filling that void? And so, I think it's a situation where the onus is a bit on individuals to choose what they're looking at and what they're going to believe out there.

Jackie: Yeah. But at the same time, it really impacts everybody if those people don't believe it. I know that it's not the same as having a press conference and having it scientifically explained. But I think that doing simple media campaigns like cheeky commercials or whatnot might not seem like the smartest thing. But do you think it would be better if more people understood because we can't just expect people to go out of their way and not go to?

Mike: Yeah, I know that was one example when I talk about the tide of social media and that the misinformation there is that I know all health authorities in the province were doing like social media campaigns about the the the intervals and directing people to the website, directing people to evidence directing people to the science. And to be honest, I think that most people understand or the rationale for it. I think people may have different perspectives, of course, as anyone is allowed to about what the right approach is, but I think people get the notion of, alright, instead of one person having two doses of vaccine, and let's say, an individual going from 80%, immunity to 90%. So let’s have two people who each get a dose of vaccine. So both of them go from zero to 80%. And I think that most people get that. I think there are obviously people who are going to have different thoughts regardless. But I do think just in general that communications throughout the pandemic and trying to justify the rationale for every decision is just such a difficult battle against misinformation, and also just the pace that decisions are being made. Because I guess we the province and all health authority communications got to really pick their battles of what decisions, they're going to really try to do a campaign on to say like, here's the rationale for it, because, you know, there are new decisions every day about something regarding the pandemic.

Jackie: I don't want to push further on that one. But I'm sure that there's a lot to be discussed there and other people will have their own conversations. What is the percentage of the population that we need to have vaccinated for things to go back to a relatively normal?

Mike: The first answer to that is, is I don't know. Because I know that that's being discussed at the provincial level about setting those parameters and how those restrictions are going to be peeled away, I think it's understandable that people get fixated on a particular threshold. And I appreciate what you ask Jackie, but like, you know, a clear threshold and one thing will happen, like whenever restrictions will be lifted because that's something that's possible. This other threshold that people get fixated on is going to be the threshold where we eliminate COVID. And I think that's the science is pretty clear that there's basically never going to be a threshold we reach that COVID will be eliminated from society. This is a virus that will likely be here to stay. And what I predict is that more like measles, where with measles, we try to keep coverage rates up as much as possible. When there is a dip, particularly that there's a dip among a specific group of people in close proximity, there may be a cluster or an outbreak among that population. That's something that we could certainly see happening with COVID-19 in the future. We're all looking forward to the pandemic being over and for those restrictions to be removed. But the COVID-19 is going to be here to stay, regardless of how high the vaccination coverage will end up being. 

Jackie: The United States has so much impact on our thinking in Canada, and we look south, and we kind of look at what they're doing, and then think about it in terms of what we should be doing. They did announce that people who are vaccinated shouldn't or don't have to wear masks anymore. Is that something that is going to be a difficult thing to communicate to people because I have a feeling that our recommendations aren't going to be the same? 

Mike: It hasn't been difficult for me yet because I feel like, during this pandemic, there has been a bit more of a divergence between the guidance from the US and the guidance of Canadian residents before it was a lot more fluid. What you do in the States, it's the same as what you're doing in Canada, except you have stranger-looking money. Now, many people say, “Oh, that's what the states are doing.” But we're in a different situation here in Canada, and we're going to follow our restrictions and rules here in Canada because we can't really compare the two. Of course, people are tired of the pandemic; absolutely, they want to go back to whatever the new state of normal is. So I know that people, when they see that in the States, they say like, Okay, well, I wonder when that's going to happen for us. And my message would be for everyone is that we're all tired, I'm tired. We're all looking for those restrictions to be removed. But we just got to do it so carefully. What we don't want to do is to take back a restriction too quickly and then have to put it back on because that's going to feel a lot worse. I think gradually peeling away those restrictions and making success every way. So just bear with us a little longer.

Jackie: Mike, thank you so much for your time.

Mike: Thank you so much for having me, Jackie. And I get some to end if I could just, of course, encourage anyone who's listening. If they haven't yet registered for a vaccine, go online to do it. Just search “vaccine COVID-19 BC” click the first link that pops up. If you don't have a personal health number or have any problems, there's a phone number you can call on the website. And yeah, happy vaccination.

Jackie: For this interview, you'll hear a new voice on the podcast. Kate Helmore is our intern who has been doing some great work on the podcast for the past few weeks, and she's going to be taking over for this one.

Kate: Hi, Heidi, thanks for coming on the show. 

Heidi: Hi Kate, thanks for having me. 

Kate: So, let’s start by talking about your report on effective health communications. In that report, you examined numerous countries from Norway to Senegal to find five key principles that are essential to effective communications. Which of these five do you think BC has excelled at compared to other countries? 

Heidi: Yeah, that's a great question, because one of the things we really wanted to do in this report was to figure out what can we learn best practices from different countries around the world? And also not to assume that we knew the right answer, which countries those are going to be. And we actually found that some of the things that BC did are quite distinct but very effective. And so one of those is one of our key principles, which was our acronym rapid, and that all was relying on autonomy, not orders. So it wasn't to say that there should be no public health guidelines or orders. But as far as possible to create little spaces and room for autonomy, where people could still make their own decisions. So one example of that, I think, has been Bonnie Henry's insistence that we should try to keep outdoor spaces open. And that even at the point when indoor dining was sharp, we were still allowed to gather in groups of up to 10, outside acknowledging that that was far, far safer than being indoors and giving people that outlet for their mental health, fitness, wellness in general. So that's one example of how even though really pretty strict orders on the indoors, there's still room for autonomy in the outdoors.

Kate: Right. And do you think that's changed over the course of the pandemic? I mean, we've seen more restrictions as pandemics gone on.

Heidi: Yeah, I think the balance has indeed shifted. So we've certainly seen more restrictions on the indoors. But I think I would say that that's also part because of the evolving science of what we know about COVID. We know that it is airborne, and we know that it's much safer to be outdoors rather than indoors. Still, in contrast to lots of other places, even in Canada, like Ontario, we've seen a continual attempt to really try to at least carve out some spaces, where we still have some choice about what we can do and try to make sure that you're engaging in what others call, you know, risk mitigation, harm mitigation, and communicating around that rather than playing a blame game, a stigma game, a banning of everything game. So I think they've been obviously more restrictions. And we can argue about which were most effective and when they should have happened. But in terms of thing about communication, really trying to say, look, there are still some things that we can do. Let's make sure we do the things that are safer, and here's how to think about that. The classic slogan that we all know the “see fewer faces, outdoor spaces,” is one of those kind of guides that I think a lot of Henry's thinking all the way from the beginning of the pandemic.

Kate: The number of people who are vaccine-hesitant in BC is fairly low, around 11%, especially compared to Alberta and Saskatchewan, and it’s dropping. What role does effective public health communication play in that, and do you think the communication of our province has led to lower rates of vaccine hesitancy? 

Heidi: I think one way that I like to think about is a little bit differently. So rather than worrying too much about vaccine hesitancy, I like to think about it the flip side of building vaccine confidence. So I think that's one way to think about it. We've seen that in Canada, in general, in many countries around the world, views on the vaccines and confidence in them have been very malleable. It's also dependent on which brand, and so on, we can talk about that. But that confidence has gone up pretty dramatically. And in part, that's because you see others get vaccinated. Once 100 million people been vaccinated, your level of confidence goes up quite substantially. So seeing that happen in BC as well as elsewhere. So that’s one piece of the puzzle. But the other bit is about access. I think we often make a mistake, we talk about people being vaccine-hesitant, but a lot of the time, it's actually about access. Do they know how to access the vaccine? Do they understand things about it? Or are they confused? So, you know, we've seen some missteps in VC around that second part, in particular, that question of access with some of the popup clinics or BC itself; the public health officials said, “Well, we actually apologize for the confusion around communications around those.” So I think that access pieces where we can still see a lot more work to ensure that everybody knows if you're over the age of 18, you can register, how to register, how to get your vaccine. So that’s the piece where I think we could still see some improvement.

Kate: Right. And how does that fit into your five principles? So if we were to say that's one of the limitations of BC’s communication strategy, what principle is that falling under? 

Heidi: Yes, I think it's fully under two of them really, that the “P” of RAPID which is to pull in civil society. We've seen amazing civil society groups springing up who are helping with this. So, “This is our shot” is one classic example, which came out of the South Asia COVID-19 Task Force, been instrumental. Thinking about and seeing that a bit more now, think about ways to tie that into government efforts to understand the problems in particular groups in society racialized or marginalized groups and incorporate that into what the province is doing? So that's that P., and the other one is the “I,” which is institutionalized communication. So I've been banging this drum for about a year. Still, I’ll use this podcast to back again, which is to say that communications compared to almost every other non-pharmaceutical intervention is incredibly cheap. Still, you need people, and you need institutions to do it, you need to have people who can immediately translate things, you need to have people who are, let's say, in the case of VC and creating that one-pager that can be sent to all the strata, so they can put it up and tell people how to register to send to businesses, you know, popping the QR code, you just need a buddy who can do that kind of stuff. And that means you need to invest in having that person who is employed. And so that institutionalization, I think, could have helped with some of this rollout as having a couple of extra people could have made a big difference.

Kate: Even though we're only 11%, we still have some people who are staunchly against vaccines and adults actually beyond vaccine hesitancy and actually anti-vax. Why are vaccines such a difficult topic to address, even right now, when they are so essential to overcoming this pandemic?

Hedi: One reason is that we have had anti-vaxxers for quite some time. So, of course, this has come more to the public's attention. But there has been a sustained campaign by certain figures who have heavily funded anti-vaxxer sentiment for quite some time. So I think if we understand that a lot of this anti-vaxxer sentiment is not just a sort of organic development it has come out of and particularly in the US have very high profile figures, like Robert F. Kennedy, Jr, who's pumped in a lot of money. And we can even see it in a report that was done recently, which is talking about the disinformation doesn't so say most of this anti-vaxxer content is being spread by a tiny number of people, and we look into it. They’re mostly doing it for reasons of profit, right? So some of these people are doing it because they want to sell supplements. Some of them are actually selling seminars, where they will train people around anti-vaxxers. So I think once we get to that tells us a lot of the sentiment is coming from some of that. So it's not necessarily organic. However, that's a bit of a separate question of how we deal with that versus how do we deal with those individuals who have, now you know, glommed on to this anti-vaxxer sentiment. And then suppose very complicated, because once somebody is deep in the rabbit hole, how we deal with that is very different than how we deal with someone who's got, you know, some questions around vaccines, but can be convinced part of it is maybe accepting there are going to be some people who will get vaccinated in our population. And depending on the percentage, that's not necessarily a huge problem. So we have to accept, we're not going to get to a 100% vaccination rate, that's not actually what's required for herd immunity anyway, so maybe it's okay. And we could spend all of our time worrying about that 5% and not enough time, really engaging with that 30% of the population who might still have some questions and needs vaccine competence, vaccine access. So that's kind of point one; let’s aim our communications at that kind of 30%. And not too much at the 5%. If we want to deal with those people, I think the individual level is really crucial. So we've seen in questions of childhood vaccinations in lots of places in Canada, there are actually doctors who do bring people in when their parents are worried about vaccinating their kids have one on one conversations. And in some cases, they'll get over 50% of those people to vaccinate their kids. So what we need is it's a huge amount of effort, but it relies on those one-on-one conversations with experts. So we may get to the point where we have the capacity to do that. But that's going to be the kind of level of engagement that be required there. And then finally, to circle back to that question of all right, that disinformation doesn't that's really about government officials engaging with platforms like Facebook and co to see what are they going to do about those individuals? And how are they going to mitigate that profit-seeking around anti-vaxxer sentiment?

Kate: Do you think that the pandemic makes this more tricky? Does being in a global pandemic actually makes talking about vaccine more difficult?

Heidi: I'd say in a way it makes it easier because vaccines are an exit strategy to a huge extent. I was on a podcast yesterday with some infectious diseases physicians who talked about how they had gone back and forth on whether to call this vaccine a miracle. And they decided they would because it was basically eight months from the who declaring a pandemic to having a vaccine that was, you know, getting tested and basically going to people's arms and less than a year. So that has provided, I think, an incredible opportunity to talk about the vaccine. And now we've got countries that give us examples of what an amazing effect this vaccine can have. To the extent that if you are fully vaccinated, and you're not someone who's immunocompromised, if you're just an ordinary person, fully vaccinated, the chance of you dying from COVID is five times less likely they're getting struck by lightning. That is extraordinary. So I think it's great. It's a real opportunity actually to talk about the immense value of vaccines, and we can see in real-time how they totally changed the course of this pandemic. So I guess I see it as a bit of a positive there. But I guess the other thing I would say is I hope that it's an opportunity for us to really hammer home that there's also a big equity question here. We are tremendously privileged to sit in a country where theoretically, we could vaccinate 12-year-olds when they can't even back Healthcare workers in most of the world. So I hope that even once most of us are vaccinated, we'll continue to sort of bang on the drum that we see vaccines work, so we should make sure they're available everywhere globally is the fundamental question of equity.

Kate: Kind of returning to the anti-vax versus the vaccine-resistant. What are some of the biggest challenges of communicating to people who are vaccine-hesitant versus anti-vax?

Heidi: So the one big challenge, when we have these kinds of conversations, is to remain open to the other person's point of view, to make sure that what we're doing is actually a conversation. And not that we're entering into this desiring a “gotcha” moment where we get a person. Instead, what we're trying to do is really understand what's going on because there are so many legitimate questions. I remember the very beginning of thinking about these vaccines. There was a brief moment in the UK where they pause them for anybody with a medical allergy because they weren't quite sure. But then it became clear was only people who are allergic to the actual ingredients in the vaccines, which is just a minuscule number of people. So let's say in that week, or so UK authorities were trying to figure this out somebody who had questions that had allergies dismissed as an anti-vaxxer, you might unintentionally push them into that stance because they feel like they were their questions are not legitimate. And yet they were legitimate questions, and they deserve to be answered. So I think trying to enter into this in the spirit of let's understand what people's questions all, let's really make this a constructive conversation, not aimed for a “gotcha” moment, can be tremendously helpful. So I'd encourage people to if they're going to have these conversations to enter into in that spirit. And the second thing I'd say is to understand that even just keeping our conversation open is a massive win. If somebody has questions, they're still willing to explore. That's already enough, right? And sometimes it's going to take 234 conversations, and it’s going to take for some people seeing almost everyone around them backstage before they feel comfortable. And the pace that we're going in Canada, that's also okay, so all the one gets out of the conversation, and someone's saying, Yeah, I'm still not quite sure I still need to look into it. That's great because you're just keeping that line of communication open. So I think entering into a conversation with those expectations can help us feel like this was worthwhile. And we're actually maintaining a meaningful dialogue, but hopefully, get to someone feeling comfortable with the vaccine, but we're probably not going to get there in a 110-minute conversation, and that's totally okay.

Kate: That kind of brings up a question of complete transparency versus what is effective things for the public to know. So, for example, what role can the media or individuals play in addressing these slight health concerns that are not necessarily to the scientific community, but the public hears that and gets scared? And so, do we sacrifice transparency for effective communication? Or is transparency always the best policy?

Heidi: So maybe I'll talk about the transparency piece first because I think this has been something where people have noticed a balance. So I'll give you an example. At the beginning of the pandemic, in BC, particularly during the summer, we had about 10 cases a day, right. So the possibility that if you describe a case too closely, you will identify the person was actually quite high. And we saw in some other provinces in the Atlantic provinces that, in one case, a black doctor was mistakenly identified as bringing COVID into one of the Atlantic provinces, resulting in all sorts of horrific racialized abuse. So we need to be careful with this. We can see these examples where too much transparency leads to tremendously awful abuse. So there are real reasons to keep these things private, particularly because, unfortunately, we've developed a lot of stigma discourse around COVID. And that, of course, changed with the balance of the number of cases, right, where I think perhaps more transparency could have been helpful in the BC case. But I do want people to understand there are real and legitimate reasons for privacy because there can be real circumstances when insufficient privacy leads to terrible stigma or even, in some cases, abuse, whether offline or online. All right. But in terms of things like the vaccines and adverse effects, let me say a couple of things. One thing of the pandemic we've had real trouble taking on the science of risk communication, it is real science, it exists is very, very important that we learn how to communicate risk well. Unfortunately, we’ve seen failure after failure and that not certainly just in BC, but sort of broadly, difficulties in risk communication. So what are some things we need to do with risk communication, we need to inform people about risks, but we need to be careful to put them into context. So one way we can do that is to compare them with other risks, right? So you know, helping people understand all the medicines we take have some risks, right Flonase can result in a detached retina. It’s not common, very unlikely, but possibly more common than some of the side effects from AstraZeneca, particularly now, it doesn't mean it's not a concern. But it does mean that we need to do better risk communication, helping people understand how likely is this event. So I think that that's one thing where we had some trouble communicating. But I think we also want to help people understand how different points of the pandemic, do you weigh risk differently, you know, depends on what COVID there is in your community, and so on. And I think people felt very many people felt like they couldn't weigh that risk of themselves because they were normal members of the public. So that's one place where I think public health officials sometimes want to give the public a lot of autonomy to maybe in some other provinces. But that maybe didn't make sense within the particular context of this moment of the pandemic because individuals who weren't experts felt they just didn't have that level of expertise. So putting it into frameworks that could help people is, I think, useful aspect transparency, but really contextualize it within what's the risk here, really, because a number like one in 22,000 just doesn't mean anything to people. So we've got to compare it with other risks. And I say to anybody who is thinking about this position of risk communication; there’s an entire centre that works on this, the University of Cambridge, the Winton Centre of Risk Communication, so that we can do better, we know how to do better. And I hope we'll do better in the future.

Kate: Thinking about that in terms of transparency. This is a great time to bring up what happened with the data breach in BC when we suddenly discovered that BC was collecting community-based data and wasn't disclosing it. For kind of reasons that you just mentioned, would you be able to like dive into that a little bit, too?

Heidi: Yeah, so we did have a data leak, I guess, which was published by, I believe, the Vancouver Sun showing that although journalists had been asking for quite some time for much more neighbourhood based data, as was available in places like Toronto, the CDC have been saying, you know, don't want to release that maybe we don't have it and now we found that that they did. So I think it's one example where mutating over the course of the pandemic, in terms of the data that one provides, could be very helpful. But I think there will also potentially, and this is me extrapolating, you know, some concerns about whether this might lead to stigmatization around certain communities, who might have been the racialized communities living in certain places where there was great prevalence. And so I think there are potential reasons why these approaches were taken. But on the other hand, at a point when the public is so hungry for data wants to know what's going on, it can be useful to learn throughout a pandemic and decide when you want to release more, or if you're not going to release everything, maybe figuring out when do you want to bring in outside researchers to look at some of that data, some of the models and others who are doing things independently, maybe they could be brought in. And then I would say there were also some weird facets of this. Some of the best graphics that have been created were coming out of places like the CBC, like Justin McElroy, so there was already. However, it wasn't really an explicit cooperation between BC public health officials releasing data and journalists. It was happening in practice that journalists were creating some of the most widely spread graphics. So I think what it teaches us is looking forward to the future. There are many more people that I guess public health officials could ever have imagined who want to delve into this data, that some of that transparency can be incredibly helpful. But we also, on the flip side, need to educate the public better about why there are sometimes concerns around privacy and what are some of the dangers, right? So why you might want to produce stats in the aggregate, and why you might want to go so granular? For example, an individual can be stigmatized and targeted. So I think giving people a little bit more of a sense of why does this bounce drop learning over time, and maybe thinking about how you can involve researchers and journalists in analyzing presenting that information and some ways we can think about this moving forward. 

Kate: Were there also concerns about the flip side that people wouldn't care if their communities were really low, and that would lead them to disregard rules? 

Heidi: Yes. And I think this goes back to one of the debates around here should that be regional restrictions in BC. You may remember the sort of confused moment when there were very briefly different regional restrictions. And then that was removed because in part, what might happen is Oh, people here that on the island, things are much more open. So this is very anecdotal. But I remember when that order came down, and things were going to be more restricted here in Vancouver; suddenly, many people hopped in their cars and seemed to be heading for the ride. So this is, unfortunately, something that we saw. They are in Italy as well when certain parts of the country will close but not others, that this can a create confusion because you have to remember which region you're in. So what's your regional restriction, your provincial restriction, your federal restriction, but you can also get people flowing into the place where there seem to be fewer cases. So I think this is actually something to, to bear in mind is part of the reason I think after that sort of a mini couple of weeks experiment, why it's been pretty clear that things are going to remain at the provincial level, it's so much easier to communicate around a province-wide structuring, you also prevent people I guess, regulation hopping, and thereby perhaps inadvertently spreading COVID. 

Kate: Speaking to communicating to different communities differently, does the way in which we can communicate, or we should be communicating to different age groups or demographics in a different way, both on a governmental level, but also on a personal level as an individual speaking to another individual? 

Heidi: Yeah, so I'll take the personal first. The vast majority of people over the age of 65 have already been vaccinated. Right. So I guess, in thinking about sort of vaccination question, we're thinking more about those other age groups. So one of one of the ways that we can communicate around this right is to make sure that younger people understand that getting vaccinated has maybe three things that it's doing. So one of the ways we've maybe embedded the idea of COVID is that it really is a disease that more directly affects older people. But I think we can at least communicate with younger people. Listen, you could still get along COVID, you know, it's very unlikely that some of the much, much worse outcomes will happen to you, but it's not impossible. But you know, something like on COVID is, you know, we don't know that much about it's not fantastic. So that's for yourself. The other is for your community, of course, right? Protecting people around you, who may be older, who may have co-morbidities, etc. And the third element and the way that I think the Public Health Agency of Canada been framing this as well, as, you know, this is also for lifting restrictions because they've tagged some of this to the percentage of people who have been vaccinated. So even if you're pretty on the fence about it, you're 20, you're kind of on the fence. “Do you want stuff to open up again? This is the way that you can make it happen faster.” So I think I'd lay out those three different aspects of it for younger people because I think that third one particular, we don't talk about it enough like that, that you, the one thing you can do that is going to get us closer to lifting restrictions is getting yourself vaccinated.

Kate: Where have media communications in BC excelled? You mentioned Justin McElroy, and why have we fallen short? And what should the conversation look like?

Heidi: I think one thing that we've seen in a whole host of different places, and BC is not completely excluded from that, was a bit of an obsessive focus on the outdoors, even though we actually know it to be very safe. And some of this was just through the pictures that were chosen to accompany articles, right. So in an article would talk about restrictions, number of cases, and it would almost inevitably be accompanied by a picture of people being outdoors, almost always depicting very safe behaviour, but implying that that behaviour was not safe, right. And so sort of ingrained a narrative in there that the outdoors bad and it's sort of understandable. It's very hard to photograph people indoors as a bad thing, right? You only want a photo that is current. So you're taking a photo of what people are actually doing, which is outside. So I think that that's one thing we've seen, not just NBC but elsewhere, sometimes just completely, unreflectively, right, because you got to pop a picture up. So so that's what you do. And you know, I published a co-written op-ed in the Toronto Star about why we need to change the narrative on the outdoors. And even though the picture was of outdoor people doing a good thing, I hope, you know, people realize we're saying this is very, very safe. The other thing is the risk communication aspect. I’d love to see more real sort of risk communication going on within articles talking about things like the terrible, but very, very uncommon, adverse effects coming out of the vaccines. So helping people understand that these are individual stories, they are in some cases, tragic, but let's put it into the context of how many people have had these vaccines and the tremendous safety of them compared to the number of adverse effects you know, particularly now that we've moved away from using AstraZeneca. Even just helping people contextualize that, even as the media wants to tell me the individual stories of terrible things that have happened. And I think the other thing is to emphasize the incredible efficacy of these vaccines, right? So we've had a bit of, and this is a classic thing, and media is a bit of a negativity bias to sort of focus on your bad stories of things happening. Here's the one party that got busted, and we've seen Bonnie Henry push back on that right, continually saying, most people are doing the right thing. And but I think we slipped so quickly from Wow, these vaccines are amazing. Oh, here's all the problems for us to worry about. But hopefully, we can also contextualize some of these stories with some of the issues to think about. But we're already in this good place. Here are all the things we see about how effective these vaccines are so that people don't get the sense that getting the vaccine won't improve things. I've actually got pretty tremendous data on how quickly cases going down even in BC, but that's before we even talk about places like Israel for the population that they have vaccinated, and so on. So I'd love to see some bigger context going on there about the incredible ways in which this vaccine has already changed in the course of this pandemic.

Kate: And do you think there's a tendency? Because the media kind of focuses on isolated incidences, negative news instead of focusing on positive trends. 

Heidi: Yeah, and I guess, you know, the other bit that I would say, is, we can also all be interesting and nice to contemplate is your when regulations start to change, and it will be gradual, right? We're not going to go from where we are now to zero research, and it’s going to be relatively gradual. But it wouldn't be nice to have some stories about the things that people are now able to do the joy that that will bring because that's some of the ways that Europe is messaging around getting the vaccine, right. So it's not just a sort of fear-based messaging of getting the vaccine or else it's also a get the vaccine here, the great things that have come, you know, you'll be able to hug your grandkids or will be able to, you know, get a meal together. So, I wonder if and this sort of thinking ahead, I personally would feel great joy and reading stories about nice things people are able to do, right, like seeing their grandkids for the first time or what have you like the stories from me on Twitter, say coming out of the US or elsewhere where, where people see their parents for the first time as someone who hasn't seen her parents, you know, nearly two years. So, it’s both heartbreaking to me and joyous, and it gives people hope, and hope should be a good four-letter word in this pandemic, right? Because it's been a long pandemics been hard on people. And one way to encourage people to think about getting the vaccine is also seeing life can be different, and maybe getting some stories around how we are starting to open up and what looks like some other sort of joy that will come with that, alongside all of these kinds of negativity bias pieces of information.

Kate: Thank you so much, Heidi, for coming on the show. It was so wonderful to pick your brain. I really appreciate it. 

Heidi: Hey, thanks for having me, Kate. I appreciate it as well. 

Jackie: For up-to-date information on the vaccination effort on Vancouver Island, you can visit our vaccination tracker in the COVID section at capitaldaily.ca. Thank you again for joining the podcast today. If you enjoyed it, share on your socials so that more people can find us and also rate review, subscribe and don't miss any episodes. We post new shows every Monday to Friday. My name is Jackie Lamport. This is the Capital Daily Podcast. We'll talk to you tomorrow.