Americans’ Vaccine Skepticism

Welcome back. I’ve blogged about Americans and vaccinations several times, most recently to highlight Dog Vaccine Hesitancy. If you recall, dog owners are especially likely to doubt dog vaccines if they themselves have reservations about human vaccines, though there’s also evidence of vaccine politicization.

Earlier I blogged that most Americans believe vaccinations are safe and effective, though you might get the impression from social media that the topic is up for debate. That post reviewed an assessment of the impact of bots and trolls and the content of Russian troll activity (Vaccination Tweet Meddling).

Reaching even further back, when blogging about conspiracy theories, I reviewed a study that suggested that medical conspiracy theories are widely known in the United States, endorsed by a rather broad segment of society and generally predictive of common health behaviors (Conspiracy Theories, Continued).

Celebrity anti-vaccine advocates compete with medical experts (from Conspiracy Theories, Continued).

All this is to introduce a recent survey that showed Americans have less confidence in vaccines than they did just a year or two ago. Vaccine confidence fell as belief in misinformation grew.

The Vaccine Survey
The survey was conducted by SSRS, an independent market research company, for the Annenberg Public Policy Center of the University of Pennsylvania. Over the past two-and-a-half years, the center has been tracking Americans’ knowledge, beliefs and behaviors regarding vaccination, COVID-19, flu, RSV and other consequential health issues.

Annenberg Public Policy Center’s 13 surveys; N – number of respondents. MOE – measure of error, Deff – estimated design effects, Fielded/Closed – initial and final survey dates (from cdn.annenbergpublicpolicycenter.org/wp-content/uploads/2023/10/APPC_ASAPH_Toplines_W13.pdf).

The most recent of the series of surveys was conducted 5-11 October 2023 with 1559 nationally representative respondents (1528 in English, 31 in Spanish; 1520 via website, 39 by telephone). The margin of sampling error was ± 3.4% at the 95% confidence level. Respondents’ data were statistically weighted to represent the U.S. adult population.

Survey Highlights

Examples of the growth in misinformation acceptance
* Childhood autism: The percentage of Americans who believe “increased vaccinations are why so many kids have autism these days” grew to 16% from 10% in April 2021.
* MMR-autism link: 12% incorrectly believe that vaccines given to children for diseases like measles, mumps and rubella (MMR) cause autism, up from 9% in June 2021.
* Flu shot and COVID-19: 9% incorrectly believe that getting a flu shot increases the risk of contracting COVID-19, up from 6% in January 2023.
* Vaccines and toxins: 12% incorrectly believe that “vaccines in general are full of toxins and harmful ingredients like ‘antifreeze,” up from 8% in April 2021.
* Cancer and mRNA vaccines: 12% incorrectly believe that mRNA vaccines against COVID-19 cause cancer, up from 9% in January 2023.
* COVID-19 vaccine: 21% say the vaccine is not safer than the disease, up from 10% in April 2021.
* Ivermectin and COVID-19: 26% incorrectly say ivermectin is an effective treatment for COVID-19, up from 10% in September 2021. 

Survey responses to question D49: Ivermectin is an effective treatment for COVID-19; superscript letters indicate statistically significant differences with the corresponding survey (from cdn.annenbergpublicpolicycenter.org/wp-content/uploads/2023/10/APPC_ASAPH_Toplines_W13.pdf).

Examples of reduced belief in vaccine safety, effectiveness or both since August 2022
* MMR vaccine: 81% believe the MMR vaccine is safe, 83% believe it’s effective; down respectively from 88% and 87%.
* Flu vaccine: 75% believe the flu vaccine is effective, down from 81%.
* Pneumonia vaccine: 74% believe the pneumonia vaccine is safe, 69% believe it’s effective, down respectively from 80% and 74%.
* HPV vaccine: 61% believe the human papillomavirus vaccine is effective, down from 66%.
* Covid-19 vaccine: 66% believe the Covid-19 vaccine is safe, down from 73%.

Wrap Up
Those who think approved vaccines are safe dropped to 71% from 77% in April 2021. Those who don’t think approved vaccines are safe grew to 16% from 9% over that same period.

Although the proportion of the Americans that are skeptical of vaccines is, in some cases, still small, the growth in misinformation acceptance is a warning sign. As the director of the Annenberg Public Policy Center and director of the survey noted, “Growing numbers now distrust health-protecting, life-saving vaccines.”

Thanks for stopping by.

P.S.
Article on Annenberg Public Policy Center survey: www.eurekalert.org/news-releases/1006556
SSRS methods report: cdn.annenbergpublicpolicycenter.org/wp-content/uploads/2023/10/W13-APPC-National-Survey-Wave-13_Methods-Report_Final-10302023.pdf

Dog Vaccine Hesitancy

Vaccine hesitancy:  A delay in acceptance, or refusal, of vaccines despite the availability of vaccine services and supporting evidence. The term covers refusals to vaccinate, delaying vaccines, accepting vaccines but remaining uncertain about their use, or using certain vaccines but not others. Vaccine hesitancy often results in disease outbreaks and deaths from vaccine-preventable diseases. The World Health Organization characterizes vaccine hesitancy as one of the top 10 global health threats. (from Wikipedia)

Welcome back. I’ve got another dog topic. Researchers with Boston University, Glenolden Animal Hospital, Glenolden, PA, and Colorado State University recently published a study that extends vaccine hesitancy to pet dog vaccinations.

The dangers posed by unvaccinated dogs include the possible spread of rabies and other infectious diseases and the mental and physical health risk to veterinary care providers. Notably, rabies is near-100% fatal if not treated.

Dog getting a rabies shot (from www.advancedcarevet.com/site/blog/2022/04/30/dog-rabies-vaccine).

Study Elements
The researchers partnered with YouGov to conduct a nationally representative online survey of 2,200 US adults between 30 March and 10 April 2023.

Analyzing the survey data, they first characterized the prevalence and correlates of vaccine hesitancy in the dog owner subpopulation. Large minorities of dog owners consider dog vaccines to be unsafe (37%), ineffective (22%) and/or unnecessary (30%); 53% of dog owners endorse at least one of these three positions. Those considering dog vaccines to be unsafe believe vaccinating their dog could cause autism, though there is no scientific evidence to validate that risk for animals or humans.

Outcome and explanatory variables from YouGov survey of canine vaccine hesitancy (from www.sciencedirect.com/science/article/abs/pii/S0264410X23010150?via%3Dihub).

The researchers then developed a series of statistical models that associate vaccine hesitancy to sociodemographic factors that may influence negative attitudes toward dog vaccines. These include the possibility of “vaccine spillover” from misinformation acceptance about the safety of human vaccines, political partisanship and demographic controls.

They conclude with a review of the potentially deleterious effects vaccine hesitancy may have on policies that encourage canine vaccination.

Wrap Up
Overall, the study documents dog vaccine hesitancy among US dog owners, finding that most dog owners express some doubt about dog vaccines. Dog owners are especially likely to hold these views if they have reservations about the safety of human vaccines. There is also evidence of vaccine politicization. Dog owners identifying as Democrats tend to be less likely to express vaccine hesitancy.

Given that an estimated 45% of US households own one or more dogs, vaccine hesitancy has important public health and health policy consequences. Those who express doubt tend to be more likely to oppose policies that encourage universal rabies vaccination.

Thanks for stopping by.

P.S.
Review of vaccine hesitancy on Wikipedia: en.wikipedia.org/wiki/Vaccine_hesitancy
Study of canine vaccine hesitancy in Vaccine journal: www.sciencedirect.com/science/article/abs/pii/S0264410X23010150?via%3Dihub
Article on study on EurekAlert! website: www.eurekalert.org/news-releases/1000259

COVID Cover-up

Welcome back. I hope you can tolerate a review of another COVID-19 study. There’s an interesting survey that found about 26% of parents either misled others about their children’s COVID status or did not adhere to public health measures. I’ll keep it short. 

COVID vaccination clinic, Chester, Pa., 15 Dec 2021 (AP Photo/Matt Rourke from www.witf.org/2021/12/30/top-stories-of-2021-covid-19-vaccine-offers-hope-while-misinformation-undermines-public-health).

The Online Survey
A team of researchers with Middlesex Community College; Utah, Colorado and Iowa universities; University College London; and Denver and Salt Lake City Veterans Affairs conducted a spinoff investigation of an earlier study, in which they had surveyed a large national sample of U.S. adults about COVID-19 experiences.

For the current study, they focused on a subset of the earlier study’s respondents--580 parents or guardians of children younger than 18 years old, living with them during the pandemic. Through an online survey, they asked if the 580 respondents had ever engaged in seven types of misrepresentation or nonadherence to COVID-19 recommendations for their children and reasons for their behaviors.

The average age of the respondents was 36; 70% were female; 14% were Hispanic, 67% non-Hispanic White, 15% non-Hispanic Black, 2% non-Hispanic Asian, and others less than 1%. Race and ethnicity data were collected because COVID-19 and public health measures disproportionately impacted individuals from underserved populations.

Behaving Badly
Of the 580 respondents, 150 (26%) reported misrepresentation, nonadherence or both in at least 1 of the 7 behaviors. The two most common behaviors were (1) allowing their child to break quarantine rules and (2) not mentioning that they thought or knew their child had COVID-19 to someone who was with or about to be with their child.

Frequency of parents misrepresenting and failing to adhere to COVID recommendations; a-of those who thought or knew child had COVID, b-of those whose child was not vaccinated, c-of those whose child was vaccinated, d-of those whose child was told to quarantine, e-of those who thought their child might have COVID (from Table 1, jamanetwork.com/journals/jamanetworkopen/fullarticle/2802004).

More than 50% of the respondents reported that the most common of 32 possible reasons for those two behaviors was exercising the freedom to do what they want with their child. That was also the most common reason (along with lowering the risk for school, camp, a trip or visit), for saying the child was older than he or she was to get vaccinated and saying the child was vaccinated when he or she wasn’t. Thinking it was no one else’s business was also one of the most common reasons for breaking quarantine rules.

Among other reasons for not mentioning the child’s possible COVID and breaking quarantine rules were that their child did not feel very sick; they wanted their child’s life to feel normal; they didn’t want their child to miss school or important activities; the parent didn’t want to miss an event, fun activity or work; or the parent was following guidance from a public figure, including a politician or celebrity.

Wrap Up
Given that lying about lying is a definite possibility, the researchers judge that 26% is probably the minimum number of parents who misrepresented their children’s COVID status during the pandemic.

They conclude that we need to do a better job of providing support mechanisms like paid sick leave so parents don’t feel their only option is to engage in misrepresentation or nonadherence to public health guidelines during a future infectious disease outbreak.

I expect or hope you’ll agree. Thanks for stopping by.

P.S.
Study of parental nonadherence of recommendations for prevention of COVID transmission among children in JAMA Network Open: jamanetwork.com/journals/jamanetworkopen/fullarticle/2802004
Article on study on EurekAlert! website: www.eurekalert.org/news-releases/981392

COVID-19 by State

The US spends more on health care than any other country and, in 2020, based on data collected prior to the pandemic, it was ranked best prepared of 195 nations for a pandemic. Yet the US had the highest number of recorded COVID-19 deaths and one of the highest per capita fatality rates globally.

Residents protest coronavirus stay-at-home orders in 5 states, 19Apr2020 (from abcnews.go.com/US/residents-protest-coronavirus-stay-home-orders-states/story?id=70233220).

Welcome back. Expanding on the pandemic’s overall outcome in the US, a recent study examined why the pandemic didn’t impact US states equally.

The comprehensive analysis addressed five key policy questions: (1) the role of social, racial and economic inequities; (2) whether states with greater health care and public health capacity performed better; (3) the influence of politics on the results; (4) whether states that imposed more policy mandates and sustained them longer did better; and (5) whether there were trade-offs between a state having fewer cumulative SARS-CoV-2 infections and total COVID-19 deaths and better economic and educational outcomes.

The observational and modelling study was conducted by nearly 60 researchers, most of whose primary affiliation was with either the Institute for Health Metrics and Evaluation at the University of Washington, or the Council on Foreign Relations in Washington, DC. Other affiliations included Drexel, Harvard, Pittsburgh, Toronto, Washington and Yale universities.

Study Approach
The researchers broke out data by state from public databases, 1 Jan 2020 to 31 July 2022. To facilitate comparison of states' successes in mitigating the effects of COVID-19, they standardized infection rates for population density and death rates for age and prevalence of major comorbidities.

Cumulative standardized COVID-19 infection rate per 10,000 people by state, 1Jan2020-15Dec2021 (from fig.1, www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00461-0/fulltext).

 

They statistically related these health outcomes to pre-pandemic state characteristics (e.g., educational attainment, health spending per capita), policies adopted by states during the pandemic (e.g., mask mandates, business closures), and population-level behavioral responses (e.g., vaccine coverage).

Going further, they explored potential mechanisms connecting state-level factors to individual-level behaviors. This included quantifying reductions in state GDP, employment, and student test scores to identify associated policy and behavioral responses and assess trade-offs with COVID-19 outcomes.

Selected Findings
Standardized cumulative COVID-19 death rates over the study period varied across the US (national rate 372 deaths per 100,000 population). The lowest rates were in Hawaii (147 deaths per 100,000) and New Hampshire (215 per 100,000), the highest in Arizona (581 per 100,000) and Washington, DC (526 per 100,000). 

Cumulative standardized COVID-19 death rate per 100,000 people by state, 1Jan2020-31July2022 (from fig.1, www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00461-0/fulltext).

A lower poverty rate and more years of education were associated with lower SARS-CoV-2 infection and Covid-19 death rates; states with larger percentages of non-Hispanic Black or Hispanic were associated with higher cumulative death rates.

Access to quality health care was associated with fewer deaths and infections, but higher public health spending and more public health personnel per capita were not.

Partisan politics played a nuanced role in state-level outcomes. The state governor’s political affiliation was not associated with infection or death rates, but worse outcomes were associated with the proportion of a state's voters who voted for the 2020 Republican presidential candidate.

State governments' uses of protective mandates were associated with lower infection rates but not death rates, which were impacted by many other factors. Mask use and higher vaccination rates were associated with lower infection and death rates.

State GDP and student reading test scores were not associated with state COVID-19 policy responses, infection rates or death rates.

Employment had a statistically significant relationship with restaurant closures and greater infections and deaths. On average, states with a 1% increase in employment rate were associated with 1,574 additional infections per 10,000 population.

Several policy mandates and protective behaviors were associated with lower fourth-grade math test scores, but the study did not find a link to state-level estimates of school closures.

Wrap Up
While I’ve tried to capture study highlights, there’s much more in the report.

The researchers make clear that COVID-19 magnified the polarized, persistent inequities that exist across US society. States that mitigated those inequalities, deployed science-based interventions, and promoted their adoption across society were able to minimize COVID-19 death rates. Overall, these findings could contribute to the design and targeting of clinical and policy interventions to facilitate better health outcomes in future crises.

Thanks for stopping by.

P.S.
Study of COVID-19 policies and behaviors across US states in The Lancet journal: www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00461-0/fulltext
Article on study on EurekAlert! website: www.eurekalert.org/news-releases/983582

What’s With Anti-Science?

Welcome back. When I was very young, the only concern about getting a vaccination was whether the needle would hurt. Maybe it was only my community or city or the limited media coverage. Maybe there was vaccination pushback we didn’t hear about. Anti-science is not some new creation; it’s just gotten out of hand. 

Scenes from anti-lockdown protests across the U.S. (photo-iIllustration by Eddie Guy from nymag.com/intelligencer/2020/07/republican-response-coronavirus.html).

An interesting discussion of anti-science was recently published by psychology researchers affiliated with Ohio State and Toronto universities at the time of their review.

Foundations of Anti-Science Beliefs
The researchers reference classic work on persuasion as applying to the rise in people rejecting subjects such as vaccines and climate change.

They describe anti-science beliefs as being built on four foundations or bases:
- Thinking scientific sources lack credibility
- Identifying with groups that have anti-science attitudes
- A scientific message that contradicts a person’s current beliefs
- A mismatch between how a message is presented and a person’s style of thinking.

Each of the four bases reveals what happens when scientific information conflicts with what people already think or their style of thought; each makes it easier to just reject the information.

COVID-19 vaccine protestors (photo by John Lamparski, AP, from www.theatlantic.com/ideas/archive/2021/08/vaccine-refusers-hesitancy-mandates-fda-delta/619918/).

Why Has Anti-Science Increased?
The researchers attribute the increase in anti-science attitudes to developments that made it easier to persuade people against scientific consensus.

Social media and a variety of news sources now offer people their own version of the facts.

A related development is the influence of political ideology. Although people always had political views, politics didn’t permeate everything including science and scientific beliefs. Political ideology is now a core part of people’s identity, affecting how they react to politicized scientific evidence such as climate change. Scientific information may be rejected rather than allowed to overturn pre-existing political beliefs.

Climate change has gained acceptance, but Sen. James Inhofe was on the Senate floor, 26 February 2015, using a snowball as evidence that global warming was a hoax (from C-SPAN photo).

Politics can affect all four bases of anti-science attitudes. Regarding credibility, for example, research shows that people see those with similar political views as more expert and knowledgeable. Liberals and conservatives thus find different news sources more credible, exposing themselves to different sources of scientific information and misinformation.

What Can Be Done?
The researchers write that research on attitudes and persuasion shows how to address at least some drivers of anti-science attitudes.

One way they note is to convey messages that show an understanding of other viewpoints. Acknowledge there are valid concerns but explain why the scientific position is preferred. An example they give concerning COVID-19 is to concede that wearing masks can be uncomfortable but explain the discomfort is worth it to prevent the spread of disease.

Another way is to find common ground with those who reject science even if what you have in common has nothing to do with science. Avoid making people feel they’re being attacked or that you’re so different from them as to lack credibility.

In essence, presenting a simple, accurate message may not be enough; it’s how you communicate that message. Psychological research can help scientists learn to present their work to different audiences, including those that might be skeptical.

Wrap Up
The researchers conclude that there’s an opportunity to counteract the anti-science attitudes and sentiment. There are evidence-based strategies to increase public acceptance of science.

I would add the importance of conveying that science is not always correct. In fact, it builds on being wrong, on challenging ideas and changing if new facts emerge toward greater understanding and improved solutions. Thanks for stopping by.

P.S.
Anti-science background: en.wikipedia.org/wiki/Antiscience
Study of anti-science in Proceedings of the National Academy of Sciences: www.pnas.org/doi/full/10.1073/pnas.2120755119
Article on study on EurekAlert! website: www.eurekalert.org/news-releases/958093

Journalists and Science Cons

Welcome back. Being an impatient news junkie, I’m always bothered by journalists giving both sides of an issue when one side is utter nonsense or lies. Oh, this isn’t about Trump, though it could be; this is about reporting on science--climate change, vaccinations, evolution, etc.

Robert F. Kennedy Jr. has become a major figure in the anti-vaccine movement. I remember his father well, but is it really necessary to cover Bobby’s son? (photo from CNN video, www.cnn.com/2022/01/24/politics/robert-kennedy-jr-anti-vaccine-nazis-what-matters/index.html).

In my corner are two philosophy professors, one affiliated with Illinois Institute of Technology, the other with Florida State University. They agree that journalists need not cover both sides when one side is advancing a con.

In fact, they’ve published a paper that compares and contrasts a financial con, which aims to separate people from their money, with an epistemic con, which aims to recruit people to spread doubt and falsehood about well-established claims. (Epistemology is the study of knowledge.)

Epistemic Cons
An epistemic con starts when facts emerge that threaten a powerful group (say, tobacco companies or Big Oil). They disseminate plausible but dishonest arguments to persuade you to doubt or reject the facts. The epistemic con artist really succeeds if you try to convince others, even if it’s just doubt.

What #ExxonKnew vs what #ExxonDid, graphic by John Cook, SkepticalScience.com (from www.theguardian.com/environment/climate-consensus-97-per-cent/2018/mar/23/in-court-big-oil-rejected-climate-denial).

So, don’t open your wallet to financial cons and don’t open your mind to epistemic cons. Alas, the only way to avoid falling for an epistemic con is to never trust anyone, which is no way to live. That’s why the first rule of avoiding the con is to admit you’re vulnerable. Trust sources with more reliable track records, don’t trust sources with less reliable track records.

“Settled science,” confirmed by an array of scientific subdisciplines, deserves your trust. Evolution for example, can be confirmed by the fossil record, biogeography, stratigraphy, genetics, anatomy and more.

Cons Against Settled Science
Con artists try to wow us with magic bullet arguments, most of which are dishonest, deeply confused or both. Those arguments generally follow the same themes, such as Obvious Counterexamples, e.g., global warming implies we won’t have cold snowy days in winter; Cherry Picking, e.g., 50 years ago, scientists said the Earth was cooling; or Biased Scientists, e.g., scientists believe evolution because they’re atheists.

Magic bullet arguments aren’t always easy to debunk. Yet even when they make a good point, there is no single piece of evidence on which settled science rests that can be unraveled by a magic bullet.

How do con artists open your mind to these arguments? They appeal to your epistemic virtue: You’re fair. You’re open-minded. You’re smart. Think for yourself. 

Epistemic Virtue: Have the courage to use your own understanding, by German philosopher, Immanuel Kant, born Emanuel Kant, 22 April 1724 – 12 February 1804 (from en.wikiquote.org/wiki/Epistemic_virtue#/media/File:Kant5.jpg).

Unfortunately, there’s a difference between epistemic virtue and epistemic vanity. Con artists rely on our inability to tell the difference. They rely on our overconfidence.

You think the game is figuring out the truth. The real game is to see how long the con artist can string you along. While you’re debunking one magic bullet argument, you’re being fed more.

Can You Avoid Being Conned?
Your best bet to avoid being conned on settled science is close-minded deference, which allows no room for doubt unless doubt arises within science itself.

If you’re going to consider magic bullet arguments, do so with a closed mind. Treat them as interesting puzzles or as material for exploring bad reasoning.

We fall for epistemic cons for the same reason we fall for financial cons: We trust the wrong people. More, it’s that overconfidence in our ability to figure out the truth.

Wrap Up
Even if journalists close their minds to the con, they may report facts in a way that opens their audience’s minds to the con. Reporting or not reporting fake controversies both seem to play into the con artist’s hand.

Those authors in my corner find only one technique for helping readers avoid confidence games: Tell the story of the epistemic con, how it works. Most people accept the story, at least applied to others.

The challenge comes if journalists apply the story to their readers. Expect loud and angry blowback. The villain of the story is our harsh judgments of those who’ve fallen for the con; our offended dismissals of anyone who suggests that we’ve been conned.

But the story of the epistemic con gives us the opportunity to recognize what our role in the story has been and to choose our role going forward.

Thanks for stopping by.

P.S.
Study of epistemic cons in science reporting in Frontiers in Communication journal: www.frontiersin.org/articles/10.3389/fcomm.2021.545429/full
Articles on study on Illinois Tech news and EurekAlert! website:
www.iit.edu/news/alternative-facts-are-cons-philosophers-paper-argues-and-journalists-can-help-quash-them
www.eurekalert.org/news-releases/956020

Coronavirus Variants

Welcome back. Do you remember the old days, when COVID-19 wasn’t a threat? Oh, wait, that was only a few months ago.

With vaccine hesitancy, vaccine politicization, the my-freedom-trumps-public-health crowd and loads of misinformation, it’s difficult to keep the coronavirus controlled, especially when new variants keep popping up and spreading among the unvaccinated, unmasked and un-socially distanced.

Vaccination protesters (photo by John Lamparski-NurPhoto-AP from www.theatlantic.com/ideas/archive/2021/08/vaccine-refusers-hesitancy-mandates-fda-delta/619918/).

You’re familiar with all that, of course, but to keep terms straight, COVID-19, the coronavirus disease 2019, is caused by SARS-CoV-2, the severe acute respiratory syndrome coronavirus 2, which is part of a large family of coronaviruses. Multiple variants of SARS-CoV-2 have been documented. Variants arise because viruses constantly change through mutation.

OK, now that you’ve got all that, there’s a recent article I found of interest and thought you might too. The American Chemical Society, a nonprofit organization chartered by the U.S. Congress, has a weekly newsmagazine, Chemical & Engineering News (C&EN). C&EN interviewed scientists on how coronavirus variants are studied and judgements made as to how well they can be managed with existing vaccines. I’ll review highlights from the article.

Lab Testing
Researchers test new variants by comparing them with the current variants. The tests typically mix the virus with antibodies from the plasma of people who either recovered from COVID-19 or are fully vaccinated. (Plasma is the major liquid component of blood, consisting of water and dissolved constituents, including proteins. Antibodies are proteins that our immune system produces to fight the infection after infection or vaccination.)

Testing the ability of antibodies to block SARS-CoV-2 in Duke University’s Regional Biocontainment Lab (photo by Thomas Oguin III from cen.acs.org/biological-chemistry/infectious-disease/How-to-interpret-new-studies-coronavirus-variants/99/i32).

The primary test questions are (1) will the antibodies prevent the new variants from infecting our cells, and (2) how readily the new variants spread compared with their predecessors?

Although what happens in the lab isn’t necessarily what will happen in our bodies, the testing provides rapid, effective assessments of the variants.

Variant Infectiousness
Mutations can give new variants a tighter grip on our cells, such that a smaller amount of virus can start an infection. Other mutations may help the virus reproduce more quickly or in greater quantities, increasing the chance that an infected person will spread the virus.

A more infectious virus may not make people sicker, but it will infect more people, making outbreaks harder to control. A case in point is the Delta variant, which spreads more easily than the Beta variant, even though the Beta variant is better at evading our neutralizing antibodies.

Epidemiologists and modelers use population-level data to estimate how many people each infected person will infect. The original coronavirus was calculated to spread to 2 or 3 unvaccinated people who made no change in their behavior to prevent transmission. The Delta variant is calculated to spread to 6 or 7.

Reviewing Research on New Variants
I rarely blog about studies that haven’t been peer reviewed, and I sympathize with those keeping abreast of coronavirus research. The flow of new information is a deluge. Apparently, much of that information is shared on preprint servers before peer review. And apparently claims about new variants--claims that might reach the public--don’t always match the data.

The interviewed scientists approach these studies with care, ignoring claims and focusing on the testing, source of antibodies, how data on vaccine efficacy were collected, how mild or severe disease are defined, and if multiple variants were compared head-to-head or from different labs, where anything might differ.

Wrap Up
When fully vaccinated individuals become infected (“breakthrough infections”), those who are unvaccinated may wonder why get vaccinated. Why? Because the principal goal of vaccines is to prevent severe disease and death. Thus far, the vaccines have done well with less than 5% of fully vaccinated people hospitalized. As more infectious variants evolve, infections might increase.

Summary percentages of data on COVID breakthrough hospitalizations and deaths, New York Times, August 2021 (www.nytimes.com/interactive/2021/08/10/us/covid-breakthrough-infections-vaccines.html).

For healthy, fully vaccinated people, a mild infection with a variant could boost immunity. For immunocompromised people and older adults who normally don’t produce a lot of antibodies, booster shots could be important for improved protection.

But with so many people worldwide lacking a first shot and being potential sources of new variants, we have to question whether boosters should be distributed broadly before addressing the unvaccinated. Thanks for stopping by.

P.S.
Center for Countering Digital Hate report on vaccine disinformation: www.counterhate.com/disinformationdozen
SARS-CoV-2 variants: www.cdc.gov/coronavirus/2019-ncov/variants/variant-info.html
Article on understanding coronavirus variants in C&EN: cen.acs.org/biological-chemistry/infectious-disease/How-to-interpret-new-studies-coronavirus-variants/99/i32
Summary of C&EN article on EurekAlert! website: www.eurekalert.org/news-releases/927837
Earlier C&EN article on SARS-CoV-2 variants: cen.acs.org/sections/new-covid-19-variants-vaccines-effective.html

Vaccine Lotteries

Welcome back. Do you live in a state that’s running a lottery to give COVID-19 vaccinations a shot in the arm? Is your state one of those offering a million-dollar jackpot?

Having faith in statistics, I normally ignore state lotteries. But every vaccine lottery will have a winner, and the million-dollar prize won’t entice all anti-vaxxers, COVID-19 unbelievers, those fearing side effects or needles or distrusting the vaccines or government or lacking access or believing any of many conspiracy theories or who knows what else. As such, these lotteries will have a smaller pool of “players” and much better odds--except in states where eligibility extends to those already vaccinated.

Statistics and cash incentives aside, I think million-dollar jackpots are -- how shall I put it? -- absolutely nuts! Although they’ll surely attract more attention than Indiana’s box of Girl Scout cookies for getting a shot, there must be better ways to use that kind of money to promote vaccinations.

A recent study by researchers with the Boston University School of Medicine showed it's more than my opinion.

Announcement of Ohio’s Vax-a-Million lottery (fox8.com/news/coronavirus/ohio-vaccine-lottery/ohio-vaccine-lottery-who-is-eligible-for-the-weekly-1-million-scholarship-prizes-and-what-do-they-need-to-do/).

Ohio Vaccine Lottery
Ohio was the first state to announce a cash lottery. Its "Vax-a-Million" lottery initially seemed to produce the needed incentive, and several other states followed suit with their own million-dollar jackpots--alphabetically, California, Colorado, Kentucky, Louisiana, Maryland, Massachusetts, Nevada, New Mexico, North Carolina, Oregon, Washington and West Virginia.

Unfortunately for those states and vaccination incentives, the Boston University researchers dug a bit. They analyzed trends in CDC data on vaccination rates, comparing Ohio against states that did not yet have vaccine incentive lottery programs. They focused on vaccination rates both before and after the Ohio lottery. The vaccination rates in other states thus provided a reference or control for trends in Ohio, allowing the researchers to account for factors besides the Ohio lottery.

They found that the initial evaluations of the Ohio lottery had failed to account for other changes in the U.S. vaccination rate. Most notable was the expansion of vaccinations to those ages 12 to 15.

Wrap Up
The study findings suggest that vaccine lotteries, even those with million-dollar jackpots, are of limited value for increasing vaccine uptake.

Pointing to the critical importance of increasing COVID-19 vaccination rates, the researchers emphasize that strategies to increase vaccine uptake must be rigorously evaluated. Those judged successful should be rapidly employed.

No doubt you’ve been vaccinated, but best of luck if your state has a lottery and you're still eligible. And thanks for stopping by.

P.S.
Study of vaccine lotteries in Journal of the American Medical Association: jamanetwork.com/journals/jama/article-abstract/2781792
Article on study on EurekAlert! website: www.eurekalert.org/pub_releases/2021-07/buso-lid070221.php
Forbes article on groups still refusing COVID-19 vaccine: www.forbes.com/sites/alisondurkee/2021/06/11/here-are-the-biggest-groups-that-are-still-refusing-the-covid-19-vaccine-poll-finds/?sh=28a0066d42cc
The New York Times article on state vaccine lotteries: www.nytimes.com/2021/07/03/world/covid-vaccine-lottery.html

Why Get Vaccinated for Measles?

Welcome back. I think I had measles; I must have. Just about every kid got measles before a vaccine became available in 1963. 

Getting vaccinated (from
www.allencountyhealth.com/).

The U.S. Centers for Disease Control and Prevention (CDC) reports that before the measles vaccination program began an estimated 3 to 4 million people were infected annually in the U.S. Widespread vaccinations have reduced measles cases by 99%.

Measles Can Be Serious
Measles is one of the most contagious infectious diseases. Transmitted by direct contact with droplets from the nose, mouth or throat of infected persons or by airborne spread when an infected person breathes or coughs, the virus can remain in the air or on contaminated surfaces as long as 2 hours. Up to 90% of the people in contact with an infected person will catch the disease if they’re not protected.

In addition to a fever and rash, complications can be severe, especially for those younger than 5 years and older than 20 years. Ear infections and diarrhea are common, and serious complications include pneumonia and encephalitis (brain swelling). In the U.S., about 1 in 5 unvaccinated people who get measles are hospitalized.

Of measles-infected children in the U.S., as many as 1 out of 20 develops pneumonia; about 1 out of 1,000 will develop encephalitis that can lead to convulsions and leave the child deaf or brain damaged; and nearly 1 to 3 out of 1,000 will die from respiratory and neurologic complications.

In developing countries, measles is even more serious, particularly for malnourished children with vitamin A deficiency. The rate of death may be as high as 25%. In Africa, the disease is a leading cause of blindness in children.

Effectiveness of measles, mumps,
 rubella vaccine (from ABC News).

Added Benefits of Measles Vaccine
Getting vaccinated almost ensures you’ll avoid several days of being ill, possible complications up to and including death and that you won’t spread the disease. If that’s not enough, there’s more, as shown in a recent study by researchers from the Center for Disease Dynamics, Economics & Policy; Johns Hopkins, Pennsylvania and Harvard universities; and RTI International.

The researchers compared long-term survey data on children, ages 7-8 years and 11-12 years, who had or had not been vaccinated at age 6-18 months.

The data were collected on approximately 2,000 children in each of three countries, Ethiopia, India and Vietnam. The specific measurements analyzed were height-for-age, body mass index (BMI)-for-age, weight-for-age, Peabody Picture Vocabulary Test (PPVT), Early Grade Reading Assessment (EGRA), language and math tests, and attained school grade.

Overall, the study found that being vaccinated in infancy was associated with long-term health, cognition and schooling benefits in each country.

At ages 7-8 years, for example, measles-vaccinated children had higher height-for-age scores in India, higher BMI-for-age and weight-for-age scores in Vietnam, higher PPVT and math scores in Ethiopia and Vietnam, and higher EGRA scores and school grades in all countries.

Similarly, at ages 11-12 years, measles-vaccinated children had higher BMI-for-age scores in Vietnam, higher English and PPVT scores in India, and higher school grades in all countries.

Wrap Up
All this sort of makes me angry at celebrities and politicians that slam vaccines. More so when an online survey by The Harris Poll for the American Osteopathic Association finds that 45% of the 2,007 U.S. adults surveyed have doubts about vaccine safety. Not all of that doubt can be attributed to the anti-vaccination movement, of course, but I expect much of it can if you dig a bit. (I touched on anti-vaxxers in my blog post Conspiracy Theories, Continued).

Responses of 2,007 U.S. adults in online survey conducted 28-30 May 2019 by The Harris Poll on behalf of the American Osteopathic Association (from www.eurekalert.org/multimedia/pub/204458.php).

On the flip side, the survey also found 82% of those surveyed think vaccines are safe and effective or that the benefits outweigh the risks. While that seems pretty good, measles requires 90% to 95% of the population to be vaccinated to achieve herd immunity--protection for individuals who cannot be vaccinated.

I’d better leave it there before I get angrier. Thanks for stopping by.

P.S.
Selected CDC articles on measles:
www.cdc.gov/measles/about/history.html
www.cdc.gov/measles/vaccination.html
www.cdc.gov/measles/symptoms/complications.html
World Health Organization fact sheet on measles: www.who.int/news-room/fact-sheets/detail/measles
Study of measles vaccination benefits in the journal Vaccine: www.sciencedirect.com/science/article/pii/S0264410X19307868
Article on study on EurekAlert! website: www.eurekalert.org/pub_releases/2019-06/cfdd-mvl062019.php
Article on Harris Poll survey on EurekAlert! website: www.eurekalert.org/pub_releases/2019-06/aoa-4oa062419.php

Wasp and Honeybee Stingers

Stinging wasp (from
www.healthline.com/health/wasp-sting#symptoms).

Welcome back. Having recently rolled up my sleeve for a flu shot, I was particularly interested in an investigation of wasp and honeybee stingers. It’s not that the shot stung--I hardly felt it; it was the nature of the study:

Conduct a biomechanical evaluation of stingers for insight to design a painless and mechanically durable micro syringe-needle system for biomedical applications. How cool is that?

And because I’d been on the receiving end of a wasp’s stinger a dozen or more times over the years, I was also intrigued by the detailed figures and assessment of how they (the wasps) had accomplished that task. I thought you might be, too.

Stinger Investigation
Researchers from the Indian Institute of Technology and Ohio State University analyzed wasp (Vespula vulgaris) and honeybee (Apis cerana) stingers using:

- 3D micro-computed tomography to assess stinger structure. Micro-computed tomography, like CAT scans, uses x-rays to image cross-sections of an object to produce a virtual model of the object non-destructively.

- Nanoindentation to determine their mechanical properties. Nanoindentation enables the measurement of properties, such as elastic modulus and hardness, at submicroscopic scales. The elastic modulus is the resistance to being deformed elastically when a stress is applied; hardness is the resistance to plastic deformation.

- Numerical modeling to assess the mechanical behavior during stinger penetration.

Stinger Structure
The researchers obtained the 3D-structures, geometry with approximate dimensions, and functioning mechanism of both wasp and honeybee stingers.

(a) Structure of wasp stinger and cross sections at (b) base, (c) medial region, (d) apical region and (e) near tip (from
www.nature.com/articles/s41598-018-33386-y).

Both insects’ stingers can be sectioned in length into three regions--basal, medial and apical; both are composed of paired lancets that slide back and forth for penetration, one stylet and a tip. The lancets and stylet have hollow shafts to deliver venom through the orifice, and their diameter decreases from base to tip. That gradient geometry improves mechanical stability and durability.

The wasp stinger is on the order of 2.67 millimeters (about 0.1 inch) long; the honeybee stinger is shorter, on the order of 1.62 mm (about 0.06 in).

The wasp stinger has curvature and a reinforcement rib at its medial region; the honeybee stinger has neither. The reinforcement rib improves buckling resistance during penetration.

The honeybee stinger has reverse-facing barbs that make an angle of 9 degrees with the stinger shaft, facilitating penetration. The barbs stick into the victim’s skin after insertion.

Stinger Mechanical Properties
Nanoindentation measurements along the stingers’ dorsal surface found the elastic modulus and hardness of wasp and honeybee stingers have negative gradients from base to tip, with no distinguishable gradient in the transverse direction.

Elastic modulus and hardness along length of honeybee stinger (from www.nature.com/articles/s41598-018-33386-y).

Stinger Mechanical Behavior
The numerical modeling, based on the tomographic images and nanoindentation measurements, show the stress and strain distribution of wasp and honeybee stingers for penetration are optimum at angles of about +10° and -6°, respectively. The insects would adopt these angles to sting.

Bioinspired Micro Syringe-Needle
The researchers drew upon the gradient geometry and mechanical properties, as well as the insertion angle and sliding mechanism of paired lancets with the venom pumping mechanism to design a micro syringe-needle device.

(a) Proposed design of micro syringe needle system, (b) Enlarged view of internal structure (tip removed), (c) Sliding motion of lancets to generate an outlet near tip in enlarged view (from www.nature.com/articles/s41598-018-33386-y).

The micro needle should have a decreasing diameter from base to the tip and be made of materials that have gradient mechanical properties, minimum at the tip (i.e., softest) and maximum at the base.

A geometry similar to that of the stingers (primarily the wasp stinger’s curvature at the medial region) will give minimum stress if inserted in a specific angle and should improve the mechanical durability and performance.

Wrap Up
The study demonstrated that insights gained through detailed analysis of the structural features, gradient geometry, mechanical properties and mechanical performance of wasp and honeybee stingers can be used to design a micro syringe-needle or other bioinspired devices. I repeat, how cool is that?

Thanks for stopping by. I hope it was of interest to you.

P.S.
Study of wasp and honeybee stingers in Scientific Reports journal: www.nature.com/articles/s41598-018-33386-y
Article on study on ScienceDaily website: www.sciencedaily.com/releases/2018/10/181009102420.htm

A version of this blog post appeared earlier on www.warrensnotice.com.

Vaccination Tweet Meddling

Welcome back. Every now and then, there’s an interesting study I’d like to review for this blog, but because mainstream media has covered the study extensively, I set it aside. On rare occasion, I revisit that decision and risk having you set the blog aside…like today.

Most Americans believe vaccinations are safe and effective, though you might get the impression from social media that the topic is up for debate. Collaborating researchers from George Washington, Maryland and Johns Hopkins universities studied the Twitter discourse about vaccinations with two aims: (1) assess the impact of bots and trolls and (2) analyze the content of Russian troll activity.

Twitter bot tweets Twitter
user (multiple websites).

To be sure we’re together, I’ll note that an internet bot (from “robot”) is a software application that performs automated tasks. A Twitter bot may autonomously tweet, re-tweet or direct message other Twitter accounts, promoting content.  

A disguised internet troll uses
Twitter (from www.genbeta.com).

Internet trolls are people who misrepresent their identities with the intention of promoting discord with offensive, divisive or controversial comments.

Testing Bot and Troll Vaccine-Related Tweets
The researchers reviewed nearly 1,800,000 tweets sent between July 2014 and September 2017 to quantify the effect of known and suspected Twitter bots and trolls.

To test if Twitter bots and trolls tweet about vaccines more frequently than do average Twitter users and if those tweets are more likely to be pro-vaccine, anti-vaccine or neutral, the researchers compared tweets sampled from known bot and troll accounts against tweets selected randomly.

Going further with the comparisons, they applied a machine-learning classifier (Botometer) to a random subset of vaccine-related tweets, scoring the likelihood that the tweet’s author was a bot from 0% to 100%.

In the course of their analysis, the researchers encountered vaccine-related tweets from accounts that NBC News had identified as Russian troll accounts. They examined 253 of those tweets to capture the major themes.

Impact of Bots and Trolls
The researchers collected 899 vaccine-related tweets to represent the activity of known bots and trolls and 9,895 vaccine-related tweets to represent the activity of assorted Twitter users. Scoring the latter found 5% were likely authored by humans, 3% by bots and 76% were of uncertain provenance; for various reasons, 16% could not be scored (e.g., accounts deleted).

The known bots and trolls were more likely to tweet about vaccination than did average Twitter users, but overall, the messages were no more polarized. In contrast, the accounts scored as being of uncertain provenance and those that could not be scored posted tweets that were significantly more polarized and anti-vaccine. (Similarly, content polluters--malicious accounts identified as promoting commercial content and malware--posted significantly more anti-vaccine content.)

The Russian troll tweets exhibited the same strategy as the social-media influence campaign waged during the U.S. election--promote discord by playing both sides. Of the 253 tweets, 43% were pro-vaccine, 38% anti-vaccine and 19% neutral, with messages and conspiracy theories often tied to U.S. politics and government (e.g., At first our government creates diseases then it creates vaccines…).

Example vaccine-related tweets from Russian troll account identified by NBC News (from ajph.aphapublications.org/doi/10.2105/AJPH.2018.304567).

Wrap Up
Whether their tweets are pro- or anti-vaccine, Twitter bots and trolls have a significant presence in online communication about vaccinations. Unfortunately, the vaccine-related tweets may be from malicious actors with a range of hidden agendas. The Russian troll messages, for example, were clearly designed to sow society discord and erode public trust in vaccinations.

I hope you agree it was worth my reviewing this well-reported study. Thanks for stopping by.

P.S.
Study of Twitter bot and troll effect on vaccine discourse in American Journal of Public Health: ajph.aphapublications.org/doi/10.2105/AJPH.2018.304567
Example articles on study:
www.sciencedaily.com/releases/2018/08/180823171035.htm
www.cnn.com/2018/08/23/health/russia-trolls-vaccine-debate-study/index.html
www.washingtonpost.com/science/2018/08/23/russian-trolls-twitter-bots-exploit-vaccine-controversy/
www.theguardian.com/society/2018/aug/23/russian-trolls-spread-vaccine-misinformation-on-twitter
Bots and Trolls:
www.techopedia.com/definition/24063/internet-bot
en.wikipedia.org/wiki/Twitter_bot
www.techopedia.com/definition/429/troll

A version of this blog post appeared earlier on www.warrensnotice.com.

Conspiracy Theories, Continued

I hope you read last Friday’s blog post, Conspiracy Theories, because today’s post jumps right in with one more area of research on the topic: medical conspiracy theories.

Belief in Medical Conspiracy Theories

Researchers from the University of Chicago organized a national online survey in 2013, which collected data from 1351 adults on their (i) awareness of six specific medical conspiracy theories, (ii) level of agreement with each theory and (iii) health behaviors.

Celebrity anti-vaccine advocates
compete with medical experts.
(multiple websites)

Stated loosely and with the percentage of respondents who were aware of each, the conspiracy theories listed were: doctors and government know vaccines cause autism and other disorders (69%); the FDA is suppressing natural cures because of drug companies (63%); health officials know cellphones cause cancer but corporations stop any action (57%); the CIA infected African Americans with HIV (32%); water fluoridation is a secret way for industry to dump phosphate mine byproducts (25%); and global dissemination of genetically modified foods is a secret program to shrink population (19%).

The survey found that the respondents’ agreement with the theories ranged from 12% to 37%, varying with the specific theory; disagreement with the theories ranged from 32% to 51%; and neutrality on the theories (neither agreeing nor disagreeing) ranged from 31% to 46%. 

Nutritionist’s book on belief that,
because of drug companies, the
Food and Drug Administration
suppressed clinical studies on
the essential role of vitamins
and minerals in preventing
diseases. (www.amazon.com)

For example, 37% of the respondents agreed that the FDA was suppressing natural cures, while 20% of the respondents agreed with the conspiracy theories about cellphones and vaccines. 

Overall, 49% of the respondents agreed with at least 1 medical conspiracy theory and 18% of the respondents agreed with 3 or more.

Relationship with Health Behaviors

The researchers then related the respondents’ health behaviors to whether the respondents agreed with either 3 or more conspiracy theories, 1 or 2, or none.

Health behaviors considered included: an annual physical, visiting the dentist, a flu shot, taking vitamins, taking herbal supplements, buying local/farm stand food, prioritizing organic food and using sunscreen.

The results suggested that endorsement of conspiracy theories correlates with use of alternative medicine. Differences between numbers of respondents who agreed with 3 or more theories and those who agreed with none were greatest for buying local/farm stand food, taking herbal supplements, getting a flu shot and an annual physical and visiting the dentist.

As examples, 37% or those who agreed with 3 or more theories bought local or farm stand food, compared to only 14% of those who agreed with none. The corresponding difference for taking herbal supplements was 35% vs. 13%, getting a flu shot, 39% vs. 25%, getting an annual physical 37% vs. 48% and visiting the dentist, 33% vs. 44%.

The tallies for all but one health behavior had the number of respondents who agreed with 1 or 2 theories falling between the numbers of respondents who agreed with none and those who agreed with 3 or more. Taking vitamins was the only exception.

Wrap Up

So what have we learned? The studies reviewed in last Friday’s blog post suggested that acceptance of conspiracy theories was tied to the need for control over one’s life. But it’s clear that the best predictor of belief in one conspiracy is belief in another.

Although adherents of conspiracy theories are commonly thought to be on society’s fringe, the study reviewed here suggests that at least medical conspiracy theories are widely known in the United States, endorsed by a rather broad segment of society and generally predictive of common health behaviors.

P.S.

Research letter on medical conspiracy theories in JAMA Internal Medicine: archinte.jamanetwork.com/article.aspx?articleid=1835348