School of Public Policy

Transcription

• COVID-19: Vaccine Passports & Hesitancy (with Richard Carpiano)

  Introduction: Welcome to Policy Chats, the official podcast of the School of Public Policy at the University of California, Riverside. I’m your host, Maddie Bunting. Join me and my classmates as we learn about potential policy solutions for today’s biggest societal challenges.

   

  Joining us today is UCR Professor of Public Policy and Sociology, Rich Carpiano. My fellow classmate, Andrea Rayas, and I chatted with Dr. Carpiano about vaccine hesitancy and the possibility of vaccine passports. 

   

  Maddie Bunting: Dr. Carpiano, you are a professor of public policy and sociology at the University of California, Riverside. You are a public and population health scientist and medical sociologist, currently researching social behavioral attitudinal and policy factors underlying vaccination, uptake and coverage, as well as refusal or delay in the US, Canada, and Denmark. Thank you for joining us on the podcasts yet again, I cannot believe it has been over a year since the last time we spoke about the pandemic. So again, thank you for taking the time. 

   

  Richard Carpiano: Well, thank you so much for having me. It's great to be here. Great to be back. 

   

  Maddie Bunting: I'd love to just get the ball rolling. There's been a lot of the news that has been taken up by vaccines. And more and more people are eligible. You know, I believe this week every US adult is not eligible to get the vaccine. In your expertise and vaccine refusal, what is your message to any of our listeners who may feel hesitant about receiving the vaccine? 

   

  Richard Carpiano: Well, that's a very complex issue. And there are, I think before I get into specifics about that, I think it's very important to define the terms in a sense. And the first thing that I think we all need to be aware of is that hesitancy is a very complex phenomenon and it affects people in many ways, people are hesitant for all sorts, for many different reasons. And we can think about it as existing on a spectrum. So it's understandable why certain people might have some sorts of hesitancy towards vaccines. And just maybe some questions based on things that they see online. Just some concerns about the fact that they think that the vaccine may be developed too quickly. It was called Operation Warp Speed that produced it certainly created some concerns even among people who are generally pretty pro vaccine about lots of things too. But I do want us to, I think sometimes there's this broad brush or a term that gets painted across the entire vaccine hesitancy population where those individuals are being labeled as being anti-vaxxers. And I don't think that's an appropriate term. When we use that word, we're usually referring to people who are on a very extreme end of the spectrum. People for whom vaccines are very much part of their core beliefs and a core identity. And often get into very political types of activities around vaccines and vaccine legislation. And might even engage in activities like perpetrating, are producing disinformation online and creating falsehood and myths and being involved in different types of misinformed efforts to misinform the public and in those sorts of issues. Now that's a very small, still very heterogeneous, very lots of variety in that population too, but a very small, very vocal minority. So for this broader population, so now that we've gotten that out of the way, there's lots of individuals that would have questions and it's completely understandable. And we should be, everyone should be willing to listen and to hear what exactly that their perspectives might be. And that's a very important step to try to get it some type of understanding. One of the first things we should emphasize to people is the fact that the vaccines are incredibly safe. They're incredibly well monitored. They are incredibly effective. And also, I mean, that's important to think to you that it's going to be, vaccines are going to help us to get back to the semblance of normality of what we've had pre-pandemic. And it's important to recognize that it's, it's not something that somebody does just for themselves. It's something that you're doing for other people. This is a vaccine that prevents an infectious disease and infectious diseases are very different than what we're normally used to. The diseases that we might usually get in the United States in terms of things that just might affect me and me only are you and you and you only related to heart disease or cancer and things that you can't necessarily spread to other people. But in this case, as the name implies, we can give it to other people. It's an infectious disease. And so by being vaccinated, we are helping our families, we're helping our communities. And that's something that's really quite important in terms of reducing me, reducing my risk for getting it. It means that the chances and all of us doing that reduces the chances of transmission. We're still getting, of course, the understanding of to what degree people might still be able to spread COVID even after the, after the vaccine. But the fact is that the more people that are vaccinated, the less chance that there is for the spread to be. And so this really is something that we're all in it together. This is a crisis that we're all facing and we're only going to get out of it through doing something that's collective for our communities and for, and for our families and our loved ones. 

   

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  Andrea Rayas: You kind of touched upon it and you've reassured us but, as you know, some Americans do not plan on receiving the vaccine and instead are depending on herd immunity. Can you clarify this concept and speak on what herd immunity would really look like?

   

  Richard Carpiano: Yes. So herd immunity is a very important component to vaccines for infectious diseases. Because, well, no vaccine is 100 percent protective against a disease. And so we need as many people as possible to be vaccinated in order to provide additional protection to reduce those other sorts of opportunities that we might have for an infection. And also there are going to be certain individuals that aren't going to be able to receive the vaccine. Well, at this, in this we're set up right now for the COVID vaccine. That's going to include children. But there's going to be some adults who can't receive it as well as there are for other vaccines. There's different sorts of contra indications, different types of medical conditions for why people might not get a vaccine. And so it's very important for other people to be vaccinated as a way to provide protection to those other people who can't get the protection immediately from the vaccine itself. And so the higher the percentage of people in a population who are vaccinated, the less opportunity that there is for any sort of infection to spread, in this case COVID. And so through that and for different diseases and for different types of viruses, There are the percent of the population that needs to be vaccinated is going to differ. But things that are more, that have greater potential for spread usually require a higher percentage of the population to be vaccinated. Measles is a very good example of that. We're still sort of figuring it out for COVID. But generally what people have been saying, what the experts have been estimating around and around 80 percent is what is sort of a good ballpark for where it is where we need to aim for. And so that's, I think that's a good sort of collective challenge for our country. But also I think it's important for us to remember too, that the news might report herd immunity in terms of a sort of a national type of goals that we've achieved. I don't know, 80 percent of Americans are vaccinated. Look forward to that day to get that type of news. But we have to realize the fact is that herd immunity is really a function of the location of what you're talking about. And with infectious diseases, everything is local. Somebody who is even, when we think about California, if we talk about herd immunity here, we do have to keep in mind that that different sorts of coverage rates, even at a state level, is going to mean that there's going to be lots of variations still at local levels throughout the state. And so that's going to mean that not everybody is going to be in every part of California is going to have sort of going to be at the same level of coverage as we're gonna see, sort of what we might see at the state level. And so as a result of that, we have to be thinking about too how we can get Riverside County to be to achieve, to get to herd immunity levels, we have to be thinking about how even our local communities. This is the main issue that always comes up when it comes to child vaccinations and why people get very concerned when we see schools that are below particular rates of coverage. Because we know that just by being social environments and people engaging with each other, that they become the opportunity for spread and in a local area regard. So again, herd immunity, I mean very, very important, but we have to also be thinking about it as not just a some sort of statewide goal or a county level goal, but we really do have to be thinking about it in terms of sometimes herd immunity is referred to as community immunity. And I think that is sort of a nice way to be thinking about it in terms of how it really is something where we should all be invested in it and we all get something out of it. 

   

  Maddie Bunting: Yes. So herd immunity means still get your vaccine if you can.

   

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  Maddie Bunting: I'd like to shift a little bit. There has been a lot to talk about vaccine passports. And if the Biden administration will require it, even what it looks like internationally. What can you tell us about these vaccine passports? And do you happen to know where the nation, but also in the international community stands on this issue?

   

  Richard Carpiano: Yeah, it's amazing when we think about over the past year how many different issues have just popped up that are sort of new or kind of old ideas, but some sort of new Twenty-First Century variation on the matter. Now, we have to think about it in a whole different sort of way. And vaccine passports are the latest chapter, I guess you could say in the COVID novel tragedy that it's been. In that sense, vaccine passports are nothing more than really either electronic or paper type documents that indicate that you've been vaccinated, whether an individual has been vaccinated. So it's a fancy way of thinking about your vaccination card if you've been vaccinated already. And in many respects, it's yeah, it's a very fancy name, I guess you could say for even that one piece of paper which, in essence, is itself a vaccine passport. Now, where that's gone. More, where this is kind of, I guess you could say that the discussion around has been much more amped up. It's, you know, that becomes a lot more than just people possessing a card, but people having some sort of certified proof of their vaccination. And so There's different ways that that has been proposed in terms of things like App type devices, some sort of electronic certification that you can carry on your phone so that you could go to different places and it can be scanned. And that would enable you to go to a resort for example, if we think domestically in terms of domestic travel or go to a concert and, or some sort of other maybe, you know, a sporting event, some other sort of collective crowd event where there would be a potential for transmission. But where it's really received much more sort of significant attention is in respect to travel, international travel. We've heard the debate. Well, I shouldn't just say It's just that, but I think that's really where we are seeing a lot of force behind it. Well, while certain states there have been like for example, Rhonda Santa in Florida, Governor of Florida has said that he made an executive order or against any sorts of efforts that might be put under wage require a form or some sort of variation of a vaccine passport for Florida businesses. And we could, we might be seeing that popping up and in particular states throughout the nation, it's going to be interesting to see how that might play out for so many different things. Whether it becomes mask mandates or for vaccine priority protocols, the United States has been very much a sort of a 50 states plus the territories and DC, experiment in terms of seeing how things might get rolled out and so much variation across the country with this. And at this point, the federal government has taken a very sort of hands-off attitude towards in saying that they're not going to be sort of involved in that and just really shown as a sort of reluctance in sort of being the main source of the regulation, like we might expect for regular travel passports for example. However. So this is where it gets the button. This is also where we get into international travel and I guess to complicate things. Well, there are going to be other countries that are going to require understandably. So they don't want people showing up and bringing infection into their countries. And so they're going to want to be able to monitor and surveil the status of people entering and leaving. And so as a result of that is they are going to be requiring documentation that the EU is already making a move towards some sort of vaccine passport ype system. And so it's going to come down to, in a sense, a lot of external forces I think on an Americans in terms of their, well, you want to, if you want to go travel internationally, just to say, Hey, I don't believe in them isn't going to be good enough to get you into certain countries. And in a way, I mean, there's just a big to do about this and the anyon some cases I think a little bit of hyperbole, I guess you could say in terms of some of the, some of the arguments around this, when you consider that there are lots of countries already where travelers have to show evidence of certain getting certain vaccinations before they arrive. So this is really not all that different. Issues have been raised about privacy concerns around this. But honestly, I think that's sort of a weak argument as well. When we think about all the different sorts of private information that we have, things even that we might even already have on the web are tied to our social media accounts or things like that. To the extent to which somebody might find out that you've received the vaccine is not really exactly, I would say the most  high risk, high-stakes sort of information, I think to be revealed as that goes public. Yeah. I've received both of my shots there. I've just said it publicly and I've got it myself. And I seriously doubt that that's really a cause for some sort of identity theft, kind of argument that goes along with it. So there's these external pressures from different countries that could certainly affect things from flying to the cruise industry we could imagine to certain island nations where the regular stopping points, ports of call for different cruise ships sailing out of Florida, sailing out of North Carolina and California along both coasts. We can see that's certainly being an issue of demanding that of travelers. And then also to the extent to which we will see this, not just maybe nations in terms of different ports of call in and at airports, but also just in terms of the free market, I really think that we're going to start to see lots of different pressures from businesses to require this. So again, you know, resorts within the United States, for example, or concert venues and stadiums. And there have been for months now, you know, even before, I believe even before there were any EOs ever issued for any of the vaccines. They might have. I'm trying to remember if they were even the trials were still in the way. People were already talking about different, well, they're different businesses and how this were really some different opportunities for startups to try to create different types of electronic identification to indicate your vaccination status. So with these different types of pressures, I think government is going to have to respond in one way or another. And I don't think that necessarily just the forcing of these executive orders is going to be the way to go about doing it. And it's really sort of interesting, there's sort of this weird or sort of, I guess you could say, ironic. Maybe it's paradoxical of whatever sort of term you want to use for it. But people who are arguing the most about government, it seems government staying out of stuff in particularly related to COVID and issuing orders seem to be the ones that are going right to government and wanting government to intervene when it comes to these what seemed to be heavily sort of market related sort of pressures around vaccine passports. So there are interesting sorts of contradictions that we see in terms of the political discourse that's occurring with this. And as with so many things now that we've seen with the pandemic that well, in some cases things that shouldn't have been. But to the extent to which government runs public health, we see that a lot of public health activities get brought, this sort of political lens or these kinds of political angles get in brought into lots of public health decisions to and so but once again, you know, in a way, I mean, I think it just gets back to some just fundamentals about public health. And these tensions that always exist around individual freedoms versus the rights and the safety of the collective. And that is something that is at the core of public health. It is what legal precedent around public health law has continuously sort of supported and taking the side of, but it's a very sort of foreign concept to a lot of Americans when we think about how that libertarian streak of Americans who are really something in the, you know, it's in the DNA of our nation in a way, you know, it's what, it's what cast-off the king and the monarchy for the revolution in a sense. And so that's, it's been a characteristic of American culture since its founding. And, you know, and obviously, you know, there's some people who subscribe to that more than others. But when it comes down to these issues, particularly around infectious diseases and pandemics for public health threats that we are not used to seeing in our country that we've been very fortunate to have been able to escape. Not to say that we haven't had things like the AIDS epidemic or issues related to worries about Ebola coming over or H1N1 or you know others. We think of sexually transmitted infections in general or bad flu seasons. But to the extent of something that's sort of extreme, that's to help become a major killer of Americans in just one year; This is a very different sort of situation. And strangely, while this should have been a situation where and I will confess, I think when you had me on I think a year ago I might have even a bit talked about this, that this might have been a situation where we thought, well, this is probably take some of the wind out of a, I'll tell, take full ownership of this. Because I did say to some people, this might take the wind out of some of the anti-vaccine movement and people that are really involved in that and those campaigns. And now really what we've seen is sort of this. We've seen an amplification. Now that well, we really thought originally that was sort of a more fundamentalist, that there was this idea that we, well a lot of anti-vaccine sentiment exists because unlike a lot of other nations, we don't really get to see besides from a bad flu season or maybe a measles outbreak here and there, we really don't get to see the real extreme effects of infectious diseases. It's really sort of an American kind of privilege in a sense. And so now at this sort of event coming that we have, this should have been the wake-up call, but now we really see that this is actually, it's kinda gone sadly in a counter-productive sort of way. And in many respects, you know, sort of sentiment around personal freedoms, around what's called the Health Freedom Movement. The idea that personal autonomy and that any of these sorts of public health decisions are somehow a violation of personal freedoms and symptom infringement upon some fundamental, basic rights as Americans is really, that's really been amplified and politicized in many sorts of ways to an extent to which we've not seen before. And in very concerning sorts of ways, particularly as we're seeing it now really going to tie it in a lot more To right wing, extreme right-wing types of positions, to extremist type groups, in the wake of the capital insurrection. And really how public health is getting bundled up within these kinds of anti-government sorts of sentiments and in some cases activities. 

   

  Maddie Bunting: As a final question, bringing back to the anti-vaxx sentiment with the pause on the Johnson and Johnson vaccine, with discussion on blood clots, do you think that aided the anti-vaccine movement of the “do you see we’re right?” Even though numbers have come out, statistics have come out saying, you know, there's a greater chance of getting blood clots with ABC and D. Do you think that that hurt public health even more? 

   

  Richard Carpiano: Yes. But it's also not the first incident. I mean, we had the well, it didn't affect the United States, but, internationally there were the issues with the AstraZeneca vaccine as well that came up. But we've seen, I mean, nothing is going to be perfect. No vaccine is perfect. There's no such thing as 0 risk when it comes to vaccines. There's incredibly low risk and that's why they get approved, not just the COVID vaccines. And so we have, unfortunately, we've kind of, we respond and we sort of, I would say we sort of hone in or a missile lock onto the negatives, onto the fear without looking at the positive in front of us. And I mean, the thing I think that, I think it's important to emphasize is six cases got picked up out of how many millions of doses. I mean, that is if that's not a testament to our public health system and the surveillance that we have in place, our vaccines are incredibly well monitored. When we had the trials going on, when there was just some weird sorts of side effects that popped up. In just one person, things were stopped and things were looked at. And so everything was done very carefully. Nobody wanted to take any risks with this. And nothing is, nothing in a sense is new. These are based off of sort of existing technology and existing sorts of vaccine platforms which enabled us to do really incredible things within a year's time, which is really, really amazing. And I can't, you know, we can, we can say that the name Operation Warp Speed did not help things for vaccine hesitancy. But the program itself was very much a success. And that should be we should certainly be recognized with that. But along with that and we're straight on to the point about your question is, so what I'm trying to say is there's always going to be these incidents that occur. Whether they are tied to the vaccine or not, we're still sort of determining what's going on with this. In this case, the FDA took a very precautionary approach to this and did not want to take any chances with it. They could have very well have just continued and enable. In fact, that's a risk trade off. Some people have argued even that maybe, given the risk of COVID and taking a vaccine out of play, you know that you're now putting more people at risk by doing that, then you would be by then anything of these sorts of side effects. But unfortunately, in terms of doing all this sort of very careful activity, issuing these kinds of pauses to make sure that everything is going on right? Thinking about the reputation of and how something bad, could even spill over onto other sorts of therapies and devices that the FDA reviews and approves and what that might mean for public confidence. Yeah, I really do think that they did the right thing. And lots of other people in public health have made that same argument. And we can, but there's lots of second guessing and there's nothing that's sort of a clear equation that you can just then check in the back of the textbook to see if you're right or not. You know, sort of thing is these are always sort of up in the air. But unfortunately with that, when that happens, you know, anything is going to be used as fodder for people who are either skeptical in a sort of a genuine way and you'll just might not know and just be, have a sort of general level of knowledge on these things isn't clear. But people who have very sorts of disingenuous interests in terms of pushing different anti-vaccine sorts of agendas. As we see with the anti-vaccine movement again and again. You know, this stuff is going to be totally taken and used. Now the extent to which this is going to be used to paint a broad brush towards all the vaccines that are currently available is certainly up for question. As is the extent to which this is going to undermine public trust and just the Johnson and Johnson vaccine. So I am worried that people, once this gets resolved, and no matter what comes out of this, even if they just say. Okay, certain individuals should not, we don't recommend it for certain individuals and all they give it to other people who don't fit certain criteria. I could still imagine that we might see public trust might be such that there's going to be some people who are going to vaccine shock. So if they're finally able to get there, they get their appointment and they see that they're only able to get the Johnson&Johnson vaccine at that site. Do they not show up as they're going to be sort of a bottleneck at places that only have the Pfizer vaccine for example. So there are those, those types of concerns, but these things are always going to pop up. And when the reality of it is that the system worked as it should. And this is really great and we should be really proud of that. And ironically too, I think again, this is, these t a lot of where you hear a lot of also gets bundled up in a lot of what we're seeing now with some sort of this current COVID denialism are a lot, there's lots of politics that get bundled up in it that are unrelated to vaccines. Add the things around sort of which, which one would think are usually hear a lot of rhetoric about American exceptionalism and about how wonderful and great America is as a country. And so any Go USA sort of, sort of with some of these more sort of extremist, right-wing types of subcultures where we're seeing a lot of kind of typically it's not to say that everybody is of that, but we've certainly seen in recent years with the anti-vaccine movement itself is skewed a bit more right-wing. And so I always think that there's a bit, this is sort of a strange irony that those are the type of people that think that America is the greatest nation in the world. You know, they might even think about it in a religious sense with it that it's God's plan for the United States be so good. Well, if that's the case, then shouldn't our science and shouldn't our doctors and our scientists be the very best too and so shouldn't we then in that case, we should have extreme handover our hearts sort of trust you that you know, that they're doing the right thing. And if they're saying that something is safe, that should be good enough. Unfortunately, it isn't.

   

  Maddie Bunting: I think that's a really great point. I just want to thank you so much Professor Carpiano, you've made so many wonderful points. I learned a lot about herd immunity and the vaccine passports and I’m interested to see what these next few months look like when traveling and trying to get back to normalcy. Yes. Fingers crossed or sure. And so just thank you so much for joining us again, a little one-year anniversary. I really appreciate it. 

   

  Richard Carpiano: Well, thank you very much for having me back. And unfortunately we had to be back talking about these things again, but this is, in many respects, you know, COVID is going to be with us. In many respects this is the new normal. So the extent to which much of that new normal looks like the old normal, you know, it's very much, I think in the average American’s sorta hands at this point you don't have the capacity to be able to interact with the, with the vaccine with other sorts of measures we have, as New Zealand has shown us as other, other countries too, we have the capacity to have a fairly normal life again that doesn't mean impacting us and it's not overcrowding hospitals and being a major killer of Americans. And so it's really it's now in our country. Well, it's always been our country in many respects, but it very much so as you know, we're not out of this yet.

   

  Maddie Bunting: Exactly, but hopefully soon and hopefully everyone who can does get their vaccine. And yes, we will have to speak again on a different topic, hopefully when things are more under control. So just thank you again. 

   

  Richard Carpiano: Thanks for having me!

  
  Outro: This podcast is a production of the UC Riverside School of Public Policy. Our theme music was produced by C Codaine. I'm Maddie Bunting, till next time.