Public health officials are failing to communicate effectively about AstraZeneca

Written by , Ryerson University. Photo credit: THE CANADIAN PRESS/Nathan Denette. Originally published in The Conversation.The Conversation

People line up at a mass vaccination centre during the COVID-19 pandemic in Mississauga, Ont.

It’s a frightening and perplexing time for Canadians who have either been vaccinated against COVID-19 or are trying to determine what vaccine to get.

On May 3, the National Advisory Committee on Immunization (NACI) updated its COVID-19 vaccine statement and recommended that Canadians less likely to contract COVID-19 may want to wait for a Pfizer or Moderna vaccine instead of AstraZeneca (AZ).

Days later, Ontario said it would not administer AZ as a first dose due to the risk of rare blood clots.

Although the NACI update did not contradict its earlier guidance when it recommended expanding the use of the AZ vaccine to all Canadians over the age of 30, people were understandably left with the impression that viral vector vaccines — including AZ and Janssen/Johnson & Johnson — are less safe and effective than their mRNA counterparts. Combined with Ontario’s move, that impression will undoubtedly intensify.

NACI’s advice of “waiting for preferred vaccines if you can” provoked an immediate backlash both in the virtual House of Commons and on social media.

When questioned by Michelle Rempel Garner, the Conservative health critic, on whether Health Canada still recommends “taking the first vaccine you’re offered,” Health Minister Patty Hajdu dodged the question by suggesting that “people should consult their health-care professional to decide which vaccine is right for them.”

Federal Health Minister Patty Hajdu is seen after receiving her first dose of COVID-19 vaccine in Thunder Bay, Ont., on April 23. Photo credit: THE CANADIAN PRESS/David Jackson.

On social media, other health experts expressed their frustration that NACI’s message may fuel vaccine hesitancy, while some recipients of AZ were startled to learn, after being advised weeks earlier to get the vaccine, that it’s second-rate or possibly dangerous.

David Williams, Ontario’s chief medical of health, has also faced a social media backlash.

There’s no doubt NACI, Health Canada and now Ontario’s top public health official have run into a serious communication problem.

Let’s delve into crisis management and communication theories to elaborate on what’s gone wrong in NACI’s vaccine messaging, and what lessons can be learned to improve future communications.

Communicating uncertainty

How messages are framed has a significant impact on the public. For instance, it has been found that media discourses emphasizing the connection between COVID-19 and China, and deeming the pandemic a threat caused by foreigners, have been a major contributor to the notable increase in racist and xenophobic attitudes during the pandemic.

News can be conveyed via a variety of communication strategies, and story-telling is arguably the most powerful one. British media scholar Philip Seargeant argues in his analysis of the rise of conspiracy theories and post-truth politics that stories framing “corrupt states controlled by ruthless elites” fuel the prevailing anti-establishment sentiments found in both right-wing populist movements and disinformation online.

People wait after being vaccinated at a COVID-19 vaccine clinic at Woodbine Racetrack in Toronto. Photo credit: THE CANADIAN PRESS/Nathan Denette.

A vivid story can easily capture public attention away from abstract charts and figures because it plays on our emotions.

What initially triggered recent public anxiety and confusion about COVID-19 vaccinations was NACI’s statement that “it continues to preferentially recommend authorized mRNA COVID-19 vaccines due to the excellent protection they provide and the absence of safety signals of concern.” The word preferentially inevitably provoked readers to think a comparison to other vaccines was being made.

Making a bad situation worse

Then on May 4, NACI’s chair, Dr. Caroline Quach-Thanh, appeared on CTV’s Power Play in an apparent attempt to clarify confusion and ease public anger. Yet the hypothetical story she presented further worsened the situation.

When explaining why NACI advocated for an “informed consent” regarding which vaccine to take, Quach-Thanh commented:

“If, for instance, my sister was to get the AstraZeneca vaccine and die of a thrombosis when I know that it could have been prevented and that she’s not in a high-risk area, I’m not sure I could live with it.”

Dr. Caroline Quach-Thanh appears on CTV News.

As soon as a hypothetical story of this nature lodges in people’s minds, scientific information about the extreme rarity of vaccine-induced blood clots becomes less relevant for people wondering whether they should opt for AstraZeneca. Getting the vaccine, after all, has been framed as a “risk-taking” behaviour by a top public health official.

There are two additional problems in advocating that people should make their own risk assessments. First, people tend to under-estimate the risk of contracting COVID-19, especially in the absence of relevant knowledge.

With so many uncertainties associated with the community spread of COVID-19, it’s inherently difficult for the general public to figure out whether the infection risk in the areas they live is high enough to warrant an immediate AZ shot.

Second, an individual cost-benefit analysis encourages a personal calculation: If I feel comfortable that I have a low risk of contracting COVID-19, then I can wait for my preferred vaccine. This contradicts early vaccine communication efforts in which getting vaccinated was portrayed as an act of responsibility that could protect family members, neighbours, front-line workers and colleagues.

A unique crisis

None of this is meant to discredit NACI’s critical contributions to public health. The COVID-19 pandemic has surpassed all previous public health crises in terms of its scope, duration and severity, creating enormous challenges to public health communicators on a daily basis.

The ongoing situation also defies the conventional wisdom about crisis communication in many ways. Traditionally, crisis management and communications instruction involves training students to handle tasks arising from a potential crisis and to prepare for it, and to provide daily updates both during the crisis and in its aftermath.

When conflicting messages appear in news media, the spokespeople for organizations often adopt strategic ambiguity to grapple with uncertainty while maintaining a public image of transparency and openness.

This playbook has been rewritten by the outbreak of COVID-19. The pandemic’s abrupt, evolving and global nature has transformed it into what’s known as a syndemic in which unexpected communication crises can be triggered by even a single word — in this case, “preferentially.”

Meanwhile, with almost all public conversations taking place online, it’s almost impossible for a public institution to single-handedly control the mainstream narrative. Any ambiguity can lead to outright misinformation.

Ultimately, the NACI and other COVID-19 messaging controversies highlight the importance of closely co-ordinating communication among different stakeholders. That will ensure any possible conflicting messages can be negotiated and presented in a far less confusing and damaging manner to the public.