Covid-19 Vaccine Hesitancy

Where is it coming from?

I spent a good chunk of last week talking with people about reasons why people are not taking the vaccines for Covid-19 despite the fact they’ve been proven safe, been proven effective, and are free. I have heard a number of excuses in person—perhaps the subject for another post. But those are all anecdotal stories, though evidence that such reasons exist. Well this weekend I found some quantitative data.

The source is the Kaiser Family Foundation (KFF), a group that focuses on health, health information and its communication. For Covid-19 they’ve been running quite a bit of information communication as one can imagine. One part of that? Public polling.

The latest survey covers the middle of June, but does include a question on why the unvaccinated remain unvaccinated.

Let’s start from the top, shall we?

I’ve got some quibbles with the design of the chart, primarily axis labels vs. a data label for every single bar, but I want to focus on the content today.

The vaccines is too new? I will grant you that it was developed very quickly. But there are two big reasons for that. First, to give the Trump administration credit where credit is due, whilst they didn’t really plan for a federal rollout of the vaccine they did eliminate much of the red tape and bureaucratic hassles that can slow down vaccine research. They did not, however, reduce the scientific rigour with which the vaccines were tested. Keep in mind that often times we heard stories of how the administration wanted to approve the drug well before it was ready. That is a sign that the testing wasn’t rushed.

Second, the mRNA method is new, but had been in advanced stages of research for a number of diseases including both influenza and zika. Scientists simply began to “reprogramme” the RNA bit to battle the SARS-CoV-2 virus that causes Covid-19. In other words, we had been researching the type of vaccines for decades, but we just found a new target for its first widespread application.

Worried about side effects? Fair question. Last numbers I specifically saw were something like fewer than 300 severe allergic reactions out of over 3,000,000 million doses of Pfizer. In other words, that was a 0.01% chance. If you get Covid-19, the mortality rate is somewhere between 1% and 5%. In other words, you’re far more likely to get sick or even get sick and die from Covid-19 than from the Covid-19 vaccine.

Just don’t want to get the vaccine? Well now you’re being selfish. Vaccines aren’t just about you. They are a public health and safety measure. If you get sick, you put others at risk. In 1905, we heard similar arguments for people not wanting to get the new smallpox vaccine. (A disease we’ve almost entirely eradicated thanks to vaccinations, go look up how devastating it was to populations pre-vaccine. I’ll wait.) But these people who didn’t want the smallpox vaccine took their argument of “it’s a personal choice” all the way to the Supreme Court.

They lost.

The Supreme Court decided that personal liberty does have limits and can be overruled by what we call the police power of the state, specifically when personal liberty risks public health and safety. Here’s a simlar example. I have the freedom to speak without being censored by the government. However, I cannot go into a crowded theatre and scream fire. Because at that point I am endangering the stampeding masses. The government has the right to limit my speech in that specific area.

There are lots of things we don’t want to do, but have to do. Getting vaccinated is one of those things.

Don’t trust the government? Well the vaccine wasn’t developed by the government. The three big ones in the United States are Pfizer, Moderna, and Johnson & Johnson. For my UK audience, you’re also looking at Oxford-AstraZeneca. I believe it was Pfizer even rejected accepting development money from the US government specifically to ensure that its research remained above reproach. In other words, the government hired the scientists who conducted the tests that proved the vaccines were safe for use.

But, and this is the kicker, the vaccines first began to roll out to the public in December 2020. We now have seven months’ worth of evidence and data in real world scenarios. The vaccines consistently have been proven safe and effective.

Don’t think you need the vaccine? Well like I said above, the vaccine isn’t about just you, it’s about society at large. We have personal liberty, but social responsibility. And your choice to not get vaccinated threatens and endangers the lives of others. Because there are, and we’ll get to this, some people who cannot receive the vaccine even if they want to. And you not getting it, threatens them.

Don’t believe the Covid-19 vaccines are safe? We spent nearly six months studying them in clinical trials and they were proven safe. We now have an additional seven months of real world, in the shit testing. And they have been proven safe time after time after time.

Don’t trust vaccines in general? If you’re grandparents or great-grandparents are still alive, ask them about how deadly smallpox was. Or maybe ask your parents about how terrible the mumps were. Or measles. Go ahead, I’ll wait. Turns out they were pretty terrible. There was a reason that older generations generally rushed to get vaccines, because they protect us from the scourge of viruses and bacteria. I haven’t seen a person with smallpox in my entire life because vaccines all but eradicated the virus. (It exists only within the bio-weapon laboratories of the United States and the Russian Federation.)

Have a medical reason why they can’t receive the virus at this time? Great, I mean, not great, but this is a real reason why people cannot and should not receive the vaccine for Covid-19. And this is why we want everyone who doesn’t have a precluding reason to get the vaccine, so that we can help protect you. But hopefully you’ll be able to get vaccinated at some point in the future.

Too busy or have not had the time to get it? Well, it’s been several months and it’s increasingly hard to believe you don’t have a half-hour or an hour to spare. It took me a 15-minute walk and then walked through an empty, snaking line for about five minutes, then had the little prick in a minute, then waited 15 minutes. Then walked home. Did that twice in a matter of weeks.

But let’s say you’re working crazy hours. Well, that’s one reason the White House is asking employers to give employees paid time off to receive the vaccine.

Don’t like getting shots? Neither do I. I told that to the corpsman who administered my first shot and I simply looked away. I’d rather get two little pricks than risk needing to go to hospital or die or infecting someone else.

Worried about missing work? As I said above, it doesn’t take long. The actual processing is just a few minutes. You have to wait longer in observation to make sure you don’t have an allergic reaction. But also like I said, that’s why the White House is pushing employers to give their employees paid time off to receive the vaccine.

Difficult to travel to a vaccination site? This would have been especially hard in the early months when the goal was to equip mass vaccination sites in city centres that could serve the most people the most effectively and the most efficiently. Since then, most pharmacies and many doctors offices are offering the vaccine. There are a number of mobile vaccination sites around.

Check out Vaccines.gov: https://www.vaccines.gov/search/ It will help you locate where you can get your shots.

Not sure how or where to get your vaccine? Again, check out https://www.vaccines.gov/search/ and search for wherever you live.

Worried you will have to pay to get the vaccine? You don’t have to! The government is footing the bill for all of us. All you need to is show up with the required ID to prove you are who you say you are, wait your turn in line, get your shot, and wait for your observation period. Then, if you receive either Pfizer or Moderna, because you need two shots, you go back and present them with your vaccination card, and do it all over again.

But nowhere in that do you have to pay.

That was it for the reasons in the survey. But like I said, maybe I’ll address some of the other things in a post later this week.

Credit for the piece goes to the KFF graphics team.

Politicising Vaccinations

Yesterday I wrote my usual weekly piece about the progress of the Covid-19 pandemic in the five states I cover. At the end I discussed the progress of vaccinations and how Pennsylvania, Virginia, and Illinois all sit around 25% fully vaccinated. Of course, I leave my write-up at that. But not everyone does.

This past weekend, the New York Times published an article looking at the correlation between Biden–Trump support and rates of vaccination. Perhaps I should not be surprised this kind of piece exists, let alone the premise.

From a design standpoint, the piece makes use of a number of different formats: bars, lines, choropleth maps, and scatter plots. I want to talk about the latter in this piece. The article begins with two side by side scatter plots, this being the first.

Hesitancy rates compared to the election results

The header ends in an ellipsis, but that makes sense because the next graphic, which I’ll get to shortly, continues the sentence. But let’s look at the rest of the plot.

Starting with the x-axis, we have a fairly simple plot here: votes for the candidates. But note that there is no scale. The header provides the necessary definition of being a share of the vote, but the lack of minimum and maximum makes an accurate assessment a bit tricky. We can’t even be certain that the scales are consistent. If you recall our choropleth maps from the other day, the scale of the orange was inconsistent with the scale of the blue-greys. Though, given this is produced by the Times, I would give them the benefit of the doubt.

Furthermore, we have five different colours. I presume that the darkest blues and reds represent the greatest share. But without a scale let alone a legend, it’s difficult to say for certain. The grey is presumably in the mixed/nearly even bin, again similar to what I described in the first post about choropleths from my recent string.

Finally, if we look at the y-axis, we see a few interesting decisions. The first? The placement of the axis labels. Typically we would see the labelling on the outside of the plot, but here, it’s all aligned on the inside of the plot. Intriguingly, the designers took care for the placement—or have their paragraph/character styles well set—as the text interrupts the axis and grid lines, i.e. the text does not interfere with the grey lines.

The second? Wyoming. I don’t always think that every single chart needs to have all the outliers within the bounds of the plot. I’ve definitely taken the same approach and so I won’t criticise it, but I wonder what the chart would have looked like if the maximum had been 35% and the grid lines were set at intervals of 5%. The tradeoff is likely increased difficulty in labelling the dots. And that too is a decision I’ve made.

Third, the lack of a zero. I feel fairly comfortable assuming the bottom of the y-axis is zero. But I would have gone ahead and labelled it all the same, especially because of how the minimum value for the axis is handled in the next graphic.

Speaking of, moving on to the second graphic we can see the ellipsis completes the sentence.

Vaccination rates compared to the election results

We otherwise run into similar issues. Again, there is a lack of labelling on the x-axis. This makes it difficult to assess whether we are looking at the same scale. I am fairly certain we are, because when I overlap the graphics I can see that the two extremes, Wyoming and Vermont, look to exist on the same places on the axis.

We also still see the same issues for the y-axis. This time the axis represents vaccination rates. I wish this graphic made a little clearer the distinction between partial and full vaccination rates. Partial is good, but full vaccination is what really matters. And while this chart shows Pennsylvania, for example, at over 40% vaccinated, that’s misleading. Full vaccination is 15 points lower, at about 25%. And that’s the number that needs to be up in the 75% range for herd immunity.

But back to the labelling, here the minimum value, 20%, is labelled. I can’t really understand the rationale for labelling the one chart but not the other. It’s clearly not a spacing issue.

I have some concerns about the numbers chosen for the minimum and maximum values of the y-axis. However, towards the middle of the article, this basic construct is used to build a small multiples matrix looking at all 50 states and their rates of vaccination. More on that in a moment.

My last point about this graphic is on the super picky side. Look at the letter g in “of residents given”. It gets clipped. You can still largely read it as a g, but I noticed it. Not sure why it’s happening, though.

So that small multiples graphic I mentioned, well, see below.

All 50 states compared

Note how these use an expanded version of the larger chart. The y-minimum appears to be 0%, but again, it would be very helpful if that were labelled.

Also for the x-axis in all the charts, I’m not sure every one needs the Biden–Trump label. After all, not every chart has the 0–60% range labelled, but the beginning of each row makes that clear.

In the super picky, I wish that final row were aligned with the four above it. I find it super distracting, but that’s probably just me.

Overall, this is a strong piece that makes good use of a number of the standard data visualisation forms. But I wish the graphics were a bit tighter to make the graphics just a little clearer.

Credit for the piece goes to Danielle Ivory, Lauren Leatherby and Robert Gebeloff.

Vaccinate Me, Baby, One More Time

With the rollout of the first vaccination programme in the United Kingdom, the BBC had a helpful comparison table stating the differences between the four primary options. It’s a small piece, but as I often say, we don’t necessarily need large and complex graphics.

A nice little comparison table

Since there are only four vaccines to compare and only a handful of metrics, a table makes a lot of sense.

But I wanted to take it a step further and so I threw together a quick piece that showed some of the key differences. In particular I wanted to focus on the effectiveness, storage temperatures (key to distribution in the developing world), and cost.

My quick take

You can pretty quickly see why the United Kingdom’s vaccine developed by Oxford University and produced by AstraZeneca is so crucial to global efforts. The cost is a mere fraction of those of the other players and then for storage temperature, along with Russia’s Sputnik vaccine, it can be stored at common refrigerator temperatures. Both Pfizer’s and Moderna’s need to be kept chilled at temperatures beyond your common freezer.

And in terms of effectiveness, which is what we all really care about, they’re fairly similar, except for the Oxford University version. Oxford’s has an overall effectiveness of 70%. (In)famously, it exhibited a wide range of effectiveness during trials of between just over 60% and 90%.

The 60-odd% effectiveness was achieved when using the recommended dosage. However, in one small group of trial participants, they erroneously were given a half-dosage. And in that case, the dosage was found to be far more effective, approximately 90%. And this is why we would normally have longer, wider-ranging trials, to dial in things like doses. But, you know, pandemic and we’re trying to return to some sense of normalcy in a hurry.

All that said, Oxford’s will be crucial to the developing world, where incomes and government expenditures are lower and cold-storage infrastructure much less, well, developed. And we need to get this coronavirus under control globally, because if we don’t, the virus could persist in reservoirs, mutating for years until the right mutation comes along and the next pandemic sweeps across the globe.

I know we’re presently all fighting about wearing masks, but when we get to having vaccines available to the public, let’s really try to not make that a political issue.

Credit for the original piece goes to the BBC.

Credit for my piece goes to me.

How Would the Covid-19 Vaccines Work

Over the last week or so, we have been receiving some encouraging news from the makers of three viable Covid-19 vaccines: Pfizer, Moderna, and AstraZeneca. All three have reported their vaccines as at least 90% effective. This doesn’t mean the relevant regulatory agencies have verified that data, but it’s better than injecting ourselves with bleach.

Keep this in mind, though, a full vaccination roll out will take months. Having 20–40 million doses is great, but the population of the United States is 330 million. The expectation is a return to normalcy will not really begin until the end of Q3 or beginning of Q4 2021.

This article from the Washington Post does a good job of explaining some of the next steps—and some of the significant logistical hurdles. They illustrate part of the process of shipping the Pfizer vaccine, which needs to remain cooled -70ºC. That’s -94ºF. A wee bit colder than most normal freezers operate.

The Post article also illustrates how the Pfizer/Moderna type of vaccine works—the Pfizer and Moderna tackle it one way whilst AstraZeneca tackles it via a second method.

The first steps in the process.

There’s a lot going on here, but I like the simplified approach the designers took. This whole situation is complicated, but here we see the process distilled to its most essential elements. And the restrained use of colour helps tremendously.

The vial and then needle are filled red, and that red colour carries through into the messenger RNA (mRNA) that is absorbed by the cells and ultimately creates the spike proteins used by the virus (not the virus itself).

Credit for the piece goes to Carolyn Y. Johnson and Aaron Steckelberg.

The Vaxx Path

Today we look at a wee graphic from the BBC examining the current state of Covid-19 vaccines. None have been approved, but 163 are on the path to approval.

The vaxx path

This falls into the category of not everything has to be super complex. Each vaccine is shown as a discrete unit, a small square. For me in this instance this works better than a bar chart showing the total number per each phase. It highlights how each vaccine is a distinct unit and that it can move from one section down to the next. (Although I suppose if it fails a phase it can also be removed entirely.)

And if you want another reason why a nationalist, isolationist foreign policy that bashes foreign countries is not great…none of the Phase 3 candidates, closest to approval, are from an American company or institution.

Credit for the piece goes to the BBC graphics department.