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Biden’s Speech on Vaccine Mandates and the Delta Variant: Full Transcript

“My message to unvaccinated Americans is this: What more is there to wait for?” President Biden said on Thursday. “We’ve been patient, but our patience is wearing thin.”

The following is a transcript of President Biden’s remarks on Thursday about his administration’s push to mandate coronavirus vaccines for two-thirds of American workers as the Delta variant surges across the United States.

Good evening, my fellow Americans. I want to talk to you about where we are in the battle against Covid-19 — the progress we’ve made and the work we have left to do, and it starts in understanding this: Even as the Delta variant 19 has — Covid-19 has been hitting this country hard, we have the tools to combat the virus, if we can come together as a country and use those tools. If we raise our vaccination rate, protect ourselves and others with masking, expanding testing and identify people who are infected, we can and we will turn the tide on Covid-19.

It will take a lot of hard work, and it’s going to take some time. Many of us are frustrated with the nearly 80 million Americans who are still not vaccinated , even though the vaccine is safe, effective and free. You might be confused about what is true and what is false about Covid-19. So, before I outline the new steps to fight Covid-19 that I’m going to be announcing tonight, let me give you some clear information about where we stand.

First, we’ve made considerable progress in battling Covid-19. When I became president, about two million Americans were fully vaccinated. Today, over 175 million Americans have that protection. Before I took office, we hadn’t ordered enough vaccine for every American. Just weeks in office, we did. The week before I took office on Jan. 20 of this year, over 25,000 Americans died that week from Covid-19.

Last week, that grim weekly toll was down 70 percent. And then three months before I took office, our economy was faltering, creating just 50,000 jobs a month. We’re now averaging 700,000 new jobs a month in the past three months. This progress is real. But while America is in much better shape than it was seven months ago, when I took office, I need to tell you a second fact. We’re in the tough stretch, and it could last for a while.

Highly contagious Delta variant that I began to warn America back in July, spread late summer, like it did in other countries before us. While the vaccines provide strong protection for the vaccinated, we read about and hear about and we see the stories of hospitalized people, people on their death beds among the unvaccinated over the past few weeks. This is a pandemic of the unvaccinated.

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• Copy URL https://www.pbs.org/newshour/politics/watch-live-president-biden-gives-remarks-on-covid-19-at-the-national-institute-of-health

WATCH: President Biden gives remarks on COVID-19 at the National Institute of Health

BETHESDA (AP) — President Joe Biden is set to kick off a more urgent campaign for Americans to get COVID-19 booster shots Thursday as he unveils his winter plans for combating the coronavirus and its omicron variant with enhanced availability of shots and vaccines but without major new restrictions.

Watch Biden’s remarks in the player above.

The plan includes a requirement for private insurers to cover the cost of at-home COVID-19 tests and a tightening of testing requirements for people entering the U.S. regardless of their vaccination status. But as some other nations close their borders or reimpose lockdowns, officials said Biden was not moving to impose additional restrictions beyond his recommendation that Americans wear masks indoors in public settings.

Biden traveled to the National Institutes of Health outside Washington on Thursday for a briefing on the virus with his COVID-19 response team and scientific advisers before delivering remarks outlining his strategy.

Biden said Wednesday that going forward the U.S. would fight the virus “not with shutdowns or lockdowns but with more widespread vaccinations, boosters, testing, and more.”

The White House released details of Biden’s plan early Thursday, in advance of the speech.

The Biden administration has come to view widespread adoption of booster shots as its most effective tool for combating COVID-19 this winter. Medical experts say boosters provide enhanced and more enduring protection against COVID-19, including new variants.

“There’s a national campaign to get the 100 million eligible Americans who have not yet gotten their booster a booster,” White House COVID-19 response coordinator Jeff Zients said Thursday on CBS.

READ MORE: What’s the status of the COVID-19 vaccine mandate in the U.S.?

Much remains unknown about the omicron variant, including whether it is more contagious, whether it makes people more seriously ill and whether it can thwart the vaccines.

About 100 million Americans are eligible for boosters under current U.S. policy, with more becoming eligible every day. Convincing those who have already been vaccinated to get another dose, officials believe, will be far easier than vaccinating the roughly 43 million adult Americans who haven’t gotten a shot despite widespread public pressure campaigns to roll up their sleeves.

And while Biden’s vaccination-or-testing requirement for workers at larger employers has been held up by legal challenges, the president on Thursday will renew his call for businesses to move ahead and impose their own mandates on workers so they can stay open without outbreaks.

In a effort to encourage more people to take the booster doses, the Biden administration is stepping up direct outreach to seniors — the population most vulnerable to the virus. The Centers for Medicare & Medicaid Services will send a notice to all 63 million Medicare beneficiaries encouraging them to get booster doses, the White House said. The AARP will work with the administration on education campaigns for seniors.

So far about 42 million Americans, about half of them seniors, have received a booster dose. The Centers for Disease Control and Prevention this week broadened its booster dose recommendation to cover all Americans aged at least 18 starting six months after their second dose of the mRNA vaccines from Pfizer or Moderna.

The White House said the CDC was also developing new guidance for schools in an effort to reduce or eliminate current quarantine requirements for those are not fully vaccinated and exposed to the virus. The new policies, which the White House said will be released in the coming weeks, could include so-called “test-to-stay” policies, in which those who are considered close contacts can continue to go to school but wear masks and undergo serial testing, in a bid to minimize learning loss and disruption.

The administration’s upcoming rule to require private insurers to cover at-home testing is still being drafted, and many details remain to be worked out, including under what criteria they will be reimbursable, officials said.

Those insured by Medicare and Medicaid would not be eligible, but the White House said as many as 150 million people with private insurance would see easier and cheaper access to the at-home tests. The administration said it is making 50 million COVID-19 tests free for older people and other vulnerable groups for pickup at senior centers and community sites.

Beginning next week, the White House said, all travelers to the U.S., regardless of nationality or vaccination status, will need to provide proof of a negative COVID-19 test within one day of boarding their flights. That’s down from three days right now for those who have been vaccinated, in an added precaution against the omicron variant. But the White House has shelved tougher options, like requiring post-arrival testing or requiring quarantines upon arrival in the U.S.

The White House has not yet moved to require domestic U.S. travelers to be vaccinated or get tested, as officials believe such a requirement would be immediately mired in litigation.

“We base our decisions on the advice of the health and medical experts, what’s going to be most effective and what we can implement,” said press secretary Jen Psaki on Thursday. “What’s most implementable, so we look at a range of factors as we make decisions about what steps we can put in place.”

Biden is also extending his directive requiring masks on airplanes and other public transit, which had been set to expire in January, through at least the middle of March, the White House said.

The administration is also informing states that it has more than 60 teams available to help them or their municipalities address surges in cases and public health shortages heading into the winter, with half aimed at bolstering hospital services and 20 targeted at supporting life-saving monoclonal antibody treatments.

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Feb 25, 2021

Joe Biden Speech on 50 Million COVID-19 Vaccines Transcript February 25

President Joe Biden gave a speech commemorating the 50 millionth COVID-19 shot given in the U.S. on February 25, 2021. He also gave updated on the vaccination distribution process. Read the transcript of his speech remarks here.

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President Biden: ( 05:31 ) Well, thank you all. Dr. Fauci, thanks for your leadership. Thanks for being here. Two weeks ago I spent some time with you and Dr. Francis Collins, excuse me, the Director of National Institute of Health, NIH. And he gave me a tour of the vaccine research center in Bethesda, Maryland. And it’s the place where our top scientists spend years researching and developing vaccines and treatments for all kinds of viruses. The brilliant team there made possible the rapid deployment and development of COVID-19 vaccines, and they’re truly remarkable. And this administration will follow the science to deliver more breakthroughs.

President Biden: ( 06:19 ) We are doing that to beat COVID-19 and other diseases like cancer, which is something that’s so personal in so many families including me and Kamala’s and many of yours. We’ve asked Dr. Eric Lander, renowned Harvard, MIT scientist, to serve as my science advisor and Head of the Office of Science and Technology Policy and co lead the Presidential Council on Advisory Science and Technology. These are the White House offices that bring together the country’s top scientists to address our most pressing needs. And they’ll be part of the work to develop a DARPA like advanced research effort on cancer and other diseases, just like we do DARPA in the Defense Department which develops breakthrough projects to secure our national security. And relatedly, I’m delighted to see five of the nation’s leading cancer centers are joining forces today to build on the work of the Cancer Moonshot I was able to do during the Obama, Biden administration to help break through silos and barriers in cancer research. We’re making progress.

President Biden: ( 07:29 ) There’s so much we can do, so much progress within our reach and that’s why I’m thankful the folks here today for getting their vaccine shots. Gerald Bon and Corey Hamilton are both DC firefighters. I said to Corey that old expression, God made man, then he made a few firefighters. Thank God we have them. And Linda Bussey is a manager of a Safeway grocery store in Bethesda. Victoria Ledgerwood Rivera, who is a local school counselor. And Elizabeth Calloway, who is a registered nurse who administered these shots. And the more people get vaccinated, the faster we’re going to beat this pandemic. That’s why one of my first goals in office just before I was sworn in, I indicated that my goal was to get 100 million COVID vaccine shots in people’s arms in my first 100 days as president. At first critics said that goal was too ambitious, no one could do that.

President Biden: ( 08:36 ) Then they said it was too small. At the bottom line though is that America will be the first country, perhaps the only one to get that done. And today I’m here to report we’re halfway there. 15 million shots in just 37 days since I’ve become president. That’s weeks ahead of schedule. Even with the setbacks we faced during the recent winter storms which devastated millions of Midwestern cities, towns, and also the same in the South. We’re moving in the right direction though despite the mess we inherited from the previous administration which left us with no real plan to vaccinate all Americans. And every time we administer another 50 million shots, I’m going to use that milestone and report to the American people on our vaccination program, on our overall fight against this pandemic. The good and the bad, I’ll tell you. The success and the failures.

President Biden: ( 09:32 ) And here’s the deal, here’s the deal. The story of this vaccination campaign is like the story of everything hard and new America does. Some confusion and setbacks at the start and then if we do the right things, we have the right plan to get things moving. That’s what we’re seeing right now. The weeks before I became president, the previous administration saw 6 million shots administered in the last week. This coming week, we will administer over 12 million shots, double the pace, in just six weeks that we’ve been in office. Other milestones. We’ve increased vaccination distribution to states by 70%. Nearly 60% of people over the age of 75 have now received at least one shot. It was 14% six weeks ago. And close to 50% of people over the age of 65 have at least one shot now. It was 8%, six weeks ago. It’s important because people over 65 account for 80% of all the COVID deaths. Additionally, about 75% of the people who live in long-term facilities have gotten their first shot.

President Biden: ( 10:46 ) And those cases are at the lowest level since reporting began in May. Here’s how we’ve been doing it. It starts with increasing the supply. My team has worked very hard with vaccine manufacturers, Pfizer and Moderna, it to ensure we have enough supply for all adult Americans by the end of July. When we discovered the vaccine manufacturers weren’t being prioritized when it came to securing supplies they needed to make the vaccine, we fixed the problem. I used the Defense Production Act to speed up the supply chain for key equipment, which has already helped increase vaccine production. Last week, I toured the Pfizer facility, manufacturing facility, a plant in Kalamazoo, Michigan. It’s incredible, the precision, the safety, the pride, and the sense of purpose everyone involved in that process and project has. We’ve all seen the news about Johnson & Johnson’s vaccine. The idea of a third safe and effective vaccine is very promising. The Food and Drug Administration, the FDA, is reviewing the data and review recommendations from outside committee of experts that will be meeting tomorrow.

President Biden: ( 12:04 ) Let me be clear, we are going to do this the right way. The FDA will decide on emergency use authorization of a vaccine based on science, not due to any political pressure from me or anyone else. No outside factors. What I will say to the American people is this. If, if the FDA approves the use of this new vaccine, we have a plan to roll it out as quickly as Johnson & Johnson can make it. We’ll use every conceivable way to expand manufacturing of the vaccine and we’ll make even more rapid progress on overall vaccines in March. I’ll have more to say about this in the days after the FDA review. Look, we’ve been laser focused on the greatest operational challenge this country has ever undertaken, administering shots in the arms of hundreds of millions of Americans. We’re increasing the number of vaccinators. What we found was you may have the vaccine, but not enough people to put the vaccine in someone’s arm like you just saw.

President Biden: ( 13:10 ) We brought back retired, doctors and nurses. We’ve already deployed more than 1,500 medical personnel you see during national disasters from the Federal Emergency Management Agency, FEMA. And we commissioned our commission corps from the Department of Health and Human Services and the Defense Department, including the National Guard, supplying vaccinators. We’re lining up thousands more to do the vaccinations. We’re also setting up more places for people to get vaccines. As of today, we provided $3.8 billion to states, territories, and tribes to create hundreds of new vaccination centers and ramp up the existing ones that there are already. Working with governors across the country in red and blue states to bolster their efforts to stand up hundreds of vaccination centers from stadiums to community centers, houses of worship, large parking lots, we’re providing personnel and equipment and covering the cost for the states including for the use of their National Guard, which had been there incredible.

President Biden: ( 14:19 ) Today, Jill and I, or should I should say tomorrow, Jill and I will travel to Houston, Texas to tour one of the first federal mass vaccination centers and to thank everyone involved. This is an example of the kind of partnership between federal, state and local governments and public and private partners that’s going to get this job done. We also sent millions of vaccines to thousands of local pharmacies all across America to make it easier for folks to get the vaccine shot like they would their flu shot. Going to a familiar place, familiar folks that they can trust and know to get the shot. And for folks who don’t live near a vaccination center or a pharmacy, we’re deploying mobile units. These are special vehicles and pop-up clinics that meet folks where they live and where they don’t have transportation to get to the places to get the shots.

President Biden: ( 15:21 ) We’ve also started to send vaccines directly to community health centers to help the hard to reach folks in cities and small towns of rural communities and black, Latino, and native American communities that have higher rates of COVID infections and deaths than any other groups. As a result of these round the clock efforts, in five weeks, America’s administered the most shots of any country in the world, any country in the world, with among the highest percentage of population fully vaccinated. That’s progress we promised. And it’s also true that while COVID-19 vaccinations are up, COVID cases and hospitalizations are coming down. But I need to be honest with you, cases and hospitalizations could go back up with new variants as they emerge. So I want to make something really very clear. This is not a time to relax. We must keep washing our hands, stay socially distanced, and for God’s sake, for God’s sake, wear a mask.

President Biden: ( 16:28 ) Some of our progress in this fight is because so many Americans are stepping up and doing those things. And the worst thing we could do now is let our guard down. Of course, it’s my hope to come back in the next report after we’ve done another 50 million shots before the end of my first 100 days. But here’s the critical point, as hard as it is now to believe, we’re going to hit a phase in this effort, maybe as late as April or May, where many predict that instead of long lines of people waiting to get a shot, we’ll face a very different scenario. We’ll have the vaccine waiting, we’ll have ramped up vaccine supplies. We’ll have folks to administer the shots to the most of the people who aren’t eager to get the shots.

President Biden: ( 17:26 ) At least that’s been the prediction. I don’t think it’s going to happen. I think more people see other people getting the shots, it’s going to build confidence. But at the same time, there are people who live in hard to reach areas who can’t get them. And there are folks who are hesitant to take the shot in the first place. We all know there’s a history in this country of subjecting certain communities to terrible medical and scientific abuse. But if there is one message that needs to cut through, it’s this. The vaccines are safe and effective. And I believe as you see your neighbor, your husband, your wife, your son, your daughter, getting it, that you will be much more inclined to get it. Listen to Dr. Fauci, listen to the scientists to developed these vaccines and the extensive and rigorous review they went through.

President Biden: ( 18:14 ) I did. I took my shots publicly to demonstrate to the American people that it’s safe and effective. But the time is coming, maybe 60 to 90 days, when the supply is adequate but not enough people can access the shots or don’t want them. To address that challenge, we’re going to launch a massive campaign to educate people about vaccines, that they are safe and effective, and where to go to get those shots in the first place. And we’re going to bring together leaders of all segments of our society to educate and encourage all Americans to get vaccinated. So I hope the Senate will soon confirm a key leader of that effort. My nominee for the Secretary of Health and Human Service, Xavier Becerra, who did so well in his hearing of this week. I hope Congress passes the American Rescue Plan which I’ve been pushing, which provides funds for everything we need to do to beat this pandemic and get the economy going again.

President Biden: ( 19:16 ) Now, critics say the plan is too big, that it cost too much. But let me ask a rhetorical question, what would you have me cut? What would you have me cut out on vaccines alone if we don’t invest $20 billion to vaccinate the nation, doesn’t that make sense? Or 160 billion in total towards the pandemic for testing, to protective gear, to vaccine production and distribution. I’m ready to hear any ideas on what will make the American Rescue Plan better, stronger, and effective? But we’ll have to answer who will get help and who will get hurt. I want to close with this, the question I’m asked most often is, when will things get back to normal? My answer is always honest and straight forward. I can’t give you a date. I can only promise that we’ll work as hard as we can to make that day come as soon as possible. While things are improving are we’re going from a mess we inherited to moving in the right direction at a significant speed, this is not a victory lap.

President Biden: ( 20:29 ) Everything is not fixed. We have a long way to go. And at that day when everything is back to normal, depends on all of us. It depends on Congress passing the American Recovery Plan. And also for us to remain vigilant, to look out for one another. I’ve said it before, wash your hands, stay socially distanced, wear a mask, get the vaccine when it’s your turn. When your friend or neighbor or loved one is eligible, encourage them to get vaccinated. And above all, remember, we can do this. This is the United States of America. There’s nothing we can’t do when we do it together. So it’s not over yet, but we’re getting close. And God willing, if we do all we know we have to do, we’re going to beat this. Beat it sooner than later. May God bless you all and may God protect our troops. Thank you for your time.

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Does Free Speech Protect COVID-19 Vaccine Misinformation?

• April 22, 2022
• Sharon Beckstrand
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We all know, or have heard about, someone who’s refused to get a COVID-19 vaccine. While some individuals have medical or religious reasons for avoiding vaccination, for some, other factors influence their decision. Despite the importance of vaccines for public health — and the serious risk associated with being unvaccinated — getting the shot may feel like a betrayal of certain political beliefs.

But where does this feeling come from? Throughout the pandemic, some politicians and other influencers have promoted advice that’s not based on scientific data — sometimes it’s with good intentions, other times it’s intentionally misleading. But the outcome is the same: misinformation.

This led  Michelle Mello , JD, PhD, a  Stanford Medicine  professor of health policy and  Stanford Law  professor, to dig into questions that surround this issue.

While some might say making or spreading known false statements related to the vaccine should be criminalized, the First Amendment, which guarantees free speech, continues to provide protection for people who promulgate such faulty information. So, how can the spread of misinformation be stopped without quashing free speech?

I spoke with Mello and asked her to address the Supreme Court’s view on vaccine misinformation — an issue she addressed in a recent  Viewpoint piece  in  JAMA Health Forum . The following Q&A has been edited and condensed.

Several countries have criminalized vaccine misinformation, but the United States has not. Has the Supreme Court’s interpretation of the First Amendment allowed the continued spread of false claims?

The Supreme Court has held that many kinds of false statements are protected speech under the First Amendment. In a 2012 case called  United States v. Alvarez , the Supreme Court struck down a law that made it a criminal offense to lie about having received military medals. It refused to hold that a statement’s falsity put it outside the realm of First Amendment protection.

But there are some kinds of false speech that can be penalized by the government, including lying in court, making false statements to the government, impersonating a government official, defaming someone and committing commercial fraud. But it’s a pretty limited list. The Supreme Court’s general finding is that false statements can often be valuable in terms of allowing people to challenge widely held beliefs without fear of repercussions, and that things could go pretty wrong if the government had a wider berth to regulate them.

What risks would be involved in allowing the government to police false claims?

One problem is that we may not all agree on how demonstrably false something has to be in order for it to be restricted.  For vaccine risks, for example, some claims about health harms have been persuasively disproven, while others have simply not been studied. So, if I claim that a vaccine was the reason my hair fell out, is that false or just not demonstrably true? Should the difference matter?

A related problem is that for some claims, especially scientific ones, the knowledge base that makes a statement true or false evolves over time. To complicate things further, some people who disseminate false statements know they are lies, while others believe they’re true. Finally, many people just don’t trust the government to not abuse the power to declare something false speech.

All of these challenges make the Supreme Court wary of restricting speech that might ultimately prove to be truthful, or at least contribute to public debate that aids in discovering the truth. The Supreme Court would prefer to let the decision about what’s true be hashed out by “the marketplace of ideas.”

But the interesting thing is, these problems also apply to areas where courts do allow regulation of false statements. Lawmakers have found ways of addressing them, such as requiring the government to prove certain things about the statement or the speaker’s state of mind. It’s not clear, therefore, why the Supreme Court draws the lines it does.

How does our reverence for freedom of speech in the United States intensify our vulnerability to public health threats?

It limits our policy toolkit. Rather than curbing misinformation about health issues, the government is relegated to trying to fight it with counter-speech. Although the idea that clashing ideas will surface the best ideas is appealing to judges, it doesn’t always work out in practice. People’s false beliefs arising from vaccine misinformation, in particular, are extremely difficult to change.

First Amendment protections also make it hard for the government to do things like require warnings about health risks. For example, the Food and Drug Administration fought legal battles for years over its initiative to require cigarette makers to put pictorial warning labels on cigarette packs, with the industry arguing that the requirement constituted compelled speech in violation of free speech rights. The City of San Francisco had similar problems when it tried to require beverage companies to put warnings on their billboard advertisements about the link between consumption of sugary drinks and obesity.

What is the broader impact of taking medical advice from non-medical professionals who may have an agenda not grounded in science or medicine?

Many people — including some medical practitioners — have made it harder for Americans to understand how to protect themselves during the pandemic by crowding the information space with claims that aren’t evidence-based.

It can be hard for people to distinguish between reliable and unreliable sources of information, especially about a new health threat and especially when unreliable information is disseminated by individuals who seem trustworthy by dint of their professional role.

In the case of COVID-19 vaccines, misinformation has led as many as 12 million Americans to forgo vaccination, resulting in an  estimated  1,200 excess hospitalizations and 300 deaths per day, according to Johns Hopkins’ Center for Health Security.

What are the ramifications of the continued politicization of the COVID-19 pandemic on our ability to make public health decisions? 

Often, when an issue becomes politicized, people view messages from the group they don’t identify with as suspicious, and messages from the group they do identify with as trustworthy — regardless of how well the messages align with the evidence. If we can’t make sound decisions about how we interact with information, we can’t make sound decisions about health.

(Originally published by  Stanford Medicine’s Scope Blog on April 21, 2022) 

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Persuasive messaging to increase COVID-19 vaccine uptake intentions

Erin k. james.

a Yale Institute for Global Health, New Haven, CT, USA

b Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA

Scott E. Bokemper

c Institution for Social and Policy Studies, Yale University, New Haven, CT, USA

d Center for the Study of American Politics, Yale University, New Haven, CT, USA

Alan S. Gerber

e Department of Political Science, Yale University, New Haven, CT, USA

Saad B. Omer

f Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA

g Yale School of Nursing, West Haven, CT, USA

Gregory A. Huber

Associated data.

Widespread vaccination remains the best option for controlling the spread of COVID-19 and ending the pandemic. Despite the considerable disruption the virus has caused to people’s lives, many people are still hesitant to receive a vaccine. Without high rates of uptake, however, the pandemic is likely to be prolonged. Here we use two survey experiments to study how persuasive messaging affects COVID-19 vaccine uptake intentions. In the first experiment, we test a large number of treatment messages. One subgroup of messages draws on the idea that mass vaccination is a collective action problem and highlighting the prosocial benefit of vaccination or the reputational costs that one might incur if one chooses not to vaccinate. Another subgroup of messages built on contemporary concerns about the pandemic, like issues of restricting personal freedom or economic security. We find that persuasive messaging that invokes prosocial vaccination and social image concerns is effective at increasing intended uptake and also the willingness to persuade others and judgments of non-vaccinators. We replicate this result on a nationally representative sample of Americans and observe that prosocial messaging is robust across subgroups, including those who are most hesitant about vaccines generally. The experiments demonstrate how persuasive messaging can induce individuals to be more likely to vaccinate and also create spillover effects to persuade others to do so as well.

The first experiment in this study was registered at clinicaltrials.gov and can be found under the ID number {"type":"clinical-trial","attrs":{"text":"NCT04460703","term_id":"NCT04460703"}} NCT04460703 . This study was registered at Open Science Framework (OSF) at: https://osf.io/qu8nb/?view_only=82f06ecad77f4e54b02e8581a65047d7.

1. Introduction

The global spread of COVID-19 created an urgent need for safe and effective vaccines against the disease. However, even though several successful vaccines have become available, vaccine hesitancy in the general population has the potential to limit the efficacy of vaccines as a tool for ending the pandemic. For instance, in the United States, the public’s willingness to receive a vaccine has declined from 72 % saying they would be likely to get a COVID-19 vaccine in May 2020 to 60 % of people reporting that they would receive a vaccine as of November 2020 [ 1 ]. Given the considerable amount of skepticism about the safety and efficacy of a COVID-19 vaccine, it has become increasingly important to understand how public health communication can play a role in increasing COVID-19 vaccine uptake.

Vaccination is both a self-interested and a prosocial action [ [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] ]. By getting vaccinated, people protect themselves from a disease, but they also reduce the chance that they become a vector through which the disease spreads to others. If enough people receive a vaccine, the population gains protection through herd immunity, but this also creates an incentive for an individual to not get vaccinated because they can forgo vaccination and receive protection from others who do vaccinate. Recent research on vaccination in general has demonstrated that people view vaccination as a social contract and are less willing to cooperate with those who choose not to get inoculated [ 10 ]. This work also implies that highlighting the reputational costs of choosing not to vaccinate could be an effective strategy for increasing uptake. Further, appeals to herd immunity and the prosocial aspect of vaccination have been shown to increase uptake intentions [ [11] , [12] , [13] ], but emphasizing the possibility of free riding on other’s immunity reduces the willingness to get vaccinated [ 14 ].

Focusing specifically on vaccination against COVID-19, recent studies have found that messages that explain herd immunity increase willingness to receive a vaccine [ 15 ] and reduces the time that people would wait to get vaccinated when a vaccine becomes available to them [ 16 ]. However, other work has found that prosocial appeals did not increase average COVID-19 vaccination intentions [ 17 ] and the effect of prosocial concerns was present in sparsely populated places, but absent in more densely populated ones [ 18 ]. Given the current state of evidence, it is unclear whether appealing to getting a COVID-19 vaccine as a way to protect others will increase willingness to vaccinate.

Viewing vaccination through the lens of a collective action problem suggests that in addition to increasing individuals’ intentions to receive a vaccine, effective public health messages would also increase people’s willingness to encourage those close to them to vaccinate and to hold negative judgments of those who do not vaccinate. By encouraging those close to them to vaccinate, people are both promoting compliance with social norms and increasing their own level of protection against the disease. Also, by judging those who do not vaccinate more negatively, they apply social pressure to others to promote cooperative behavior. This would be consistent with theories of cooperation, like indirect reciprocity or partner choice, that rely on free riders being punished or ostracized for their past actions to encourage prosocial outcomes [ [19] , [20] , [21] , [22] , [23] ]. Thus, effective messaging could have outsized effects on promoting vaccination if it both causes people to vaccinate themselves and to encourage those around them to do so.

We conducted two pre-registered experiments to study how different persuasive messages affect intentions to receive a COVID-19 vaccine, willingness to persuade friends and relatives to receive one, and negative judgments of people who choose not to vaccinate. In the first experiment, we tested the efficacy of a large number of messages against an untreated control condition (see Table 1 for full text of messages). A subgroup of the messages in Experiment 1 drew on this collective action framework of vaccination and emphasized who benefits from vaccination or how choosing not to vaccinate hurts one’s social image. A second subgroup drew on contemporary arguments about restrictions on liberty and economic activity during the COVID-19 pandemic. In Experiment 2, we retested the most effective messages from Experiment 1 on a nationally representative sample of American adults. By utilizing this test and re-test design, we guard against false positive results that are observed by chance among the large number of messages tested in Experiment 1. In our analysis of both experiments, we examined whether specific messages were more effective among certain subgroups of the population.

Experimental treatment messages for Experiment 1 and Experiment 2. All messages add the prose in the table to the content of the Baseline informational control. All of the messages in the table were tested in Experiment 1. The messages that are bolded were retested in Experiment 2.

Experiment 1 was fielded in early July 2020. Participants were randomly assigned to either a placebo control condition in which they read a story about the effectiveness of bird feeders or one of eleven treatment messages. The first message is a Baseline informational control condition that describes how it is important to receive a vaccine to reduce your risk of contracting COVID-19 or spreading it to others. Informational messages have been shown to be effective at increasing COVID-19 vaccine uptake intentions [ 24 ]. This message also emphasized that vaccines are safe and estimated to save millions of lives per year. The other messages add additional content to this baseline message.

The subgroup of messages that emphasized collective action varied who would benefit from vaccination or what other people might think of someone who chooses to be a free rider by not vaccinating. Focusing on who benefits from vaccination, the second message invoked Self Interest and reinforced the idea that vaccination is a self-protecting action (“Remember, getting vaccinated against COVID-19 is the single best way to protect yourself from getting sick.”). The third message, Community Interest, instead argued that vaccination is a cooperative action to protect other people (“Stopping COVID-19 is important because it reduces the risk that members of your family and community could get sick and die.”). This message also invoked reciprocity by emphasizing the importance of every-one working together to protect others.

The fourth, fifth, and sixth messages added an invocation of an emotion, Guilt, Embarrassment, or Anger, to the Community Interest message. These messages prompted people to think about how they would feel if they chose not to get vaccinated and spread COVID-19 to someone else in the future. Emotions are thought to play a role in cooperation, either by motivating an individual to take an action because of a feeling that they experience or restraining them from taking an action because of the emotional response it would provoke in others [ [25] , [26] , [27] ]. Further, anticipated emotional states have been shown to promote various health behaviors, like vaccination [ [28] , [29] ].

The seventh and eighth messages evoked concerns about one’s reputation and social image, which influences their attractiveness as a cooperative partner to others. The seventh, a Not Bravery message, reframed the idea that being unafraid of the virus is not a brave action, but instead selfish, and that the way to demonstrate bravery is by getting vaccinated because it shows strength and concern for others (“To show strength get the vaccine so you don’t get sick and take resources from other people who need them more”). The eighth message was a Trust in Science message that highlights that scientists believe a vaccine will be an effective way of limiting the spread of COVID-19. This message suggests that those who do not get vaccinated do not understand science and signal this ignorance to others (“Not getting vaccinated will show people that you are probably the sort of person who doesn’t understand how infection spreads and who ignores or are confused about science.”).

The final three messages drew on concerns about restrictions on freedom and economic activity that were widespread during the COVID-19 pandemic. A pair of messages focused on how vaccination would allow for a restoration of Personal Freedom (“Government policies to prevent the spread of COVID-19 limit our freedom of association and movement”) or Economic Freedom (“Government policies to prevent the spread of COVID-19 have stopped businesses from opening up”). These messages take a value that is commonly invoked in individuals’ decision to not vaccinate [ [30] , [31] ] and reframed vaccination as something that would actually restore freedoms that had been taken away. The final message, Community Economic Benefit, argues that a vaccine will help return people’s financial security and strengthen the economy This message is similar to the Community Interest messages that are described above, but instead focuses on cooperating to restore the economy (“We can all end this outbreak and strengthen the national economy by working together and getting vaccinated”).

2.1. Experiment 1 results

Panel A of Fig. 1 plots the effect of each vaccine message relative to the untreated control group on intention to vaccinate. The intention to vaccinate measure was formed by combining responses to a question about the likelihood of getting a COVID-19 vaccine within the first 3 months that one is available with a question about getting a vaccine within the first year that one is available. Specifically, for respondents who did not answer that they were very likely to vaccinate within the first three months that a vaccine is available to them, we asked how likely they would be to vaccinate within a year. This measure coded those who are very likely in the first three months at the highest value on the scale followed by very likely within a year descending down to very unlikely within the first year. Analyzing the vaccination item separately does not substantively change the results. All outcome variables were scored 0 to 1, with higher values indicating greater willingness to endorse the pro-vaccine action or belief (Underlying regressions appear in Table S1 and unless otherwise noted, all analyses were pre-registered).

Experiment 1. Messages that frame vaccination as a cooperative action to protect others or emphasize how non-vaccination might negatively affect one’s social image increase reported willingness to advise a friend, and judgment of non-vaccinators. Panel A displays treatment effects for the combined measure of intention to vaccinate, Panel B displays the advise a friend outcome, and Panel C displays the judging a non-vaccinator outcome. Treatment effects for both panels were estimated using OLS regression that included covariates. The effects displayed are a comparison against the placebo control baseline and are presented with 95% confidence intervals. The dashed vertical line is the effect of the Baseline informational control for each outcome.

Compared to the untreated control, the Baseline informational message was associated with modest increases in intention to vaccinate by 0.034 units (95 % CI:0.002, 0.065; p < .05). This effect represents an increase of approximately 6 % in the scale score compared to the outcome in the control condition.

By comparison, the Community Interest, Community Interest + Guilt, Embarrassment, or Anger, Not Bravery, Trust in Science and Personal Freedom messages all produce larger effects, at least qualitatively, than the Baseline informational message on the intention to vaccinate outcome. Effects for the Self-Interest, Economic Freedom, and Community Economic benefit messages were not consistently distinguishable from the untreated control group outcomes, and their effects were indistinguishable from the effects of the Baseline informational message.

The most promising messages were the Not Bravery, Community Interest, and Community Interest + Embarrassment messages. These messages were associated with effects that were statistically distinguishable from the untreated control group (Not Bravery: 0.077 units, 95 % CI: 0.035, 0.119; p < .01, Community Interest: 0.090 units, 95 % CI: 0.050, 0.129; p < .01, Community Interest + Embarrassment: 0.094 units, 95 % CI: 0.054, 0.134; p < .01) at p < .01. Moreover, their effects were always more than twice as large as the Baseline informational treatment and these differences were significant at p < .05 (two-tailed tests). The effects of the Trust in Science message and the Personal Freedom message were not statistically significant when compared to the Baseline informational message.

To put the magnitudes of the effects into context, we re-estimated our analysis after dichotomizing the intended vaccine uptake measure such that those who report they were “somewhat” or “very” likely to get the vaccine, either with three months or a year, are coded as 1 and those who do not are coded 0 (this analysis was not pre-registered). This produced a predicted rate of intended vaccination in the control group of 58.2 %. Respondents who read the Baseline informational message were 7.4 percentage points (95 % CI: 2.9 pp, 12.0 pp; p < .01) more likely to receive a vaccine. Among those assigned to the Not Bravery or Community Interest messages it was predicted to increase by 10.4 percentage points and 12.7 percentage points (Not Bravery: 95 % CI: 4.3 pp, 16.4 pp; p < .01, Community Interest: 95 % CI: 6.7 pp, 18.7 pp; p < .01) respectively, while among those assigned to the Community Interest + Embarrassment message it was predicted to increases by 15.9 percentage points (95 % CI: 10.2 pp, 21.6 pp; p < .01). This last difference was substantively large, representing a proportional increase of 27 % (0.159/0.582) compared to the control condition and a 13 % increase compared to the Baseline informational condition (0.159-0.074)/(0.582 + 0.074).

Turning to the other regarding outcomes that focused on spurring action by others, Panel B plots the effects of each vaccine message relative to the untreated control for advising a friend to receive a vaccine and Panel C plots the effects for negatively judging someone who refuses to receive one. Here, the effect of the Baseline informational intervention was modest and statistically insignificant. However, the Not Bravery, Trust in Science, Personal Freedom, Community Interest, Community Interest + Guilt, and Community Interest + Embarrassment messages had larger effects on both outcomes that were statistically distinguishable from the control outcome.

The most promising message was the Community Interest + Embarrassment message for the advise a friend outcome, which was associated with a 0.09 unit increase in the scale outcome (95 % CI: 0.049, 0.132; p < .01 two-tailed test), an effect that represents an increase of 27 % compared to the mean scale score in the control group. The effect was 0.067 units compared to the Baseline informational message (95 % CI: 0.027, 0.105; p = .001, two-tailed test). We conducted a similar exercise to the one describe above to gauge the relative magnitude of these treatment effects. For the Community Interest + Embarrassment message we estimated a 15 percentage point increase (95 % CI: 0.088, 0.209; p < .01, two tailed test,) in a binary intention to advise others to vaccinate outcome, a proportional increase of 27 % compared to the control group baseline of 53 % (0.15/0.53). This effect was also 6 percentage points larger than the effect of the baseline message (95 % CI: 0.008, 0.121; p = .03, two-tailed test).

The most promising outcome for the negative judgment of non-vaccinators was the Not Bravery message, which had an effect of 0.09 scale points (95 % CI: 0.052, 0.126; p < .01, two-tailed test) compared to the untreated control and 0.072 scale points versus the Baseline information (95 % CI: 0.037, 0.106; p < .01 Baseline message, two-tailed tests). This corresponded to a 21 % increase compared to the scale outcome in the control group (0.09/0.43). These are both substantively and statistically meaningful effects. The Community Interest, Community Interest + Guilt, Community Interest + Embarrassment, Trust in Science, and Personal Freedom messages all produced effects that were statistically distinguishable from the control condition.

We also investigated the robustness of these findings to sample restrictions and whether certain subgroups were more responsive to specific treatment messages (reported in Figures S2-S12 ). Results were generally robust to restricting the sample to those who were over the 10th percentile and under the 90th percentile for completion time. For subgroup analyses, those scoring low in liberty endorsement appeared more responsive to the Baseline treatment and to the Not Bravery message than are those who scored high in liberty endorsement. Those who report being less likely to take risks appeared robustly more responsive to the Not Bravery message than those who were high in risk taking. Those who were high in risk taking appear more responsive to the Personal Freedom message with regard to their own behavioral intentions. Certain groups appeared generically easier to persuade (Democrats rather than Republicans, an important divide that has emerged during the pandemic [ 32 ], and Women rather than Men), but there were no clear differences in which treatments appeared most effective across these groups. We explored the robustness of these subgroup differences in Experiment 2.

Taken together, the most successful messages in Experiment 1 were those that were theoretically motivated by viewing vaccination as a collective action problem. Consistent with previous work that demonstrates that prosocial appeals are effective in promoting vaccination, the Community Interest message and Community Interest + Guilt, Embarrassment, or Anger messages increased COVID-19 vaccine uptake intentions. Moving beyond who benefits from vaccination, the Not Bravery and Trust in Science messages that invoked concerns about one’s social image if they choose not to vaccinate also increased uptake intentions. All of the collective action oriented messages increased intentions to advise a friend to vaccinate and negative judgments of those who do not, potentially creating spillover effects that induce others to vaccinate. In addition to this subgroup of messages, we found that reframing vaccination as a way to restore freedom was also effective, though the other messages motivated by contemporary debates about the pandemic were generally no more effective than the Baseline condition.

2.2. Experiment 2 results

Experiment 2 tested the subset of the best performing messages from Experiment 1 on a nationally representative sample in September 2020. Notably, in the several month period between Experiment 1 and Experiment 2, the public had grown increasingly skeptical of a potential COVID-19 vaccine [ 1 ]. Panel A of Fig. 2 plots the effect of each vaccine message, relative to the untreated control group, on the same measure of intention to vaccinate used in Experiment 1. (The model specifications shown in the figure were from our pre-registered specifications, underlying regression appear in Table S2.). Given that we observed the messages from Experiment 1 were effective at increasing vaccine uptake, we pre-registered directional hypotheses for Experiment 2 that tested whether the effects could be replicated on a nationally representative sample. Accordingly, we report one-tailed hypothesis tests and 90 % confidence intervals in the results presented below. Results largely confirmed the patterns observed in Experiment 1.

Experiment 2. The Not Bravery, Community Interest, and Community Interest + Embarrassment messages increase both intentions to vaccinate and other-regarding outcomes. Panel A displays treatment effects for intentions to vaccinate, Panel B displays the advise a friend, and Panel C displays the judging a non-vaccinator outcomes. Treatment effects for both panels were estimated using OLS regression that included covariates. The effects displayed are a comparison against the placebo control baseline and are presented with 90 % confidence intervals. The dashed vertical line is the effect of the Baseline informational control for each outcome.

The Baseline informational treatment was associated with a modest increase, 0.029 units, in intention to vaccinate (90 % CI: 0.011, 0.046; p < .01, one-tailed test). This effect was a 6 % increase of the observed scale outcome in the untreated control group.

The Community Interest and Community Interest + Embarrassment messages were associated with qualitatively larger effects on intended vaccine uptake. These messages were associated with increases of 0.045 units (90 % CI: 0.021, 0.070; p < .01, one-tailed test) and 0.043 units (90 % CI: 0.019, 0.067; p < .01, one-tailed test), respectively. As with Experiment 1, we recoded those who stated they were “somewhat” or “very” likely to receive the vaccine as 1 and those who did not report that they were likely to receive it as 0 (this analysis was not pre-registered: for consistency we report 90 % confidence intervals). This binary measure produced a predicted rate of intended vaccination in the control group of 51.4 %. Intended uptake was 3.3 percentage points higher in the Baseline information condition (90 % CI: 0.5 pp, 6.0 pp; p < .05, one-tailed test), 3.5 percentage points higher in the Community Interest + Embarrassment condition (90 % CI: −0.1 pp, 7.0 pp; p = .06, one-tailed test), and 5 percentage points higher in the Community Interest condition (90 % CI: 1.3 pp, 0.8.7 pp; p < .05, one-tailed test). The latter effect was proportionally large—10 % compared to the baseline predict rate in the control group (0.050/0.514).

On average, the Not Bravery, Trust in Science, and Personal Freedom messages were approximately as effective as the informational content to which they were added in increasing intention to vaccinate, which differs from Experiment 1 where they modestly outperformed the Baseline informational condition.

Turning to other regarding outcomes, Panel B of Fig. 2 plots effects for advice given to others and Panel C does so for negative judgments of non-vaccinators. The Baseline informational treatment was again associated with statistically significant increases in each outcome. For these outcomes, the Not Bravery, Trust in Science, and both Community Interest messages produced effects that were at least descriptively larger than the Baseline treatment. The effects for the Personal Freedom message were smaller than the Baseline informational treatment, a result that again diverged from Experiment 1.

In terms of advising others to vaccinate, the most effective message was the Community Interest + Embarrassment message, which was also the most effective message in Experiment 1. This effect was 0.07 scale points (90 % CI: 0.043, 0.095; p < .01, one-tailed test), an increase of 14 % compared to the control group average scale score of 0.51 (0.07/0.51). This effect was also statistically distinguishable from the effect of the Baseline informational treatment (difference = 0.045; 90 % CI: 0.020, 0.069; p < .01, one-tailed test). When dichotomizing the advise a friend outcome to better describe the magnitude of the effect, we estimated that the Community interest + Embarrassment message was associated with a 10 percentage point increase (90 % CI: 0.064, 0.140; p < .01, one-tailed test) in intention to advise others to vaccinate compared to the control group, a proportional increase of 27 % compared to the control group baseline of 38 % (0.10/0.38). This effect was approximately 6 points larger than the effect of the Baseline message (90 % CI: 0.026, 0.099; p < .01, one-tailed test).

In terms of judging non-vaccinators, the largest effects were for the Not Bravery and Trust in Science messages, with each effect also statistically distinguishable from the Baseline message. Notably, in this sample the Trust in Science message had large effects on beliefs and actions toward others but appeared ineffective in changing an individual’s own intended vaccination behavior. The Not Bravery message was also the most effective message in this regard in Experiment 1.

We examined three pre-registered differences in subgroup treatment effects to test the patterns observed in Experiment 1. First, confirming Experiment 1 we found that those who did not endorse liberty values were more responsive to the Not Bravery message (compared to the baseline message) than those who endorsed liberty values for the three outcome measures. Second, we did not confirm either preregistered prediction with regard to differences in treatment effects by risk taking that were observed in Experiment 1.

The remaining subgroup comparisons were not pre-registered. Beginning with gender, in comparison to the untreated control, women responded more to the Trust in Science and Community Interest + Embarrassment message than did men (all five outcomes), while men responded more to the Not Bravery and Community Interest (without embarrassment) messages. Democrats were more responsive than Republicans across the board to the different treatment messages, while Republicans appeared to react only to the Community Interest and Community Interest + Embarrassment messages (magnitudes similar to those of Democrats). We observed a similar pattern for differences by baseline vaccine confidence, measured pre-treatment with a multi-item battery of questions [ 33 ]. Those high in vaccine confidence responded to all messages, while those low in confidence responded reliably only to the Community Interest messages.

3. Discussion

Overall, the results point both to a set of effective messages and the potential efficacy of specific messages for some particular subgroups. On average, a simple informational intervention is effective, but it is even more effective to add language framing vaccine uptake as protecting others and as a cooperative action. Not only does emphasizing that vaccination is a prosocial action increase uptake, but it also increases people’s willingness to pressure others to do so, both by direct persuasion and negative judgment of non-vaccinators. The latter social pressure effects may be enhanced by highlighting how embarrassing it would be to infect someone else after failing to vaccinate. The Not Bravery and Trust in Science messages had substantial effects on other regarding outcomes and for some subgroups, but do not appear to be as effective as the Community Interest messages in promoting own vaccination behavior. Importantly, in distinct samples fielded several months apart, the Community Interest, Community Interest + Embarrassment, and the Not Bravery messages produced substantively meaningful increases for all outcomes measures relative to the untreated control, and in some instances did so in comparison to the Baseline information condition.

Our findings are consistent with the idea that vaccination is often treated as a social contract in which people are expected to vaccinate and those who do not are sanctioned [ 10 ]. In addition to messages emphasizing the prosocial element of vaccination, we observed that messages that invoked reputational concerns were successful at altering judgment of those who would free ride on the contributions of others. This work could also help explain why social norm effects appear to overwhelm the incentive to free ride when vaccination rates are higher [ [34] , [35] ]. That is, messages that increased intentions to vaccinate also increased the moralization of non-vaccinators suggesting that they are fundamentally linked to one another. These messages will need to be adapted in specific cultural contexts with relevant partners, such as community leaders.

The robust effect of the Community Interest message advances our current understanding of whether public health messaging that deploys prosocial concerns could be effective at increasing COVID-19 vaccine uptake. The results of both experiments presented here support prior work that demonstrated the effectiveness of communication that explains herd immunity on promoting vaccination [ [15] , [16] ]. It also suggests that a detailed explanation of herd immunity may not be necessary to induce prosocial behavior.

Beyond the theoretical contribution, the results have practical implications for vaccine communication strategies for increasing COVID-19 vaccine acceptance. We identified multiple effective messages that provide several evidence-based options to immunization programs as they develop their vaccine communication strategies. Importantly, the insights into differential effectiveness of various messages by subgroup (e.g. men vs women) could inform messaging targeted to specific groups. Understanding heterogeneous treatment effects and the mechanisms that cause differential responses to persuasive messaging strategies requires additional testing and theoretical development. We view this as a promising avenue for future work.

The experiments presented here are not without limitations. First, we measured intentions to vaccinate at a time when a vaccine was not currently available and the effectiveness and side effects of potential vaccines were not known. This also meant that we could not observe actual vaccination behavior, which is ultimately the outcome of interest. While intentions predict behavior in many contexts [ [36] , [37] ] including vaccination [ [38] , [39] , [40] ], past research examining the effect of behavioral nudges on COVID-19 vaccine uptake has produced divergent evidence when testing the effect of the same treatments in the field on behavior and in a survey experiment on a behavioral intention [ 41 ]. This observation highlights the need for field testing messages that have shown to be successful on increasing uptake intentions in survey experiments to ascertain whether they also increase vaccine uptake. It may be that field tests reveal certain messages are particularly less effective than in the survey context, or that messages are uniformly less effective. Second, given the rapidly evolving nature of the COVID-19 pandemic, attitudes about vaccines may have changed since the experiments were fielded which could also change the efficacy of the messages that we tested. Third, we cannot be sure whether, or how long, the effects we observe here persist. Finally, we only tested text-based messages, but public health messaging is delivered through many mediums, like public service announcements, videos, and images. Future work can adapt the successful messaging strategies found here and test their efficacy when delivered in alternative formats.

Efforts to vaccinate individuals against COVID-19 are currently underway in the United States and it remains important to convince the mass public of the safety and efficacy of COVID-19 vaccines to ensure that the threshold for herd immunity is reached. Our experiments provide robust evidence that appealing to protecting others has effects on intentions to get vaccinated and to apply social pressure to others to do so as well.

4. Materials and methods

4.1. ethics statement.

The experiments reported here were fielded under an exemption granted by the Yale University IRB. Informed consent was obtained from participants and they were informed that they could stop the study at any time. Data was collected anonymously and contained no personally identifiable information.

4.2. Experiment 1

Participants and Procedure. Participants were recruited by the vendor Luc.id to take a survey. Of those who were recruited, 4,361 participants completed the survey. An examination of attrition during the survey reveals that attrition was balanced across groups which minimizes concerns that the treatment effects estimated in the main manuscript are affected by attrition. The survey was programmed using the survey software Qualtrics. The survey was fielded between July 3, 2020 and July 8, 2020.

Experimental Design. Participants first completed basic demographic and pre-treatment attitudinal questions and were asked about their experience with COVID-19. After this, participants read a treatment message. They were required to spend at least 20 s on the survey page that contained the message to given them an adequate amount of time to read it. We allocated 2/15 of the sample to the untreated control condition and 1/5 of the sample to the Information baseline condition due to the number of comparisons that would utilize these conditions. Each of the remaining conditions received 1/15 of the sample. The design and analysis were pre-registered at ClinicalTrials.gov (protocol ID: 2000027983).

Outcome Measures. For COVID-19 vaccine uptake intentions, participants were asked “How likely are you to get a COVID-19 vaccine within the first 3 months that it is available to you?” and “How likely are you to get a COVID-19 vaccine in the first year that it is available to you?” Respondents answered this question on a five-point scale with end points of “Extremely unlikely” and “Extremely likely.” The main text describes how these items were combined for analysis. Turning to the likelihood of advising someone to vaccinate, respondents were asked “How likely are you to advise a close friend or relative to get vaccinated against COVID-19 once a vaccine becomes available?” Respondents also answered this question on a five-point scale with end points of “Extremely unlikely” and “Extremely likely.” Finally, for judging someone who chooses not to vaccinate, respondents read “we would like you to think about a friend or relative who chose not to receive a COVID-19 vaccine when it is available. What would you think about this person? Are they…”. This prompt was followed by four traits: trustworthy, selfish, likeable, and competent. The response options were “not at all”, “slightly”, “somewhat”, “mostly”, and “very.”

Analysis. We used OLS regression with robust Huber-White standard errors and indicators for assigned treatment to estimate treatment effects. We use robust standard errors to address the heteroscedasticity observed when estimating our primary analysis models without them. We included covariates as described in the Supplementary Materials . Comparisons across treatments are from linear combination of coefficients tests. For the subgroup analyses, we restricted the sample to the stated criteria and estimate the model specified here on the subsample. For liberty endorsement and risk taking, we determined who was high and low by splitting the sample at the mean.

4.3. Experiment 2

Participants and Procedure. Participants ( n  = 5,014) were recruited by the vendor YouGov/Polimetrix. YouGov provides subjects using a sampling procedure that is designed to match a number of Census demographics. To determine the sample size, we conducted a power analysis to detect effects that were 80 % as large as those observed in Experiment 1. The experiment was fielded between September 9, 2020 and September 22, 2020.

Experimental Design. Participants first completed basic demographic and pre-treatment attitudinal questions and were asked about their experience with COVID-19. Participants were randomly assigned to one of seven conditions: the untreated control, the Information baseline control, Community Interest, Community Interest + Anticipated Embarrassment, Not Bravery, Trust in Science, or Personal Freedom. As in Experiment 1, more participants were assigned to the untreated control condition and the Baseline information control condition, 1/5 and 3/10 of the sample respectively. The remaining five conditions each received 1/10 of the sample. Participants were required to spend at least 30 s on the survey page that had the treatment message. The design and analysis were pre-registered at Open Science Framework.

Outcome Measures. The outcome measurement was the same as described in Experiment 1 with the exception of intelligent being added to the judgment of a non-vaccinator scale.

Analysis. We used the same modeling approach described above to produce the results displayed in Fig. 2 . We included covariates as described in the Supplementary Materials . For subgroup analyses, we estimated OLS regression models with an indicator variable if a person was a member of a subgroup (e.g. high endorsement of liberty) and zero otherwise.

CRediT authorship contribution statement

Erin K. James: Conceptualization, Writing- original draft, Writing- review and editing. Scott E. Bokemper: Conceptualization, Data curation, Formal analyses. Alan S. Gerber: Conceptualization, Writing- review and editing. Saad B. Omer: Conceptualization, Writing- review and editing. Gregory A. Huber: Conceptualization, Data curation, Formal analyses, Writing- original draft, Writing- review and editing.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgments

The authors would like to acknowledge support for the Tobin Center for Economic Policy at Yale University. EKJ and SBO were supported by the Yale Institute for Global Health.

SEB, ASG, and GAH received support from the Institution for Social and Policy Studies and the Center for the Study of American Politics at Yale University.

Appendix A Supplementary data to this article can be found online at https://doi.org/10.1016/j.vaccine.2021.10.039 .

Appendix A. Supplementary material

The following are the Supplementary data to this article:

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Vaccine Misinformation and the First Amendment—The Price of Free Speech

• 1 Stanford Law School, Stanford, California
• 2 Department of Health Policy, Stanford University School of Medicine, Stanford, California
• Viewpoint Public Health Messaging in an Era of Social Media Raina M. Merchant, MD, MSHP; Eugenia C. South, MD, MSHP; Nicole Lurie, MD, MSPH JAMA
• Medical News & Perspectives When Physicians Spread Unscientific Information About COVID-19 Rita Rubin, MA JAMA
• Viewpoint Reducing “COVID-19 Misinformation” While Preserving Free Speech William M. Sage, MD, JD; Y. Tony Yang, ScD, LLM, MPH JAMA
• Viewpoint Government Role in Regulating Vaccine Misinformation on Social Media Platforms Y. Tony Yang, ScD, LLM, MPH; David A. Broniatowski, PhD; Dorit Rubinstein Reiss, PhD JAMA Pediatrics

During COVID-19, the public health toll of vaccine misinformation has risen from bothersome to titanic. As many as 12 million persons may have forgone COVID-19 vaccination in the US because of misinformation, resulting in an estimated 1200 excess hospitalizations and 300 deaths per day. If 5 fully loaded 747s crashed each week due to wrong information, regulators would be apoplectic.

Several other countries have criminalized the spread of vaccine misinformation. But because of the Supreme Court’s attachment to a particular conception of free speech rights, the thrust of the US government’s response is to disseminate accurate vaccine information and hope it corrects misconceptions. Although a few kinds of false statements lie outside the First Amendment’s protections, many others are considered protected speech. The Supreme Court recognizes that false speech can cause harm, but is more willing to abridge speech rights to avoid some kinds of harm than others. Legal scholars have long bemoaned the Supreme Court’s selective attention to harm avoidance, and the pandemic has exposed its public health consequences.

In a 2012 case invalidating a law that criminalized lying about receiving military medals, the Supreme Court refused to hold that false statements lie wholly outside First Amendment protection. The Supreme Court emphasized that false statements can have value; allowing widespread consensus to be challenged without fear of reprisal may facilitate truth discovery. 1

When a government-imposed restriction on misinformation is based on the content of the speech, courts will apply their most intensive level of review. The government must show that its restriction furthers a compelling government interest that a more narrowly tailored policy—one that burdens speech less—could not achieve as effectively. Allowable restrictions on false speech include bans on perjury, false statements to the government, impersonating government officials, commercial fraud, and defamation. These prohibitions “protect the integrity of Government processes,” preclude people from gaining material advantage through deceit, and prevent “tangible harm to others.” 1

Courts would certainly deem combating COVID-19 a compelling interest, and the government could readily demonstrate that vaccine misinformation harms its interest. The problem is that courts have proven too willing to endorse more narrowly tailored policy alternatives. Although in theory courts limit their review to “effective alternatives,” 1 in cases involving other important health matters, courts have suggested policies that public health experts would find laughable—for example, in lieu of restricting prescription drug sales representatives from promoting off-label uses , capping the number of off-label prescriptions a physician can write; instead of requiring that “crisis pregnancy centers” inform patients that the State of California offers low-cost family planning services, funding a public advertising campaign (something California had already tried).

Arguments that health officials could simply fight vaccine misinformation with “counter speech” would find favor, despite evidence that false beliefs arising from vaccine misinformation are extremely difficult to dislodge. 2 , 3 The volume of misinformation, its rapid spread through trusted social networks, and cognitive biases reinforcing preexisting beliefs all undercut the notion that the solution to false speech is more speech in this case.

Courts’ readiness to accept ineffectual policies when public health is at stake underscores that the scales are heavily tipped toward First Amendment rights. Yet, restricting false statements about health products in some contexts is permissible. For commercial speech (such as advertising), misleading statements enjoy no First Amendment protection. 4 The US Food and Drug Administration can act against companies that claim without sufficient evidence that their products help prevent or treat disease. The Federal Trade Commission and state attorneys general can bring civil and criminal actions against businesses that sell health products using deceptive advertising or fraudulent misrepresentations. There is also latitude for regulating professional speech: state medical licensing boards can suspend the licenses of physicians whose statements constitute unprofessional conduct, 5 and have done so occasionally when physicians have spread false information about COVID-19 vaccines and therapeutics.

Thus, the Supreme Court will allow the government to police false statements in some contexts regardless of how remote the risk of actual harm. But other falsities that can directly lead to serious harm enjoy legal protection. Although an advertisement from a health products company calling vaccines less safe and effective against COVID-19 than hydrogen peroxide is actionable, the same statement from a television news pundit is not. Moreover, noncommercial harms that the Supreme Court has allowed the government to prevent through speech restrictions—like ensuring that government processes function smoothly and a person’s reputation is not damaged by defamatory statements—pale compared with other harms arising from false speech, such as prolonging a pandemic.

Certainly, allowing the government to police false claims has real risks. Although some claims are demonstrably false, others are less so, and regulators may err in distinguishing among them. Especially in the scientific realm, the knowledge that makes statements demonstrably true or false evolves. In addition, some people who disseminate false statements know they are lies, whereas others believe they are true. Thus, there is a risk of suppressing speech that ultimately proves to be truthful, and of chilling discourse by making people worry about whether they can back up their claims.

But these problems also apply to areas where courts allow regulation of false statements. Lawmakers have found ways of addressing them, such as by requiring the government to prove certain things about the statement or the speaker’s state of mind. These measures could also be applied to vaccine misinformation.

If courts are concerned about disruption of government processes and tangible harm to individuals, they should recognize that vaccine misinformation causes both. Furthermore, if courts allow the government to restrict false speech to prevent economic harms such as being defrauded, should they not also allow speech restrictions to prevent loss of life? If officials may ban false advertising to prevent people from ingesting unsafe, unproven treatments, why can they not also ban false statements to prevent people from forgoing safe, proven vaccines?

At a minimum, courts ought to permit prohibitions on false information disseminated with reckless disregard for its falsity that materially influences people’s vaccination decisions. And yet, the current Supreme Court is unlikely to do so. The risks associated with allowing the government to suppress information about a contested scientific issue would be considered too great.

This leaves the government with anemic countermeasures for false speech about important health issues. It can continue to issue messages supporting vaccine safety and fund vaccine education initiatives. It can also continue to pressure social media platforms to do what the government itself cannot. 6 , 7 Because the First Amendment does not apply to private actors, digital media companies such as Facebook, Twitter, and Spotify have more latitude to restrict speech.

However, making corporations the primary bulwarks against vaccine misinformation is an unpromising public health strategy. Platforms have scant incentives to aggressively monitor vaccine-related speech, even if they could someday gain the technical capacity to do swiftly, at scale, with low error rates. 7 COVID-19 vaccine misinformation also spreads through television and radio outlets, which may be economically rewarded for spreading misinformation and appear disinclined to stop.

Vaccine misinformation during the COVID-19 pandemic underscores how reverence for freedom of speech in the US intensifies our vulnerability to public health threats. Given what we know about how vaccine misinformation influences vaccine acceptance and how intractable false beliefs are, this misinformation may be among the most significant barriers to controlling infectious disease in the 21st century.

Published: March 10, 2022. doi:10.1001/jamahealthforum.2022.0732

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2022 Mello MM. JAMA Health Forum .

Corresponding Author: Michelle M. Mello, JD, PhD, MPhil, Stanford Law School and Department of Health Research and Policy, Stanford School of Medicine, 559 Nathan Abbott Way, Stanford, CA 94305 ( [email protected] ).

Conflict of Interest Disclosures: Dr Mello reported receiving personal fees for serving as an adviser to Verily Life Sciences LLC on a product designed to facilitate safe return to work and school during COVID-19, for serving as an expert witness on behalf of a generic pharmaceutical company in an antitrust lawsuit against other pharmaceutical manufacturers, and for serving as an expert witness on behalf of a health insurer in litigation against a brand-name drug manufacturer relating to off-label drug promotion.

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Mello MM. Vaccine Misinformation and the First Amendment—The Price of Free Speech. JAMA Health Forum. 2022;3(3):e220732. doi:10.1001/jamahealthforum.2022.0732

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Does Free Speech Protect COVID-19 Vaccine Misinformation?

• Sharon Beckstrand

We all know, or have heard about, someone who's refused to get a COVID-19 vaccine. While some individuals have medical or religious reasons for avoiding vaccination, for some, other factors influence their decision. Despite the importance of vaccines for public health — and the serious risk associated with being unvaccinated — getting the shot may feel like a betrayal of certain political beliefs.

But where does this feeling come from? Throughout the pandemic, some politicians and other influencers have promoted advice that's not based on scientific data -- sometimes it's with good intentions, other times it's intentionally misleading. But the outcome is the same: misinformation.

This led  Michelle Mello , JD, PhD, a  Stanford Medicine  professor of health policy and  Stanford Law  professor, to dig into questions that surround this issue.

While some might say making or spreading known false statements related to the vaccine should be criminalized, the First Amendment, which guarantees free speech, continues to provide protection for people who promulgate such faulty information. So, how can the spread of misinformation be stopped without quashing free speech?

I spoke with Mello and asked her to address the Supreme Court's view on vaccine misinformation -- an issue she addressed in a recent  Viewpoint piece  in  JAMA Health Forum . The following Q&A has been edited and condensed.

Several countries have criminalized vaccine misinformation, but the United States has not. Has the Supreme Court's interpretation of the First Amendment allosed the continued spread of of false claims? 

The Supreme Court has held that many kinds of false statements are protected speech under the First Amendment. In a 2012 case called  United States v. Alvarez , the Supreme Court struck down a law that made it a criminal offense to lie about having received military medals. It refused to hold that a statement's falsity put it outside the realm of First Amendment protection.

But there are some kinds of false speech that can be penalized by the government, including lying in court, making false statements to the government, impersonating a government official, defaming someone and committing commercial fraud. But it's a pretty limited list. The Supreme Court's general finding is that false statements can often be valuable in terms of allowing people to challenge widely held beliefs without fear of repercussions, and that things could go pretty wrong if the government had a wider berth to regulate them.

Read the Full Q&A on the School of Medicine's Scope Blog

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On June 27, 2024, the CDC Director adopted the ACIP’s recommendations for use of 2024–2025 COVID-19 vaccines in people ages 6 months and older as approved or authorized by FDA. The 2024–2025 vaccines are expected to be available in fall 2024. This page will be updated at that time to align with the new recommendations. Learn more: www.cdc.gov/media/releases/2024/s-t0627-vaccine-recommendations.html

Myths & Facts About COVID-19 Vaccines

What to know, getting a covid-19 vaccine is a safer and more dependable way to build immunity to covid-19 than getting sick with covid-19..

COVID-19 can cause severe illness or death. You can also continue to have long-term health issues after COVID-19 infection . Getting sick with COVID-19 offers protection from future illness. This protection is sometimes called “natural immunity”. The level of protection people get from a COVID-19 infection may vary depending on how mild or severe their illness was, the time since their infection, and their age.

Getting a COVID-19 vaccine can provide added protection for people who already had COVID-19 .

Learn about why you should get vaccinated even if you already had COVID-19 .

The ingredients in COVID-19 vaccines are safe.

None of the COVID-19 vaccines contain ingredients like preservatives, tissues (such as aborted fetal cells), antibiotics, food proteins, medicines, latex, or metals. Exact vaccine ingredients vary by manufacturer.

Learn more about what ingredients are and are not in Pfizer-BioNTech, Moderna, and Novavax COVID-19 vaccines.

COVID-19 vaccines do not cause new variants.

COVID-19 vaccines do not create or cause variants of the virus that causes COVID-19. As the COVID-19 virus spreads, it has more opportunities to change.

Learn more about variants.

COVID-19 vaccines do not contain microchips and they cannot make you magnetic.

Vaccines work by stimulating your immune system to produce antibodies. After getting vaccinated, you develop immunity to that disease, without having to get the disease first.

COVID-19 vaccines are not administered to track your movement. They are free from manufactured products such as microelectronics, electrodes, carbon nanotubes, and nanowire semiconductors.

COVID-19 vaccines are free from metals such as iron, nickel, cobalt, lithium, and rare earth alloys. They do not contain ingredients that can produce an electromagnetic field at the site of your injection.

Learn more about the ingredients in the COVID-19 vaccinations authorized for use in the United States.

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COVID-19 vaccination is recommended for people who are pregnant, trying to get pregnant now, or might become pregnant in the future, as well as their partners.

Learn more about COVID-19 vaccines and people who would like to have a baby .

COVID-19 vaccines do not alter DNA.

Both messenger RNA (mRNA) and protein subunit COVID-19 vaccines work by delivering instructions (genetic material) to your cells to start building protection against the virus that causes COVID-19.

After the body produces an immune response, it gets rid of all the vaccine ingredients just as it would get rid of any information that cells no longer need. This process is a part of normal body functioning.

The genetic material delivered by mRNA vaccines never enters the nucleus of your cells, which is where your DNA is kept, so the vaccine does not alter your DNA.

Learn more about how COVID-19 vaccines work .

Not all events reported to the Vaccine Adverse Event Reporting System (VAERS) are caused by vaccination.

Some VAERS reports may contain information that is incomplete, inaccurate, coincidental, or unverifiable. Vaccine safety experts study these adverse events and look for unusually high numbers of health problems, or a pattern of problems, after people receive a particular vaccine.

The number of deaths reported to VAERS following COVID-19 vaccination has been misinterpreted and misreported as if this number means deaths that were proven to be caused by vaccination. Reports of adverse events to VAERS following vaccination, including deaths, do not necessarily mean that a vaccine caused a health problem.

Learn more about VAERS .

COVID-19 vaccines recommended for use in the United States do not shed or release their components.

None of the COVID-19 vaccines recommended for use in the U.S. contain a live virus. mRNA and protein subunit vaccines are the two types of currently authorized COVID-19 vaccines available in the U.S.

Learn more about mRNA and protein subunit COVID-19 vaccines .

Finding credible vaccine information

Accurate vaccine information can help stop common myths and rumors. Yet, it can be difficult to know which sources of information you can trust.

Before considering vaccine information on the Internet, check that the information comes from a credible source and is updated on a regular basis. While the Internet is a useful tool for researching health-related issues, it should not replace a discussion with a healthcare professional.

Learn more about finding credible vaccine information .

COVID-19 (coronavirus disease 2019) is a disease caused by a virus named SARS-CoV-2. It can be very contagious and spreads quickly.

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US admitted it spread anti-vax COVID propaganda in Philippines to disparage China

Washington, D.C. – The U.S. Defense Department admitted it spread propaganda in the Philippines aimed at disparaging China’s Sinovac vaccine during the COVID-19 pandemic, according to a June 25 document cited by a former top government official earlier this month.

The U.S. response to the Philippines was recounted in a podcast by Harry Roque, who served as spokesman for former Philippine President Rodrigo Duterte. Reuters subsequently reviewed the document, which hasn’t been publicly released by either government. The news agency was able to verify its contents with a source familiar with the U.S. response.

“It is true that the (Department of Defense) did message Philippines audiences questioning the safety and efficacy of Sinovac,” according to the document, which references information sent from the U.S. Defense Department to the Philippine Department of Foreign Affairs and Department of National Defense. According to the document, the Pentagon also conceded it had “made some missteps in our COVID-related messaging” but assured the Philippines that the military “has vastly improved oversight and accountability of information operations” since 2022.

The U.S. admission followed a June 14 Reuters investigation that revealed how the Pentagon launched a secret psychological operation to discredit Chinese vaccines and other COVID-19 aid in 2020 and 2021, at the height of the pandemic.

Through phony internet accounts with tens of thousands of followers meant to impersonate Filipinos, social media posts decried the quality of face masks, test kits and China's Sinovac shot. As a result of the Reuters investigation, the Philippine Senate Foreign Relations Committee launched a hearing into the matter and sought a response from the U.S.

COVID in Paris Olympics: What happens if an athlete tests positive?

According to the June 25 document, Pentagon officials concluded its anti-vax campaign was “misaligned with our priorities.” It says the U.S. military told Filipino officials that operatives “ceased COVID-related messaging related to COVID-19 origins and COVID-19 vaccines in August 2021.”

The Philippines’ defense and foreign affairs departments did not respond to requests for comment about the U.S. military’s admission that it ran the propaganda program. Department of Defense spokesperson Pete Nguyen declined to confirm the U.S. response cited in the document. But he acknowledged the Pentagon did distribute “social media content about the safety and efficacy of Sinovac.”

At the time the Pentagon launched its campaign, national security officials in Washington worried that China was exploiting the pandemic to negotiate important geopolitical deals and undermine U.S. alliances internationally by sending aid to the Philippines and other nations.

The clandestine psychological operation uncovered by Reuters wasn’t limited to the Philippines. It also targeted developing countries across Central Asia, the Middle East and Southeast Asia in 2020 and 2021. The Philippines and those other nations were, at the time, heavily reliant on China’s Sinvoac to inoculate their populations against the deadly virus.

In Southeast Asia, the Philippines was among the countries hit hardest by the coronavirus. By 2024, COVID-19 had killed almost 67,000 Filipinos, and the number of infections there had reached more than 4 million, according to World Health Organization data.

In the wake of the U.S. propaganda efforts, however, then-Philippines President Rodrigo Duterte had grown so dismayed by how few Filipinos were willing to be inoculated that he threatened to arrest people who refused vaccinations.

“You choose, vaccine or I will have you jailed,” a masked Duterte said in a televised address in June 2021. “There is a crisis in this country … I’m just exasperated by Filipinos not heeding the government.”

Reuters identified a network of hundreds of fake accounts on X, formerly Twitter, that closely matched descriptions shared by former U.S. military officials familiar with the Philippines operation. When Reuters asked X about the accounts, the social media company removed the profiles after independently determining they were part of a coordinated bot campaign.

The military program started under former President Donald Trump in the spring of 2020 and continued for months into Joe Biden’s presidency, Reuters found – even after alarmed social media executives warned the new administration that the Pentagon had been trafficking in COVID-19 misinformation. The Biden White House issued an edict in the spring of 2021 banning the anti-vax effort, which also disparaged vaccines produced by other rivals, and the Pentagon initiated an internal review, Reuters found.

Nguyen, the Pentagon spokesperson, had said the review "found that the U.S. military was not responsible for the troubling social media content related to the Philippines."

Asked whether the social media accounts with those particular posts were handled by contractors or other non-military partners working on behalf of the U.S. government, Nguyen declined to say. He also declined to answer questions about U.S. military anti-vax propaganda efforts across Central Asia and the Middle East.

Briefed on the Pentagon’s secret anti-vax campaign by Reuters, some American public health experts also condemned the program, saying it put civilians in jeopardy for potential geopolitical gain. An operation meant to win hearts and minds endangered lives, they said.

“I don’t think it’s defensible,” Daniel Lucey, an infectious disease specialist at Dartmouth’s Geisel School of Medicine, told Reuters. “I’m extremely dismayed, disappointed and disillusioned to hear that the U.S. government would do that,” said Lucey, a former military physician who assisted in the response to the 2001 anthrax attacks.

The effort to stoke fear about Chinese inoculations risked undermining overall public trust in government health initiatives, including U.S.-made vaccines that became available later, Lucey and others said. Although the Chinese vaccines were found to be less effective than the American-led shots by Pfizer and Moderna, all were approved by the World Health Organization.

“It should have been in our interest to get as much vaccine in people’s arms as possible,” said Greg Treverton, former chairman of the U.S. National Intelligence Council, which coordinates the analysis and strategy of Washington’s many spy agencies. What the Pentagon did, Treverton said, “crosses a line.”

In a statement to Chinese media after the Reuters investigation in June, a Sinovac spokeswoman blasted the U.S. military. “Stigmatizing vaccination will lead to a series of consequences, such as a lower inoculation rate, the outbreak and spread of disease, social panic and insecurity, as well as crises of confidence in science and public health,” said Sinovac spokeswoman Yuan Youwei.

The Reuters investigation has spurred a Senate probe in the Philippines led by Senator Imee Marcos, head of the Foreign Relations committee. At a hearing on June 25, Marcos described the U.S. military campaign as “evil, wicked, dangerous, unethical.” She questioned whether it violated international law and wondered whether the Philippines had any legal recourse.

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Modified self-amplifying rna provides opportunities for new vaccines and treatments.

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HOLLYWOOD, FLORIDA - AUGUST 07: Lisa Taylor receives a COVID-19 vaccination from RN Jose Muniz as ... [+] she takes part in a vaccine study at Research Centers of America on August 07, 2020 in Hollywood, Florida. Research Centers of America is currently conducting COVID-19 vaccine trials, implemented under the federal government's Operation Warp Speed program. The center is recruiting volunteers to participate in the clinical trials, working with the Federal Government and major Pharmaceutical Companies, that are racing to develop a vaccine to potentially prevent COVID-19. (Photo by Joe Raedle/Getty Images)

A paper published on July 8, 2024 in the journal Nature Biotechnology presents promising data that offers a foundation for developing future vaccines and treatments. Researchers Joshua McGee, lead author, senior authors Mark Grinstaff, Wilson Wong, and Florian Douam and other colleagues from Boston University solved a longstanding challenge with self-amplifying RNA. They used modified building blocks, called NTPs to build their saRNA. Once they established proof of concept in cells, they tested their method in vaccinated mice against a SARS-CoV-2 lethal challenge. Their vaccine yielded much higher antibody levels and better protection against the challenge than a similar mRNA-based vaccine.

mRNA Vaccines Explained

Most readers are aware that messenger RNA technology was used in the vaccines given to protect against SARS-CoV-2, the virus that causes Covid-19 illness. Reviewing some of the basics, our genetic material is encoded in DNA. In order to make vital proteins in the body, such as enzymes to run cellular functions or to build tissue, cells translate DNA into mRNA and mRNA into proteins. Both DNA and RNA are made up of building blocks, called NTPs.

Similar to any transport vessel, once injected into the muscle, mRNA can carry sequences of NTPs, called cargoes, into cells. The mRNA is then translated by the body’s cellular machinery into proteins of interest. If the cargo sequence is intended as a vaccine, proteins against the pathogen of concern are generated and the body then develops an immune response against those proteins and ultimately protects us against the pathogen.

Challenges of mRNA Vaccines

There are a couple challenges with mRNA vaccines. First, they cause a robust immune response, which can be assessed by measuring interferon levels. This robust response limits the amount of time that they remain viable, which in turn reduces the amount of protein that they can crank out, prompting the need for additional booster doses of the vaccines. Second, mRNA has a short half-life and requires high doses. The high doses coupled with a robust immune response can lead to inflammation and unappealing side effects, such as fever, body aches, and fatigue that many of us have experienced. Third, the mRNA carries only a single cargo and thus only codes for a single protein of interest.

How Are saRNAs Different?

The promise of using saRNA as an alternative to mRNA is that it provides the “gift that keeps on giving.” Since saRNA self-replicates , a much smaller dose is needed than mRNA, because they could essentially turn the cells into protein production factories, continuing to crank out proteins over a longer period of time than mRNA. In doing so, they could then lead to much better long-term immune response and protection over time. Unfortunately, because they are self-replicating, saRNA causes a robust interferon response, which rapidly shuts off protein production.

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Trump campaign files complaint over harris receiving over $90 million in biden funds, today’s nyt mini crossword clues and answers for wednesday, july 24, the scientific approach used.

The data from Boston University overcome this hurdle. The BU researchers started by making a “library” with multiple modifications to the NTP building blocks for saRNA. They then conducted a screening process in cells to determine which of their modified saRNAs maintained robust protein production – they found three. They selected the one for further study that was most efficient in entering the cells and determined that it led to higher protein production in different types of cells compared with native, unmodified saRNA and mRNA. Basically, they were looking for the sweet spot of an saRNA that caused robust protein response along with a dampened inflammatory response.

All good so far. Next they needed to demonstrate proof of concept in live animals. They compared three different platforms to vaccinate mice with the spike protein from SARS-CoV-2 as the cargo: their new modified saRNA versus mRNA versus an unmodified saRNA. They gave an initial vaccine and a booster vaccine 21 days later to different groups of mice to test the response from three doses: 10 ng, 100 ng and 1000 ng. Then, they challenged the mice through the nose with a lethal dose of SARS-CoV-2 virus 35 days after the first vaccine.

At the 1000 ng dose, all mice survived. The real distinction occurred at the lowest dose of 10 ng: 25% of those receiving mRNA survived, versus 45% with an unmodified saRNA and compared to 75% survival with their modified saRNA. More exciting was that the antibody response in the mice receiving their modified saRNA was 121 times higher than the mRNA-vaccinated mice. They also found that Interferon I levels induced by their saRNA were lower than the mRNA mice and gone by 48 hours. They had found their sweet spot. Grinstaff states “The unexpected finding that modified saRNA works at ultra-low doses and with a reduced immune response changes the way we think about RNA engineering and therapeutics.”

What Could The Future Hold?

This is not the first use of saRNAs – research on similar vaccine platforms has occurred for over twenty years, with significant challenges. The tide is shifting. A vaccine using saRNA was licensed recently as a Covid-19 booster in Japan. The ARCT-154 vaccine (Arcturus Therapeutics, San Diego) works at one-six the dose compared with other mRNA Covid-19 vaccine doses. Having this as a precedent might help spur development of other new vaccines based on an saRNA platform to reach clinical testing. Modified saRNA takes use of saRNA one step further – to doses one hundredth of existing doses.

Wong and Grinstaff have also tested an saRNA construct carrying up to four protein cargo sequences successfully. “This result opens the door to assessing potentially multiple vaccines given as a single shot,” says Dr. Douam of the BU National Emerging Infectious Diseases Laboratories. Wouldn’t that be great? Also, there are other potential benefits of a vaccine that works with a significantly lower dose than current mRNA vaccines. The amount of production required to vaccinate a population would be lower. Moreover, vaccine could be generated, potentially at lower cost per person and thus might be more affordable for wider distribution. Reduction of the need for boosters would be a plus, in addition to fewer unwanted side effects with a lower dose.

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WHO Director-General's opening remarks at the media briefing on COVID-19 - 12 October 2020

• Around the world, we’re now seeing an increase in the number of reported cases of COVID-19, especially in Europe and the Americas.  
• There has been some discussion recently about the concept of reaching so-called “herd immunity” by letting the virus spread.    
• Never in the history of public health has herd immunity been used as a strategy for responding to an outbreak, let alone a pandemic.  
• WHO is hopeful that countries will use targeted interventions where and when needed, based on the local situation. We well understand the frustration that many people, communities and governments are feeling as the pandemic drags on, and as cases rise again.  
• There are no shortcuts, and no silver bullets. The answer is a comprehensive approach, using every tool in the toolbox.  

Good morning, good afternoon and good evening.

Around the world, we’re now seeing an increase in the number of reported cases of COVID-19, especially in Europe and the Americas.

Each of the last four days has been the highest number of cases reported so far.

Many cities and countries are also reporting an increase in hospitalizations and intensive care bed occupancy.

At the same time, we must remember that this is an uneven pandemic.

Countries have responded differently, and countries have been affected differently.

Almost 70% of all cases reported globally last week were from 10 countries, and almost half of all cases were from just three countries.

For every country that is experiencing an increase, there are many others that have successfully prevented or controlled widespread transmission with proven measures.

Those measures continue to be our best defence against COVID-19.

There has been some discussion recently about the concept of reaching so-called “herd immunity” by letting the virus spread.

Herd immunity is a concept used for vaccination, in which a population can be protected from a certain virus if a threshold of vaccination is reached.

For example, herd immunity against measles requires about 95% of a population to be vaccinated. The remaining 5% will be protected by the fact that measles will not spread among those who are vaccinated.

For polio, the threshold is about 80%.

In other words, herd immunity is achieved by protecting people from a virus, not by exposing them to it.

Never in the history of public health has herd immunity been used as a strategy for responding to an outbreak, let alone a pandemic. It is scientifically and ethically problematic.

First, we don’t know enough about immunity to COVID-19.

Most people who are infected with the virus that causes COVID-19 develop an immune response within the first few weeks, but we don’t know how strong or lasting that immune response is, or how it differs for different people. We have some clues, but we don’t have the complete picture.

There have also been some examples of people infected with COVID-19 being infected for a second time.

Second, the vast majority of people in most countries remain susceptible to this virus. Seroprevalence surveys suggest that in most countries, less than 10% of the population have been infected with the COVID-19 virus.

Letting the virus circulate unchecked therefore means allowing unnecessary infections, suffering and death.

And although older people and those with underlying conditions are most at risk of severe disease and death, they are not the only ones at risk. People of all ages have died.

Third, we’re only beginning to understand the long-term health impacts among people with COVID-19. I have met with patient groups suffering with what is now being described as “Long COVID” to understand their suffering and needs so we can advance research and rehabilitation.

Allowing a dangerous virus that we don’t fully understand to run free is simply unethical. It’s not an option.

But we do have many options. There are many things that countries can do and are doing to control transmission and save lives.

It’s not a choice between letting the virus run free and shutting down our societies.

This virus transmits mainly between close contacts and causes outbreaks that can be controlled by implementing targeted measures.

Prevent amplifying events.

Protect the vulnerable.

Empower, educate and engage communities.

And persist with the same tools that we have been advocating since day one: find, isolate, test and care for cases, and trace and quarantine their contacts.

This is what countries are proving works, every day.

Digital technologies are helping to make these tried-and-tested public health tools even more effective, such as mobile applications to support contact tracing efforts.

Germany’s Corona-Warn app has been used to transmit 1.2 million test results from labs to users in its first 100 days.

The Aarogya Setu app from India has been downloaded by 150 million users, and has helped city public health departments to identify areas where clusters could be anticipated and expand testing in a targeted way.

In Denmark, more than 2700 people have been tested for

COVID-19 as a result of notifications received through a mobile application.

And the United Kingdom has rolled out a new version of its NHS COVID-19 app, which had more than 10 million downloads within the first week.

As well as alerting users that they may have been exposed to a positive COVID-19 case, the app allows users to book a test and receive results, keep track of the places they’ve visited and receive the latest advice on local restrictions.

WHO is working with the European Centre for Disease Prevention and Control to help countries evaluate the effectiveness of their digital contact tracing apps.

This is just one example of the innovative measures countries are taking to control COVID-19.

There are many tools at our disposal: WHO recommends case finding, isolation, testing, compassionate care, contact tracing, quarantine, physical distancing, hand hygiene, masks, respiratory etiquette, ventilation, avoiding crowds and more.  

We recognize that at certain points, some countries have had no choice but to issue stay-at-home orders and other measures, to buy time.

Many countries have used that time to develop plans, train health workers, put supplies in place, increase testing capacity, reduce testing time and improve care for patients.

WHO is hopeful that countries will use targeted interventions where and when needed, based on the local situation.

We well understand the frustration that many people, communities and governments are feeling as the pandemic drags on, and as cases rise again.

There are no shortcuts, and no silver bullets.

The answer is a comprehensive approach, using every tool in the toolbox.

This is not theory: countries have done it and are doing it today, successfully.

My message to every country now weighing up its options is: you can do it too.

I thank you.