EU digital communication strategy during the COVID-19 vaccination campaign: Framing, contents and attributed roles at stake

If in recent years the European Union (EU) has had to face complex and multifactorial "poly-crises" (such as Brexit, refugees or the euro), the pandemic caused by COVID-19 has been an unprecedented event on a global scale with important implications at all levels. Indeed, it has reinforced public health issues aimed at protecting the population as nodal elements of the policies implemented by this organization. This research aims to analyze the different organizational communication strategies on Twitter implemented by the main EU institutions during the COVID-19 vaccination campaign, in order to examine the presence of this exceptional milestone. This study has been carried out using an eminently quantitative methodology, based on a content analysis to quantify the different variables and indicators established for the publications of the official profiles of the European Commission, the European Parliament and the European Council. The proposed categories focus on exploring their predominant thematic areas, as well as main purposes/attributed functions. In the light of the results obtained, it is concluded that the vaccination campaign is a milestone with a considerable volume of publications by all profiles. However, among the attributed functions, the distribution of aseptic information has been predominant, which is why it is discussed whether these institutions have sufficiently taken advantage of the possibilities offered by the digital environment of Twitter for the dissemination of the European message. [ FROM AUTHOR] Copyright of Communication & Society is the property of Servicio de Publicaciones de la Universidad de Navarra, S.A. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Simple solutions to wicked problems: Cultivating true believers of anti-vaccine conspiracies during the COVID-19 pandemic

The pandemic has produced an abundance of medical misinformation, disinformation and conspiracy theories about the safety and efficacy of vaccines. Many of these narratives appear impervious to scientific evidence and indifferent to the authority of the state. This has resulted in ‘true believers' being cast as paranoid and irrational. In this article, we take a different approach by exploring the cultural appeal of anti-vaccine conspiracy theories about COVID-19. Drawing on qualitative analysis of two leading figures of the anti-vaccination movement – Robert F. Kennedy Jr. and Joseph Mercola – we demonstrate how these influencers establish authority by staging indignation against a corrupt scientific establishment and positioning themselves as Truthers offering simple solutions to complex (wicked) problems. By conceptualising what we refer to as the Truther Playbook, we examine how anti-vaccine Truthers capitalise on existing grievances and conditions of low institutional trust to further solidify people's troubled relationship with institutional expertise while drawing attention to the structural conditions and social inequalities that facilitate belief in conspiracy theories. We contend that conspiracy theories offer not only offer alternative facts and narratives but are predicated on identification and in-group membership, highlighting the limits of debunking as a strategy to tackle disinformation. [ FROM AUTHOR] Copyright of European Journal of Cultural Studies is the property of Sage Publications, Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Thoughts on vaccine hesitancy in the context of coronavirus disease 2019 epidemic.

Vaccines have made great contributions to the prevention of infectious diseases, but vaccine hesitancy is widespread in the world. The reasons for vaccine hesitancy are complex, but the main reasons are the lack of public awareness of vaccine-preventable diseases and the lack of confidence in vaccine effectiveness and safety. In the context of the continuous spread of the coronavirus disease 2019 (COVID-19) epidemic, boosting public confidence and ensuring the orderly development of the vaccination work of COVID-19 vaccines and conventional vaccines are necessary to curb the resurgence of the COVID-19 epidemic and prevent the outbreak of various infectious diseases in China. Under the current situation, the main measures to deal with vaccine hesitancy are to play the role of health care institutions, improve public health literacy, normalize the public opinion orientation of the media platform, strengthen the supervision of vaccine clinical research and production, and do a good job in surveillance and compensation for adverse events following immunization.Copyright © 2021 by the Chinese Medical Association.

One voice or multi-issue movement? Exploring the role of bonding and bridging social capital within the COVID-19 antivax movement

Activism represents a prominent and growing body of knowledge in public relations scholarship and practice. Most of the extant studies focus on progressive and prosocial activism, understanding activism as a form of communication that aims to further social justice and equality. However, arguably, activism is a polylithic concept and not all movements are progressive in nature or seek to further issues in a given society's best interest. One such example is the so-called antivax protest movement that emerged in response to the global COVID-19 pandemic. In contrast to its depiction as a large, single-issue protest movement, the authors highlight it as a movement that brings together multiple issues, agendas, and worldviews. Drawing on Putnam's notions of bridging and bonding social capital, the authors argue that a movement's lack of ability to convert bridging into bonding social capital limits its longevity and impact. They suggest that public relations professionals need to avoid the temptation to apply convenient umbrella labels to multi-issue movements, emphasising the need to adopt a critical awareness of a movement's underlying issues and motivators, which may be varied, to develop nuanced and effective messaging. • The COVID-19 antivax movement is a multi-issue movement, which has been uncritically presented as a single-issue group • Activism is a polylithic concept deserving further critical attention beyond the extant focus on progressive movements • Bridging social capital may temporarily increase the impact, reach, and visibility of a social movement or activist group • A single-issue focus can strengthen bonding social capital, enhancing a social movement's potential longevity and impact • Multi-issue responses require active listening and consideration of different types of social capital & diverse objectives [ FROM AUTHOR] Copyright of Public Relations Review is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

High seroprevalence of anti-SARS-CoV-2 antibodies in the capital of Chad

Background. Since the start of the COVID-19 pandemic, Chad has had 7,417 confirmed cases and 193 deaths, one of the lowest in Africa. Objective. This study assessed SARS-CoV-2 immunity in N'Djamena. Methods. In August-October 2021, eleven N'Djamena hospitals col-lected outpatient data and samples. IgG antibodies against SARS-CoV-2 nucleocapsid protein were identified using ELISA. "Bambino Gesu" Laboratory, Rome, Italy, performed external quality control with chemiluminescence assay. Results. 25-34-year-old (35.2%) made up the largest age group at 31.9+/-12.6 years. 56.4% were women, 1.3 women/men. The 7th district had 22.5% and the 1st 22.3%. Housewives and students dominated. Overall seroprevalence was 69.5% (95% CI: 67.7-71.3), females 68.2% (65.8-70.5) and males 71.2% (68.6-73.8). >44-year-old had 73.9% seroprevalence. Under-15s were 57.4% positive. Housewives (70.9%), civil servants (71.5%), and health workers (9.7%) had the highest antibody positivity. N'Djamena's 9th district had 73.1% optimism and the 3rd district had 52.5%. Seroprevalences were highest at Good Samaritan Hospital (75.4%) and National General Referral Hospital (74.7%). Conclusion. Our findings indicate a high circulation of SARS-CoV-2 in N'Djamena, despite low mortality and morbidity after the first two COVID-19 pandemic waves. This high seroprevalence must be considered in Chad's vaccine policy.Copyright © 2022 The Authors and PAGEPRESS PUBLICATIONS.

The problem of anti-vaccine attitudes in the COVID-19 era: analysis in the context of psychopathological dimensions and treatment proposals based on own experience

Anti-vaccine attitudes against COVID-19 are a common phenomenon, but rarely understood as a medical problem. In patients who are already under psychiatric treatment, it is worth paying attention to diagnosis and starting of psychotherapy of this problem. The association of the anti-vaccine issue with anxiety, obsession and paranoia is an opportunity to achieve solution and may lead to the progress of psychotherapy. The problem with the right choice of authority seems to be one of most important challenges for psychiatry these days.

A County-Level COVID-19 Response

Accurate COVID-19 information has seemed contradictory and inconvenient to find since the beginning of the pandemic in March of 2020. There are many sources that could be blamed for this, including the newspapers, Facebook, or the government itself at federal or even county levels. But where does the average user stand in their ability to access and understand accurate, relevant information relating to COVID-19? We explored twelve county websites picked from six states across the country—Washington, New York, Nevada, Kansas, Louisiana, and Ohio—to see how effective and accessible information at the county-level response differs between Democrat and Republican-leaning states, when those counties acted, and how the information compares regarding lockdowns, vaccines, and quality-of-life documents (such as unemployment forms and aid) during the pandemic. For a birds-eye view of this government information problem, we have chosen to highlight five of these sites to provide a brief look at our findings, which includes observations on population size, political leanings, and information availability and accessibility. [ FROM AUTHOR]

COVID-19: A History: by Jacalyn Duffin, Montreal and Kingston, McGill-Queen's University Press, 2022, 232 pp., CAN $27.95 (cloth), ISBN 978-0-2280-1411-9

Duffin estimates that 55 vaccines were in development and some, such as the mRNA vaccines developed by Pfizer-BioNTech and Moderna, were entirely novel. These are minor quibbles since Duffin works to her strengths as an historian and maintains a clear focus on the science, medicine, and public health responses to COVID-19. Duffin then turns to the science and medicine of COVID, including topics like testing, treatments, and the development of vaccines. [Extracted from the article]

A caregiver's view, a citizen's view of the Covid-19 pandemic

The pandemic linked to Covid-19 let the notion of freedom rights arise: freedom of expression, of movement, of vaccination, etc. In this context, this article focuses on the vaccination process. Between pro-vaccination, "anti-vax" and undecided, the question of freedom, of the individual decisional autonomy of the citizen and the collective/societal benefit to be oriented towards a choice arises. The dispensation of information, via the media (television, written, radio) and the multitude of sources available on the Web, may or may not facilitate decision-making. But what about the position of caregivers? Beyond the principle of wanting to care without counting, the Hippocratic oath ("I will respect all persons, their autonomy and their will, without any discrimination according to their condition or their convictions"), is it easy to keep these convictions? Is it legitimate to ask the question "Would it be ethical to prioritize vaccinated patients in intensive care?", a question joined by certain doctors of Wallonia (Belgium) in an approach of ethical debate. A look at the literature tries to understand this questioning, which can be both positive and disturbing. Level of Evidence: NA. Copyright © 2022 Elsevier Masson SAS

COVID-19 Vaccines

COVID-19 episode was and is a devastating pandemic. The morbidity and mortality have skyrocketed at its peak. In the initial phase it was challenging to restrain the outcome of the disease and then in finding a suitable and effective control measure (a vaccine) to prevent further spread and occurrences. The production of the vaccine was fast tracked and a number of vaccines was the outcome of the global effort. Four major types of vaccines were made - whole virus vaccines, protein based vaccines, viral vector vaccines and nucleic acid vaccines. The outcome of these vaccines have been inconstant and at present emphasis in on the protection levels achieved due to the vaccines. Although there have been sporadic aftereffects of COVID vaccines, which is common outcome of vaccination, excessive limitations have been perceived as exceptions. On the whole there has been some amount of control of the viral infection, even if not for the expected long duration. As the protective levels are not as expected and due to the occurrence of many variants of SARS-CoV-2 and other reasons, multiple doses of the same or combination of the different vaccines is advocated at this present situation. In addition, antivaxxers have hindered or tried to hinder the vaccination process in many countries around the world. There are other aspects, such as non-availability of vaccines, non-compliance and others to be taken note in regards to COVID vaccines. Time will tell the factual outcome of the COVID vaccines. Get protected against COVID infection through COVID vaccines for whatever the outcome of the vaccination may be.

Principles of Forming a Strategy for Reducing the Psychological Tension of Social Network Users

Aims: The purpose of the study was to develop principles of a strategy for influencing the psychological state of social network users using the example of the Russian-language segment of Twitter, one of the reasons for which is the lack of awareness about aspects of the coronavirus infection. Background(s): In contrast to the existing works on mood management and Emotion Regulation Strategies, there are principles based not on emotional regulation (cognitive reappraisal and expressive suppression), but on information processing of the content of social media messages and forums. Objective(s): The objective of the study was to develop principles of a strategy for reducing the psychological tension of social network users (further - Strategy) based on the Russian-language segment of Twitter. Method(s): The proposed research methodology includes a study of the discussion field in the active forum of the Runet (the qualitative aspect of emotionality as a reflection of psychological tension) and the Russian-language segment of Twitter (the quantitative aspect of terminology frequency). The qualitative research consisted in isolating the sensitive words used by vaccine opponents to describe their beliefs. A multi-stage methodology has been developed for the meaningful analysis of Twitter users' messages. Result(s):. The result of the study is a methodology for developing principles of the Strategy. Based on this methodology, the following aspects of the problem have been developed: 1) the principle of clarifying the definition of psychological tension;2) the principle of comparing the user and scientific meanings of terms, taking into account the contexts of their use;3) the principle of contextual comparison of the user's and scientific meanings of the term;4) the principle of visual popularization of scientific knowledge. Conclusion(s): An original methodology was created for developing principles of the Strategy. In contrast to the existing works on mood management and Emotion Regulation Strategies, there are principles based not on emotional regulation (cognitive reappraisal and expressive suppression [1]), but on information processing of the content of social media messages and forums. Other: A new approach to reducing the psychological tension of social media users can contribute to sharing timely, accurate and positive information about COVID-19, and reduce excessive discussions about COVID-19, which can positively affect the psychological well-being of the general public. Copyright © 2022 Khakimova et al.

Patient-Guided Talking Points to Address COVID-19 and General Vaccine Hesitancy.

Vaccination remains one of the most effective ways to limit spread of disease. Waning public confidence in COVID-19 vaccines has resulted in reduced vaccination rates. In fact, despite vaccine availability, many individuals choose to delay COVID-19 vaccination resulting in suboptimal herd immunity and increased viral mutations. A number of qualitative and quantitative studies have been conducted to identify, understand, and address modifiable barriers and factors contributing to COVID-19 vaccine hesitancy among individuals with access to vaccine. Vaccine confidence may be improved through targeted patient-provider discussion. More patients are turning to pharmacists to receive their vaccinations across the lifespan. The primary goal of this commentary is to share evidence-based, patient talking points, tailored by practicing pharmacists, to better communicate and address factors contributing to vaccine hesitancy and reduced vaccine confidence.

The online structure and development of posting behaviour in Dutch anti-vaccination groups on Telegram

Online communities play an important role in spreading public discontent and could contribute to polarization. This study focuses on anti-vaccination views in the Netherlands, which have intensified during the COVID-19 pandemic. We examined the structure and development of five Dutch anti-vaccination Telegram groups and studied their interactivity and posting behaviour. Using group-based trajectory modelling, we examined the development of users’ posting behaviour in these groups. We find four posting trajectories across all five groups. A small group of users contributes the majority of posts. Overall, posting frequency declines over time and our results do not show evidence for a group of users whose posting frequency increases. This is taken to indicate that only a small group of users spread their anti-vaccination views through Telegram groups. While social media can reach a broad audience, most users are not necessarily engaged to also actively contribute to the online anti-vaccination community. [ FROM AUTHOR] Copyright of New Media & Society is the property of Sage Publications, Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

DEVELOPING VACCINES TO COMBAT HUMAN DISEASES: A HISTORY

This article traces the development of vaccines from the early attempts to combat a fatal disease caused by variola (smallpox) virus in antiquity, through to the highly technical advances which have led to the efficacious vaccines targeting COVID-19. As vaccine preparation has advanced, so has the understanding of the immune response to immunisation and the realisation that the use of adjuvants is essential to boosting the immune response. Furthermore, coupling polysaccharides to proteins is important in achieving vaccine efficacy in young children and older adults. Successful vaccination programmes have led to marked reductions in mortality associated with the diseases targeted by those vaccines – and to the unintended consequence of cultural amnesia regarding those diseases. The anti-vaccination movement has gained traction by riding on this cultural amnesia to capitalise on spurious associations, infrequent public-health disasters around inadvertent administration of faulty vaccine preparations and rare adverse events to build a case against vaccination. This tension between the advances in vaccine production and the criticism cast at the pro-vaccination agenda should be viewed as an agent for growth in the development of safe and effective vaccines, and in the planning to combat future pandemics.

COVID-19 and compulsory vaccination in Brazil: initial discussions in Information Science

Brazil is one of the biggest movements of resistance to mandatory vaccination since the Vaccine Uprising and has experienced leadership rates in the number of deaths by COVID-19. From this perspective, this study seeks to investigate, by a bibliographic search in Information Science databases and in Brazilian laws, compulsory vaccination in the context of COVID-19. The objective is to contribute to the Brazilian discussions about compulsory vaccination in relation to COVID-19, in the scope of Information Science and its subareas. The results point that Information Science can base this type of conflict, because its sub work areas lead to rethinking the meanings that knowledge receives in society. It is concluded that clarifying and guideding the population of the efficacy and need for vaccination can be an even greater challenge than overcoming the disease itself. Therefore, educating society about the legal provisions that lead to vaccination and that dispel anti-vaccine and anti-scientific discourses is a theme to be incorporated into the scope of investigation of Information Science, mainly in areas such as Knowledge Organization, Information and Knowledge Management, Information Literacy, and Information Mediation. © 2022, Centro Nacional de Informacion de Ciencias Medicas. All rights reserved.

ATTITUDES TOWARDS VACCINES AGAINST COVID-19 IN BULGARIA

This research registered attitudes towards COVID-19 vaccines among Bulgarians above the age of 16 years and shows a clear division in society on the matter. The proportion of those who trust vaccines is equal to the proportion of those who would not accept a vaccine against the coronavirus infection. The research took place immediately after the beginning of the national vaccination campaign in Bulgaria and allows for further research on the factors of the polar opinions in society. Although those factors are not subject to this research, the anti-vaccine movements and attitudes in Bulgaria and abroad were taken into consideration as those traditionally have an impact on the immunization coverage in our societies. In the process of the survey implementation, the research team directly observed some anti-vaccine movements and their constant efforts to undermine the public efforts for curbing the pandemic. © 2021, Central Medical Library Medical University – Sofia. All rights reserved.

COVID-19 vaccination primary and secondary hesitancy among veterans with cancer in the Arkansas-Louisiana-Texas Region

Introduction: The COVID-19 pandemic continues to be a major socioeconomic disruptor worldwide. The intervention that has a far-reaching impact is the adoption of an efficient nationwide vaccination campaign with the effective COVID-19 vaccines. The success of this strategy is dependent on the capacity of the existing healthcare systems and the public vaccine acceptance. Vaccine hesitancy is considered among the top global health threats. Its patterns and intensity vary by geosocial contexts. Due to the roll-out of the vaccine which was followed by the booster dose, we explored the demographic pattern and reasons behind the primary and secondary COVID-19 vaccine hesitancy among our ArkLATX cancer patients. Methods: Two cohorts were used to conduct this study (cohort 1 for primary and Cohort 2 for secondary vaccine hesitancy). An in-person survey of a random sample was conducted across 5 Hematology-Oncology clinics asking the veterans whether they are interested in receiving the initial COVID-19 vaccine and later the booster dose. If the veterans declined, they were asked to state the reason behind their decision. Age, sex, race, and state of residence were captured for each participant. Descriptive statistics were calculated and X2 and logistic regression were carried out to determine the impact of demographic factors on COVID-19 vaccine hesitancy. Results: Cohorts 1&2 consisted of 240 and 303 veterans, respectively. The median age was 71 years. The participants were around 92% male vs 8% female and around 41% Black vs 59% White. In cohort-1, 21% declined due to concerns about safety (33%), not wanting to be the first (33%), anti-vaxxer stance (14%), and inadequate information (8%). Among other reasons (12%), 3 saw no reason for the vaccination, 2 cited severe reactions to prior vaccines, and 1 cited mistrust of the government. In cohort-2, 14% declined booster dose due to concerns about the need (55%) and safety (14%), anti-vax (19%), suspicious (5%), and medical reason and timing (7%). There were no statistical differences between veterans that approved of or declined receiving the vaccine with respect to demographic characteristics. Conclusions: Our survey indicates that the majority of ArkLATX high-risk veterans with cancer are willing to be vaccinated against COVID-19. The major reasons behind vaccine primary and secondary hesitancy seem to be categorized as information issues consisting of questions about safety and the need for the vaccine. For primary hesitancy another major group consisted of a diffusion of innovation late majority that are open to COVID-19 vaccination, but they do not want to be the first to take it. Such barriers can be potentially circumvented by providing the appropriate targeted information campaigns and provider counseling.

Increasing Population Adherence to Vaccination: Evaluation and a Systematic Approach to Implementation

Relevance. The problem of vaccine hesitancy is becoming even more urgent in the light of the coronavirus pandemic, which acted as an impetus for increasing public skepticism about vaccination. In 2019, the WHO declared vaccine hesitancy as one of the global health threats. Aims. The purpose of the research is a comprehensive analysis of the factors that cause vaccine hesitancy in Russian Federation, followed by recommendations for increasing population adherence to vaccination. Materials & Methods. Statistical, factual analysis of the research objects, as well as a qualitative and quantitative analysis of open sources data carried out. The main sources of information were anti-vaccination messages on social networks and the media, information from anti-vaccination communities on Vkontakte, official websites and social networks of relevant federal executive authorities of the Russian Federation. Results. Communication space. Social networks are the main source of dissemination of false information about vaccination. The most active platforms for the dissemination of anti-vaccination messages on social networks are Odnoklassniki and Vkontakte. Semantic analysis. Anti-vaccination rhetoric on Facebook, Instagram, Vkontakte, Odnoklassniki, Telegram, Twitter, Tik Tok, You Tube, Live Journal, the media, and forums is generally similar. As the object of anti-vaccination rhetoric, the words “vaccines”, “vaccination”, “vaccinations” most often appear in posts. Such rhetoric is more directed towards childhood vaccinations. The target audience of anti-vaccination propaganda is parents. The target audience. The sample of the target audience of the doubting population, compiled on the basis of social network Vkontakte users, amounted to 90,937 people. A significant part of the doubting population is represented by women (85%). As a result, the average age of target audience representative is 35.4 years. Major part of the audience is married – 83.1% of the total sample. Almost a third (24.1%) of the Russian audience of the anti-vaccination movement are residents of the Central Federal District. Influence groups. The activity of key influence groups members is characterized by a high level of cohesion within the anti-vaccination movement, which is manifested in mutual reposts of information, joint actions, live broadcasts and announcing the events of “comrades-in-arms”. Among the main motives for participating in the anti-vaccination movement are commercial interests in promoting services and products that are alternative to vaccination, as well as attracting the attention of the audience. It is important to note that the most active representatives of the anti-vaccination movement, for the most part, do not have a medical education. Measures to increase adherence. The state policy in relation to increasing the population adherence to population, as well as the activities of the pro-vaccination movement representatives, play an important role in strengthening the public's confidence in immunization. As part of increasing adherence to vaccination, a wide range of methods and means of informational impact on citizens is used-separate information portals, social networking, face-to-face educational events, special projects, organization of hotlines on vaccine prevention. Conclusions. Solving the problem of vaccine hesitancy under the influence of the anti-vaccination movement activities, rhetoric in the media and social networks, distrust of the state and the healthcare system, and personal perception of vaccination risks require an integrated approach to organizing measures for increasing adherence at the federal and regional levels. The immunization system development should be carried out by changing the regulatory legal framework in order to effectively implement such activities at all levels of the country's health care system. © 2022, Numikom. All rights reserved.

ATTITUDE TOWARDS COVID-19 VACCINE AND AFFECTING FACTORS IN ADULTS FROM TURKEY

Objective: This study aims to examine the attitude towards COVID-19 Vaccine and its affecting factors in adults from Turkey. Materials and Methods: This descriptive study was conducted in February 2021 with a total of 645 adult individuals. The Introductory Information Form, The Scale of Vaccine Hesitancy, and The Attitudes Towards the COVID-19 Vaccine Scale were used to collect the research data. The data were collected online via the snowball sampling method through social media. Results: In the study, 33.8% of the participants stated that they will not get vaccinated for Coronavirus. The concerns of the participants about getting the COVID-19 vaccine were, the fact that the vaccine was produced in a very short time (19.8%), fear of the side effects of the vaccine (18.9%), and not finding the contents of vaccines safe (16.2%). Conclusions: The factors affecting the positive attitude towards the COVID-19 vaccine are, in turn, thinking about getting COVID-19 Vaccine, finding it useful to wear a mask, thinking that the source of COVID-19 is natural, being a healthcare professional and not refusing the vaccine in the past.