key: cord-1037033-38ryejgo authors: Saich, F.; Martiniuk, A. title: Government messaging about COVID-19 vaccination in Canada and Australia: a Narrative Policy Framework study date: 2021-12-21 journal: nan DOI: 10.1101/2021.12.19.21268042 sha: 9e99d0bc48ea2a3ed6d6e52d8f5840f1eda1c771 doc_id: 1037033 cord_uid: 38ryejgo Background: Storytelling and narratives are critical components to public policy and have been central to public policy communicators throughout the COVID-19 pandemic. Aim: This study applied the Narrative Policy Framework to compare and contrast the policy narratives of the Canadian and Australian Prime Ministers regarding COVID-19 vaccination. Methods: Official media releases, transcripts and speeches published on the websites of Prime Minister Morrison and Prime Minister Trudeau between 31 August 2020 and 10 September 2021 relating to COVID-19 vaccines were thematically analysed according to the Narrative Policy Framework. Results: The policy narratives of Scott Morrison and Justin Trudeau tended towards describing both governments as heroes for securing and rolling out vaccines. Trudeau tended to focus on the villain of COVID-19 while Morrison regularly described other countries as victims of COVID-19 to position Australia as superior in its decision-making. These findings also demonstrate how narratives shifted over time due to changing COVID-19 case numbers, emergence of rare complications associated with the AstraZeneca vaccine and as new information arose. Conclusion: These findings offer lessons for COVID-19 times as well as future pandemics and disease outbreaks by providing insight into how policy narratives influenced policy processes in both Australia and Canada. Storytelling and narratives are critical components influencing public policy, particularly in a time of crisis. [1] [2] [3] Consequently, policy narratives have been central to public policy communicators throughout the COVID-19 pandemic to convince the public of a problem and legitimise a policy solution. 2, [4] [5] [6] [7] [8] With the rapid development and rollout of COVID-19 vaccines, policy actors have been required to deploy narratives to convince the public of their safety and efficacy, and encourage the population to get vaccinated. However, significant media and expert attention has been drawn to COVID-19 vaccine hesitancy. 9 Studies regarding the uptake of COVID-19 vaccines have largely focused on individuals' views, their trust in governments, and the information they receive. 10 There has been limited critical exploration of government policy and the narratives that have been deployed surrounding COVID-19 vaccines, particularly between countries with differing epidemiological profiles. This is a critical area of study as facts, evidence and data often do little in isolation to convince the public. 1 Instead, it is typically the narrative used to weave together the context, problem and resolution, combined with evidence, that influences opinions and behaviours. 1 The Narrative Policy Framework is a relatively new framework that applies scientific techniques to the study of policy narratives. 1 The Narrative Policy Framework is premised on the fact that narratives must have distinct components including settings (bounded by time, geography or other characteristics), characters (hero, villain and victims that may either be a human, place or thing), plots (which connect the characters to the setting) and a moral of the story (policy solution). 1, 11 This framework has been used to analyse the influence of policy narratives on individual decision-making (micro), their effect on the policy processes (meso), and how policy narratives amongst cultures and institutions change over time (macro). 1, 11 To date, most Narrative Policy Framework studies conducted in the context of COVID-19 have focused on policy narratives at the onset of the pandemic and no studies have applied this framework to policy narratives in relation to COVID-19 vaccines. 4, [7] [8] This is worth further exploration as the dynamic nature of the pandemic has meant that the narratives used by governments have also had to shift with the advent of new variants, research and medical developments and as new information arises. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The Narrative Policy Framework requires a deep understanding of the cultural setting in which the narrative is constructed. 1, 11 Canada and Australia share many similarities; both are federated nations comprised of provinces/states and territories, and both Federal Governments have been responsible for COVID-19 vaccine procurement, approvals and providing scientific advice, while provincial, state and territorial governments have been largely responsible for administering the vaccines. [12] [13] Politically, Australia and Canada differ in their leadership at the federal level with Prime Minister Justin Trudeau (Canada) the leader of the left-leaning Liberal Party whereas Prime Minister Scott Morrison (Australia) is the leader of the right-leaning Liberal Party. [14] [15] The COVID-19 experience has been vastly different in Canada and Australia. As of 1 November 2021, Canada recorded a total of 1.7 million COVID-19 cases and approximately 29,000 deaths in a population of 38.2 million. 16 In comparison, Australia has been relatively successful on a global scale at controlling COVID-19, recording 170,000 cases and over 1,700 deaths within the same period in a population of 25.9 million. 17 This study applies the Narrative Policy Framework to compare and contrast narratives deployed by both the Canadian and Australian Prime Ministers regarding COVID-19 vaccines to convince the public of their safety and efficacy and encourage citizens to get vaccinated. Official media releases, speeches and press conferences published on the websites of Prime Minister Morrison 18 and Prime Minister Trudeau 19 published between 31 August 2020 and 10 September 2021 were reviewed. To be included for analysis, materials were required to reference COVID-19 vaccines or vaccinations. In accordance with the Narrative Policy Framework these materials were also required to include at least one character (hero, villain or victim) and a plot to be included for analysis. 11 As this study was focused specifically on vaccination communication and uptake in Australia and Canada, materials that only focused on donation of COVID-19 vaccines or global meetings of leaders discussing COVID-19 vaccines were excluded. If a document contained excerpts from other Ministers or Health Officials, that material was excluded and only the excerpts from Morrison or Trudeau were included for content analysis. In total 216 materials met the selection criteria (87 for Canada and 129 for Australia). A qualitative methodology for analysing these data was chosen to explore the nuances and framing of the narratives. These materials were organised according to phase: procurement, approval, early rollout, AstraZeneca blood clots and scale-up of rollout. Within these phases, Microsoft Excel was used to is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted December 21, 2021. ; https://doi.org/10.1101/2021.12.19.21268042 doi: medRxiv preprint code the differing characters between Canada and Australia as well as the overall plots and moral of the story (policy solutions) as described by Trudeau and Morrison. In this phase, Trudeau's plot embodied that of 'stymied progress' -that is to say that the first wave of COVID-19 cases was terrible, but then the situation improved due to a hero (Federal Government) but COVID-19 was worsening again emphasising the need for the Federal Government to procure vaccines. 11 By 23 October 2020, eight vaccine agreements were signed securing a total of 358 million doses resulting in "the most diverse vaccine portfolio of any country". 20 Canada also pursued sovereign vaccine manufacturing and capability, as part of the "made-in-Canada" approach to the pandemic. 21 Despite this, Trudeau reminded Canadians on four occasions that a "vaccine won't help you -or your family -if you get COVID-19 now" encouraging Canadians to adhere to the public health restrictions to protect others and save lives. 21 Building on Weible and Schalger's 22 plot descriptions, the Australian phase of vaccine procurement will be described as 'near complete victory' as the villain (COVID-19) is never truly vanquished and thus vaccines were needed to maintain this victory which is achieved by the hero (Morrison and his government). To illustrate this, between 19 August and 5 November 2020 Morrison announced four vaccine deals. Similar to Canada, Morrison couched two of the vaccine deals (AstraZeneca and University of Queensland) as part of a "home-grown sovereign vaccine plan" 23 that would utilise local manufacturing that is amongst the "best in the world" in order to secure supply chains. 24 Morrison said this placed Australia amongst an "elite circle of countries that has been able to respond on behalf of their population" with just 20 countries able to manufacture COVID-19 vaccines. 25 These announcements were largely devoid of explicit mention of a villain and instead emphasised the heroic nature of Australia having heeded the medical advice of experts and controlling COVID-19 infections earning it a ranking among the leading economies in the world. The vaccine announcements sought to further this leading position to "keep Australia right up the front", without taking any shortcuts on safety. 23 The stymied progress plot continued into this phase for Canada. On 9 December 2020, the Pfizer vaccine was the first vaccine to be approved in Canada. This came in the midst of Canada's second wave -at the beginning of winter in the Northern Hemisphere -when cases and hospitalisations . CC-BY-NC-ND 4.0 International license It is made available under a perpetuity. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted December 21, 2021. ; https://doi.org/10.1101/2021.12.19.21268042 doi: medRxiv preprint were the highest in the pandemic thus far. As a result, the development and approval of the vaccines was regularly described by Trudeau as the "light at the end of the tunnel" and as a symbol of hope to Canadians, thus Trudeau's government was the hero for securing these vaccines. 26 In the lead up to the approval, Trudeau emphasised "Canada's globally recognized gold standard for medical approvals" and that "any vaccine approved in Canada will be safe and effective". 27 As subsequent vaccines were approved in December 2020, February 2021 and March 2021, Trudeau again stated "the best experts have upheld this highest standard" 28 and that they have each been "independently approved". 29 The moral was thus implicit that Canadians should be confident to get vaccinated. It was not until the 25 January 2021 that the first vaccine, Pfizer, was approved in Australia with the AstraZeneca vaccine approved nearly a month later on 16 February 2021. On 12 occasions, Morrison stated that neither of these vaccines had been approved under an emergency approval process, as had occurred in many European nations such as the UK. Morrison used a 'blame the victim' plot 11 to describe how COVID-19 was out of control in these countries and were thus victims with no choice but to 'cut corners' on regulatory approvals by rushing them through emergency approval processes. Morrison also maintained the 'near complete victory' plot by positioning Australia in stark contrast by not taking any "short cuts" on the approval process. 30 Australia was positioned as a hero because of "our amazing efforts" 31 and our "2020 achievements" 32 where the virus was successfully suppressed and controlled. Australia was a hero as "we are one of only a handful of countries to have gone through such a comprehensive and thorough level of oversight to ensure the vaccines are safe" 30 having been "overseen by the best medical experts in the world" at the TGA. 33 Morrison regularly stated that Australians could have confidence in the vaccine and that no one was being put at risk (moral of the story). Months later in August, Moderna was approved. At this point the narrative shifted from not rushing approvals, to the TGA expediting approvals by "accepting rolling data submissions for review, collaboration with international regulators, and proactive work with the sponsor, Moderna." 34 Ahead of the rollout Trudeau emphasised that as soon as the doses were approved, Canada would be ready. In line with these statements just a few days after Pfizer was approved in Canada, doses arrived in the country and the rollout began. Throughout this phase, Trudeau regularly described the Federal Government as the hero for working "tirelessly" 35 and "around the clock". 36 On 14 occasions, during this phase, Trudeau stated that the Federal Government was working with the provinces and territories to get the vaccine delivered, distributed and administered 'as quickly as possible' and noted this as an example of a true 'Team Canada' approach. He also stated that the "Federal is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint Government is covering the cost of the vaccines and the supplies needed to administer them" again emphasising the heroic nature of the Federal Government in securing and paying for the vaccines. 37 Throughout this time, COVID-19, the pandemic, 'the virus' and variants -framed as the villain -were used to encourage Canadians to get vaccinated while employing other measures (distancing, mask wearing, handwashing etc.) to get through the 'long winter'. While there were some delays with the Pfizer doses, Trudeau described these as "temporary, short-term issues" that were "to be expected" 38 and despite this, things were "going as expected". 39 Nearly a month after receiving approval from the TGA, the first Pfizer doses arrived in Australia on 15 February 2021. Morrison sought to allay concerns about the vaccines, stressing the "care that is being provided to every Australian through the amazing processes and systems that have been built here". 40 At the same time Morrison stated, "these are all great vaccines, they're not better than each other". 40 Morrison continued the 'near complete victory' plot by describing how the "Australian way through this pandemic" 41 had led to greater success than other countries and called on Australians to "continue on the successful path we've been on" by getting vaccinated (moral of the story). 42 Morrison also maintained the 'blame the victim' plot when Italy blocked supply of Pfizer doses to Australia, describing how Italy "are in an unbridled crisis situation". 43 This furthered Morrison's argument for sovereign vaccine production of the AstraZeneca vaccine, and on 12 occasions Morrison reiterated that few countries had that capability, making Australia "part of a small club". 44 Furthermore, Morrison stated that "were it not for the fact that our Government took the strategic decision last August to not rely on international supply of vaccines, then Australia would not have a vaccination programme now." 45 As the rollout continued and as criticism mounted that Australia was not meeting its early vaccination targets, Morrison reverted to emphasising safety stating, "It's not a race. It's not a competition…" 46 and "I don't intend to rush the proces" 47 and detailed the processes that needed to be followed by the TGA before administration to the population. By April, Morrison began comparing Australia's rollout to comparable countries such as Germany, Canada, Japan, South Korea and New Zealand, stating that Australia was either on par or further advanced than they had been at the same stage in their rollout and "most of the world would want to be right here at the moment" given the lack of community transmission and relative freedoms across the country. 48 There was no explicit mention by Trudeau is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted December 21, 2021. ; https://doi.org/10.1101/2021.12.19.21268042 doi: medRxiv preprint and that Canadians "can feel very confident getting it" and confirmed to Canadians that "the best vaccine for you is the first one you're offered". 49 Following this, Trudeau stated that he and his wife had both received AstraZeneca and were "feeling great. We're feeling more protected, and we're also feeling like we're part of the solution going forward." 50 In comparison, Scott Morrison held a late-night press conference on 8 April 2021 to announce that the Australian Technical Advisory Group on Immunisation (ATAGI) had advised a preference to vaccinate people under 50 with Pfizer (thus over 50s would eligible only for AstraZeneca). The next day, Morrison confirmed this was not "a ban on the AstraZeneca vaccine. It is not a prohibition on the AstraZeneca vaccine" and said that his mother would be vaccinated with AstraZeneca in a couple of weeks. 51 Given that less than four percent of the population had received a COVID-19 vaccine and the rollout had largely been contingent on the use of AstraZeneca, the program would need to undergo "recalibration". 51 The Prime Minister conceded several times that the changing advice regarding this AstraZeneca vaccine "caused some hesitation" 52 and that Australia was "prisoners of our own success". 53 To encourage uptake of the AstraZeneca vaccine, Morrison noted on several occasions that "we saw it save countless number of lives in the United Kingdom, and it will save lives here, too", 54 a fundamental shift from the 'blame the victim' plot having previously described the UK as helpless in comparison to Australia. On 19 February 2021, Trudeau declared that Canada was in the ramp-up phase of the vaccination program. With substantial increases in supply and as mass vaccinations commenced, "better days are ahead". 55 Trudeau encouraged Canadians who had already been vaccinated "to keep doing their part to keep others safe as we continue to increase vaccinations". 56 is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted December 21, 2021. ; https://doi.org/10.1101/2021.12.19.21268042 doi: medRxiv preprint emerged after being ranked third amongst G20 countries for total proportion of the population vaccinated. By 4 June Canada was first amongst the G20 nations and even overtook the US on 19 July. Trudeau again described these achievements as a "true Team Canada approach". 58 The promise of a "better summer" sought to encourage Canadians to continue to get vaccinated and get back to the things they had previously enjoyed. 59 Despite transmission continuing to occur, Trudeau applied the 'complete victory' plot stating that "Canada has come through this pandemic better than almost any other country in the world. And it's because we've been there for each other" adding weight to Canada's collaborative narrative to increasing vaccinations. 60 From July 2021, Morrison's narrative experienced a fundamental shift with outbreaks of the Delta variant on Australia's east coast in New South Wales, Victoria and the Australian Capital Territory that resulted in lockdowns that would last until October 2021. Similar to Trudeau's comments over the 2020-21 winter, vaccines were presented as one strategy to suppress COVID-19 infections with the tools of contact tracing and testing no longer proving sufficient to control COVID-19. Vaccines were also described as the "light at the end of the tunnel" and "doses of hope", similar to how Trudeau described them in 2020-21. [61] [62] [63] In August 2021, with one third of the population having received one dose of a COVID-19 vaccine, Morrison acknowledged that there had been some setbacks in the rollout but that it was also his responsibility to fix these problems. Morrison was again a hero for leaving "no stone was left unturned in the global search to find additional vaccines" having secured deals with foreign governments that led to substantial increases in supply. 63 By 19 August 2021, Morrison declared that Australia had reached a 'turning point' in its vaccination rollout -reaffirming the 'near complete victory' plot -and by late August detailed how Australia was again a hero for exceeding the peak of the UK and US vaccination programs and as a result had "done better than almost any other country in the world in saving lives and livelihoods." 64 This study has offered a unique use of the Narrative Policy Framework to explore the narratives used to convince the public to get vaccinated against COVID-19 and has added to the growing application of this framework in times of crisis and specifically to the COVID-19 pandemic. 3, 8 This study has is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted December 21, 2021. However, this made the policy solution (to get vaccinated) somewhat unclear as Australians were encouraged to trust in the process and the vaccines, although many were ineligible or confused by the changing official advice as well as advice offered by Morrison. This highlights the importance of coherent narratives as well as narratives being matched with the appropriate resources for them to succeed. 4 Canada also received criticism for its handling of the AstraZeneca vaccine. While it was unable to be explored in this study given the focus on the national policy narrative, some of the provincial governments suspended the use of the AstraZeneca vaccine for first doses. 66 Furthermore, the Canadian National Advisory Committee on Immunization (NACI) had recommended that mRNA vaccines were preferred over viral-vector vaccines such as AstraZeneca, despite Trudeau continuing to emphasise that all vaccine types were safe and effective. 67 Both countries' handling of their advice around the AstraZeneca vaccine offers a cautionary tale for future risk communication given the confusion caused by rapidly changing advice. It is also worth considering the influence of the Australian narrative as a hero and having achieved 'near complete is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted December 21, 2021. ; https://doi.org/10.1101/2021.12.19.21268042 doi: medRxiv preprint control' of COVID-19 and whether this led to a lack of urgency and complacency within both policy decisions and amongst individuals. Given that policy narratives are essential to policy processes and decisions, 68 these findings also demonstrate the inherent complexity of making 'policy on the run'. From the outset Canada chose to procure as many vaccine candidates as possible. While this has been met with criticism for being greedy with the highest number of vaccines per capita, 69 it nonetheless protected Canada from Australia's situation in relying ultimately on just two vaccines (for the most part of 2021) and the issues that ensued with supply, rare medical complications that did not arise until mass vaccination and a changing risk/benefit profile of vaccine types either due to rare adverse effects and/or COVID-19 variants. It is also clear how the 'near complete victory' narrative influenced decision-making particularly in Australia in not seeking to 'rush' the rollout initially, but then by May 2021 Australia was prepared to expedite the approval process of the Moderna vaccine. It is worth comparing this to another country that has fared similar to Australia, Singapore, which commenced its vaccination program at the end of December 2020 when case numbers were low and was able to vaccinate upwards to 80% of the total population while simultaneously keeping case numbers low. 70 While this warrants further attention, it nonetheless adds further evidence to the role of narratives in policy processes and decision-making and subsequent realities on the ground. There are several limitations of this study. The study design did not include the narratives used by other Federal Ministers or State, Provincial and Territory leaders or officials and how these narratives may echo or diverge from that of Morrison and Trudeau. This may be particularly important in the Australian context whereby the pandemic has resulted in greater trust in state and territory leaders and declining trust in the Federal Government. 71 In Canada, trust in both the Prime Minister and provincial premiers has declined which may be reflective of the lack of success in controlling COVID- 19 in Canada compared to Australia. 72 Future research could assess the effectiveness of similar policy narratives in influencing public opinion and intention to vaccinate. Lastly, we are unable to conclude whether one approach or another policy narrative approach was more successful using, for instance, overall vaccination rates by time, given the likely confounding role of changing medical advice, supply issues, cultural and COVID-19 related factors. . CC-BY-NC-ND 4.0 International license It is made available under a perpetuity. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint The copyright holder for this this version posted December 21, 2021. ; https://doi.org/10.1101/2021. 12.19.21268042 doi: medRxiv preprint This study has explored the differing narratives used by Trudeau and Morrison to encourage vaccination uptake in the context of divergent epidemiological profiles in the COVID-19 pandemic. This adds to the growing use of the Narrative Policy Framework to analyse and understand policy narrative during crises and uniquely in regards to COVID-19 vaccines. 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