The Chowdhurian

Vaccinations are the community’s best defence against preventable communicable diseases. As the problem continued to grow, health practitioners and a concerned public drew attention to the issue of people who do not vaccinate. However, our default response as a society was confrontation, which backed dissenters into the corner which they continue to vigorously defend.

What’s the Real Problem

The strategy to call-out and challenge the mental fitness of those we label “anti-vaxxers” has, surprisingly, not worked well. Several reasons come to mind, which are very well summarized by Hank Green and the great people at SciShow (4 minutes 55 seconds in). If we are to successfully promote good public health practices, we need to first understand the problem.

The rise of people and children infected by diseases is a consequence of the problem. More people are getting sick because fewer people are vaccinated. But what is the cause of a falling vaccination rate?

The choice to not vaccinate is the problem. Solutions must focus on changing the outcome of this choice. Those who choose not to vaccinate do so for different reasons. A recent study sorted them into 4 broad groups, based on the source of their decision.

4 Types of Non-Vaccinators

1. Confidence: This group is comprised of individuals who have incorrect knowledge that distorts their perceived risk of immunization and weakens their trust in vaccinations.

2. Complacency: Those in this group are not concerned that the diseases to be vaccinated against pose a real danger and so do not care about immunization.

3. Convenience: These are individuals who lack sufficient willpower to vaccinate or face the inconvenience of cost and travel.

4. Calculation: This group includes people who have apparently evaluated the pros and cons of vaccination and have rationalized not vaccinating.

Now we understand a wee bit about the perspective of non-vaccinators. Excellent. Instead of berating them on the result of their perspective, i.e. the decision to not vaccinate, let’s think about influencing the perspective itself. Can we do something about this?

Fixing the Real Problem

Do not verbally attack anti-vaxxers. For starters, using the term “anti-vaxxer” is a bad idea and will immediately put someone on the defensive. Not unexpected, as the term is intended to be derogatory.

If you find it difficult to understand why a person may be dismissive of inoculation, I’d suggest reading “I thought all anti-vaxxers were idiots. Then I married one” by Adam Mongrain. It gave me much needed perspective and probably helped me keep some of my friends.

Choosing the Right Strategy

For each type of decision-maker the same paper suggested strategies to convince them otherwise. Contrary to what we may think, the Confidence group actually comprise a minority of the non-vaccinators and are difficult to engage. This insight suggests that health promotion efforts are best applied towards the Complacency, Convenience and Calculation groups.

The Convenience group faces barriers to accessing vaccines. The solution here is straight-forward and possible with improved public policy. The system must make it easier to get vaccinated, either with compensation for time or improving access to healthcare.

While waiting for policy to pass through bureaucracy, individual practitioners can try their own methods. Have people agree to inoculations ahead of time and you’ll find that commitment amounts to motivation. Reminders over the phone or text messages will help. This is much like telling a friend how you’ll be quitting smoking and asking them to check-in on you later.

The Complacency group includes young parents who have not experienced deadly outbreaks of disease and are understandably not worried enough to value inoculation. Tell them about outbreaks in the past. Explain how vaccines so reduced the danger from communicable diseases that we no longer remember to fear them today, even though many are still around.

Children waiting for inoculations in Australia, October 1946.

The Calculation group are on the whole rational people who are resisting vaccination after having received misleading information. Give them clear and reliably sourced information about inoculation. Show them the likelihood of infection and explain how vaccinating themselves also helps protect their community. Trust them to factor better information into their decision.

It’s Not a Silver Bullet, But…

As much as I’d rather not raise the idea of a one-size-fits-all solution in context of a behavioural public health issue, we should be aware of a strategy that’s likely to work and can be called on easily when needed.

Give people with anti-vaccination attitudes factual information about the dangers of communicable diseases. Written or recorded anecdotes from parents of children who had contracted diseases can be effective. If you can’t get hold of any, show visual examples of the danger. Google public domain pictures of a child with measles or rubella. Photos showing the consequences of infection can appeal to the same protective instinct that created a misinformed fear of vaccines.

This method was tested by another recent study that successfully changed attitudes by making people appreciate the consequences of failing to vaccinate their children. They used information we can all access through the Centers for Disease Control and Prevention website.

The method works better than attempts to debunk vaccination myths and so may be the best strategy when engaging people in the Confidence group. They are the most difficult to persuade when attempts to counter their scientific beliefs may entrench them even further.

And, Remember

Vaccinations are a choice. Nobody anticipated that people would begin choosing to refuse vaccines because they never experienced the horrifying alternative. Their society had achieved a level of immunity that allowed most people to live their lives without seeing a large-scale outbreak of deadly communicable disease. In the past fear of death, or worse, was enough for everyone to get a vaccine the moment it became available.

I don’t think that mandatory inoculation is a long-term solution. Our community should have achieved a level of independent and rational decision-making. They are able to choose the correct solution. Holdouts must understand the danger to which they expose themselves, their children and their community. If aggressively pursuing combative verbal arguments is enough to entrench people in their mistaken beliefs, imagine the scale of fear and mistrust if vaccinations were involuntary. No, the solution must be more elegant, it must be more human.

There are many reasons people choose to be on that side of the discussion. Giving them real information and letting them make their own decision is the only way to both solve the problem and build on the fabric of society. This is the best solution available to us.

Sources:

Using Behavioral Insights to Increase Vaccination Policy Effectiveness (Policy Insights from the Behavioral and Brain Sciences)

Countering antivaccination attitudes (PNAS)

An electric vehicle itself may be zero-emissions but what about the fuel source? This question could undermine the appeal of electric vehicles, unless policies are already in place to account for these shortcomings.

Source: Tennessee Valley Authority

The measure to remember is the CO2 emissions per unit distance traveled, even if it was not directly emitted by the car! If a hypothetical Tesla Model S travels 1 km using energy that emitted 5 g of CO2 by its generation (in a fossil-fuel power station) then it is less “green” than another hypothetical Honda Civic that emitted 3 g of CO2 burning diesel on its own.

The above may be the case in China, Tesla’s newest and largest target market where the bulk of energy is generated using coal-fired power stations. In contrast, a Model S charged using the power grid in Norway where Tesla’s newest iteration recently became the best-selling car, has a lower CO2 footprint because hydroelectricity is the primary source of power in the Scandinavian kingdom.

According to the paper by Babaee and friends (link below) the crucial element to reducing air pollution are policy mandates to limit carbon dioxide emissions. Continuing with the example, Norway has strict policies levying additional charges based on emissions resulting in electric cars having a price advantage which contributed to the appeal of the Model S and other electric and low-emission vehicles. Until other places do the same, incentive discrepancies will continue to exist.

Sources:

How Much Do Electric Drive Vehicles Matter to Future U.S. Emissions? (Environmental Science and Technology via Scientific American)

Tesla readies for Model S sales in China (Gigaom)

Norway’s best-selling car (Bilnorge.no)

Tesla entered the automotive market in 2006 with a car no sane person would buy: a shiny electric car of the future tied to charging stations that barely existed. They had to adopt a strategy more familiar to the technology industry than that of run-of-the-mill car-makers. If no sane person would buy it, who would they target?

Enter the Tesla Roadster. All-electric and all of US$128,500. With a high-end product aimed at the luxury sports-car niche, Tesla waited for the consumer market in electric vehicles to mature. It paid off. Tesla spent the time developing a car that targeted a lower price point. The Tesla Model S, released in 2012, is currently priced at US$65,000 thanks to U.S. federal tax credit. Its next model, code-named BlueStar, will be a $30,000 car targeting the mass-market. At this price range, low-end BMWs and the rest of the usual choices  are going to look a comparative joke.

The Model S displayed on Tesla’s Canadian regional site

And why not?

An incident on the 14th of January this year was a source of many chuckles. The U.S. National Highway Safety Administration released two recalls related to problems that could cause fires. One was from Tesla Motors and the other from GM. Owners of 370,000 General Motors vehicles will need to take time out of their day to turn in their cars and pickups at dealerships’ for updates. In Tesla’s case, 29,222 happy owners got their fixes over-the-air, a la Apple iPhone software upgrades.

Of course, this sort of fix is limited to software problems. However it does indicate two things: 1) Tesla is getting things right, more so than an established player like General Motors, and 2) Electric cars, once a source of derision due to unreliability and infeasibility, are no longer the butt-end of the joke.

Market sentiment agrees. Barely one year ago, Tesla share price was at US$39. Today it’s US$196. Now if Elon Musk’s hints about a new plant in China hold any promise, Tesla will find that its planned entry into the potentially lucrative Chinese market propels that value even higher just that much faster.

Source: Google Finance

Sources:

Tesla Motors’ Over-the-Air Repairs Are the Way Forward (MIT Techonology Review)

I bet on Tesla because most investors don’t understand electric cars (The Globe and Mail)

The cigarette-smoking lifestyle has been on the decline. Earlier this January marked the half-century anniversary since Luther Terry, U.S. Surgeon General, himself a long-time smoker, announced that smoking cigarettes caused lung cancer and possibly even heart-disease. His brazen call for the government to act was an early catalyst for the results we see today.

Cigarette-smoking has by no means disappeared, but it’s a far cry from 50 years ago when lighting-up was fashionable and commonplace. Grocery stores, restaurants, hospitals – everywhere you went you could smoke.

Source: http://cigarettezoom.com/

These days we can’t smoke on aircraft and most places indoors, although the legislated standards vary. Attitudes have changed and smokers often find themselves almost apologetically explaining their desire to smoke to people who catch them in the act of lighting up.

A change of heart

Canadian policy since 1997 has been to regulate the sale of cigarettes and restrict its promotion (translation: hide them inside innocuous white panels behind the cashier). In the U.S., taxes on cigarettes have been lower and they are generally more available. American pharmacy CVS is now making waves as the first U.S. healthcare company to begin phasing out tobacco sales, putting an end to the absurdity of selling both medication and the cause of disease.

Even with cigarettes estimated to rake in an estimated $1.5 billion annually for the company, investors have responded well and CVS Caremark stock value went up the day after the announcement: a good indication of competitors making similar moves in future. Moral reasons aside, the shift in public sentiment against smoking has doubtless had a tangible effect on such bold corporate decisions.

Before you begin to feel sorry for Big Tobacco taking such a beating, keep in mind that such changes are not echoed everywhere. It is true that there are now more former smokers than current smokers; and the percentage of smoking Americans has fallen from 42% of total population in 1964 to just 18% today. However, Asia is a wholly different story.

In countries like Australia, the U.K., and Canada, public demand has pushed policy to reduce sales by raising cigarette prices, creating a strong incentive for tobacco companies to move to regions with less legislation and less resistance to a cigarette-smoking culture. Big Tobacco takes a look at the global market and sees 1,959 cigarettes being smoked per person in South Korea, 1,841 in Japan and 1,711 per person in China. Huzzah! That’s more than the odd 1000 being smoked in the U.S. and Canada. It also sees that Russians smoked upwards of 2,750 per person! Disappointment all around when it’s realised that new restrictions being phased in by 2014 will make it a less attractive market, leaving eastern Asia as a better target.

Dodging certain death

Devising one response strategy is not sufficiently hedging your bets in a changing market, so geographical re-targeting is not the only card being played. $4.4 billion (CAD) was the direct healthcare cost for tobacco-related illnesses in Canada, according to a report in 2012. Similar estimates for the U.S. put the number at $96 (USD) billion. The $750 billion industry is well aware that the taxpayer and the government spender are now united in the decision to reject tobacco products in their current form. Which is why in 2012 Philip Morris International spent $250 million researching “harm-reduction” programs that develop various types of e-cigarettes. With persistence comparable to that of celebrity stalkers, it seems Big Tobacco is not going anywhere, for now.

Sources:

CVS to become first major U.S. pharmacy to stop selling cigarettes (via Harvard Health Blog)

Who Smokes Most:  A surprising map of smoking rates by country (via The Washington Post)

Global study finds alarming rates of smoking in the Pacific and Asia (via Radio Australia)

Surgeon General’s 1964 report: making smoking history (via Harvard Health Blog)

Agnes Mainka and colleagues over at Heinrich Heine University in Düsseldorf, Germany, published a study using findings from their examination of the social media services provided by the governing institutes of 31 major cities around the world. The cities all have advanced infrastructures and are informally classified as Informational World Cities.

Re-engaging our citizens

Vancouver places 6th, ahead of Toronto and surprisingly Tokyo, but behind such cities as Berlin and New York. With much of the younger population active on social media, such platforms can be leveraged by the city to tackle the disengagement of its citizens. In September 2013 it launched the Talk Vancouver citizen engagement community in collaboration with Vision Critical, which polls citizens regularly on topics in which they are interested.

We’ve come a long way since then. Just use the technology.

The study measured the types of social media service used by each city and the level of activity in each account they manage. The most common type of account used is Twitter with YouTube following close behind, but Twitter activity far outstrips that of YouTube. Barcelona is diverse and active on Twitter, Flickr, Instagram, Foursquare; plus they blog! Berlin tops the list  in activity but is almost exclusively on Twitter.

Future direction

Thus far, Vancouver is active on Youtube, Twitter and Flickr. Its activity on Flickr is on the higher end of the scale but on YouTube there is much left to desire. This is surprising for a city well-known as a go-to filming location for movies and television shows. Maybe the local talent ought to be leveraged to both promote the city and showcase skills that could attract revenue to help the city towards its ambitions Greenest City 2020 goals.

Citizen opinions on interacting with government on social media platforms vary by country. 31% of residents in South Korea and 42% of residents in India would like to use such services to engage the government administration compared with just 22% in the U.S. In Brazil, 40% would like to be involved with policy decisions through social media platforms versus just 19% in the U.S. The take-home message: growing cities need to leverage technology to keep citizens in the loop and satisfied with the direction of progress.

Sources:

Government and Social Media: A Case Study of 31 Informational World Cities

Why London Comes Last in Social Media City Rankings via MIT Technology Review

Vision Critical, City of Vancouver Launch Talk Vancouver, an Innovative Online Community via Vision Critical

The ATRS Global Airport Benchmarking Report has identified YVR as Canada’s leader in efficiency. UBC’s Professor Tae Oum of the Air Transport Research Society (ATRS) reports that Vancouver International Airport charged airlines about $400 in landing fees for a Boeing 737-800 in the 2012 operational year, in contrast to approximately $700 at Montreal (YUL) and $2,000 at Toronto’s Pearson (YYZ).

The Air Transport Research Society was established in 1995 at UBC’s Sauder School to initiate research on air transportation. Its Global Airport Benchmarking Report was first released five years later in 2000. The report compares the operational efficiency and cost competitiveness of airports in North America, Europe, Asia and Oceania.

A US Airways domestic flight awaiting a cargo load at the gate.

The report indicates that higher efficiency airports are more likely to get a large share of total revenues from concession and other retail activities. Vancouver’s YVR receives 54% from such sources compared to 46% at Montreal’s YUL and 33% at YYZ in Toronto. Professor Oum adds, “We can also see that airports that outsource terminal services, ground handling and other services also achieve high efficiency.” The rankings are used by airport and airlines executives, governments, consultants, institutional investors and researchers and is reported to be the most comprehensive independent evaluation of global airport performance.

More efficient airports offer lower aircraft landing fees and reduced terminal services costs, allowing for the possibility that airlines pass on reductions on fare prices on to travelers. Airports with increased ability to do so are also indicated to receive a larger share of revenue from parking, office rentals, and real estate development. Vancouver charges airlines $14.11 per passenger, close to half that of Toronto which levies $33.34.

The stark difference in the price of seats on flights originating in Vancouver in comparison to those taking-off south of the US-Canada border, dampens demand and induces people to border-hop using cost-effective short-range buses (think Boltbus) in order to save on overall travel costs. The cost difference increases significantly when comparing long-distance intercontinental trips, with the airfare higher if the flight departs from YVR as opposed to Seattle (SEA), the closest international airport aside from Victoria, just of 200 km south of the metropolis.

Sources:

Global study ranks world’s most efficient airports (UBC News)

YVR top performing airport in Canada (Vancouver Sun)