Understanding parents’ concerns about vaccinating their children against SARS-CoV-2

Uptake of the SARS-CoV-2 vaccine for children aged 5–11 years has been lower than anticipated in Canada. Although research has explored parental intentions toward SARS-CoV-2 vaccination for children, the drivers of parents’ decisions to seek vaccination for their children - or not -  have not been studied in-depth. 

A research paper published in CMAJ,  entitled Parents’ perspectives on SARS-CoV-2 vaccinations for children: a qualitative analysis, sought to explore parents’ decision-making. It was a collaboration between physicians, social scientists and research scientists. 

On this episode, four of the paper’s authors discuss their findings with hosts, Drs. Omole and Bigham. They emphasize the importance of existing trusting relationships between parents and their primary care providers when it comes to making difficult healthcare decisions for children.

Join us as we explore medical solutions that address the urgent need to change healthcare. Reach out to us about this or any episode you hear. Or tell us about something you'd like to hear on the leading Canadian medical podcast.

You can find Blair and Mojola on X @BlairBigham and @Drmojolaomole

X (in English): @CMAJ
X (en français): @JAMC
Facebook
Instagram: @CMAJ.ca

The CMAJ Podcast is produced by PodCraft Productions

Transcript

Dr. Mojola Omole:

Hi. I'm Mojola Omole.

Dr. Blair Bigham:

I'm Blair Bigham. This is a CMAJ Podcast.

Dr. Mojola Omole:

Blair, on today's podcast, we are discussing phenomenal qualitative research that looks at the process that parents go through to make the decision to vaccinate their children against the COVID-19 virus.

Dr. Blair Bigham:

This is going to be a really interesting conversation, Jola, and definitely something that I'm really curious about. I can get so frustrated sometimes having conversations in the emergency department when kids are not vaccinated. I have this gut reaction to it that I really need to check sometimes. So I'm really curious what we learn today about how best to communicate with parents who have questions about vaccines, particularly new ones like the COVID vaccine. You're a parent, Jola, what did you think when it came time to potentially vaccinate your kid?

Dr. Mojola Omole:

For me, it was a bit of an easier decision because I was already part of vaccination programs in the Black community. So I've had a lot of information regarding it. And I had a different ... kind of a nuanced approach to it, so it was much of an easier decision for me. But I would say I have other physician friends who chose not to vaccinate their children because they also were not a hundred percent clear on what the actual risk-benefit of it was.

Dr. Blair Bigham:

I think we have to untangle all these different ideas of misinformation, disinformation, poorly communicated correct information, and that everyone digests new information differently and a one-size-fits-all approach doesn't necessarily work. I'm very excited to see what our panel today has to say. They are co-authors of the study in CMAJ entitled, Parents' perspectives on SARS-CoV-2 vaccinations for children: a qualitative analysis. How about we just jump right into it?

The research paper is a fascinating collaboration between physicians, research scientists, and social science researchers. We've invited all of them to join us today. Dr. Jonathon Maguire is a pediatrician and researcher at St. Michael's Hospital, and co-leads a large pediatric research network called TARGet Kids. Dr. Janet Parsons is a research scientist for St. Michael's Hospital, and an associate professor at the University of Toronto in the Department of Occupational Science and Occupational Therapy. Kathryn Hodwitz and Dr. Jannah Wigle are clinical research specialists in the Applied Health Research Center at St. Michael's Hospital. Thanks for joining us, everyone.

Dr. Jonathon Maguire:

Good morning.

Dr. Janet Parsons:

Good morning.

Dr. Jannah Wigle:

Thanks for having us.

Dr. Mojola Omole:

Jonathon, I'll just start off with you. Tell us, what were you hearing in your clinic from parents about COVID vaccinations once the vaccine became available to children?

Dr. Jonathon Maguire:

Well, what was fascinating early on in the development of the vaccine is that people were pretty cautious about it. I think understandably because everybody wants their children, their precious children, to be as healthy as possible. People were worried about getting the COVID-19 virus. They were worried about the vaccine being relatively newly-developed, and some unknowns at the time. There were some clinical trials done on the vaccines, but with relatively low numbers of children involved, relative to the number of children that would now be vaccinated, so parents were worried about giving their children the vaccine. But the kinds of questions we were getting at that time were ... they were sort of different than the kinds of questions that we get usually about vaccination. That made us think that maybe this time around something was going on that was a little bit different.

Dr. Mojola Omole:

What were the kind of questions that you were getting that surprised you?

Dr. Jonathon Maguire:

For example, "This is all very new. I don't know if I want to be a guinea pig here." Usually vaccines have been developed over a very long period of time and we don't get those kind of questions. Or, "I'm hearing a lot of information from my friends, everybody's really worried about this. Do I have something to be worried about?" We usually don't get those kinds of questions.

Dr. Mojola Omole:

Janet, you've studied public attitudes and perspectives towards vaccinations for many years. What struck you as different this time around concerning what parents were expressing as their concerns for getting the vaccination for their kids?

Dr. Janet Parsons:

People were saying about the novelty, as Jonathon has already mentioned. The novelty of the vaccine, the fact that it's been approved quite quickly, that was something that was not something that usually came up. Because, for example, we've done studies of influenza vaccination, which has been around for many years, and peoples' perspectives on that were quite different from their perspectives on COVID vaccination.

Dr. Blair Bigham:

Janet, you had said that people were nervous about it because it had been rushed. Was it that it was new, or was it the sense that maybe the scientists had been so desperate to find something that they cut corners and literally rushed through something that might not be whole? Or was it just that it was new and it hadn't been really tested, and we haven't seen it in action for a couple of years? Or was it a bit of both?

Dr. Janet Parsons:

I think it was both, actually. I think it was actually both because people talked about, "Yes, this is a new vaccine." People talked about the new technology of mRNA versus other forms of vaccine. So that was less familiar to them. But then there was also ... people talked about the number of children, for example, it had been tested in. They had tried to sort of consume studies, tried to search for studies to find out how many children it had been tested on before. So that came up in our interviews. If it's okay, I'm going to look at Jannah and Kathryn and pass it over to them in case they want to add in on that.

Kathryn Hodwitz:

Yeah, quite a number of our parents talked about the challenge that they felt in sourcing and weighing evidence. Compared to routine vaccinations, where there's a pretty large evidence base supporting them and years of evidence to look back on, we just didn't have that for the COVID vaccines, particularly for children. So it was just this newness and this sense of wanting to wait just a little bit longer, just to see how things played out and to get a little bit more long-term evidence on potential side effects.

Dr. Mojola Omole:

As I'm thinking about how we actually rolled out the vaccine, it seemed as if we relied heavily on social media, the media, to really roll out the vaccine. But what it seems like, from what you guys saw, Jannah and Kathryn, was that people really wanted it to come from their healthcare providers. Is that correct?

Kathryn Hodwitz:

Absolutely. That was a really loud and clear finding that we heard from parents. Some people enjoyed having the extra attention in the media and by government, they found that very compelling to have that level of recommendation. But I would say a lot of the parents wanted it to be a conversation between themselves and their doctor. One parent in particular said, "I really felt like this should have been between me and my doctor and, the fact that government was involved really made me uncomfortable and, had politicians stayed out of it, I may have gotten vaccinated." But the fact that there was that politicization element actually dissuaded them from getting vaccinated themselves or having their child vaccinated.

Dr. Blair Bigham:

Kathryn and Jannah, you conducted the interviews. Are there any other conversations that stick out in your mind?

Dr. Jannah Wigle:

I think really, overall, something that came across from the findings was that this was a challenging decision for all parents, and that even though many parents had higher vaccination rates, almost all parents shared that they had some level of concern about whether to vaccinate their child or not. That really illustrated to us that this concern fell on a spectrum. It wasn't just that parents were pro-vaccine or anti-vaccine, but, rather, it fell on a spectrum of what we've called a “continuum of concern,” which really reflected a range of attitudes around the vaccination for their children. That it was something that they took really seriously and they spent a lot of work and effort to find evidence and find information to inform this decision. And then it was something ... really a sense of responsibility for making the best decision for their child.

Dr. Blair Bigham:

Often when we use the term anti-vaxxer, we think of a certain, maybe, political angle or argument. Tell me a little bit about how the people you interviewed were ... compared to that sort of stereotype, were they anti-vaxxers? Were they hesitant? Were they reluctant?

Dr. Jannah Wigle:

From the findings from our work, the parents really came across as concerned about being labeled as an anti-vaxxer, or being considered anti-vax. Many of them just felt they couldn't even ask questions or express levels of concern around the vaccination for their children without being labeled as anti-vax. That really tied into some of the political context at the time, the trucker convoy, the various protests around vaccination and other mandates. This was all happening while we were doing these interviews with parents and families about vaccinating their children, and many really strongly emphasized their support for other routine childhood immunizations as evidence that, of course, they weren't anti-vax because they had all the other vaccines for their children and they were really supportive of vaccines. One parent really said, "I'm not against vaccines. I'm not an anti-vaxxer. I'm not anti-western medicine. I'm just trying to gather information and make the best decision I can for my child."

I think another interesting point was that a lot of parents even felt vilified for not wanting to vaccinate their children. I think that was from, in the media, fear-mongering, and that kind of messaging that had come across as well that had really framed people who were concerned or had not yet decided about whether or not to vaccinate their children, as it really portrayed them in a negative light. So many even reported vaccinating their children for fear of social exclusion, not being able to see their families, not being able to speak about it with their neighbors and their friends and their friend groups, and even shared, one of the main reasons they vaccinated their children was so that they wouldn't be ostracized at school, or their child would be able to continue in their extracurricular activities. Many somehow felt coerced into that decision as well. I think that really speaks to just that level of stigma that was associated with being unvaccinated at that time in the media, and just all the different messaging that the public was receiving about vaccination.

Dr. Mojola Omole:

That is actually really unfortunate to hear because I'm assuming that is not the intention of pediatricians or the healthcare community in terms of what the end goal is. I guess this question is for both Jonathon and Janet is, having that type of situation around the COVID-19 vaccination, how do you think that could possibly affect future vaccinations for something like another COVID or something else?

Dr. Jonathon Maguire:

Great question. The circumstances during the COVID pandemic, particularly around vaccination, were different than circumstances, I think, at other times. Our research is supporting that families wanted to have conversations with their healthcare providers, while, at the same time, the healthcare providers weren't there. It was difficult to see your healthcare provider because practices were closed. The rollout of the vaccine was done, at a provincial level, at vaccine centers where there was very little discussion that could be had. I think those factors came together to make a really different kind of scenario for parents with children. I'm not sure, ahead of time, that had been thought through that way. I think if we were to do it again, all of us sitting back with some evidence in hand, maybe we would do things a little bit differently next time.

Dr. Janet Parsons:

I'd just like to support what Jonathon just said. I think that idea that came out in these interviews and in other studies that we've done, which is that idea of the trusted healthcare provider. Really, that's where those decisions and where those conversations need to happen. That's definitely what people tell us in different contexts, not just in this context. That trusted … "Who do you trust? Who do you go to for that information? Who's a trusted source of information?"

Dr. Blair Bigham:

I want to go down another avenue that we've heard a lot about, and that's the perceived effectiveness of the vaccines and how that might have played into the reluctance to vaccinate children. Early in the pandemic, we kept saying, "Oh, children don't seem to be affected," or, "The vaccines might not be effective." Was there an element that this vaccine just isn't necessary for kids compared to what people were making decisions for themselves, as parents getting vaccines?

Kathryn Hodwitz:

Definitely. I think that's something that came up a lot. It was that potential lack of efficacy that you just mentioned for the childhood age groups, but also this balancing of collective gains versus individual gains. So, looking at the collective benefit of getting as many people vaccinated as possible, they are very on board for that, when we're speaking about adults, but as soon as we're bringing kids into that, there's sometimes more of a weight put on the individual child, and the individual risks and benefits for their own child. We saw a lot of parents talking about that, the balancing of recognizing the collective good of large-scale vaccination programs, but the immense weight of making an individual decision for their own child and their own family. And sometimes wanting to feel children shouldn't necessarily be held responsible for the collective good of everybody, so there was a different weight placed on it for their children.

Dr. Janet Parsons:

I just was going to build off of the great conversation that's happening here, which is I think one of the things that was so interesting about COVID was that the evidence kept changing over time. People were trying to keep up with this, and sort of, "What was the vaccine for?" Not just about the vaccine, but, "Was it going to prevent illness? Was it going to prevent transmission?" There were a lot of questions people had around that. And then we were interviewing people during the Omicron wave where suddenly people were getting it even though they'd been vaccinated. So you can imagine that can be confusing for people who aren't experts in vaccination. But that's, I think, true of the broader COVID context as well, because there were other kinds of evidence and policy communications, and that kind of thing, where people were trying to find their footing and it kept shifting. I think that's really challenging for people, for people to make sense of it.

Dr. Jonathon Maguire:

There was a recent editorial about this topic in a prominent journal, citing the evidence, and the author said, "The decision to vaccinate your children against COVID-19 should be an easy one." Yet, it's not. I think this is the flavor of what's going on. Unpacking the story, as our group has tried to do, I think is going to be helpful to figuring out what's going on inside homes.

Kathryn Hodwitz:

I think something that was evident in the interviews that we conducted with parents as well was that when they're making this decision, they're weighing all kinds of sources of information, and population level statistics is only one piece of the puzzle. Personal anecdotes and stories that they're hearing from friends and family members and colleagues often held a lot more weight. So that's just another sort of balance of information that was factoring into their overall perceptions and decision making.

Dr. Blair Bigham:

I'm going to take the opportunity here to flow into a conversation about how misinformation was affecting peoples' decision making and the vaccine campaigns. Janet, I'll start with you. Generally speaking, how did misinformation during COVID differ from misinformation in previous vaccination campaigns or outbreaks?

Dr. Janet Parsons:

That's a huge topic, but I think we're in a setting now where social media ... that's not to blame it, but more that it's just that there were ... we're surrounded by so many sources of information, so there's a lot of different kinds of information vying for attention. Sometimes I think it's very dizzying for anyone to try to make sense of it, so that sort of ... I think that's what played into the misinformation more was that there's multiple sources of amplification of different voices. So that, I think, may be more difficult for people to navigate than, say, in previous eras. I would pass it to my colleagues and see if they have anything that they'd like to say.

Dr. Blair Bigham:

Jannah, Kathryn, what were you hearing when you interviewed parents?

Dr. Jannah Wigle:

One of the questions we asked parents was, "What sources of information did you use to make this decision?" As Kathryn said previously, it was really a wealth of evidence, but it was just a lot of evidence and information for parents to wade through. Many even went as far to say they didn't listen to the media for information, they didn't go to social media. They shared that they read research papers or government websites as key or trusted sources of information as well. I think, in terms of just the sheer effort the parents put in, too, was something that really came across. It was a difficult decision that they took seriously, and they considered a lot of different evidence and information to make that decision.

There wasn't as much sharing of misinformation. A lot of families were really trying to learn more about it and were really actively pursuing information to inform themselves about the vaccine, the technology, side effects, benefits and risks. There was not as much misinformation communicated by the parents in the study as seen in other social media or other spaces.

Dr. Blair Bigham:

In this particular pandemic, we used a lot of mass vaccination centers or popup clinics. There were buses where you could go on board to get your vaccine. How did that affect the vaccine rollout compared to just meeting in a physician's office or a nurse practitioner's office?

Kathryn Hodwitz:

Sure. Some of our parents certainly brought up the fact that virtual care had just been introduced at this time. A lot of people weren't comfortable with it yet. Often, virtual appointments were only for urgent or critical matters, not just to have a discussion about, "What are your thoughts about the COVID-19 vaccine, and is this something I should do for my child?" So there was a little bit of a barrier put between people and their family health physicians, or their family healthcare providers. We definitely saw that as a factor of adding that additional layer of uncertainty around making this decision for their own child.

Dr. Jonathon Maguire:

Certainly, from a provider point of view, those are difficult decisions to have with families ... or discussions to have with families over the telephone, particularly considering we weren't giving the vaccine. We weren't having the in-the-moment discussion, and there was really no opportunity for in-the-moment discussions. So people were having discussions in different ways. I think a lot of that fed into some challenging decisions for families.

Dr. Blair Bigham:

Let's transition our conversation towards solutions and the future. And, as we do that, Janet, let's set this conversation with the intention-behavior gap. Can you just tell us what the intention-behavior gap is and how that played a role in the conversations that you heard about in this research?

Dr. Janet Parsons:

Well, I'll start off and then I'm going to pass it all over to Jannah and Kathryn, but one of the things at the outset of this study was that Jonathon leads a huge cohort of research around outcomes for young children. He'd actually had the opportunity to survey parents about their intentions around vaccination and some of their attitudes around vaccination before we did this particular study. So we had some information about what people were thinking about doing and how they felt about vaccination for themselves, how they felt about vaccinations for their children, their relative level of concern. We were actually able to purposively sample, in this study, to ask people from a range of perspectives about that ... these surveys were conducted prior to the vaccination coming on the market and being able to actually be administered in real time. When we looked at those intentions, that was really interesting to see ... Many people were saying that they were going to vaccinate themselves and their child, but there was a range of opinions around that.

But we also know, Jannah and Kathryn, I'm hoping you're going to jump in at some point, but that we also know from prior literature that there was higher intention expressed about vaccination. And then when it actually came to the decisions, what our study shows is that, when people actually had to come to actually saying, "Okay, now, am I going to do it or not?" that there is that gap. People may express intentions but then, in the moment, those concerns come maybe flooding to the surface. And then it's actually harder to actually go forward and actually decide to vaccinate your child. But Jannah and Kathryn, I know that sort of came up in the interview, so I'm handing it over to you.

Kathryn Hodwitz:

Yeah. I'll just reiterate that we had looked at the literature and there was a considerable amount of work done looking at parental intention to vaccinate their child once a vaccine became available. It was relatively high. I think two-thirds of parents in Canada said that they would vaccinate their child as soon as they could, but then we found that the actual uptake, once vaccines were available, was much lower. So there was certainly an intention-behavior gap there that we were interested in exploring. Just understanding why are parents making this decision, and how?

Dr. Jannah Wigle:

To speak to that, a lot of the work that was done in this area previously was quantitative. It involved surveys. It didn't really dig deep into parents' perspectives and to really unpack some of those ideas. So this study really contributed an understanding of that nuance, the real complexity of these decisions around whether or not to vaccinate their children against COVID-19. And to really understand that parents' attitudes around COVID vaccination really ranged, and that many had some concern, even if they were really, in theory, supportive of the vaccine. That was something that was really novel in this study that contributed to that literature as well, and that understanding to help address that intention and behavior gap.

Dr. Mojola Omole:

Jonathon, as a physician, what is your ... Two part question, what is your takeaway for research? And second, if you were queen for a day - because queens are more important than kings - what would you do differently regarding vaccinations in the future?

Dr. Jonathon Maguire:

Yeah, thanks. Maybe I'll answer the second question first because I would just love to be queen. Yeah, I think if we're going to do it again ... We know how to give vaccines. We know how to do vaccine rollouts for children. It's a very personal thing for many families involving discussion and thought, and the relationship that has been built between the families and their healthcare providers. Almost all children in Ontario have a healthcare provider that provides primary care for them. We built that system on purpose over a long period of time so that we can do things like that. That kind of fell apart a bit during the pandemic. I think this was a consequence and part of that. If we were to do it again differently, I would hope that we would recognize the value in what I just said, and help us support our families and children through the relationships they have with their wonderful healthcare providers. I think that's the most important thing I think I would do differently.

If you take a few steps back and you say, "Well, what if we rolled this out without all of this pressure that happened on top, would we have done any better?" I don't know if we would've done worse. I think, in terms of vaccination, it's around 30% for children right now. Could we have done better? Maybe, but I don't think we would've done worse. So I think we just need to take everything, like Janet and the team were saying, into context. These are very personal decisions that people make, relying on information that's trusted.

Dr. Mojola Omole:

Great. Thank you, guys, so very much for joining us. Dr. Jonathon Maguire is a pediatrician and researcher at St. Michael's Hospital, and coleads TARGet Kids, a large pediatric research network. Dr. Janet Parsons is a research scientist with St. Michael's Hospital, and an associate professor at the University of Toronto in the Department of Occupational Science and Occupational Therapy. Kathryn Hodwitz and Dr. Jannah Wigle are clinical research specialists in the Applied Health Research Center at St. Michael's Hospital.

Dr. Mojola Omole:

Blair, I have so many thoughts after this really dynamic panel, but can you tell me what jumps out at you most?

Dr. Blair Bigham:

The message that preexisting relationships with family doctors, nurse practitioners, whoever parents were comfortable with and trusted and knew, might have been the best avenue to pursue to discuss pediatric vaccinations, instead of ideas like mass clinics. But then I also kind of wonder about the pragmatic angle on that. How easy is it to do that when you're trying to rapidly vaccinate people from a new virus causing a global pandemic? But it's a really curious thought for me to think that all this information is new, all of it is somewhat ... there's some uncertainty to all of this. Even as physicians, public health professionals. Things were changing rapidly. We were learning more every day. That trusted component was probably missing for a lot of those sort-of mass communications. That's a big problem and a challenge for us in the future: can we establish trusted mass communications, so that we don't have to rely on this very work-intensive, somewhat maybe not-pragmatic approach of having 40 million people sit down for one-on-one conversations with their family doctors, who are already completely strained under the pressures of the pandemic?

Dr. Mojola Omole:

For me, it's similar. I think I was really heartened to know that, for people, that relationship that they have with their primary care provider, pediatrician, is really central to how they get information. It seems to me that people haven't lost faith in the healthcare system, they've lost faith in the political system that funds our healthcare system, and that the problem is not-

Dr. Blair Bigham:

Underfunds our healthcare system.

Dr. Mojola Omole:

That doesn't fund our healthcare system. That the problem is not that relationship, but is all the external forces on it. I heard from many friends who are family physicians that they actually wanted to have these conversations with their patients, and also provide the vaccinations. They're like, "We immunize kids ... We immunize all the time, how is this different?" I do wonder, when we do the autopsy of this, the amount of money that we put into mass vaccinations, could we have done it differently? Of having ... whether you group it by region, and saying, "Family doctors in this area of Scarborough will be available for this amount of time to talk to their patients." It's booked through their clinic, or whichever way we want to do it, and vaccinations are available. Doing it that way, where you actually bring the family doctors into the fold, versus completely excluding them from the fold.

Because I'm a general surgeon and I was giving vaccinations. I was trying to have this, develop a relationship with someone in five minutes, where their family doctor has been having this relationship with them for 20 years, right?

Dr. Blair Bigham:

Right.

Dr. Mojola Omole:

It seems as if we got this part wrong, and this is something that ... There's going to be another virus that we need to actually do a proper examination of what we could have done better.

Dr. Blair Bigham:

I think teasing apart the child vaccines from adult vaccines is important, too, because mass vaccinations worked very well for adults. Particularly in that January when COVID was causing a lot of mortality, particularly in nursing homes…we saw Canadians roll up their sleeves and end up with very high vaccination rates in the adult population. It does seem like we need a finer approach for the pediatric population because children are so precious and parents are so protective, and take that responsibility to make the right decision for their child so heavily.

Jola, in the interviews, we didn't really talk about some of the racial considerations or cultural considerations of different groups. You've worked a lot on vaccines in the Black community. Does what we talked about in the panel resonate with you when it comes to the Black community?

Dr. Mojola Omole:

A hundred percent. I would say that… actually, because we used to say vaccine-hesitant, but as Dr. Wigle pointed out, that's probably not a really great term to use for people who are just trying to make the best decision. They're not hesitant about the vaccine-

Dr. Blair Bigham:

They're curious.

Dr. Mojola Omole:

... maybe their hesitancy is ... Yeah, they're curious in the process of this. I would say that that's something that, because funding was really tied to mass-vaccinations, we weren't able to actually target the people that patients already had ... that doctors already had a relationship with. Oftentimes, though, coming to the clinic I was working in, the family doctor would be like, "Well, 10 of my patients are coming in today. I told them to come in because I'm here today," and those 10 patients came in. It's almost as if we really need to change that. And it's not saying that there needs to be more that family doctors need to do, we also just need to add extra funding to help them do this job. We need to support them because they're the ones who've developed this relationship with their patients.

Dr. Blair Bigham:

Well, one thing we've learned is that different people have different approaches to all these different decisions in a pandemic. For some people, mass vaccination sites might work very well. And for others, a family doctor visit or a nurse practitioner visit might be the way to go.

Dr. Mojola Omole:

Or pediatrician.

Dr. Blair Bigham:

Or pediatrician, absolutely.

Dr. Mojola Omole:

That really needs to be incorporated into our next pandemic plan for vaccinations.

Dr. Blair Bigham:

Maybe there's this out-of-the-box, hybrid approach where family doctors create YouTube videos, or family doctors have a WhatsApp channel. Maybe family doctors can find other ways of engaging with their patients when we have this mass prerogative to move quickly and rapidly at a national scale.

Dr. Mojola Omole:

If we do that, though, we need to make sure that they get compensated for the time and effort they put in to taking care of the population.

Dr. Blair Bigham:

As Jola and I know, all this communication and science advocacy, it's very, very labor intensive, and a lot of people have been doing it for free for the last three years.

Dr. Mojola Omole:

That's a great point.

Dr. Blair Bigham:

Show them their money.

That's it for this week's episode of the CMAJ Podcast. Thanks so much for joining us. Please do remember to like or share our podcast wherever it is you download your audio. I'm Blair Bigham.

Dr. Mojola Omole:

I'm Mojola Omole. Until next time, be well.