The verdict has been rendered: The Covid-19 vaccines on offer in the United States — Pfizer, Moderna, and Johnson & Johnson are safe and effective. The vaccines protect (to some degree) against Covid-19 infections, but they also vastly reduce the chances of serious illness, hospitalization and death following rare “breakthrough” infections. Except for a smattering of transient, relatively mild side effects and extremely rare severe reactions, what’s not to like?
Yet a sizable number of people here and abroad have refused vaccination. Only about 60 percent of Americans have gotten at least one vaccine dose. You can blame America’s lax vaccine attitude on a variety of factors, but other countries that have national health care systems, universal access to the vaccines, and cultural and class homogeneity have struggled to jab everybody, too. Take the egalitarian republic of Iceland, which has only 360,000 residents. Just 80 percent of this well-educated population of civic-mind folks have taken the shot, and the rate of vaccination has slowed, maybe even plateaued. The United Kingdom’s vaccination rate similarly has slowed, currently standing at about 70 percent, as has Canada’s, currently at about 73 percent.
In polls, people offer a grab-bag of reasons for resisting vaccination. They intend to get the jab later. They worry about the side effects, or about how quickly the vaccines were produced. They say they can’t afford to miss work if the vaccine makes them sick. They express distrust of big pharma and doctors. They regurgitate vaccine misinformation. They protest they don’t know where to get the shot. For some Americans, rejecting a vaccine could be related to their faith — 24 percent of white evangelicals told a pollster in June that they wouldn’t get vaccinated, the highest share of any religious group. And even though some 4.7 billion doses of Covid-19 vaccines have been administered in 183 countries so far, some people still say they’re waiting until the shots are proven safe. (Covid- 19 vaccine hesitancy is not just a U.S. thing, by the way. Russia, other parts of Eastern Europe and parts of the Middle East lag, too.)
Without questioning the poll respondents’ motives, we can agree that these excuses are paper-thin. Yet reluctance to get vaxxed seems to be built into many vaccination programs in the United States, including vaccines for the flu, shingles, hepatitis, polio and others. No matter what vaccine is packed into the syringe, no matter the quality of persuasion and education applied, most vaccines hit a ceiling well below 100 percent of the U.S. population. Vaccine reluctance has been with us since the first vaccine, which prevents smallpox, proved its worth in the late 18th century. During the 2019-2020 flu season, only 48 percent of U.S. adults took the flu vaccine. It’s unlikely the avoiders declined that vaccine over “trust” or because they couldn’t find it or they wanted to wait until it was proven absolutely safe. Only about 35 percent of people over age 60 have taken the recommended shingles vaccine. At least that 24 percent of white evangelicals who said they would avoid the Covid-19 vaccine are consistent on the subject: In a 2018 Pew survey, 22 percent of them said they oppose mandatory vaccinations for children. Nor is mass vaccine avoidance new. At the turn of the previous century, the Anti-Vaccination Society of America was founded to combat mandatory vaccination.
Where, exactly, does this long-held indisposition come from? Wall Street Journal columnist William A. Galston surmised earlier this summer that, in the United States, an innate Republican antipathy for being told what to do informs the reluctance. He might be right, but that doesn’t explain the vaccine holdouts in Iceland or Canada, home to very few Trump Republicans. Scientists studying the vaccine conundrum have found that some people anchor their vaccine mindset to initial doubts about safety or efficacy, and that those attitudes harden even after safety and efficacy have been assured. “Once people question the safety or effectiveness of a vaccine, it can be very difficult to get them to move beyond those negative associations,” said Feng Fu, one of the study’s authors.
Setting aside mathematical models, political analysis and polls for a moment, we should remind ourselves that most vaccines are elective, designed to prevent or reduce the severity of illness in healthy people. Taking a vaccine is like buying insurance. You might never know for sure if the vaccine blocked disease, but taking it will buy you some peace of mind. Most other medicines are the opposite of elective — they’re taken by the sick in order to get better. Although there are some outliers, most people take meds without making the excuses vaccine resisters offer. Sick people demonstrate almost no “drug hesitancy.” Instead, some people who come down with serious Covid-19 infections experience a deathbed conversion and ask if they can still take the vaccine. (Sorry, it’s too late.) Of course, there’s an obvious downside to the resisters who catch Covid-19: Their infections spread the contagion. The ghoulish upside is that they also increase herd immunity.
Often, the more medicine people take, the more medicine they want. Old people, many of whom already take statins or blood thinners, have normalized drug-taking. They sense their mortality, and this knowledge makes them open to additional medical intervention. Adding a shot of Pfizer is a simple matter of adding another arrow to their medical quivers.
The million-dollar lottery appears to have failed to win vaccine hearts and minds. Can we change resisters into enthusiasts by encouraging them to become pill-popping hypochondriacs? Probably not. Convert them into enthusiasts by providing more facts? Assuredly not. Now that billions of doses safely have been served and untold thousands of lives have been saved, it’s hard to imagine a fact we could conjure that would persuade them. If visiting an intensive care unit and finding that nearly every ventilated person is unvaccinated won’t convince you to take the vaccine, what will? Should we teach fear of the virus by screening the Covid-19 equivalent of those old bloody drivers’ ed films? Lecture the anti-vaxxers for the 100th time that prevention via vaccination is superior in almost every way to treatment? Explain the cost-benefit argument one more time? Appeal to their altruism? Explain once more that, absent a vaccine, it’s less a question of whether you’re going to get a brutal case of Covid-19 than when?
Mandating vaccination for employment or for admittance to the next Foo Fighters concert will move some people on the margins, as will public shunning of the unvaccinated. But persuasion, shame, nudging and the setting of barriers have limited powers over people. Governments can enforce laws requiring vaccination, according to a Supreme Court precedent from 1905. But the punishment is only a fine, and recent rulings have upheld religious exemptions to the laws.
A world in which 100 percent of the population volunteered for Covid-19 vaccination would be the best. But that’s not the one we live in. Vaccine resistance is not solely about this particular vaccine. Don’t vax me, bro, has been the default setting for many adults since the invention of the first vaccine, and door-to-door visits and passports can’t change that. As much as the campaign to vaccinate might want to exercise zero-tolerance policies against resisters, in the absence of a law mandating universal compliance, we can’t reach that goal. Realism requires us to accept — though not salute — deadenders who have burrowed deeply into their tunnels. Some people will never surrender their lost causes.
Send me your best reason for not getting vaccinated: Shafer.Politico@gmail.com. My email alerts collect vaccinations the way Jay Leno collects cars. My Twitter feed seeks an Ebola vaccination. You don’t have to convince my RSS feed that it’s sick.