“The oldest and strongest emotion of mankind is fear, and the oldest and strongest kind of fear is fear of the unknown.” - H.P. Lovecraft, American writer of horror fiction
“Fear defeats more people than any other one thing in the world.” - Ralph Waldo Emerson
Vaccines continue to show that they work exceedingly well. In the U.S., mounting evidence suggests that while the COVID-19 is not yet behind us, it is rapidly receding. Buoyed by 70% COVID-19 vaccination rates both New York City and the state of California declared June 15 as a “momentous day” and “opened up,” that is, they lifted most of their virus restrictions. Nonetheless, the pace of vaccinations in the U.S. has stalled. Close to one third of Americans remain hesitant about getting vaccinated. On June 22nd, President Biden announced that the goal to have 70% of U.S. adults at least partially vaccinated by July 4th won’t be reached. In this Germ Gems post, I’ll provide my assessment of the underlying basis of vaccine advocacy or activism on one hand, and of vaccine antagonism or hesitancy on the other.
Fear: the common denominator. I am a vaccine advocate, a physician who believes that vaccines are by far the biggest accomplishment in all of medical history. While it is hard for me to understand anti-vaxxers or vaccine antagonists, I believe the emotion that drives them is fear—of an overreaching government that threatens their freedom or the side effect of vaccines. And it is this same emotion that drives vaccine advocates who are fearful we won’t reach herd immunity giving time for viral variants to emerge that won’t be stopped by current vaccines.
What are vaccine advocates afraid of? Vaccine advocates are convinced that the three COVID-19 vaccines that are available in the U.S. are highly effective and safe. (And the good news is that a powerful fourth vaccine, developed by Novavax, is headed for approval.) The main fear vaccine advocates share is that herd (community) immunity—pegged most recently at 80% to 90% of the population—won’t be reached, thereby providing time for additional viral variants (mutants) to emerge that won’t be thwarted by existing vaccines.
Currently, it is the SARS-CoV-2 Delta variant that is most alarming to vaccine advocates. This variant arose in India about eight months ago and has rapidly spread around the world including in the UK, where it is now the predominant viral type. In the U.S., Delta currently accounts for about 10% of COVID-19 cases, but this is changing rapidly. The Delta variant is more contagious than the original SARS-CoV-2 virus, and it doubles the risk of hospitalizations. Careful analyses show, however, that the available vaccines remain protective against this variant.
An even bigger fear that vaccine advocates in the U.S share, a fear that overshadows their concern for fellow citizens who refuse to be vaccinated, is the worry that a huge number of people globally won’t have access to vaccines. This concern is not only humanitarian. Everyone in the world is in this together. Therefore, a large majority of the world’s population needs to become immune, by natural infections or by vaccinations, in order to achieve herd immunity. As of June 19th, only about 21% of the world’s population had received at least one vaccination. Even more worrisome is that only 0.8% of people in low-income countries were vaccinated. And while the donation of one billion doses of vaccine by world leaders at the recent G7 meeting is a good start, it falls far short of the number of doses needed to reach herd immunity and end this pandemic.
What are vaccine antagonists afraid of? The “anti-vaxxers” pose a significant threat to reaching heard immunity and quashing this pandemic. These antagonists purposely sow misinformation about the dangers of the COVID-19 vaccines via social media sites on the Internet. A large number of anti-vaxxers appear to be fearful mainly of the government impinging on their right to decide for themselves or their children whether to get vaccinated (a fear rooted more in political philosophy than in science). There are also vaccine antagonists or anti-vaxxers who share a fear of the side effects of vaccines. It is important to address this fear.
All of the highly effective COVID-19 vaccines in use in the U.S. do have side effects. They are, however, monitored and analyzed on an ongoing basis by both the U.S. Federal Drug Administration (FDA) and the Center for Disease Control and Prevention (CDC). Both of these organizations prioritize vaccine safety above efficacy. According to both the FDA and the CDC, the benefits of the approved vaccines far outweigh their risks. It is important for us to build trust in these regulatory agencies. Their public health stance is similar to the medical profession’s prioritization: primum non nocere or “first, do no harm.”
A question regarding vaccine safety that surfaced recently is, “How safe are the vaccines in children?” This concern was fueled by a recent report from the CDC that they are investigating rare heart problems following COVID-19 immunizations, most of which were in vaccinees ages 12 to 24.
To date, only the PfizerBioNTech and Moderna mRNA vaccines are approved for use in children ages 12 to 18. Therefore, this issue pertains mainly to those in this age group. Vaccines for younger children are expected, however, to roll out this fall. Thus, what is a parent to do?
We do need more data on the safety of COVID-19 vaccines in children. Nonetheless, an article in MedPage Today on June12, “Let’s Recognize Childhood COVID as the Crisis It Is: the calculus of risk is different for kids,” provides a convincing case for vaccination of children, a conclusion shared by the CDC, that is, the benefits of the vaccines far outweigh their risks. My advice to parents: consult with your pediatrician or family medicine doctor about COVID-19 vaccination of your children.
Motivational strategies to counter vaccine antagonism. To increase the pace of COVID-19 vaccinations, a number of creative strategies have arisen. Some use incentives (carrots), others punishments (sticks). Free admission to the state fair and free lottery tickets are among the carrots in Minnesota, and according to the New York Times, several locations across the U.S. are allowing adults to claim a free marijuana joint when they receive a shot (“Joints for Jabs”).
Targeting health care workers who refuse vaccination is one logical punishment. For example, in early June, a large Houston-based health system suspended 178 hospital workers for not complying with COVID-19 vaccination policy. Many K-12 schools, colleges/universities, and businesses have implemented mandatory SARS-CoV-2 vaccinations. And in Pakistan, the government recently announced plans to block cell phone service to residents who don’t get vaccinated.
What can we do? This pandemic affects all of us on planet Earth. This is a time when “it’s not all about you.” Instead, it is all about us. As I’ve advocated in my other Germ Gems posts, “Get vaccinated!” Moreover, “become a vaccine activist.” Awaken the apathetic. Promote vaccines to those who lack access. We are all in this together, and the only way we can get through this is to put fear behind us and pull together to end this pandemic.