Given the devastation caused by the COVID-19 pandemic, many wonder why people would hesitate to get vaccinated against it. That’s the question that bounces around the heads of countless doctors, public health experts, journalists, politicians, and others. But before attempting to answer the question, it might be reasonable to ask why people do, or do not do, other things that negatively affect their health.
Why does a patient with diabetes go to the emergency department with a blood sugar level over 500 and have not received insulin for 2 weeks? Why does the patient with lung disease continue to smoke two packs a day despite having difficulty breathing 24 hours a day? What prompts the elderly patient with abdominal pain to go out and go home to be with her dog? And for God’s sake, why do young people take that first shot of heroin or methamphetamine?
The easy and ruthless answer is to say that these people are just plain stupid. Stupid people don’t take insulin shots and keep smoking. Ignorant and uneducated people refuse to receive medical care. Unwise young people start using drugs.
And yet, having practiced medicine for 28 years, I can say that none of the above patients would be more willing to follow my suggestions if I told them that their decisions were “stupid.”
Human decisions are much more complex, nuanced, and personal than most of us realize. So, reviewing the above scenarios, the diabetes patient may not be able to afford the insulin. It may be that the smoker has few joys in life, and nicotine is one of them. As is often the case, the dog owner has no family or friends, and his dog is his closest companion. Finally, the person who uses drugs may be anesthetizing a life of terrible abuse, or it may come from a home where drugs were always on the back burner. Are your decisions worrying? They certainly are. But they are understandable. We do not need to agree with a choice to understand it.
Still, in light of a deadly pandemic, why would people avoid a vaccine that could save their lives or those around them? As before, the easy answer is: “because they are simply ignorant or don’t care if they hurt other people.” This argument is inappropriate and unproductive. Let me suggest some alternative reasons why people might not want the vaccine.
Despite the fact that “following the science” is a common mantra, science is often quite difficult to understand. Few people understand the incredible complexities of virology, immunology, or epidemiology. Despite my own upbringing, the complexities of human biology and medical science may still seem a bit far-fetched to me.
The understanding of science is not innate. Also, reading and posting science news clips that one simply agrees with is not the same as “following the science.” Many people with 4-year college degrees have only a passing knowledge of science at best. Also, science classes in high school are often relatively basic. As such, our understanding of the science in the general population makes it very difficult to explain the research that might alleviate anxiety among the unvaccinated. Any practicing physician knows how difficult this is when trying to explain a disease process, procedure, or imaging or laboratory results to a patient.
Another commonly cited reason for vaccinations hesitation is that the COVID-19 vaccine was developed and released much faster than typical vaccines and most pharmaceuticals. While those who express this are often viewed with some disdain, the fact remains that for years we have been told by medical scholars that we should view drug companies with suspicion and that they are often dishonest in their research. It may be that some of those who hesitate to vaccinate are just doing what they have been told to do … until now.
Those in rural America, particularly those in the midst of the current opioid crisis, may have more personal reasons to distrust Big Pharma. After all, they were sold OxyContin as a less addictive way to manage chronic pain. And yet the death and devastation left by the opioid crisis has been truly apocalyptic.
Many low-income people distrust the government in general, and not without reason. Poor citizens in the US (and around the world) suffered terribly during shutdowns advocated by public health professionals and the government. Unable to work from home, they lost jobs, businesses and homes as their children suffered from education problems, depression and anxiety. Rates of overdose and interpersonal violence have risen significantly due to the agony of lockdowns and endless restrictions.
It was easy for those who had money, or could work from home, tell others to stay home, order food, and watch Netflix. Those without money, both urban and rural, are unimpressed by the kind of pseudoscientific orientation, shrouded in politics, that nearly destroyed them. As such, your concerns about vaccine targeting may seem a bit more reasonable, feeling suspicious as they certainly have reason to be.
Doubt about the vaccine is certainly amplified by social media, which constantly produces half-truths and falsehoods, which are easily shared with the click of a button. The classic example is that the vaccine implants a kind of chip in the body that allows humans to be tracked. False information abounds.
On the other hand, ideas initially treated as crazed tirades turn out to have some value. For example, there is now growing support for the idea that COVID-19 originated in a laboratory. The shift in this viewpoint, as previously recalcitrant experts have come to hesitantly embrace a viewpoint that was once vilified, is also a source of confusion and mistrust for the masses.
While problematic, no one should be surprised by the effect of social media on this debate, or in the way it has become increasingly toxic. In fact, social media is used by movements and advocates of all kinds, and not always in an honest way.
It can be very difficult to know who to trust; all the more so when legacy media and big tech seem to increasingly apply censorship that is markedly partisan in their treatment of the pandemic. Additionally, social media algorithms intentionally drive anxiety and division in an already divided population in search of clicks and ad dollars.
In short, it is not so surprising that many people have not yet received the COVID-19 vaccine. After treating COVID-19 patients for many months, I finally received the vaccine last winter. I am a rural, southern evangelical Christian and have actively encouraged patients, friends, and family to get vaccinated. Unlike the general narrative, I have encountered very little criticism of the idea of vaccination. Obviously, that is anecdotal. But it is relevant.
Along with many doctors, I believe that the science of the vaccine is good and the benefit is great. While we are in the early stages of the process and need to be vigilant (and honest) about potential problems, I believe that the COVID-19 vaccination effort was one of the great scientific and government triumphs of the last century.
However, I work with real human beings and with their very real doubts and fears. I urge everyone to try to understand the vaccine and talk to them. Treat them as potential allies rather than enemies. Try to learn from them and apply that information to future situations. But don’t, under any circumstances, treat them like simpletons or dismiss their concerns out of hand.
We change the minds of our patients and our loved ones with compassion and kindness. We only alienate them with disdain. And this is more true nowhere than on the subject of questions about the COVID-19 vaccine.
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