[Este artículo está disponible en español. La traducción al español apareció por primera vez en la revista Pensar.]
We now have several vaccines for COVID-19. They have been adequately tested. They are safe and effective; and as more people have gotten vaccinated, infection rates, hospitalization rates, and death rates have fallen. Herd immunity may be in sight. Getting vaccinated seems like a no-brainer, but there are still a lot of people who are refusing the vaccines. A member of my own family said, “I don’t understand why anyone would refuse to get a COVID-19 vaccine.” I think I do understand, and I think it would be a mistake to write those people off as stupid or call them idiots.
An authoritarian government could require vaccinations and could punish anyone who fails to comply or who spreads negative information about vaccines. But we live in a democratic society that values free speech and personal autonomy. “I disapprove of what you say, but I will defend to the death your right to say it.” If we just characterize vaccine refusal as “stupid,” we have no reason to interact with the refusers. Who would want to bother listening to their stupid assertions? But if we try to understand their reasons for refusal, we might be able to communicate with them and influence some of them to accept vaccination.
Perhaps the biggest reason for refusal is the widespread misinformation and ridiculous conspiracy theories that have been circulating. (No, the vaccines don’t put surveillance microchips into your body!) Some people still don’t believe the pandemic is real; they think we’ve been lied to. They think masks are useless or even harmful. Some think the virus is harmless and the vaccines are making people sick. It’s not enough to correct the misinformation by providing true information, because they have no reason to think the true information is more reliable than the false information they’re accustomed to hearing. There is a distrust of science and of authorities that will be difficult if not impossible to overcome.
Many refusers distrust the vaccines because of the speed with which they were developed. They don’t understand how that was possible. Perhaps a thorough discussion of the underlying science and the way the vaccines were tested might have a chance of changing their minds.
And then there’s politics. Some people’s entire world view and self-identity are bound up with belonging to a political group that downplays the pandemic and rejects mask-wearing. Peer pressure and the need to belong to the group can be very powerful. I can understand but I can’t condone.
Minority racial groups are less likely to be vaccinated due to a combination of distrust and lack of access. They know the long history of racial bias in medical care with incidents such as the Tuskegee syphilis study fiasco and racial disparities that continue to the present day. They can hardly be blamed for distrusting the medical establishment. Trust is likely to grow as they see more of their peers get vaccinated and as they see the vaccinated are helped rather than harmed.
Some refusers are not refusing indefinitely. They are waiting to see what happens to others. This is especially true for parents who are reluctant to vaccinate their teenage children who have now been approved to get the vaccine. We can call that wrong, and we can call it over-cautious; but we can’t really call it unreasonable.
Some people are afraid the vaccines may have adverse effects in the long term. Because they are so new, we won’t know for a long time yet. Time will tell, but the current very real danger from the pandemic far outweighs speculation about the remote possibility of harm in the future.
Some people who haven’t been vaccinated don’t actually reject the vaccines. Some say they will get the vaccine if it is required, for instance if it is a condition of employment. Some are procrastinating because of their fear of needles. A friend of my daughter’s is a case in point. He knew he should get vaccinated but kept delaying. He deeply regretted his procrastination when both he and his wife came down with COVID-19 and he ended up spending a week in the hospital.
Some people haven’t been vaccinated simply because they have not had a convenient opportunity. They don’t want to go to the effort of seeking out a vaccine appointment, and they don’t want to miss work and income to get vaccinated. Surely there are things society can do to help those people.
There is one valid reason to reject vaccination, but it is a selfish one. If enough people in the community get vaccinated, the risk of catching the infection will drop for unvaccinated individuals. They can get a free ride on the coattails of others without any risk to themselves of possible side effects and without a needle stick. This makes a lot of sense and is an argument that has frequently been made as an excuse to refuse other vaccinations; but it is seriously unethical.
So I think I do understand why so many people refuse vaccination. I think their decision is wrong, but I don’t think it is stupid. Some of these people are intelligent and informed (albeit usually mis-informed) and they think their reasoning is valid (and sometimes it is). They are doing the best they can with the information they have. By understanding where they’re coming from, we may have a chance to influence some of them; others will remain unreachable. The real problem boils down to an ideologically divided society that has lost respect for science, for authorities, and even for truth itself.
But there is hope. As more and more people are vaccinated, a bandwagon effect will kick in. Many who currently reject vaccination will want to join in and do what they see the majority are doing, especially when they realize how effective it has been in reducing the infection rates and death rates.
This article was originally published as a SkepDoc’s Corner column on the CSI website.