“Even if God himself came down from the heavens and said it will do you no harm, I’d say ‘No thank you,’ I believe in a whole different way of taking care of the body. I believe in healthy foods, sunshine, love, Earth connection, exercise. I just don’t believe good health can ever be found in an injection.”
– Rita Palma, founder of the anti-vax group “My Kids, My Choice” launched on Facebook in 2006, after her petition to have her children exempted from vaccinations for religious reasons was denied by her school district
Shocking? I think so. Such stubborn resistance in the face of the global pandemic defies logic. It seems a belief in natural remedies and vaccines should coexist, especially in life-and-death decision making.
But, the anti-vax movement is nothing new – in 2019, the World Health Organization listed “vaccine hesitancy” as one of the top-ten threats to global health – but the growing distrust of a vaccine that, at this point, is only hypothetical is a rare cultural phenomenon.
Scott Ratzan, a physician and medical misinformation expert at the City University of New York and Columbia University, says anti-COVID vaccine sentiment is the result of “a massive assault on trust in government, in science and in public-health authorities.”
(Eric Spitznagel. “Scientists worry as more Americans say they’ll refuse COVID-19 vaccine.” New York Post. October 17, 2020.)
"There is a general anti-science, anti-authority, anti-vaccine feeling among some people in this country -- an alarmingly large percentage of people, relatively speaking," the government's top infectious diseases specialist, Dr. Anthony Fauci, told CNN recently.
(Stephen Collinson with Caitlin Hu. “What if they make a Covid-19 vaccine but Americans refuse to take it?” CNN. July 17, 2020.)
Psychologists tell us people are prone to continue to believe what they’ve long believed already. And such biases increase when faced with anxiety-inducing societal events, such as public health threats. As the situation worsens, these biases can become more entrenched.
According to a survey conducted by the Pew Research Center (Sept. 8-13), the number of Americans who planned to get a COVID-19 vaccine has fallen from 72% in May to just 51% in September. What’s more, according to the report, when asked about the pace of the vaccine approval process, 78% say their primary concern "is that it will move too fast, without fully establishing safety and effectiveness.”
What else underlies people's resistance to taking a COVID-19 vaccine? It's a symptom of the politicization of every layer of American life. Some conservatives balk on principle at the government ordering them to take a jab. Some are suspicious of the power of the pharmaceutical industrial complex. Others are swayed by false conspiracy theories that whip around the social media echo chamber.
According to an August survey from STAT and the Harris Poll, 78 percent of Americans are worried that a COVID-19 vaccine is being influenced more by politics than science.
It’s a largely bipartisan opinion: 72 percent of Republicans and 82 percent of Democrats (This was before the election.) don’t trust a vaccine pushed by politicians, regardless of their party affiliation.
Here's an alarming fact: last year, the US recorded the most cases of measles since 1992. A total of 704 cases were reported. Among the 704 cases, 503 (71%) were in unvaccinated persons and 689 (98%) occurred in U.S. residents. Increased global measles activity poses a risk to U.S. elimination, particularly when unvaccinated travelers acquire measles abroad and return to communities with low vaccination rates. According to the CDC, recent outbreaks have been driven by misinformation about measles and MMR vaccine, which has led to undervaccination in vulnerable communities.
What does this say about refusal to take a coronavirus vaccine?
The percentage of the population that needs to be immune against a disease for it to stop spreading depends on how infectious it is. This is what makes measles, an extremely infectious disease, so susceptible to the whims of a small minority.
Yascha Mounk of The Atlantic reports …
“On average, each person who contracts measles infects 12 to 18 others. (The exact number depends on a host of circumstances, including the density of the affected area, and can vary even more widely, according to a recent study in The Lancet.) This is why a relatively small number of anti-vaxxers can wreak terrible damage: If as few as 10 percent refuse to protect themselves (or their children) against measles, Beyrer told me, a population may lose its herd immunity—with potentially devastating consequences for those who are too young or too sick to get a vaccine.
“But the novel coronavirus is far less infectious than measles. Instead of 12 to 18 people, the typical COVID-19 patient infects two to three. As William Moss, the executive director at the International Vaccine Access Center at Johns Hopkins University and a professor in its School of Public Health, told me, “It’s not as transmissible a virus, so the herd-immunity threshold is much lower.”
(Yascha Mounk. “When a Vaccine Arrives, People Will Ignore the Anti-Vaxxers
Even if some Americans opt out, the country will still reach herd immunity against COVID-19.” The Atlantic. July 31, 2020.)
According to the experts Mounk spoke with in July, the threshold for herd immunity for COVID-19 is likely to fall somewhere between 50 and 70 percent of the population.Vaccine efficacies to protect against infection above 80% are desirable.
But don’t expect herd immunity to rescue the U.S. from the COVID-19 pandemic anytime soon. The country needs about 200 million infected and immunized citizens before the chain of infection can be broken. And the numbers just don’t add up, according to James L. Madara, MD, executive vice president and CEO of the AMA. So, to achieve the 130 million more immune individuals, nearly all of the remaining population would have to be immunized, to get the right amount for herd immunity.
(Len Strazewski. “Why hopes for fast track to coronavirus herd immunity don’t add up.” American Medical Association, October 26, 2020.)
So, it appears the bottom line about the vaccines is summed up by this statement:
“Taking novel vaccines successfully through phase 1 to phase 3 trials within a year has been an outstanding achievement, but equally challenging over the coming year will be persuading governments and populations to use COVID-19 vaccines effectively to create herd immunity to protect all.”
(Roy M. Anderson, Carolin Vegvari, James Truscott, Benjamin S. Collyer. “Challenges in creating herd immunity to SARS-CoV-2 infection by mass vaccination.” The Lancet. November 04, 2020.)
And, these researchers cite certain problems;
* Duration of protection will remain uncertain for a number of years post licensure of COVID-19 vaccines. Preliminary evidence suggests waning antibody titres in those who have recovered from SARS-CoV-2 infection,
* Antibodies are only one part of the human immune response and acquired immunity to reinfection or the prevention of disease when reinfected.
* Data on immunity to other coronaviruses suggest that immunity to SARS-CoV-2 might be short lived, perhaps 12–18 months in duration.
* Whether past infection will prevent severe COVID-19 on re-exposure to SARS-CoV-2 is not known at present.
* The percentage of the population that must be vaccinated in year 1 is much larger than the percentage that must be vaccinated once the system has stabilized after a few years, since most of the population will be susceptible as mass immunization starts, but after a few years, hopefully, a high proportion will be immunised such that effective herd immunity is created.
* What is clear from their estimates based on the assumptions that efficacy is satisfactory (>80%) but duration of protection is short (1–2 years), is that a large proportion of the total population would need to be vaccinated if there is to be any chance of getting herd immunity to block the continued transmission of SARS-CoV-2. If the vaccine is protective over a longer duration than natural infection, then their estimates will be too pessimistic.
(Roy M. Anderson, Carolin Vegvari, James Truscott, Benjamin S. Collyer. “Challenges in creating herd immunity to SARS-CoV-2 infection by mass vaccination.” The Lancet. November 04, 2020.)
Predictions for what daily life be like if, say, one-fourth of the population refused to be vaccinated say, at the very least, the virus could remain an ever-present problem for years. The population would still need to mask and social distance. And, schools and businesses would still face restrictions and shutdowns.
Can a Vaccine Be Mandated?
Any vaccine mandates must reasonable, proportional, and enforced in a nondiscriminatory fashion.
The Federal Government almost certainly will not mandate taking a vaccine. It has limited powers expressly spelled out in the Constitution; the rest belong to the states. However, it can impose conditions on certain things – such as getting a passport.
States have the authority to regulate public health and they have in the past mandated vaccines. The classic case in this area of law, Jacobson v. Massachusetts in 1905, was decided by the Supreme Court after a smallpox outbreak.
Cities have powers, too: In 2019, New York City required people living in four ZIP codes in Williamsburg, Brooklyn, to get the measles vaccine, prove they've already had it or face a $1,000 fine.
A vaccine could be compulsory for certain groups of people such as health workers, universities, and schools
Employers can regulate to make the workplace safer, people who refuse to get immunized could be fired. could fire those who refuse to get immunized. Employees who are part of a union may be exempt from the vaccine requirement.
Anti-discrimination laws also provide some limits. If people can’t get the vaccine for medical reasons, that could be a disability under the Americans with Disabilities Act, which would require an employer to accommodate them.
The Civil Rights Act of 1964 may protect people who have a religious objection to a vaccine. An employer would have to make a reasonable accommodation as long as it’s not too costly for the business. These laws apply only to companies with 15 or more employees, so smaller businesses are exempt.
Airlines, restaurants, stores and stadiums make the vaccine a condition of doing business with you? Within the anti-discrimination laws mentioned above, they can decide to refuse service to you for pretty much any reason. People who are covered by anti-discrimination laws can’t just demand a business let them do whatever they want. The company just has to give you a reasonable accommodation, so a store might refuse you entry but offer curbside pick-up of groceries.
(A. Pawlowski. “Will the COVID-19 vaccine be mandatory? What the law says.” Today. November 16, 2020.)
Factual Conclusions
Those who refuse the COVID-19 vaccine reject the moral imagination to think of how their decision will fail to protect those who are vulnerable in our communities. If these skeptics don’t get vaccinated, they will likely undermine herd immunity, causing pockets of illness to periodically break out and more people to die – especially older folks and those with underlying medical conditions such as obesity, heart disease, diabetes, lung disease, or cancer.
And, yes, many people will have mild, short-term side effects after getting a COVID-19 vaccine. These side effects can include: fever, fatigue, headache, muscle and joint pain. Experts speculate vaccine side effects may happen in about 10% to 15% of people. But for most people, these side effects are mild and go away on their own in a couple of days.
Although it's always possible that vaccines have health consequences that have not yet become clear, the Pfizer/BioNTech vaccine has been deemed “safe” in that the balance of unwanted effects compared with the benefit is very clearly in favor of the benefit.
"If you mean absolutely no adverse effect, then no vaccine is 'safe' and no drug is 'safe'. Every effective medicine has unwanted effects.”
– Professor Stephen Evans, the London School of Hygiene & Tropical Medicine
I agree with the UN Secretary-General Antonio Guterres who stated he intends to take the COVID-19 vaccine when it becomes available and he will do so publicly, asserting that vaccination for him is a moral obligation towards the whole community – a global public good.
Speaking of ethics and morality, there appears to be some confusion in the media regarding the moral permissibility of using the vaccines for COVID-19 developed by Pfizer Inc. and Moderna. Trenton Monitor – news site of the Roman Catholic Diocese of Trenton, New Jersey reports: “Neither the Pfizer nor the Moderna vaccine involved the use of cell lines that originated in fetal tissue taken from the body of an aborted baby at any level of design, development, or production. They are not completely free from any connection to abortion, however, as both Pfizer and Moderna made use of a tainted cell line for one of the confirmatory lab tests of their products. There is thus a connection, but it is relatively remote.”
Some are asserting that if a vaccine is connected in any way with tainted cell lines then it is immoral to be vaccinated with them. This is an inaccurate portrayal of Catholic moral teaching. The Pontifical Academy does call for appropriate expressions of protest against the origins of these vaccines as well as for vigorous efforts to promote the creation of alternatives.
(“Is it morally permissible to take the COVID-19 vaccine?” Trentonmonitor.com. November 23, 2020.)
Research long before the pandemic confirms there exists a duty of easy rescue – a type of duty on which most reasonable people would agree – that can be applied to collectives to ground a collective obligation to realize herd immunity. A principle of fairness in the distribution of the burdens entailed by such collective obligation allows to derive from it an individual moral obligation to be vaccinated.
(Alberto Giubilini et al. “The moral obligation to be vaccinated: utilitarianism, contractualism, and collective easy rescue.” Medicine, Health Care, and Philosophy. November 30, 2018.)
So, I believe the
willingness to accept a COVID-19 vaccine must be better understood
and addressed – by the U.S. and by the world. Not only does refusal
to address vaccine hesitancy risk spikes in American infections and
death rates, but also differences in vaccine coverage between
countries could potentially delay global control of the pandemic.
Scott Ratzan, founding Editor-in-Chief of the Journal of Health Communication: International Perspectives, says: "We need to develop a robust and sustained effort to address vaccine hesitancy and rebuild public confidence in the personal, family and community benefits of immunizations.
(City University of New York Graduate School of Health and Health Policy, News Release. October 20, 2020.)
I can see that taking the vaccine is both ethical and utilitarian – it increases goodness of behavior while being both practical and sensible. COVID-19 has already divided the country in thought and in action. I believe refusing vaccination will only make this division deeper … and possibly more permanent. We must ease the tremendous suffering even in the face of those who – for whatever reason – deny the global public good. And, we must encourage these anti-vaxers to conform for the future of the country.
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