This past week I spent time coaxing a neighbor into going to the emergency department because he was having trouble breathing, and felt like he was dying. I assumed COVID, given his symptoms and that he had not been vaccinated. Eventually he was admitted for COVID, and was also diagnosed with cancer. While startling, it was the continuation of a trend.
In the past few months, I have attempted 20 medical interventions with folks who have sought out local healthcare confidants to debate policies at the intersection of science and politics. About half went ahead and got the shot. For the group we will not reach — physically or ideologically — they are finding out that some members of the vaccinated club are putting up a steel velvet rope, seeking to bounce them from a growing party of protection.
The majority sitting out on the sidelines are not members of the “flat earth society,” or seeking to make a misguided political statement (although one colleague did debate me for hours on the rumored tracking device inside the vaccine, a scare tactic put out by charlatans on the internet). Many are open-minded, received prior vaccines, understand data, but find themselves genuinely suspicious, given the breakneck pace and disjointed messages.
Some I meet subscribe to the “natural immunity is the best immunity” philosophy, which is believed to give the recovered durable protection (although we lack large studies). This path assumes one makes a successful recovery if infected. I believe this is a calculated risk that may result in an irreversible gamble: severe disease.
The unvaccinated who get sick have found their vaccine skepticism is not celebrated when they engage our burned-out healthcare system. My friends in the emergency department wonder why this group skipped the preventive treatment (vaccine) only to demand the urgent, expensive care now. It is a fair societal question, as these individual actions do affect the larger population on both health and economic fronts.
However, shaming and punishing this cohort will not bring the millions of unvaccinated to the clinic. We will only devolve into a Hunger Games, where swaths of the population relocate to a district where their views are upheld and likely protected by law in some cases. To some extent, this is playing out now, where certain states with low vaccination rates are seeing the blunt-force trauma of the delta variant. It is a sad story.
Only the vaccinated can participate
Those getting by on natural immunity or luck, which is also a form of confirmation bias, are now seeing their individual choices collide with public health policies designed to protect the vulnerable. Right now, policy implementation is being driven by local leadership, and in some places, a vise grip is closing hard. Several employers have made employment contingent on receiving the vaccines, while some countries and concerts are making it mandatory for entry. And due to the highly contagious delta variant (now accounting for nearly 58 percent of all cases), officials have decided to re-up mask mandates in certain locations.
The irony is there is no foolproof way to validate vaccination status or immunity (currently), as we do at passport control or intercepting a fake ID at a bar. And time is not on our side to wait on divisive or draconian measures to play out. Some families have begun to “state-hop” if they are forced to vaccinate their families, with some complaining that the system is making them feel like second-class citizens. This is an exaggeration, given how much loss of life we have seen, how many are truly treated like a second class for conditions not of their choosing, like the billions (not a typo) desperately praying for their first vaccine dose.
At the end of the day (and pandemic), there will be millions who will never get vaccinated. There are groups who will never get vaccinated because of an illegitimate reason (internet-based conspiracy theories, pseudo doctors spreading disinformation to sell unproven remedies), a legitimate reason (religion or a medical condition), or an inexcusable one (they are poor and forgotten). We must prepare for this reality, and focus on the segments we can get to with reasonable measures.
Local leaders are our best shot
Leaders who have experience in crisis management (or marketing) know reasonable vaccine holdouts will run the other way if targeted with a third shot message before their first (especially when the data is unfolding). And imagine, living in Africa or India praying for your first shot, but getting hit with a variant instead, while watching wealthier nations squabble over their oversupply of shots.
I do not know one person who took the vaccine because a political official said to. But I do know hundreds who chose to get vaccinated (or medical care) because of people like me; those open to listening first, debating respectfully with data, and finding mutual ground. The latter must also include agreement on the absurdity of some policies, or you lose all credibility (masking in between bites at a restaurant, U.K. visa travel jiujitsu ,and the utter absurdity of washing groceries and wiping down cardboard delivery packages).
In the end, I am brutally honest with folks. Yes, there are contradictory messages from the public health community that at times can seem confusing. Yes, some are jumping the gun (or shark) on interventions, including mass boosters. And yes, you may skate through with luck, but the risk of dying alone in an ICU while isolated from family is a price too steep to pay. Let us not trade the infinitesimal risk of vaccine complications for an enormous relative risk of hospitalization and possibly death. As someone who spent 20 years in healthcare, teaches public health, and worked in emergency medicine, I can tell that story better than most. And so can thousands of others like me living next to a neighbor who wants to listen and learn.
Meghan Fitzgerald is an adjunct associate professor with the Columbia University Mailman School of Public Health, and a healthcare investor. She is the author of “Ascending Davos: A Career Journey from the Emergency Room to the Board Room.” She lives in Aquinnah.