“I’ve been reading…” That was the response I received from one of the staffers of Skeptic magazine when I asked why she wasn’t vaccinated. My query came on the saddest day in our 30-year history—we were mourning the death of Pat Linse, the Art Director, co-founder of the magazine and the Skeptics Society, and my business partner, friend, and confidant of three decades. Pat was 73, overweight, and in poor health, so she was in the high morbidity cohort for contracting the SARS-CoV-2 virus that produces the COVID-19 disease. As she was herself vaccinated, socially isolated, and hyper-vigilant about outsiders coming into the office, I just assumed everyone else in the office was vaccinated.
Pat’s cause of death was not COVID-19. Nevertheless, Skeptic has been at the forefront of debunking conspiracy theories and quackery related to the pandemic, so the discovery that one of our staffers had not been vaccinated was troubling. “I read about people having seizures, getting violently sick, having heart attacks, and even dying from the vaccine,” she explained. “And getting injected with a foreign substance like that just doesn’t seem like a healthy thing to do.” Her reasons for being vaccine hesitant are not unique and are shared by tens of millions of people, who have also “been reading.” Google readily provides a massive trove of misinformation, disinformation, lies, damn lies, and distorted statistics.
I was so distraught that I forgot the overarching mission of the Skeptics Society, captured in Baruch Spinoza’s maxim “I have made a ceaseless effort not to ridicule, not to bewail, not to scorn human actions, but to understand them,” and I shamed her for putting the lives of those around her at risk (I later apologized). In keeping with the findings of psychological science,1 my shaming made her even more resistant as cognitive dissonance kicked in,2 and so the subsequent deluge of data, anecdotes, and analogies didn’t help at all. Not a few people with whom I shared this story expressed their opinion that I am the one who is confused about the science. So let me use this personal experience to address three of the most important underlying concerns that I think drive vaccine hesitancy.
1. Doubts about the vaccines themselves
The vaccine hesitant may be compared to spectators at a witch burning, more concerned about women being witches (believed to cause plagues, among other catastrophes) than about the inquisition burning people alive. It’s an imperfect analogy, since rare vaccine side effects are real and witches aren’t. But the point remains: during a pandemic, it is important to focus on the real, not the imagined threat.
Here’s another comparison to put the risk-benefit calculation into perspective: According to the National Highway Traffic Safety Administration, 38,680 people died in automobile accidents in the US in 2020. Yet few people think twice about going for a drive, and will sometimes do so while texting, eating, drinking alcoholic beverages, and fiddling with sound and nav systems. By comparison, according to the CDC, COVID-19 killed 345,000 Americans in 2020 alone, making it an order of magnitude deadlier than driving. So why are some people hesitant to protect themselves from a lethal disease but not from injury in far less common traffic accidents?
What about allergic reactions to the vaccine, known as anaphylaxis? According to the CDC, the rate of anaphylactic reaction from the vaccines is roughly two per 1,000,000 people, or 0.000002. By comparison, according to the CDC, the death rate from lightning strikes in the US is roughly one per 500,000, or 0.000002. So, you have the same chance of dying from a lightning strike as you do from going into vaccine anaphylactic shock, and yet we’ve seen no corresponding run on lightning rods. (And that’s assuming that after you received the vaccine you promptly left the facility rather than waiting 15 minutes, as instructed, so that you can be treated in the event of an allergic reaction. I waited 30 minutes after my vaccine stabs just in case, as several years ago I went into anaphylactic shock from a bee sting and now carry an EpiPen with me on bike rides.)
Another possible side-effect of the vaccine is thrombosis, or blood clotting, which is a serious health risk. According to the CDC, two confirmed cases of thrombosis have resulted from administration of the Moderna vaccine out of 328 million doses worldwide, which would be roughly the equivalent of getting struck by lightning 300 times in one year. The risks of myocarditis and pericarditis are slightly higher—there have been 716 reports of incidents (not deaths) out of over 300 million doses. There is no evidence whatsoever that the vaccines cause infertility in women.
All told, the CDC reports that, out of 346 million doses of COVID-19 vaccines administered, they received reports of 6,490 deaths affiliated with the vaccines, “even if it’s unclear whether the vaccine was the cause.” Let’s take that number as a worst-case scenario and divide it by 346,000,000—the risk of dying from a COVID-19 vaccine is 0.000018, again, roughly the rate of being stuck by lightning. You are far more likely to drown in your bathtub or pool or die in an airplane crash, tornado, hurricane, or earthquake, not to mention succumb to heart disease, cancer, stroke, diabetes, lower respiratory diseases, nephritis, influenza and pneumonia, homicide, and suicide, causes of death to which most of us don’t give a second thought.
Many people have an understandable aversion to being injected with a derivative of a virus designed to train the body for combat with the fully armed viral enemy. The very idea engages our disgust emotion and negativity bias, in which bad is stronger than good (and in many cases a lot stronger). Bad smells, for example, elicit far more animated facial expressions than good or neutral odors.3 Negative stimuli have a stronger influence on neural activity than positive stimuli.4 Bad information is processed more thoroughly than good information.5 Traumatic events leave traces in mood and memory longer than good events.6 There are more cognitive categories and descriptive terms for negative than positive emotions.7 Evil contaminates good more than good purifies evil, as in the old Russian proverb: “A spoonful of tar can spoil a barrel of honey, but a spoonful of honey does nothing for a barrel of tar.”
COVID-19 vaccines, however, are completely different from any that came before as they contain no traces of the SARS-Cov-2 virus. As the CDC explains, unlike previous vaccines that inject “a weakened or inactivated germ into our bodies,” these new messenger RNA (mRNA) vaccines “teach our cells how to make a protein—or even just a piece of a protein—that triggers an immune response inside our bodies. That immune response, which produces antibodies, is what protects us from getting infected if the real virus enters our bodies.” Once the mRNA instructions are inside the muscle cells of your upper arm, the cells use them to make the protein piece. Then, “the cell displays the protein piece on its surface. Our immune systems recognize that the protein doesn’t belong there and begin building an immune response and making antibodies, like what happens in natural infection against COVID-19.” If you felt ill after your second jab, as I did for a day, that is your body building immunity to the disease.
This is not only the fastest vaccine ever developed, it is also the most effective with the lowest rate of side effects ever recorded (with the usual caveats here that we don’t know the long-term consequences yet; then again, we have some confidence in the long-term consequences of COVID-19, and they aren’t good, starting with death). In the long history of medical inventions, this vaccine could well be the most miraculous, and as an atheist I don’t toss that word around lightly. To date, if you are vaccinated, there is a 99.999 (yes, three nines!) percent probability that you will not be hospitalized or die from COVID-19. Arguments that the vaccination process itself is leading to new strains of COVID were refuted by a July 30th, 2021 study published in the journal Nature that concluded: “As expected, we found that a fast rate of vaccination decreases the probability of emergence of a resistant strain,” and that “a period of transmission reduction close to the end of the vaccination campaign can substantially reduce the probability of resistant strain establishment.”
A final objection to vaccines is that the death rate from COVID-19 is so low that it’s not worth the risk of getting vaccinated. As of August 12th, 2021, 619,723 Americans have died out of the 36,446,791 reported COVID-19 cases, or 0.017. Compare that to the aforementioned worst-case vaccine death total (which is probably an order of magnitude too high) of 6,490 out of the 346 million vaccine doses, or 0.000018. That’s three orders of magnitude lower. If a person’s house is on fire they don’t stop to worry about the possible consequences of inhaling fine particles from the fire extinguisher chemicals. In other words, get vaccinated!
So, with all this information a few keystrokes or TV remote clicks away, why on Earth isn’t everyone clamoring to get vaccinated?
2. The politics of vaccination
A hint was on display in the first week of August, when a 31-year-old unvaccinated man named Daryl Baker was hospitalized by COVID-19. Asked to explain his reasoning by a local TV crew, with his wife and six-year-old son looking in through a window, he said, “I was strongly against getting the vaccine … because we’re a strong conservative family. But that little boy out there is a reason to have the vaccine.” Well, quite.
Then there is the “I’m unbreakable” belief, an example of which can be found in Travis Campbell, a 43-year-old man hospitalized by COVID-19 and now pleading on social media: “We just thought we were invincible and we weren’t going to get it. I’m testifying to all my bulletproof friends that are holding out, it’s time to protect your family.” He added “I have never been this sick in my life! My whole family has COVID. I truly regret not getting the vaccine … I’m over the stupid conspiracies. It’s time to be rational and protective.”
As of this writing, Baker and Campbell are recovering. But an unvaccinated 45-year-old Texas Republican official named H. Scott Apley succumbed to the disease five days after attacking vaccines on his Facebook page. He is survived by his widow Melissa and their infant son Reid. This entirely avoidable tragedy occurred after Apley invited people to a “mask burning” party at a bar, compared mask mandates to Nazism, described a program intended to incentivize vaccination as “disgusting,” and responded to Baltimore health commissioner Leana Wen’s announcement about the Pfizer vaccine’s stunning efficacy with this tweet: “You are an absolute enemy of a free people, #ShoveTheCarrotWhereTheSunDontShine.”
When I shared Apley’s story on Twitter, I proposed that “Instead of dancing on his grave for being an anti-vaxxer, let’s work toward encouraging the vaccine hesitant to hesitate no longer. Conservatives: family values include protecting your family from deadly viruses and staying alive for them.” A Kaiser Family Foundation study ranking vaccination rates and views by demographic group, placed Democrats at the top, with 86 percent having received at least one dose, and Republicans near the bottom, with only 52 percent at one dose. Astonishingly, 23 percent—more than one-in-five—of Republicans say they will “definitely not” get vaccinated.
The Skeptic Research Center recently collaborated with Dr. Kevin McCaffree and Dr. Anondah Saide to survey over 3,000 Americans on their beliefs and attitudes on 29 different conspiracy theories. Our study found a moderate-to-large correlation between the belief that “Political and medical elites are hiding the truth about the harmful role of vaccines in causing autism in children” (an older conspiracy theory) and belief that “COVID-19 was developed in a Chinese lab and Chinese officials have covered it up” (r = .39). It also found large correlations between that older conspiracy theory and belief that “5G cell phone towers reduce our immune function and increase our risk of COVID-19 infection” (r = .60), “The COVID-19 vaccine contains tiny computer chips to help make government surveillance of people easier” (r = .63), and that “Political and medical elites are hiding the truth about how the COVID-19 vaccines cause magnetic reactions” (r = .69). The only one to show any political difference was the Chinese lab origin conspiracy theory, with Democrats more strongly disagreeing with it, compared to Republicans, who were nearly seven times more likely to agree with it. Encouragingly, most people we asked rejected the conspiracy theory that COVID vaccines cause magnetic reactions, because we made that one up.
Historically, as far back as the late-19th century (the Vaccination Act of 1898 included a “conscience clause” for parents to opt out of vaccination), fears about vaccination have been disproportionately entertained by liberals (a recent holotype is Robert F. Kennedy Jr., whose anti-vaxxer beliefs are so extreme that his own family felt compelled to disown his views). So, it is disconcerting to see conservatives assume the vaccine hesitancy mantle, especially since Republicans boast about being the pro-life party.
3. What does “freedom” mean in a civil society
At a fundraising event on July 23rd, 2021 sponsored by the Alabama Federation of Republican Women, Representative Marjorie Taylor Greene (R-Ga.) said this from the podium: “You lucky people here in Alabama might get a knock on your door because I hear Alabama might be one of the most unvaccinated states in the nation.” Greene is not known for being a stickler on checking facts, but in this case she was right. According to the CDC, Alabama is tied with Mississippi for the lowest percentage of fully vaccinated citizens at only 35 percent. Her remarks produced cheers from the audience, to which she added: “Well, Joe Biden wants to come talk to you guys … What they don’t know is in the South, we all love our Second Amendment rights, and we’re not really big on strangers showing up on our front door, are we?”
Greene’s barely veiled suggestion that citizens take up arms against public health officials is surely rhetoric meant to swell campaign coffers, but the incident illuminates a deeper explanation for vaccine hesitancy—a misplaced understanding of freedom. When the Biden administration announced its plan to require federal employees to either get vaccinated or obtain regular negative COVID tests, Larry Cosme, president of the Federal Law Enforcement Officers Association, expressed this misunderstanding of freedom as follows: “Forcing people to undertake a medical procedure is not the American way and is a clear civil rights violation no matter how proponents may seek to justify it.”
No it isn’t. As the appellate attorney Chris Truax explains, “Every school district in every state in America requires children to be vaccinated to attend public schools. Most states offer exemptions in some cases … But there is no question that states and school districts have the legal authority to demand that school children be vaccinated.” Truax tracks the legality of vaccine mandates back to 1905, when the US Supreme Court determined in Jacobson v. Massachusetts that “mandatory vaccinations were perfectly constitutional and an important tool of public health. Henning Jacobson, an early anti-vaxxer, refused to be vaccinated for smallpox. Just like anti-vaxxers do today about the COVID vaccine, he argued that the smallpox vaccine didn’t work.” The court determined otherwise, siding with “high medical authority” that vaccines do, in fact, work.
What about the freedom of choice protected by the Constitution? “We are unwilling to hold it to be an element in the liberty secured by the Constitution of the United States,” the justices held, “that one person, or a minority of persons, should have the power thus to dominate the majority when supported in their action by the authority of the State.” Otherwise, they concluded, “the spectacle would be presented of the welfare and safety of an entire population being subordinated to the notions of a single individual.” As the preamble to the US Constitution makes clear:
We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.
Pandemics can decimate a population—historically, between 10 and 50 percent of entire populations have been killed by plagues.8 That certainly qualifies as a threat to our domestic tranquility and general welfare. After all, it’s hard to be free when you’re dead. Civil society is based on the fundamental premise that we give up certain liberties to secure tranquility, defense, welfare, and greater liberty, such as the freedom from fatal diseases. To paraphrase a classic libertarian line, the freedom to sneeze and cough your virus ends at my nose.
We all gladly give up the freedom to drive on any side of the road we want for the security of relatively safe passage on our highways. We routinely agree to and abide by laws regulating the safety of food, drugs, trains, planes, and automobiles, so that we can eat, travel, and medicate with confidence. And while I wouldn’t say we are all happy to give up our hard-earned money through taxation so that the government can fund a public sanitation system that reduces the risk of us dying through communicable diseases, most of us recognize the economist Thomas Sowell’s trenchant observation that “There are no solutions. There are only trade-offs.”9
With this understanding of the underlying motivations of vaccine hesitancy, we can solve the collective action problem of ending the pandemic in the simplest and safest way possible: Get vaccinated!
1 Two recent summaries of the research on the psychological underpinnings of science denial include: Science Denial: Why it Happens and What to Do About it by Gale M. Sinatra and Barbara K. Hofer (Oxford University Press, 2021) and How to Talk to a Science Denier by Lee McIntyre (MIT Press, 2021)
2 Mistakes Were Made but Not by Me by Carol Tavris and Elliot Aronson (Houghton Mifflin Harcourt, 2007)
3 Gilbert, A. N., A. J. Fridlund, and J. Sabini, J. 1987. “Hedonic and Social Determinants of Facial Displays to Odors.” Chemical Senses, 12, 355–363.
4 Ito, T. A., Larsen, J. T., Smith, N. K., & Cacioppo, J. T. 1998. “Negative Information Weighs More Heavily on the Brain: The Negativity Bias in Evaluative Categorizations.” Journal of Personality and Social Psychology, 75, 887–900.
5 Brickman, P., Coates, D., & Janoff-Bulman, R. 1978. “Lottery Winners and Accident Victims: Is Happiness Relative?” Journal of Personality and Social Psychology, 36, 917–927.
6 Cahill, C, Llewelyn, S. P., & Pearson, C. 1991. “Long-Term Effects of Sexual Abuse which Occurred in Childhood: A Review.” British Journal of Clinical Psychology, 30, 117–130.
7 The Emotions by Nico H. Frijda (Cambridge University Press, 1986)
8 Plagues and Peoples by William H. McNeill, (New York: Anchor Books, 1976)
9 A Conflict of Visions: Ideological Origins of Political Struggles by Thomas Sowell (William Morrow, 1987)
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