My wife issued an edict nixing our attendance at her family’s annual holiday gathering this year. Although proudly Jewish, I enjoy spending time with my wife’s relatives as they celebrate Christmas. We pass on pork but not on the holiday cheer. They also achieve near universal geniality, a goal unachievable in my more contentious family.
But not this year. My relatives held a “super-spreader” Thanksgiving last November. Before they realized what happened, my mother-in-law was infected by her sister, who passed it on to my wife. Fortunately, all survived, even without the therapeutic benefit of an apology.
Now, my wife’s cousin, the party hostess, is refusing vaccination. Why? She commented that she’s had COVID so she’s immune. Senator Rand Paul spread this theory as energetically as he spread his own COVID case. Unfortunately, his science was off. The data suggests that individuals who vaccinate after COVID-19 reduce their risk of re-contracting it by about half. Additionally, when natural immunity fades there’s no way to predict when it becomes ineffective. Individuals who vaccinate after having COVID-19 can follow the CDC’s advice based on the experience of millions of similarly vaccinated individuals.
Of course, like my wife’s cousin, many COVID survivors may not worry. She defended the “super-spreader Thanksgiving” by dismissing COVID as “just a cold.” Well, not for my wife who suffered for three weeks. More importantly, what about others that may have contracted the illness from my wife, my mother-in-law or from unknown cases related to that one holiday dinner? Some may be among the 700,000 dead. Unfortunately, many Americans who decline vaccines still don’t realize that it’s not only about themselves.
Why do so many shun a vaccine that’s safe and lifesaving? Part of it is clearly political.
So, why do so many shun a vaccine that’s safe and lifesaving? Part of it is clearly political. The seven states with the lowest COVID-19 transmission rates all went blue in the 2020 presidential election. The eight highest all went red. But it’s more complicated than that, as shown by a recent interview with 23andMe CEO Anne Wojcicki. She claimed that things have changed since the 2009 H1N1 flu strain outbreak when she rushed to get the vaccine and “everyone wanted it.”
Really? Maybe everyone in Wojcicki’s circle wanted it, but not all the patients of primary care providers (PCPs) like me. Absent disruptions like we’ve seen with COVID 19, many didn’t care. Only about 24% of Americans were vaccinated against H1N1. Wojcicki also suggested that healthcare discussions include too much medical jargon that interferes with vaccine messaging. To PCPs those are fighting words. Most of us work to explain vaccine benefits in plain English. Or plain Spanish. To borrow from legendary car dealer Cal Worthington, we’d “stand upon our head ‘til our ears are turning red ” to convince anyone to be vaccinated.
After months of failed discussions (and occasional successes) I’ve realized the complexities of the opposition. Yes, Trump exacerbated a problem by first minimizing the condition and then fueling a wave of right-wing enthusiasm for under-studied pseudo-treatments like hydroxychloroquine and Ivermectin. After all that, getting vaccinated would feel like caving to liberals and CDC/government elites. But most vaccine refuseniks aren’t right-wing extremists. Many are simply “vaccine hesitant.” Others just don’t understand or respect the science, don’t trust the system, or don’t like a needle poke. They may invoke their “right” to avoid vaccination or conjure up dubious religious excuses. The underlying reality is that many of them don’t like shots and don’t like being told what to do. Their opposition to COVID vaccination may be more conspicuous than refusing H1N1 or other vaccines, but it’s not much different.
Despite the intensity of the opposition, we PCPs will continue to test our powers of persuasion one recalcitrant patient at a time. The mandates may help by making vaccination more palatable than the alternative. Hopefully, adding children to the ranks of the vaccinated, increasing the vaccination rate among adults and slowing the relentless progression of the COVID variants in infecting the unimmunized, will contribute to our final success in achieving herd immunity and bringing an end to this horrific chapter of our collective lives. That would be like Christmas, Hannukah and Kwanzaa rolled into one.
Daniel Stone is Regional Medical Director of Cedars-Sinai Valley Network and a practicing internist and geriatrician with Cedars Sinai Medical Group. The views expressed in this column do not necessarily reflect those of Cedars-Sinai.
