Coronavirus, Monkeypox, and Other Contagious Diseases

There are a host of articles today about the US reaching a vaccination tipping point at which the key challenge is no longer the supply of vaccine but the supply of people willing to take it. Like “herd immunity” it isn’t a binary, clear-cut moment. It’s incremental. We’re approaching it now and the challenge will accelerate over the next two to four weeks. In many ways this challenge is a product of our success. In January I don’t think anyone thought we’d have widespread availability and half of all adults vaccinated in April. But we did it.

But most articles about the hesitancy issue talk about hesitancy as a generic, undifferentiated thing when that is almost certainly not the case. The catch-all of ‘vaccine hesitant’ includes a variety of different groups and motivations, each of which require a different strategy to overcome.

There are people who are just more fearful than most about a novel vaccine. I can relate to this. When vaccines were first approved in December I took a bit of comfort or perhaps wasn’t terribly disappointed in the fact that a bunch of people were ahead of me in line. Let some others go first to make sure the clinical trial results in the tens of thousands are duplicated in a broad campaign reaching millions. (I’m fully vaccinated.) Other hesistants come from communities with historic low confidence in public health and the medical profession, often with good reason. There’s the pre-existing anti-vax subculture which has been resisting garden variety vaccines for years, and lacks a strong ideological valence in conventional left/right terms. Then there’s the Trump resistant, Americans who are anti-vaccine for largely ideological reasons generated by the COVID polarization of 2020.

These aren’t hermetically sealed off groups. They overlap in many cases.

Finally there’s the merely indifferent. People who won’t refuse a shot but just aren’t focused on it. Maybe they’re mildly hesitant but mainly they’re not going to refuse one.

When I see polls of the vaccine hesitant I’m really much interested in these breakdowns because the strategies you would use to vaccinate the vaccine hesitant in the African-American community are quite different from the more current and deeply ideological opposition of white evangelical Trumpers. (The highest resistance is among white Republicans and particularly white evangelical Republicans.) The focus group discussed in this Washington Post article suggests a Trumpite ‘hesitancy’ which is refusal looking for a rationale. The biggest explanation given in the most recent was the Pfizer CEO’s recent statement that booster shots will likely be necessary. Again a ‘hesitancy’ looking for clinical rationales rather than one based on them.

People who are worried about side effects, unknown health risks or false rumors they’ve heard on social media can likely be convinced in many cases with time, public education and reassurance from trusted community leaders. But among Trump supporters the opposition seems primarily based on ideological commitments unrelated to safety: a generalized refusal to believe that COVID was ever that big a deal and opposition to anything that comes from sectors of society they generally view as enemies, the scientific establishment, the highly educated, COVID hawks generally. The lede of the WaPo article describes the message of the hesitant like this. “Stop talking about the possibility of coronavirus booster shots. Don’t bully people who are vaccine holdouts. And if you’re trying to win over skeptics, show us anyone besides Dr. Fauci.”

In other words, on the Trump right, vaccines are the new masks.