By Peter Doshi and Jennifer Block
Dr. Doshi, an associate professor of pharmaceutical health services research at the University of Maryland School of Pharmacy, leads the Restoring Invisible and Abandoned Trials Initiative. Ms. Block (@writingblock) is the author of “Everything Below the Waist: Why Health Care Needs a Feminist Revolution.”
Most people have been hearing for months that a coronavirus vaccine, given to a sufficiently large proportion of the population, will induce herd immunity and ultimately end the pandemic. And that now, with two authorized vaccines, the challenge is to inoculate as many people as we can — which means convincing the significant number of people who are hesitant.
But before we demonize the 40 percent of Americans who say they aren’t ready to roll up their sleeves, let’s step back and consider whether herd immunity is actually the right goal right now.
If the clinical trial results presented by Pfizer and Moderna hold up in the real world, the vaccines will be highly effective at protecting the people who receive them from getting sick with Covid-19. But the trials did not measure whether vaccinated individuals can still infect others. This means we can’t assume that the vaccines — even adequately deployed — will eradicate the virus. They might; we just don’t know. That’s why officials are urging that those who have been vaccinated continue to wear masks and practice social distancing.
In the meantime, it’s needlessly divisive to use pressure, shame or mandates to get people vaccinated. Officials could instead look at their glass half full. Sixty percent of people are willing — and until recently, 60 percent was the herd immunity goal.
(Last month, Dr. Anthony Fauci acknowledged he had adjusted his estimate upward based on what he felt the public was ready to hear, saying, “We really don’t know what the real number is.” The danger in such paternalism is that it can undermine the very thing people need to make good decisions: unbiased information.)
Perhaps a more helpful way to think about restoring public life is to think of Covid as a storm. Most people will ride it out just fine. But the storm poses a real threat to a minority of people, who, because of age or medical conditions or workplace exposure, are particularly vulnerable to its winds. These people are far more likely to have severe complications of Covid-19 that lead to hospitalizations, overwhelmed ICUs and deaths. And these individuals stand to gain the most by the shelter a vaccine hopefully provides. Let’s make sure all of them have easy access to one before attacking those who aren’t sure they want one.
There’s another reason health leaders should resist the hard sell: The vaccines are not risk free. Most side effects appear to be mild and short lived, but not all. For example, with the Moderna vaccine, the frequency of grade 3 adverse events — those severe enough to prevent daily activity, including fatigue and muscle pain— is higher than it is for mostvaccines: 17.4 percent, or nearly one in five 18-to-64-year-olds who received the vaccine in the company’s trial. (Grade 3 adverse events appear to occur less frequently with the Pfizer vaccine, but a direct comparison is not possible.) And there have been some serious allergic reactions. It’s reasonable for people to weigh all of this in making their decisions.
For those unlikely to become seriously ill with Covid, the vaccines’ risk-benefit analysis is not clear cut. Nor is it obvious for groups that were excluded from the trials, such as pregnant women and immunocompromised individuals. Then there are the millions of people who have already been infected and acquired immunity.
There is also a legitimate lack of trust between the medical establishment and women and Black and brown communities. This is finally being acknowledged by public health leaders, but the assumption is that once historical trauma is overcome, mass acceptance should follow. This can further alienate marginalized groups by denying their agency in making an informed decision, whichever way it lands.
It doesn’t help that more and more, all these people are being labeled anti-vaxxers. MSNBC’s Chris Hayes recently suggestedthat the “right wing disinformation machine” — the same one that challenged the presidential election results — could undermine confidence in the vaccine, leaving us with “a real problem on our hands.”
But considering a vaccine’s risk-benefit ratio is not the work of conspiracy theorists. Many people who are hesitant now may turn out to be later adopters.
We must be alert to misinformation, but we also need to resist magical thinking on vaccines: “Safe” is a term of advocacy, not science or journalism.
We all want the storm to pass, but we have to keep clear heads: Help the people at risk of drowning into lifeboats, then see about life jackets for the people already on board.
