Vaccine Nation

Copyright 2021 by Alan M. Puckett

The coronavirus pandemic in the U.S. offers us a long and sometimes uncomfortable look in our national bathroom mirror. The country we see gazing back at us from between the water spots and toothpaste splatters, towels hanging askew in the background, is both startlingly capable and sadly lacking. We should not turn away or vainly look only at our better side: this moment in history is revealing things we need to know about ourselves.

The most impressive aspect of our collective response to this 21^st Century plague has been the development and production of very safe and highly effective vaccines, pushed through human trials and preliminary regulatory approval and ready to begin being delivered to American shoulders in less than a year after the first U.S. case of COVID-19 was identified. This has been an incredible achievement, the biomedical equivalent of putting astronauts on the moon, and was made possible thanks largely to vaccine development work that had already been underway at the U.S. National Institutes of Health and to collaboration with and among leading pharmaceutical firms.  

To be clear, I am generally neither a fan of nor an apologist for the pharmaceutical industry in this country. But right now, we are extremely fortunate to have a tool that can help us save lives and bring the pandemic to an end in this country. Virtually all Americans over age 16 can get vaccinated against the coronavirus at no cost. The available vaccines are very safe and highly effective in reducing risk of severe illness and death due to the coronavirus. As a nation, we are extremely fortunate to be in this position amid a global pandemic which has taken more than 4.2 million lives in the past year and a half, including the lives of well over 600,000 Americans.

Since Americans began receiving the coronavirus vaccines in December of 2020, the real-world benefits of vaccination have proven to be nothing short of remarkable. While there have been cases of medically serious vaccine side-effects, those have been few in number among the millions of vaccine doses administered. Some individuals who were vaccinated have later contracted the COVID-19 illness, but those numbers are also small and overall the vaccines have proven highly effective in preventing serious illness, hospitalization and death from coronavirus infection. Despite stumbles and missteps in rollout of the vaccines during the initial months after they became available, it has become clear that widespread vaccination has been a primary factor in reducing new U.S. coronavirus case numbers from a peak of more than 300,000 per day in early January to fewer than 20,000 new cases per day by the middle of June. COVID-19 deaths also tumbled dramatically, from up to 4,400 deaths per day in January to fewer than 100 deaths on some days early in July. At this point, it’s clear that vaccination has played a major role in reducing the spread of the coronavirus and has saved hundreds of thousands of American lives.

Now, however, in the second summer of the coronavirus pandemic, vaccination rates have stalled across the U.S. while at the same time the more contagious and reportedly more dangerous Delta variant has become widely prevalent around the country. The combination of these two factors, together with elimination of most facemask requirements and the reopening of many public spaces, has reversed what had been a months-long decreasing trend in daily numbers of new coronavirus cases. Hospitals are now struggling to cope with large numbers of COVID-19 patients in some areas, and deaths have begun to climb again.

Why do many vaccine-eligible Americans currently remain unvaccinated? A July 30, 2021 New York Times article summarizes findings from several surveys intended to identify reasons for vaccine hesitancy and vaccine refusal among Americans who have not yet received the jab. The report suggests that there are two principal subgroups among the unvaxxed: those who remain on the fence about getting the jab (termed “Wait and Sees”, estimated to comprise about 10% of U.S. adults), and those adamant that they will not get vaccinated (described as “Definitely Nots”, who account for up to 20% of the U.S. adult population). The NYT article describes these two subgroups as having substantial overlap but also some notable differences in group demographics.

Many among the “Wait and Sees” expressed concerns about the safety of available vaccines or said that they wanted more information before deciding. 41% of this subgroup reported Republican party affiliation; 38% were aged 30-49; 49% were White; 52% lived in suburban areas and 11% lived in rural areas. Potential motivators for members of this subgroup to get vaccinated included having the vaccine become available through a personal physician; having vaccines receive full FDA approval rather than temporary emergency use authorization; and having vaccination mandated as a condition for air travel or attendance at large gatherings.

Many “Definitely Nots” framed their decision to remain unvaccinated in terms of personal choice and individual liberty. 67% of this subgroup reported Republican party affiliation; nearly half were in the 30-49 age group; 70% were White; 60% lived in suburban areas and 23% lived in rural areas. Fewer members of this subgroup reported factors that might motivate them to get vaccinated; those who did pointed to having the vaccine become available through a personal physician; having vaccination mandated as a condition for air travel; or availability of free transportation as potential motivators.

Regardless of which subgroup they fall into, the unvaxxed are a problem for America. They are: 1) Clogging up the health care system in some areas, making it more difficult for folks having babies, involved in car accidents or needing appendectomies to receive care; 2) Potentially serving as vectors in the chain of virus transmission, thus prolonging the pandemic and placing others at greater risk of infection or re-infection; and 3) Offering the coronavirus opportunities to replicate and to develop new variants, some of which may prove to be more contagious, more virulent, or both.

Prolonging the pandemic also increases the damage it causes to our economy. Refusing the vaccine makes it less safe for Americans to get back to work and puts the country’s ongoing economic recovery at risk. The costs to our health care system alone are staggering, but that’s not the end of it. Hundreds of thousands of small businesses have gone under all across the country, and millions of others are fighting to stay afloat. The economy can’t get back to full strength until workers and customers know that it’s safe to return to Main Street, and that won’t happen until we get the pandemic under control.

We don’t let people drive drunk. There is not as yet an individual right to possess nuclear weapons in this country. In most U.S. cities you’re not allowed to walk down a busy sidewalk swinging a machete at arm’s length. These limitations have been enacted not because the rest of us are mean and don’t want you to have fun, but to protect the public from preventable injury and death. By the same token, we can’t continue allowing unvaccinated people to sit near us in dentist waiting rooms, brush past us in Aisle 4 at the Safeway or lean over our shoulder in the bleachers at Safeco Field screaming for Jarred Kelenic to blast another home run.

The occasional dart gun fantasy aside, I’m not proposing that we vaccinate our fellow Americans against their will. But neither should the rest of us be placed at risk of illness or death, nor our public spaces, our communities, our health care system and our economy be held hostage by a noisy minority who insist that their “right” to do whatever the hell they please, no matter how dangerous and irresponsible, should take precedence over everybody else’s right to live in reasonable safety.

With vaccines readily available and the Delta variant surging in much of the U.S., while schools and many businesses around the country are struggling to reopen, the question of “mandatory vaccination” is getting lots of air play. That term strikes me as a bit of a misnomer. Driver’s licenses aren’t “mandatory”. You only have to get one if you choose to drive. And that’s where we’re headed with vaccination, too.

Nobody should be forced to take the jab. Prefer not to? Fine with me, long as you stay home and don’t place others at risk. But if you want to go to the dentist, shop at Safeway or sit in the bleachers at Safeco Field? Mmm-hmm, roll up that sleeve like a big boy. Medical exemption for people who can’t safely be vaccinated? Well sure, we don’t want to harm anyone. But what’s this about a “religious exemption”? Uhm. Do we let people drive without a license if their faith prohibits standing in line at the DMV? Nuh-uh, those folks can call they’self an Uber if they need to go somewhere. So whatever god you worship? Show the nurse your shoulder, if you want to go out in public and be part of society.

Predictably, vaccination is becoming yet another bit of politicized turf in America’s ridiculous and deadly game of Red vs. The World. Following in the muddy footsteps of Congresswoman Marjorie Taylor Greene (R-GA), the Oklahoma Republican Party last week spewed out a Facebook post comparing vaccine “mandates” to the persecution of Jews in Nazi Germany and calling for legislation to prohibit employers from requiring vaccination for workers. Florida’s governor has gone on the warpath against local facemask regulations and “vaccine passport” policies and has fought in court to block vaccine requirements on cruise ships that visit the state’s ports. Coincidentally or not, Florida now leads the current U.S. pandemic surge and on August 1 posted a new record-high one-day count of new coronavirus cases. Other Red states are following suit, and vaccine resistance is also surging in conservative regions of some blue states. Not surprisingly, the Delta variant seems to be making itself at home in many of those same areas.

Perhaps hoping to curry favor with the faithful today while softening—or at least temporarily confusing—history’s judgment down the road, Republican Governor Kay Ivey of Alabama has resorted to a time-tested politician’s gambit by talking out both sides of her mouth. Ivey signed a prohibition on “vaccine passports” back in May, then tried to cover her germy tracks by proclaiming in July that “It’s the unvaccinated folks that are letting us down.” Uh, sure, Governor. Them and a few others.

It’s like watching a game of marbles after one player got mad and threw their Big Shooter at a passing cat.

But the handwriting is on the wall. The Biden Administration is imposing vaccine requirements for many federal workers. Large blocks of public employees in the nation’s two largest states are now being required to get vaccinated or face frequent coronavirus testing. Several major corporations are also enacting vaccination requirements for at least some of their workers. It seems certain that more employers will follow suit if only as a matter of good business practice.

This is a time in which public health and safety and our ability to function as a nation have to take priority over anybody’s individual druthers. No vaccines are currently available to protect the public from ignorance, disinformation or craven political manipulation. But we do have very safe vaccines that are highly effective at slowing the spread of the coronavirus and reducing the harm it causes. The country is now in a situation where we must get more Americans to take the jab, while protecting ourselves from those who remain unvaccinated, in order to save lives and get our country back on track. It’s time to recognize a Band-Aid on the shoulder as the badge of a true American patriot.

Stay safe, I’ll write again soon.