SARS-CoV2 vaccines: "anti-vaxxers"
Don't roll your eyes quite yet.
Last time, I mentioned, amongst other things, that I was concerned about people saying “no thanks” to vaccines. Most folks say no to vaccines for probably 1 of the following reasons:
“I don’t trust anything the government says or does”
“I don’t like injections”
“I don’t trust the science”
For the first one, I don’t think anything short of 100% transparency and the most comprehensive PR campaign in history is going to help. The second one could maybe be remedied by some tough love or veiled threats from partners, significant others, and family members. The third one, though, is interesting. It’s a sentiment shared by many, across all walks of life.
“Does that make me an anti-vaxxer?”
The day after the FDA granted emergency use authorization to the Pfizer-BioNTech vaccine, my hospital received its first shipments. I went into work that day anxious and excited to be vaccinated. On my way to the appointment, I ran into an ICU physician I know and respect. I told her where I was going and told her the vaccine clinic had open slots and that she should join me. She replied that she wasn’t planning on getting vaccinated.
“I know, I know - it probably sounds crazy. But I’m taking immunosuppressants , and they didn’t study people on immunosuppressive medications”.
And she’s right; they didn’t. Looking at the data (Polack et al, NEJM, 2020) submitted to the FDA, the phase 3 trial hadn’t enrolled people like her. They hadn’t included pregnant women either, or cancer patients. It’s important to note that for historical and ethical reasons, these groups haven’t been included in many trials. Interestingly, they did include HIV-positive people and those with hepatitis B & C - but those results will be published separately later.
“I mean, I get it”, she said, almost defensively. “The vaccine works and it’s probably really safe. But I spent the past 9 months in front of COVID patients, and I never got it. I think I can go a little longer with a mask and distancing. So does that make me an anti-vaxxer?”, she ended with a chuckle.
To be clear, she’s not an anti-vaxxer. And I don’t see her as “part of the problem”. She understands the mRNA-based technology, and understands that the vaccine isn’t going to take over her body. But she’s not sure how her altered immune system will respond to it, and she’s anxious about that. She’s passing on the vaccine for now because they didn’t study people like her. And - importantly - she’s prepared to continue masking up and distancing.
Hot Take
The vaccine works VERY well, and I think it will keep people out of the hospital.
The vast majority of side effects can be treated with 1-2 days of Tylenol.
Yes, there are select, small subgroups of people who should NOT be criticized for wanting to pause and consider all the data before vaccination.
I’m hopeful that over the next few weeks to months, the messaging around these points will be loud, clear, and consistent.
I hope people passing on the vaccine are as thoughtful as my co-worker. She understands that in the post-vaccine world, everyone - regardless of political ideology - wants to “open things up”. Vaccination doesn’t mean no more viral transmission. So, when we’re back in restaurants, convention centers, and stadiums, those of us who haven’t been vaccinated might be at the same risk then as we are now. If you’re not vaccinated, social distancing might still be part of your lifestyle.