By Anna O’Malley MD
April 7, 2021
It is spring. This year, watching the death-rebirth mystery unfold in all corners of the natural world, I feel the hopeful energy of reemergence in my own life. The light at the end of our pandemic tunnel is visible, though the brightness and nearness of that light are difficult to pull into focus. Of the many variables complicating the equation is vaccine hesitancy.
As a primary care physician, I have had the opportunity over the years to counsel hesitant parents regarding childhood immunizations. As is true for so many decisions in medicine, central to that conversation is a weighing of risks and benefits. Listening to the concerns and respecting the intelligence of the person who ultimately must make the decision is of crucial importance. Now, with members of my family navigating the consequential choice of whether to take the Covid vaccine, I am drawing on my appreciation of complexity to understand them.
While hesitancy might accurately describe many people’s current stance, there are some whose stance resembles abject opposition. This great divide in perspective invites real, honest curiosity:
- What informs these perspectives?
- What reinforces our perspectives?
- Where is there common ground?
- Where are biases introduced?
- What openness to complexity is helpful?
- How do false narratives get propagated?
I have the mixed blessing of having conversations in my family about extreme concerns regarding vaccines, offering a window on the sociopolitical landscape in which the anti-vaccine theories find fertile ground. I have signed up for a prominent newsletter that brings these perspectives to my inbox and am fascinated by the intersecting themes therein.
Some resonate for me: holistic health promotion as a strategy to be less dependent on Western medicine (which is core to the integrative style of medicine I practice), the compromised pharmaceutical industry (vested interests are responsible for biases of many sorts, in medicine as in other sectors), and the idea that effective treatments for Covid are not given fair treatment in the media (a complex scientific landscape that may have truth to it).
Some themes speak to an entirely different societal narrative and set of values, such as how to “secure your perimeter” using a long-range AR-15. Many themes spin out-of-context data into dark, dystopian conspiracies. Given the number of people who are concerned, there may be truth to reports that Bill Gates may be microchipping us for surveillance, or, more importantly, that the true risk of Covid immunizations is not being disclosed, it is a good time to track these narratives back to their roots and acknowledge the importance in transparency for informed decision-making.
Many flourishing conspiracy theories arise from partial realities. The microchipping theory that is circulating stems from an actual study the Bill and Melinda Gates Foundation-funded at Massachusetts Institute for Technology, published in 2019, investigating innovations to help with vaccine recordkeeping, most relevant for global health immunization initiatives such as eradicating polio in the developing world. While the technology is fascinating, and reasonable people will undoubtedly debate whether it will be a good idea to roll out, it is not relevant to Covid immunization. It is simply not being incorporated into current vaccine technology.
In my mind, the essential conversation we need to be having is the risks-versus-benefits conversation.
Based on the findings in the initial phase of three clinical trials of each of the Covid vaccines, the risk of having a serious reaction is very low. It is not zero, but it is very low and is most associated with people who have had serious allergic reactions to other medications or to contrast dye. The accumulating evidence underscores this finding. I have seen one patient who had a serious rash following a first Pfizer immunization, a woman with a history of allergy to contrast. The vast majority of people in my practice, in my social circles, as in the larger collective, have only experienced the signs that their immune system is responding to the stimulation the immunization provides or has no symptoms at all.
We in medicine have a mechanism for watching closely for any signs that a vaccine is leading to serious problems. The Vaccine Adverse Event Reporting System, or VAERS, captures raw data—any medical provider or person who observes symptoms that might be linked to an immunization is encouraged to file a report. I filed one on the patient I mentioned above. The C.D.C. and F.D.A. surveils these reports in combination with patient medical records to determine if it is likely that the immunization is causing harm. To date, there been no pattern of adverse events indicating safety concerns with the vaccines in use.
The very low risk posed by taking the vaccines is only one level of risk consideration. This is where the conversation I’ve had with parents over childhood immunizations is so different than the one we are having now: In a pandemic that is still a clear and present danger, the risks associated with not being immunized is great. A healthy young person might argue that the risk of serious Covid infection is low; however, this perspective leaves out the community care ethic that moves so many to act in protection of those who cannot be immunized, knowing that continued rampant circulation of the virus will lead to protracted societal suffering.
We, humans, are programmed to make meaning out of our experiences. The narratives we weave around the news we read, around our personal experience or someone else’s, shape our beliefs, our actions, and in this present moment, our ability to pull out of the pandemic sooner rather than later.
A recent Pew Research Center report finds that intent to take the Covid vaccine is on the rise. Intriguingly, the report looks at factors related to this decision—for example, those who place importance on “community health” were much more likely to intend to be immunized than those who did not, as were those who trust in the scientific process of vaccine research and development. The strongest reasons cited for avoiding the vaccine included concerns about side effects and the vaccine development process.
I am listening for where we find common ground in the dystopian, fear-inducing, non-scientific narrative they’ve been absorbing in talking with my hesitant family members. I am hopeful that we all can gradually, together, move away from fear and suspicion toward transparency, truth-telling, and a community care ethos.
Our collective security, now and in the future, will not be furthered by our ability to “secure our perimeter,” but to extend care and concern to the most vulnerable. For many, that will only be possible through the understanding that a rigorous and transparent scientific process allows each of us to trust that this is safe to do.
As we move toward our common ground, we can bring curiosity to the partial realities underpinning “conspiracies” and deep listening to the fears driving hesitancy. We can own our biases whenever possible. Science, like medicine, is imperfect, and it is a process. We in medicine can seek to perfect the art in our practice through continuing to honestly look at data, standing by the science while holding space for complexity and that which is not known. We are extremely fortunate to have such effective and safe immunizations; now is the time to step into the light at the end of the tunnel.
This article originally appeared in The Point Reyes Light