Confession of a Vaccine Shopper (Who Sympathizes with Vaccine Hesitance)

Last month, I read the article “This entitlement is beyond me’: Canada hits COVID-19 vaccine milestone, but people are still ‘shopping’ between Pfizer and Moderna” and I felt irritated. Why? Because I was a ‘vaccine shopper.’ I could have gotten a Pfizer/BioNTech dose a few days before I got my J&J vaccine, but I chose the J&J appointment. I don’t like being told I’m ‘entitled’ just because I make a calculated choice about what was better for me.

Did I hurt anybody by delaying my vaccination for a few days? Nope. I even reached ‘fully vaccinated’ status faster by choosing the appointment for a J&J vaccine.

Another problem with the urging to ‘get the first possible vaccine dose’ message is that, if I took that advice literally, I would have potentially done more harm to myself than others. I could have gotten a vaccine dose faster if I had been willing to board a taxi/bus/streetcar/etc. However, between March 2020 and my vaccination, I made a rule not to board any vehicle unless absolutely necessary. If I believed that my only choices were ‘board public transit to get vaccine’ or ‘never get vaccine’ I would’ve taken my chances on public transit, but I had a third option, ‘wait until vaccine is available at a site within walking distance of my home.’ That’s the option I chose.

(Now that I’ve fully vaccinated, I’m willing to use public transit for non-essential purposes for a few months. After a few months, I’ll assume my vaccine is faded until I get a booster shot or scientific studies show that vaccine fadeout isn’t a problem.)

Public vaccination sites were slow to open in my neighborhood for a good reason: my neighborhood has one of the lowest covid infection rates in the city, and the city prioritized opening vaccination sites in neighborhoods with higher infection levels.

If I believed that the time gap between getting Pfizer and getting J&J was weeks instead of days, I would have taken the first opportunity to get the Pfizer vaccine in walking distance of my home. But for a difference of days, I preferred a single dose vaccine which probably wouldn’t make me sick for a day and differed from the most common type of vaccine (mRNA vaccines) in the city. If that means I’m ‘entitled’ then fine.

Some of the comments on that article which shamed people for rejecting AstraZeneca claimed that, at the time of publication, some pharmacies in that city were running out of AstraZeneca doses, and doctors which couldn’t get their own patients to take AstraZeneca could donate their unused doses to pharmacies. If getting people vaccinated as fast as possible was their priority, that’s what they should have done instead of shaming patients.

Instead of pushing vaccine hesitant people in the United States to get vaccinated, we should donate viable unused doses to countries where people who want vaccines can’t get them yet. First make vaccines to everyone globally who wants them, then focus on vaccine hesitant people. This would increase global vaccination rates faster and be more respectful of individual autonomy. I’m almost opposed to vaccinating 12-thru-16-year-olds in the United States since those vaccine doses could do more good in other countries, but I’ve spoken to a few teenagers who were worried and really wanted to be vaccinated. I don’t have the heart to say ‘no, that vaccine dose should go to someone else,’ especially to the most vulnerable teenagers. So yes, I approve of making the vaccine available to 12-thru-16-year-olds, but I am opposed to pushing it on teenagers who aren’t willing.

Many people in the United States who want vaccines also can’t get them, for a variety of reasons, such as not being able to get a day off work to deal with vaccine side effects, not having good physical access to vaccine sites, and fear of surprise billing. Instead of having million dollar lotteries for vaccinated people, those million dollar prizes and other ridiculous incentives should go towards removing practical obstacles to getting vaccinated.

Taking down those obstacles is more work and costs more money than shaming unvaccinated people. Furthermore, doing things like improving vaccine site accessibility doesn’t offer as quick a rush of self-righteousness as mocking anti-vaxxers.

(Yes, I am in favor of debunking falsehoods spread by anti-vaxxers. However, I’m not talking about anti-vaxxers in this post because they are over-discussed.)

Now I get to the part which feels so controversial I’m afraid to publish it on this blog.

I sympathize with vaccine hesitant people.

Reading the Emergency Use Authorization disclaimers spooked me. For a moment, I considered cancelling my vaccine appointment. Hesitating to take the vaccine because of the EUA language makes sense.

Much more complex reasons also lie behind vaccine hesitancy (and that one article doesn’t speak for all vaccine hesitant people). Specifically about Black people, it says:

“It’s not just that there was a past history of medical experimentation on Black people that makes them suspicious of new technologies today. There is a continuing practice of racism in medicine and government policies that many Black people have experienced themselves. That’s why there’s a skepticism about the government rollout of the vaccine. It’s a rational skepticism, and the only way to address it is to work toward ending the racism in medicine and health care that caused the skepticism in the first place.”

I’m still worried about long-term effects of the vaccine. That’s another reason I ‘shopped’ for J&J; we have more long-term data about vector vaccines than mRNA vaccines. When I hear declarations of ‘hesitation is foolish, there’s no evidence of long-term side effects’ I think, “of course there’s no evidence of long-term side effects, mRNA vaccines have never been tested on a large number of people over years before.” My calculation is that the real, proven thread of Covid-19 is scarier than a hypothetical vaccine side-effect, but I don’t dismiss the possibility of serious long-term side effects. I’m scared that the loud dismissals will push people to cover up and disbelieve evidence of long-term side effects, just like people with long-covid struggled for months to get the medical establishment to recognize them. If serious long-term side effects exist, such dismissals will delay treatment.

Some vaccine hesitant people want to maintain control over their bodies. They wear masks and physically isolate themselves to the greatest degree possible because those things are under their control, but don’t want a new vaccine in their body. Though I made a different choice, I understand that perspective. Not everyone can physically isolate. But for people who can stay in extreme physical isolation for many more months, that might be a better choice than getting vaccinated. Vaccines mess with our risk tolerances (it’s affected my risk tolerance) and if a vaccine-resistant variant becomes widespread, the people who refused the vaccine and stayed holed up might have the advantage. My one objection to this path is that even people who can normally stay in deep physical isolation may have emergencies which force them out of physical isolation with no warning.

I had an exchange with someone who insisted that anyone (in the United States) who got covid had only themselves to blame because vaccines are now widely available. I pointed out that was factually incorrect, and they said that technically they were wrong but they shouldn’t have needed to put in a caveat about breakthrough infections because they are all mild. (A few fully vaccinated people have died of covid, but maybe this guy considers death to be a ‘mild’ symptom). After a few comments back and forth, he softened his stance. I didn’t want to poke every single hole in his argument. His admission to a few mistakes and openness to the possibility that he might have made even more mistakes than what he admitted satisfied me.

Though I can’t read his mind, I suspect he took such a hardline stance of ‘any covid infection is now the infected person’s fault because vaccines’ was that he fervently wants to believe that the vaccines have practically ended the pandemic and that anyone (in the United States) can completely protect themselves from covid if they want. It’s scary that fully vaccinated people can still die of covid, and I understand why people might want to avoid that truth.

Some comments give me the sense that some people hope certain outgroups will refuse the vaccine and then die of covid. The prospect of these outgroups dying of covid and having only themselves to blame brings them glee. For some of these people, the outgroup is Trump supporters; for others, it’s Black people; for others, it’s working-class people of any race. They want these outgroups to die without feeling responsible for their deaths so they can self-righteously gloat over their demise.

Does anyone believe that shaming motivates people to get vaccinated? I suspect that most people subconsciously understand that shaming has little persuasive power, and they don’t care because increasing vaccination rates isn’t their true goal. Some want the outgroup to suffer and die, and may shame precisely because they want to push vaccine hesitant people into a corner. Others merely want laughs at another group’s expense.

If you can get vaccinated but have chosen not to, I won’t shame you. I won’t try to persuade you because you’ve probably heard all the pro-vaccine arguments I could make, and they already failed to change your mind. You may even be right about refusing the vaccine, much as I doubt it.

If you shame people who don’t leap at the first opportunity to get vaccinated, why do you do it? If you want to mock people, then congratulations, you’ve succeeded. I hope you had fun. If your goal is to increase vaccination rates, I suggest trying a tactic which is more likely to work, such as listening to vaccine-hesitant people before you try to persuade them.