The Morning Jolt

Health Care

We’re Not in ‘Hand-to-Hand Combat’ on Vaccines

Aditi Agarwal administers a coronavirus vaccine at a mass vaccination site at Lumen Field Event Center in Seattle, Wash., March 13, 2021. (Lindsey Wasson/Reuters)

On the menu today: A particularly ill-considered metaphor in the effort to persuade vaccine skeptics, why our country’s elites are more comfortable confronting a demand problem than a supply problem, and why a system of “vaccine passports” is probably unworkable.

No, We’re Not in ‘Hand-to-Hand Combat’ on Vaccines

This metaphor, featured high in a front-page story in the New York Times, is probably not the best choice when discussing the effort to persuade the unvaccinated to get their shots:

“If you think of this as a war,” said Michael Carney, the senior vice president for emerging issues at the U.S. Chamber of Commerce Foundation, “we’re about to enter the hand-to-hand combat phase of the war.”

Talk that we’re hitting the “demand wall” is more common than the evidence that we’re actually hitting a demand wall. We’re still averaging 3 million doses administered a day. The daily number administered is choppy, but not really sinking — and remember, each day’s data can be delayed and adjusted. The U.S. collectively administered 3.5 million shots last Thursday, 4 million Friday, 3.6 million Saturday, 3.5 million Sunday, 2.2 million Monday, 1.8 million Tuesday, and 2.6 million Wednesday. Maybe this is the start of the decline from the peak. Or, considering the decline from the weekend to weekdays, maybe we’ve just gradually worked our way through the elderly, immunocompromised, and the people most eager, and that from here on out, we’re going to be dealing with demographics less likely to take a day off from work to get a shot.

If you’re lucky, you’ll have no major reaction to the shot. Lots of people experience muscle aches, sore arms, fatigue, chills, slight fever, headaches, and dizziness. (I had short-lived but surprisingly bad vertigo three days after my first shot.) People hear the stories from others about how getting vaccinated can make you feel pretty lousy for a day or two. After nearly 200 million shots administered, we’re probably done with the “low-hanging fruit” and are now trying to vaccinate the demographics who don’t think they can afford to miss a day or two of work, school, or other responsibilities, because they fear they might have a bad reaction to the vaccine. We can disagree with the risk-vs.-reward calculations of these folks, but those people aren’t crazy.

Yesterday, Politico warned that “several states are now administering fewer [sic] 75 percent of the doses they receive, according to the Centers for Disease Control and Prevention.” Er, yes, but that’s been the case in quite a few states for at least six weeks, which means it isn’t really evidence of hitting a wall in vaccination demand. Back on March 12:

Rhode Island can justifiably brag that it has used 81 percent of its allocated doses, while Texas has used 73 percent. But the states at the top of the list, as of this morning, are New Mexico (87 percent), Wisconsin (85.1 percent), and North Dakota (84.4 percent). At the bottom of the list, as of this morning, are Georgia (63.3 percent), the District of Columbia (65.4 percent), and Kansas (66 percent). It would be just as valid to write a story featuring North Dakota as a place that’s doing it right and the District of Columbia as a place that’s doing it wrong.

Back on March 9, nationwide, we had only administered 79 percent of the doses received from suppliers.

The pandemic has brought out a lot of people’s inner Manichean, in which they are the good and wise and careful ones, and anyone who sees the issue differently or who has a different level of risk tolerance, or assessment of the trade-offs, is foolish and reckless and a danger to others. I would like to see everyone who is not allergic to the vaccine ingredients — a very, very small percentage of the population — to get vaccinated. But we are not in “hand-to-hand combat” with the reluctant. They are not the enemy. They are not a foe. They are fellow Americans who should be informed, persuaded, reassured, encouraged, and gently nudged.

National Institutes of Health director Francis Collins puts it well: “I think we’ve had too many instances of people saying, ‘Well, if you don’t get this vaccine, you’re just stupid.’ And that’s not helpful and it’s not true. You got to listen and hear what the concerns are and then try to address those point by point.”

While vaccine skepticism or reluctance among African Americans has declined somewhat, they, and other minority demographics, as well as Republican men, remain the most wary of getting vaccinated. As I observed earlier this month, a lot of people who are very comfortable mocking Republican men as paranoid and foolish would never say the same about African Americans and other minority groups who are similarly skeptical. If you find calling one of these groups stupid unhelpful, it ought to apply to the others. Consider this observation from rural Tennessee:

Pastor Omaràn Lee, a hospital chaplain in Nashville, has been working with Black churches in Tennessee to promote vaccination. He says the concerns in Black congregations in his city aren’t that different from what he hears from rural, white communities.

“‘We don’t trust the government, and we don’t trust Joe Biden’ is what they say, right?” he says.

But Lee notes that, six months ago, Black communities were saying the same thing when Trump was in office. “Anytime you have a marginalized person, you have people who [feel] left out, they’re going to be skeptical.”

The people in charge of promoting COVID-19 vaccination ought to imagine that their best friend is skeptical and think about what approach would persuade that friend the most. Berating, mocking, or insulting them isn’t likely to change their minds.

Earlier this year, I noted that a lot of people in powerful positions were comfortable with the concept of a demand problem; just run some public-service announcements and tout celebrities getting vaccines. (That is, when the celebrities aren’t reluctant to get vaccinated themselves.) They see a demand problem as essentially a communications and messaging problem, which is what a lot of powerful people specialize in, or at least they think they’re really good at communicating. It’s a sales gig, and that’s what a lot of powerful people do for a living. Companies sell products and services, and politicians sell themselves and their agenda. But thinking of this as a sales effort might be counterproductive. Some research contends that Americans are exposed between 4,000 and 10,000 advertising messages each day, once you add up everything online, every ad on the radio, television, billboards, signs in store windows, signs atop taxicabs, every brand logo, etc. Americans have gotten a lot of practice in tuning out advertising that doesn’t interest them.

But for most of this year so far, we had a supply problem. There just weren’t enough doses and enough appointments to meet demand.

The supply problem appears largely fixed right now. In my neck of the woods of Fairfax County, the waitlist is gone; they’re currently making appointments for people who registered on Sunday. But it took a long time and a lot of effort to get here; local health officials and volunteers have administered more than 570,000 shots so far — in a county with about 880,000 residents above age 18.

One chunk of people who aren’t vaccinated yet are young adults who only recently became eligible; Virginia just expanded shots to those 16 and over Sunday. It is not surprising that members of the demographic who are least likely to have a serious reaction to COVID-19 are generally not rushing out to grab the first appointment available.

Finally, the continued existence of vaccine skeptics is likely to bring more arguments and proposals for “vaccine passports,” which is a bad idea and probably a fundamentally infeasible one. Wesley Smith warns that we could see an effective corporatocracy, where the private sector becomes the enforcers of policies desired by federal bureaucrats.

But if an airline, hotel, stadium, or other business asks for your proof of vaccination, the only proof most people have is that little card they give you. It’s cardboard, and a lot of the information is filled in by hand. It’s way easier to create a counterfeit vaccination card than a fake driver’s license or other government documentation. The moment there’s a genuine need to show the vaccination card, the already-thriving fake card industry will explode. It’s not like the hotel desk clerk or stadium usher is going to double check the lot numbers listed on your card.

Sure, your vaccination is also recorded in the database of the institution that vaccinated you, but the airline, hotel, stadium, or other business can’t access that information without your permission because of HIPAA. Any efforts to institute strictly enforced vaccine-passport policies are going to generate a lot of pushback. “No, I’m not giving you access to my medical records so I can go to a ballgame.”

ADDENDUM: Further evidence that a lot of high-profile political activism is a (marginally) socially acceptable way to work through deep-rooted psychological problems, including angry tantrums and a poorly repressed desire to be obnoxiously and aggressively antisocial: “Climate activists dumped over a dozen wheelbarrows of cow poop at the White House to protest Biden’s “BS” climate plan.

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