This essay is written by one of my close friends, a doctor I trust who reads my Facebook comments and asked for permission to respond to all those who are vaccine hesitant. This opinion is my friend’s opinion, so please don’t attack me for sharing what my friend asked me to share as a public health broadcast. Also, please don’t ask me questions, as I’m not resourced nor experienced enough to answer them, and neither are my friends on the front lines. I know that many people have their valid reasons to be vaccine hesitant, so please try not to get defensive and just take in this information from someone who is very well qualified to speak about the risks of Covid versus the risks of the mRNA vaccines. I hope you find it helpful, as it’s intended to be.
A Note To The Vaccine Hesitant From A COVID Researcher & Front Line COVID Physician
With all due respect to those who are understandably vaccine hesitant, let me share a few thoughts. The vaccine hesitant are valuing an imagined (but granted not impossible) long-term side effect with no current evidence of existing, against the risks of infection by a virus that 100% exists, and has 100% probability of killing and disabling some folks who contract it. The hypothetical negatives of a vaccine- negatives that may not even exist- are less “real” than a virus with confirmed death and disability events that are happening in front of us and are guaranteed to take down some of our patients.
I want to ask these vaccine hesitant people, “So, your plan is, what? To wander around until you get the virus, and HOPE you are not someone who gets killed or disabled? Why is the risk that may not exist at all more scary to you than the risk that we absolutely can see is real and in front of us and happening to actual people? And besides the risk of harm from the virus vs. the vaccine to you, personally: If you choose to go without the vaccine, you are agreeing that you’re okay with taking the risk of getting the real virus and spreading it (because each person who gets Covid spreads it to an average of 2-3 other people–usually household members or coworkers).
So choosing to be unvaccinated means choosing to pose a hazard to other people; it’s like choosing to go maskless, or to drink and drive–it harms others. Doesn’t that matter to you, to avoid harming others?
Other points:
- If you get sick and have a mild or even asymptomatic case of Covid doesn’t mean you won’t have disabling long term side effects. As reported in this Guardian article, 21-year-old basketball star Keyontae Johnson had mild COVID in summer, but collapsed last week critically ill during a game. So, it’s actually the virus, which is “designed” to infect all your blood vessels and thus all your vital organs, that has the potential to damage you long term. While I cannot promise a non-replicating vaccine protein has zero potential of creating a long-term side effect, its design makes it unable to invade your blood vessels or vital organs, so that unknown risk is much less than the unknown long term risk of contracting the actual virus.
- There seems to be an implied assertion that we have zero understanding of the long-term effects of mRNA vaccines. While we won’t have perfect knowledge about this issue for probably a decade, we’ve already had the mRNA vaccines in over 70,000 persons for nearly a year. Most permanent adverse effects show up by now. So far, nothing. That suggests that if there are “oopsie” long term side effects, they are a 1 in 100,000 rarity. Not zero, but much less likely than death or disability from actual virus (about 1-10% of adults under 50 who get COVID and probably at least 20% of those over 50–the details depend on exact age and other chronic conditions.)We also have mRNA vaccines NOT for COVID (like for CMV) that were administered more than 5 years ago in about 2000 patients or so, all told. There have been no long term effects detected during those five years. Again, this is not perfect knowledge because science takes time and it’s a process, but there is reasonable evidence that long term side effects of these vaccines doesn’t show up by surprise years out. Again, there is not zero risk, but such potential risk would be radically lower than the known risks that the actual virus poses.
- As for the argument that the vaccine isn’t guaranteed to be effective long term, no one is making that promise- because we don’t know yet. The vaccines are approved on whether they can prevent infected people from getting so sick they wind up in the hospital and/or die. They are radically effective at achieving this goal- better than was hoped for by those of us working on vaccines (I’m working on one of the Merck ones).Dr. Shane Crotty of La Jolla Institute for Immunology and 3 other groups have looked at blood markers in patients who’ve gotten the virus or gotten vaccinated, and we estimate immunity will last on the order of “years”–maybe 2 years, maybe 10. We’ll have to wait to know for sure. Immunity against natural coronaviruses averages about 15 months- and we’ve already seen people get re-infected with COVID. A recent study of beta-coronavirus infections that went on for decades showed that a substantial minority of subjects got two infections per year. Since 1 in 7 folks with COVID need a hospital, when you multiply that times millions of infected humans, you get what we have right now: Hospitals collapsing from the burden put on us front line doctors and nurses, and then people WITHOUT COVID also dying because they cannot get care, because the hospitals are gummed up with COVID cases. That’s the world a natural virus will have us live in, for years. The vaccines clearly produce stronger and thus likely longer lasting immunity–which protects the health care system and those who need it.
- We now also know from the Moderna data presented this week that vaccinated persons also are much less likely to *spread* COVID if they actually contract it, so vaccination will actually reduce the spread of this virus to the uninfected. This contrasts with choosing to contract natural infection, which on average will result in 2-3 more people getting virus, with the attendant risks of death, disability, and health system collapse.
- The other problem with “let’s do this the natural way” ie “let’s let the virus run amok and kill tens of thousands of people” is what has occurred in the UK, where a new mutant virus that is even more contagious than the original virus from Wuhan has emerged. When you choose to have your population unvaccinated, you’re letting the SARS-CoV-2 virus (which actually normally doesn’t mutate very much) get an awesome chance to get deadlier–because you’re giving it millions of living Petri dishes (ie human beings) to evolve in.Allowing natural infections means allowing the virus to get more dangerous. Again, that does not happen in the world in which we have universal use of our existing vaccines.
Maybe the thought is “I’ll avoid vaccination but I’m cool with virtually every one else getting vaccinated so life can return to normal”–in other words, the tragedy of the commons. Being protected against circulating COVID requires most people to agree to get the vaccine. My church has a name for people who want other folks to do the work while obtaining personal benefit from that work by others: Selfish. (Judge-y, I know. But it’s honest.)
America is doing almost uniquely badly with COVID compared to most developed nations–and it’s because so many of our populace, when they were told how to help (“wear a mask”, “stay home as your work allows,” “please get the vaccine”), announced “I know more than the medical experts, I’ll do what I want”. That is why the USA has hundreds of times higher death rates than countries where people cooperated with what they were told would help the greatest number of their fellow citizens.
I laugh when I see Americans comparing one US state against another and drawing conclusions about whether restrictions work. When you compare places where there are restrictions, mostly ignored by the populace, against places without restrictions, you’re comparing apples and apples. All Americans need to do to answer the question of whether public health measures prevent COVID deaths is look to Taiwan, Singapore, Australia, China, New Zealand, Senegal, to see countries that did massively better because they focused on eradicating the virus, had citizens who cooperated with public health, and thus had a reasonably normal quality of life and preserved economies.
Americans are getting almost uniquely horrific death and economic damage because they are, on average, not doing what medical scientists have begged them to do (and the well-to-do Americans will finally suffer economically in 2021 the way my working class patients already have been in 2020–the repercussions are coming. Karma is like gravity; it can seem like you’re evading it, but it always wins, ultimately.)
I think what’s frustrating for those of us with medical training–especially when we’re dealing with “educated” people who choose not to listen to us- is that WE are the ones who pay the personal price for those folks’ selfish and ignorant choices. If that sounds judge-y, I’m sorry, but: I knew, because I knew every day that I went into the COVID ward that I stood a 1% chance of dying if I got this. I went in anyway. I did it afraid. And I saved many lives.
When I hear people without my training or experience make an argument in favor of why they get to choose the action that puts me at greater risk of death, I feel (understandable) rage on behalf of myself and my co-workers. We’ve already lost about 3000 US health care workers to COVID (the Guardian newspaper and Kaiser Family Foundation have a tracking project). We all knew we faced something deadly, and we showed up anyway. Hearing non-medical folks tell us, in so many words, that we need to die/get disabled so they can have a sit down meal in a PF Changs or have drunk karaoke with their friends, is just, argh.
Medical people are wired to be UN-selfish. We put the needs of others first. If our roles were reversed, we would NEVER risk the lives of others for our own selfish wants. But, then, that’s the difference between those of us who choose medical work and other people. We are wired to put other people first, even to the point of martyrdom and self-sacrifice. Yet too many Americans are wired to feel entitled to do whatever the hell they want, without regard for the impact of their choices on others. I honestly don’t know what to do with that.
Many health care workers in this country are planning to leave medicine after spring 2021. I’ve thought about it myself. I wonder what the non-medical folks in America will do when tens of thousands of us leave medical work, and access to care gets worse? I would have left for New Zealand already if my husband were willing to emigrate. But he’s not, so I’m stuck here. I continued to show up at the hospital for the sake of the young residents I train–6 of whom, now, have gotten COVID, one of whom has is a Covid long hauler.
This may not be the perfect way to write a “science communication to address vaccine hesitancy” piece, but it’s honest, and coming from someone who knew, better than most, what COVID was going to do to us if we didn’t take the right actions. My community in California is already at 20% of my worst projected mortality projections, and likely more than half the total deaths are still yet to happen. We will almost certainly get to 60% of my worst case scenario. Yesterday my hospital *ran out of oxygen*, something I’d expect in a dispensary in Nepal or DR Congo. And at least one patient died from that.
All I can do is shake my head.
Please: Wear a mask. Get the bloody vaccine. It’s the least people can do for those of us who will pay with our lives, our physical health, or our mental health for the ignorance and selfishness of other Americans.
A NOTE FROM LISSA’S SISTER KELI RANKIN
My sister works on the front lines in a mental health facility and had a short window to decide whether she would get the vaccine. She was hesitant but shares this story. I hope her story helps you make your own decision.
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“Last week I asked my siblings their thoughts on the vaccine in hopes it would make my decision simple and warrant little thought on my own. Their answers were great, and I trusted what they said. But did it make my decision for me? It did not. So for the last 3 days, all my spare time has been spent researching COVID and the Moderna vaccine, hoping that would make my decision for me. I quickly realized you can find seemingly credible sources that will prove whatever you want to believe, whether scientific or completely outlandish. Did my research help in my decision? It did not. So this morning before I went to bed after working an 18hr shift, knowing that I had only a few hours left to decide what to do, I did what I should have done from the beginning. I called a meeting with my guardian Angels and God. I expressed my extreme uncertainty and asked for assistance in what decision to make. Before the meeting ended, I kindly reminded God that He made me who I am, and as grateful as I am for the awesomeness He created me to be, He also created my flaws and therefore should know I needed a clear sign. In other words I asked for lightning bolts and a thundering voice, not whispers in the wind. I graciously thanked Him for all I have and all I am, and went to bed.
Three hours later, I woke up to my alarm. The earth was not shaking. I heard no thundering voice. An angel was not sitting on the edge of my bed with a note on a golden platter from God. So now what? I sat there with my two best friends- Loneliness and Anxiety- unsure and slightly pissed at God’s lack of urgency in delivering my message I so kindly asked for, which I will apologize for feeling in my bedtime prayers tonight.
So there you have it. I couldn’t make a decision. So I guess no vaccine for me. And right then, I saw that while I had been sleeping during those three short hours, I received a text from one of my most favorite people in the whole world. Malen. [Malen is Lissa and Keli’s niece, their brother’s daughter.] I was quickly flooded with an overwhelming feeling that I absolutely should get the vaccine because regardless of the unknown or the side effects or my fears and uncertainty, I was clear about one thing. I am beyond willing to do absolutely anything to ensure I don’t go another year without being able to hug her. This has been one of the loneliest years of my life, but one of the biggest lessons in the unbelievable importance of the simple things we all take for granted- like a hug from your niece. And so with a calm spirit and a sigh of relief, I received my first shot today.”
My uncle Larry Rankin, a Methodist minister, responded to my sister. “Keli, prayer is like entering into a wrestling match with God. As you implied, you were wrestling with God, as Jacob wrestled with the angel long ago (Genesis 32:22-25). Wrestling with God means that you are engaged with Her. Even He won’t deliver the answer on a gold platter. She will be with you through the struggle, and send Angel Malen, who also didn’t give you the answer, but prompted you to decide (yes, this is your decision, not God’s) that hugging someone you love far outweighs any risks you may have by taking the vaccine. Wonderful, Keli – that’s what ‘doing’ prayer is all about.”
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May you find your own way to use all four of your Whole Health Intelligences (mental intelligence, intuitive intelligence, somatic intelligence, and emotional intelligence) to make the decision that’s right for you. If you don’t know how to make decisions in this way, consider joining us at Healing With The Muse, where we teach tools to help you make wise decisions in uncertain times.
Join Healing With the Muse here.
Lissa
