Opinion | There’s Good News About Vaccinations. Now What?

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The Delta variant and its upstart sibling, Omicron, have already dispatched too many to our hospitals and morgues. And the worst may be yet to come. Medical authorities warn we could see 1 million new cases a day in the coming month. President Joe Biden took to the airwaves Tuesday to showcase the danger and said it was the “patriotic duty” of all Americans to get fully vaccinated.

But despite all the depressing news you’ve read about Omicron and the “epidemic of the unvaccinated,” and the chorus of critics who say we botched the pandemic response, we’ve done a pretty good job of giving people the jab. A year ago, Gallup Poll reported that 42 percent said they wouldn’t take a Covid vaccine, but that proved to be an illusion. In just one year, a remarkable 85 percent of American adults have gotten at least one dose of a Covid vaccine, according to the Centers for Disease Control and Prevention. Nearly three-quarters have gotten a second dose and are considered fully vaccinated.

If the vaccine were a consumer product, it would be heralded as a smash success. In New York City, 91 percent of adults have gotten vaxxed, which rivals any number in the free world. (Children lag behind, but mostly because vaccination approval came later for them.)

So rather than harp on the intransigence of the vaccine-hesitant, the vaccine-resistant and the vaccine-unmotivated, let’s celebrate the news that most people wanted to get vaccinated and followed through — and, maybe even better, a lot of people apparently had doubts but overcame them. So far 220 million American adults have taken a dose, which means doctors and public-health agencies have only about 35 million first-timers to go.

What vaccine stones have they left unturned? Biden has likely flipped as many of the unvaccinated en masse as is possible with his vaccine mandates (federal employees, armed forces, the “OSHA” directive). And if heavy White House jawboning was going to turn vax resisters, we would have seen mass conversion already. What Biden left out of his redundant national address is a real acknowledgment of how many we’ve vaccinated in such a short time, rivaling the rates in comparable countries, and that the low-hanging fruit has already been picked. Getting the last 35 million to comply will be a long, long march.

Scoldings, like the one issued earlier this week by the White House, which can be interpreted as wishing “severe illness and death” on the unvaccinated, will persuade nobody. A better option would be to focus tightly on the groups — and there are many — that have refused to budge on vaccines.

Among the largest vaccine-avoiding constituencies are rural dwellers, the less educated, the poor, the young and, most significantly, Republicans. Of the many vaccine outreach miscues, perhaps the greatest was letting anti-vaxxers publicly brand the vaccine as both a liberal and a meddlesome federal government thing, when it’s neither. The vaccines were devised by big pharma during the Trump administration, and he took credit for them in December 2020 when he described the Pfizer version a “medical miracle.” Last March, Trump urged Fox News Channel viewers to get the jab and this week has conceded he has taken the booster (he got booed) and urged Americans to line up for the vaccine. Covid vaccines are as Trumpian as medicine can get!

This would be a perfect time for a formal campaign led by... hm, how about Trump? Such a message would land with a wallop among the unvaccinated: As a September poll noted, 87 percent of unvaccinated respondents said they voted for Trump. The former president hasn’t been much of a salesman for the vaccine, putting in none of the effort he once put into selling his apparel lines, his steaks and his water. It’s probably too late to completely delink the vaccine from the Biden administration and the federal government, its primary sponsor, though Biden did good in his speech when he made the vaccine push an ecumenical achievement by crediting the Trump administration’s efforts. A Trump-led publicity campaign might persuade a few million of his supporters that the vaccine was a universal medicine, not Joe’s private-label tonic.

The best place for Trump’s barnstorming vax crusade would be the rural communities, which rank among the most Covid vax-resistant groups in the country. Pro-Trump counties, many of them rural, have experienced about three times the rate of death from Covid. A few rambling speeches to MAGA faithful at high school gymnasiums, rodeos and VFW halls would surely tip a substantial number. There’s lots of work to do in these places. Country folk don’t like being told what to do by Washington (who can blame them?), and this has made them unnecessarily resistant to some commonsense prevention tactics. They do worse on simple mitigation strategies like social distancing and masking; it should come as no surprise that they boast some of the lowest flu-vaccine rates in the nation.

In their defense, there’s an access issue: They don’t have vaccine-dispensing pharmacies on every other street corner the way city people do, nor are hospitals abundant and convenient. (There are six vax-pharmacies within a 15-minute walk from my suburban home.) So it really does require more effort. Making Trump a backwoods vaccine bumper sticker might add some motivation — and would also reduce the “big government” aura around the existing outreach of pop-up vax clinics, mobile vaccination centers and home-visit vaccinations.

There are other pro-vaccine tactics that don’t bear the stink of Washington. Researchers have long noted that social cohesion accelerates vaccine rates. That’s one of the reasons we stage mass vaccinations at schools, workplaces, libraries and churches, where people who have earned our affinity assemble. We feel safe and secure around people we trust and work/play with, and the distrust we might feel for the government or doctors recedes. Perhaps the most dramatic demonstration of how social cohesion can spur higher vax rates has come in Asian American communities. Asian American people have outdone every other ethnicity on this score, sometimes overcoming language obstacles in the process. In Philadelphia, more than 90 percent are partially vaccinated. News reports credit Asian nonprofits that have knocked on doors, leafleted nail salons and other businesses, and arranged vaccine appointments with getting the vaccine into lots of arms.

Unlike vaccines, social cohesion can’t be mandated. But the sense of togetherness produced by clubs, associations and other gathering places could be smartly exploited by the vaccinators, as would familiar places we casually congregate, like McDonald’s, Starbucks and bars. Wherever a strong sense of kin and community is expressed would make a good place to pitch the vaccine. Now that boosters are de rigueur, affinity stops like these might prove essential in keeping people fully vaxxed.

Lower education levels are generally linked to lower vax rates. But low formal education shouldn’t prevent anyone from grasping what good medicine the vaccine is. In a Census Bureau survey published last April, the most common objection respondents gave for not taking the vaccine was “Concerned about the side effects” (55.9 percent) and the runner-up was “Don’t trust Covid-19 vaccines” (55.4 percent). If the respondents are telling the truth — not a complete cinch — their excuses give persuasion a huge opening. By worrying aloud that a drug might harm their health, they’ve put the world on notice that they care about risk.

Yes, the Covid vaccines present risks. No vaccine, no medicine is 100 percent safe. But after 500 million doses of FDA-approved Covid vaccines have been dispensed in the country, the safety levels of the vaccine have proved extraordinarily high. Vaccine-avoiders who really care about risk ought to look into the risk of going unvaccinated. If your immune system loses the battle with the virus, you might join the 800,000 dead. Sounds risky, doesn’t it? But there’s more. If infected, you might infect your spouse, your children, your friends, your workmates and strangers on the subway. Or you might suffer from long Covid. As Dirty Harry once said, Are you feeling lucky, punk?

Persuasion, of course, isn’t about a simple recitation of facts. As medical researcher Gary S. Marshall wrote in 2018, well before the age of Covid, people irrationally leap from “there can be side effects” to “side effects are common” without really thinking about it. It doesn’t take education beyond elementary school to see that the risks of taking the vaccine are piddling compared to the risk of rejecting it. Covid illness, oddly, has a way of clearing the mind on this topic. Time and again, the press has reported the regrets of people who have decided once getting sick or dying from Covid that they should have rolled the vaccine dice instead. Marshall also offers that vaccine hesitancy might also be a product of a shift in contemporary medical philosophy. “Doctor knows best” has given way to doctor-patient partnerships in which the patient is supposed to be some sort of equal to his physician. Give these patients a web browser and an hour many of them begin to think they’re virologists, too. There may be no beating back this trend.

But let’s end on an optimistic note. The anti-vax sentiment remains huge in the United States. A September poll found that 83 percent of unvaccinated respondents said they would never get the shot. But it turns out that their resistance is Covid vaccine specifically, not vaccines in general. Of this group, 56 percent said they had gotten a flu shot at some point in the past and 44 percent said they were open to an antiviral or monoclonal antibody treatment should they become infected. This indicates that great reservoirs of trust in modern medicine still reside in anti-vaxxers. And why should that not be so? When anti-vax advocates get Covid, they still go directly to the hospital for care, not to Trump Tower or an herbal remedy vendor.

We can’t possibly convince all 35 million unvaccinated to reverse course. Nature abhors this sort of unanimity. A determined subset of Americans refuses all preventive care and only seek medical intervention after they’re deathly ill. They’re the people who won’t take their flu vaccines, won’t see their dentists, keep smoking cigarettes and drink their calories. Our duty, then, is to continue with our persuasion and outreach and pleading and browbeating and to keep the vaccines on ice until the incalcitrant declare, one at a time, that they’re ready for their dose.

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I never collected my Krispy Kreme donut for getting vaccinated. Does the offer still stand? Send vax and donut facts to Shafer.Politico@gmail.com. My email alerts have been boosted. There is no vaccine for what ails my Twitter feed. My RSS feed had an adverse reaction, of course.

CORRECTION: This article original misstated the year of publication of Gary S. Marshall's paper. The correct year is 2018.

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