It’s !Public! Health

August 5, 2021

The US enters its fourth surge of Covid-19 leading to unnecessary suffering, death and economic disruption. Earlier this summer it seemed that we were returning to a more normal life, with businesses begging for employees, schools preparing to reopen for in-person learning, mask mandates disappearing and travel booming.

What went wrong? There is plenty of blame to go around.

First, the statistical evidence is undeniable that the vaccines work, yet only 50.4% of Americans are fully vaccinated. In too many states the full vaccination rate has yet to reach 40%. Let’s call them out by name: Alabama, Arkansas, Georgia, Idaho, Louisiana, Mississippi, Tennessee, West Virginia and Wyoming. While these states fall at the bottom of the chart, there are 25% to 50% of the people in every state who remain at risk, both to themselves and to anyone with whom they come in contact.

I see at least five reasons that people give for failing to get a life-saving (not necessarily their own life) vaccine.

Some think that the treatment is still “experimental” because the CDC has yet to give final approval. This rationale belies the facts that the “emergency use authorization” was based on sound scientific studies and over 160 million Americans have received the vaccines and no significant problems with it have emerged.

Some have sincere religious objections to vaccines. While I sort of understand why they may refuse certain medical treatments for themselves, a treatment that helps both the individual and the public in general should be acceptable to religious leaders and their flocks.

Minority Americans, particularly African-Americans, can point to historic wrongs including the Tuskegee syphilis experiments, as a basis for trepidation about this vaccine. A 2015 HHS article states that “[m]istrust of the health care system emerged as a primary barrier to participation in medical research” among African-American adults. According to another recent article, black vaccination rates are running about 10% behind white rates. This problem is not limited to Covid-19, but perhaps the current epidemic can be an inflection point for public health officials to overcome the more general problem of African-American mistrust.

Some say that the long-term effects of the vaccines are unknown, for example, young women who anticipate having children over the next few years. Obviously, we cannot know if there will be long-term detrimental impacts of the vaccines (or any other new medical treatment) simply because it has only been in use for a few months. Anyone who remembers thalidomide may have sincere and rational concerns. However, this rationale can be applied to any new treatment and, depending on how one chooses to define “long-term,” it could delay the use of beneficial treatments or cures for many years. When the issue is “public” health, the risk/benefit analysis should come down on the side of implementing the treatment rather that indefinitely delaying, to the detriment of family, neighbors and colleagues in the community.

Finally, there is the anti-elitist, anti-science core of Trumpists. I cannot fathom a valid basis for their refusal to be vaccinated. Since rational persuasion seems to have no effect on this group, mandatory treatment (enforced by fines, loss of employment and so on) seems the only way to bring this group into the fold.

I also assign some blame for this fourth surge to public health officials, including the most high-profile leaders, Anthony Fauci, Rochelle Walensky and others. There jobs go beyond the scientific analysis, which I believe they have done well. As federal health leaders they have an obligation to find ways to reach out to all members of the public to persuade everyone that they should be vaccinated. They should be employing more sophisticated and comprehensive marketing techniques to touch each of the groups of the unvaccinated and bring them to the needle.

Most of the rationales for failure to vaccinate reflect an individual’s concern for their own health. What part of “public” in “public health” do they not understand? This virus, like all viruses, will continue to spread and mutate as long as there are unvaccinated hosts for it to infect.

The current Delta variant is more contagious and deadly than earlier forms, but it is still controlled by the available vaccines. It seems inevitable, if vaccinate rates do not increase significantly in the next few weeks, that a new variant will emerge that may not be controlled by our current vaccines. If that occurs, everyone in the world will be, again, subject to risk. It may mean that, again, we will have to revert to shutting down businesses and schools. Such a result will be devastating to our economy, exactly the result that science-deniers such as Florida governor DeSantis claim to want to avoid.

Covid-19 is a !public! health problem more than an individual health problem. Both individuals and government officials have to stop relying on individual decision-making to combat it. More effective persuasion and, most likely, mandatory vaccinations are the urgent solutions.