Issue 54: Breakthroughs, Private Choices and Public Consequences
4.24.21 | Vaccine hesitancy reveals lessons we still haven't learned
Hello,
This week the vaccine rollout seems to have started winning its tug of war against the virus in the U.S., as the national new case count turned sharply downward. Even Michigan, which had been an alarming hotspot, has turned a corner.
There’s still a long way to go — just 41 percent of Americans aged 16 and older have so far received at least one Covid vaccine dose, and at the current pace it will be late July before we top the 80 percent level at which we have a real chance of bringing the pandemic to an end here (if you want a glimpse at our possible future look to Israel, which this week, with 60 percent of its population vaccinated, had a day with zero covid deaths for the first time in 10 months).
The trouble is that the pace of vaccination is slowing. This could be a result of increased wariness fueled by the Johnson & Johnson scare, and maybe because we’re starting to run low on people who are both enthusiastic about getting vaccinated and have the resources to easily get an appointment and get to a vaccination site.
We’re making progress on the access front, through things like mobile vaccination clinics and allowing people to sidestep appointments altogether for walk-in vaccinations. In addition the federal government is reinstating use of the J&J vaccine, after a careful review concluding that the benefits of the shot far outweigh the risks, which should ease access for people who are either wary of mRNA vaccines, can’t or won’t navigate the two-shot sequence, or otherwise can’t be reached logistically any other way.
But sooner or later one of the biggest remaining obstacles to ending the pandemic in this country will be people who simply prefer not to get vaccinated or who otherwise decline to do their part in keeping themselves from getting others sick.
There’s a fair amount of talk about individual choice and liberty when it comes to vaccination but, as David Roth puts it in this essay, public consequences are unavoidable when it comes to this private choice. The decision to get vaccinated or not meaningfully affects the safety of the people around you. That’s illustrated clearly by a study out this week of a recent Kentucky nursing home Covid outbreak.
In the Kentucky case, Covid was introduced to a nursing home by an unvaccinated care worker who had contracted the virus and developed Covid symptoms, setting off a wider outbreak. From this one introduction 26 nursing home residents and 20 health care workers ultimately tested positive for the virus. These infections included “breakthrough” infections in 18 residents and four workers who had been fully vaccinated. It also included four possible cases of reinfection among people who had previously had Covid.
There’s good news and bad news in this story. The good news is that the vaccine was incredibly effective at limiting the spread and severity of the outbreak — 86 percent effective in preventing symptomatic illness among residents and 87 percent effective among staff. The virus’s attack rate was three to four times higher for unvaccinated people.
At the same time, it underscores how dangerous vaccine hesitancy and refusal is to everyone, even those who have gotten their shot. We don’t know why the staffer who was the index patient in this outbreak was unvaccinated. Maybe they had an appointment scheduled in the future, maybe they couldn’t get vaccinated becuase of a history of allergic reations, maybe they are the main breadwinner for their family and didn’t think they could afford a day or two of feeling sluggish after vaccination. But the intention matters less here than the consequences, which are real, measurable, and severe — the death of three people who contracted Covid as a direct result of an unvaccinated person coming to work in the facility where they lived.
If you’re already vaccinated, you have a stake in getting everyone else vaccinated, because the more widespread immunity is in the population, the less likely you are to encounter the virus and put your own immune response to the test. If you refuse to get vaccinated, you’re undermining the safety of everyone who comes into contact with you, and the people who come into contact with them. Which is to say that vaccine refusal is no less a public menace than drunk driving is. Except sitting U.S. Senators typically don’t advocate driving drunk.
It’s a time when the risks in the pandemic landscape are shifting in new and unfamiliar ways. This is maybe the most dangerous time to be unvaccinated, Robert Wachter argues, since the B.1.1.7 variant is more infectious and more deadly to younger people, who are themselves more likely to be exposed as society comes out of lockdown:
The problem is that the aggregate numbers — even if they show down-trending test positivity rates, hospitalizations and deaths — may be masking an important duality. The situation may be getting enormously better in the growing vaccinated population, while at the same time growing somewhat worse in the unvaccinated group. Taken together, the overall curve shows moderate improvement. It would be like looking at a graph of lung cancer cases in a population whose rate of nonsmokers is growing. The overall curve looks good, but the risk to an individual smoker hasn’t budged. And if smokers saw the falling case rates, concluded that smoking had become safer and decided to add a pack a day, their risk would go up.
The vaccine rollout continues to be a massive success — even with the latest downturn we’re still averaging more than 2.8 million doses administered every day, and several states this week either approached or passed the mark of having administered at least one dose to 50 percent of their total populations. Eventually the pace of vaccination will have to slow, as fewer and fewer people are left to get the shot. But how quickly the pace slows, and how many more people will become sicked and die from the virus, will depend largely on the private choices of millions of Americans currently on the fence about whether or not to get their shot.
// Service Announcement
Since I didn’t get to take a break last week, I’ll take this coming week off, which means the newsletter will return May 8th.
// Arts Roundup
In lieu of a normal link roundup this week, I want to draw your attention to two things I really enjoyed.
The first is a collection of student work shared by illustrator Tomer Hanuka, who tasked his illustration students at SVA to produce speculative New Yorker covers illustrating post-Covid New York City. They’re all incredible. The full collection is in a thread here, but here are four of my favorites:
By “Lauren V”
By Katrina Catacutan
By Chenmiao Shi
By Jiaci Grace Qiu
The second thing I really enjoyed this week is Vulture Prince, the new album by singer and composer Arooj Aftab. It’s a meditative, genre-defying and all around gorgeous work from start to finish.
That’s it for this week! Share the newsletter with a friend while you’re making awkward small talk at the park, subscribe through the link below if you haven’t already, and I’ll see you in two weeks in your inbox.