Why Patients Refuse the Covid-19 Vaccination – It’s Political, Mostly

Synopsis:

  • Despite having created the most effective Covid-19 vaccines, the US is falling behind other countries in our vaccination rate.
  • My unvaccinated patients have a variety reason for remaining unvaccinated.
  • Some unvaccinated patients can be convinced that a Covid-19 vaccination is in their best interest, but not most.

The US is progressively falling behind other countries when rated on the percent of population that is vaccinated against Covid-19. Although we began at the top of the list, as of late September 2021 we have dropped to 43; even Vermont, which is our most vaccinated state, does not rank in the top ten countries.

I ask all my patients if they are vaccinated against Covid-19 and estimate that 80% are vaccinated. The unvaccinated can be unscientifically categorized into 3 groups, which I will highlight using 3 real but anonymous patients.

Politically Indifferent, Medically Uneducated

The first patient is in their 5th decade of life and has diabetes. During or Covid-19 discussion at the patient’s most recent office visits it became apparent that neither the patient’s friends nor family were vaccinated and that the patient did not listen to or read any news sources. As a result, the patient’s decision to remain unvaccinated was either a result of inertia or based on the recommendation of their family and peers.

I explained to the patient that in science, medicine, and politics, it is sometimes difficult to know what is “true.” This is particularly an issue in medicine and science, as new information continually emerges which necessitates a reassessment of long-standing “truths.” It is also important to acknowledge that no person is sufficiently omniscient to allow them to claim that they alone know the real “truth.” (see The Constitution of Knowledge by Jonathan Rauch.)  With these tenets in mind, one method of optimizing their medical decision-making process is to seek out information from a wide variety of sources, and include my treatment recommendations as but one of many inputs.

I also told the patient that it has required decades of basic science and medical research to create the mRNA vaccines. The design of the mRNA clinical trials was similar to other vaccines clinical trials and included 75,000 patients.  (Full disclosure: I was a patient in Moderna’s first phase 3 clinical trial.) The reason the mRNA vaccines became available in record time was a result of the elimination of all FDA bureaucratic delays and President Trump’s decision to order the manufacturing of the mRNA vaccines before the clinical trials were completed. Thus, in less than 1 year from the start of the first mRNA clinical trial, mRNA vaccinations began to be put into American arms.

In an attempt to reassure the patient of the vaccine’s safety, I explained that 6+ billion coronavirus vaccinations have been administered to 3+ million people with at most one serious side effect per 100,000 patients; the risk of a vaccination side effect is lower than most prescribed medications and  “lower…than your chance of getting bit by a shark if you go to the beach, of getting hit by a car if you cross the street, or being killed in an airplane crash.

To highlight the vaccine’s efficacy I explained that the Covid-19 vaccination reduces the risk of death and serious illness by 10-11 fold, reduces the risk of infection, the duration of infectivity, and the probability of “long-Covid” symptoms like brain fog, muscle weakness, shortness of breath and chronic neurological disorders.  

Several weeks after the office visit, I learned that the patient had been vaccinated.

Politically Indifferent, Medically Educated, Under Peer Pressure

The second representative patient was in their fourth decade of life and told me that they had been vaccinated but “regretted it.” I asked them which side effects they had experienced. They told me they had no side effects. During our conversation, it became clear that they understood the risk and benefits of the vaccination but their family and peers were Trump supporters. In the end, I concluded (although I did not explicitly ask) that the individual regretted being vaccinated as they received criticism from their peer group.

Die-Hard Trump Supporter

The third patient is in their 6th decade of life and had significant cigarette-induced lung disease (COPD) which would markedly increase their risk of dying from a Covid-19 infection. They responded to my inquiry “Have you been vaccinated?” by vigorously telling me (paraphrasing) “I give Trump a lot of credit for creating the vaccine but I hate Fauci, he is the worst person in the world and I do not trust anything the Federal government does or says.“

I told the patient Trump and all his associates were among the first people vaccinated which occurred immediately after the vaccines received Emergency Use Authorization. Recently, Trump publicly recommended that everyone should get vaccinated. 

No matter what I said, this patient demonstrated no willingness to consider being vaccinated.

How to Increase Covid-19 Vaccination Rates

In my experience, patients in the first group (Politically Indifferent, Medically Uneducated) represent 20% of the unvaccinated and can be convinced that it is in their interest to be vaccinated by patiently explaining that the vaccines have been rigorously tested and are certainly safe and effective. While some will state “I need to wait for more data,” I explain that research has demonstrated there is little to no probability that science will eventually conclude that the risks arising from the mRNA Covid-19 vaccinations exceed their benefits. 

I also tell my patients that if they do not trust my opinion regarding the Covid vaccinations, they probably should not trust my (or any physician’s) medical or surgical treatment recommendations as they are determined using the same thought process.

The second group of patients (Politically Indifferent, Medically Educated, Under Peer Pressure) are harder to convince than the first group and are about30% of my unvaccinated patients. At this time, I am uncertain if my entreaties are effective in this group of patients.

The third group of patients, the Die-Hard Trump Supporters, are about half of my unvaccinated patients and they cannot be convinced to be vaccinated as their decision is a political decision, not a decision based on science. They have concluded it is in their best interests to adhere to the rules of their tribe (see Political Animals, Rick Shenkman and How To Think, Alan Jacobs) and no amount of scientific information will convince them otherwise. Members of this group frequently say that they’re waiting for more scientific data but in reality that is a sound bite that enables them to avoid acknowledging that it is a political decision. They do not reject science, as they promote the use of and accept convalescent plasma when they become ill but being vaccinated is tantamount to consorting with the enemy.

Moving Forward

We don’t have to vaccinate everybody to end the pandemic; public health experts estimate we need to vaccinate 75-85% of the population. If we simultaneously implement efficacious public health measures (e.g. indoor mask when in crowds), isolate the exposed, and implement contact tracing we will expedite our return to some semblance of our pre-pandemic life.

While I would like to say that ending the pandemic is “not rocket science,” in reality, the politics of this pandemic are far more complicated than rocket science.

Hayward Zwerling, M.D.

September 28, 2021