Vaccine Hesisitancy: a Hypothesis

In the early ’90s, it was my standard practice when offered health insurance through my job for me to refuse. I needed what little money I was making to survive, and judging by how often I actually went to the doctor, health insurance just seemed like a waste. In fact, from 1990–2005, if I’d had health insurance, I would’ve spent roughly $18,000 (15 years X $1200/year) for an insurance policy that I would’ve used twice. In those 15 years, I went to the doctor twice, for Pink Eye, and thus spent $40/visit plus $20 for the anti-biotic eyedrops. I was basically pretty healthy, yet I also mountain biked and rock climbed regularly so it wasn’t like I was not exposing myself to dangers; I was. I just didn’t have many medical issues. I still don’t but in 2005, I got a job where paying $100/month for health insurance didn’t effect my day to day life, and I’d turned forty and having health insurance seemed like an adult thing to do.

Getting a primary care doctor also seemed like a thing to do, so we (married now) found Dr. _____ and she served as my primary care until her practice no longer accepted our insurance and we started using Dr. _________ as our primary care. As I grew older I started seeing our doctor a bit more: once for chronic depression where I was prescribed a low dose of an anti-depressant for six months and after not liking the side effects (decreased libido) said I would pursue other options, once for chronic insomnia where she recommended I get a sleep study, which I never did, once for a case of Shingles, and once for a boil on my back. The other times I’ve been to see Dr. ___________ has been for routine physicals that my insurance pays for. But I don’t even do that with the frequency that I could. So, essentially, my insurance company is making a lot of money off me. The way I see it health insurance is like a nuclear weapon; it’s nice to have but I hope I never have to use it.

So, since my interactions with the medical industry were so minimal, I was, at first, a little perplexed about why people weren’t jumping at the chance to get the COVID-19 vaccine when it first became available. Didn’t people want their lives back? When I became eligible, I signed up right away. I’d missed being able to sit down at a bar and shoot the shit while I casually watched a baseball game. I’d missed being able to go to a club and stand in the front row while a singer belted out rock and roll above me. I missed being able to stand outside the back door of the club and pass a joint around. I missed being able to get up on stage myself and spit into the microphone about my latest foibles and anxieties that passes for poetry. I wanted my life back. Yet as the summer dragged on, it became increasingly clear that not everybody had the same relief when the vaccine became widely available. In fact, many of them simply refused. And I want to know why.

If you’d asked me before I started researching this why people didn’t want to take the vaccine I would’ve probably said, “Because it became a partisan issue. We’ve become so tribalized that anything one side is pushing is automatically rejected by the other side.” And the media, to try and appease and keep an audience, has also sort of broken down into specific tribes such that one tribe gets its information from one source and another tribe from a different source and that much of that information is conflicting. Yet I’m not entirely sure that is the case. Yes, Fox News pundits and Republican officials trumpet people having a choice on whether they want the vaccine or not but many of those same pundits and Republican officials are vaccinated. Does their audience not know this?

I think the vaccine hesitancy goes much deeper than that, and I’m going to hypothesize that it comes from three distinct beliefs: 1) distrust of government, 2) distrust of the medical community, and 3) a healthcare system where profit is incentivized over health.

Distrust of Government

It’s been widely pointed out that there has always been a sizeable constituency that doesn’t trust government. Indeed, one can make an argument that the stories we tell about our founding reinforce this belief. What was the driving factor behind the Boston Tea Party? The colonists were mad at the British for imposing a tax on tea. “No taxation without representation” was born. Likewise, you have the draft and the Vietnam war, the invasion of Iraq, the Great Recession, and the never-ending war in Afghanistan. All events point to a government that has lied to the very people it is supposed to protect and represent. And those are just the big lies (no pun intended), if you were African American, you have chattel slavery; Native American? genocide, the Trail of Tears, and countless broken treaties; Japanese American? Japanese internment camps, and Hispanic American? the Treaty of Guadalupe-Hidalgo and more. Almost every American alive today can point to a period in our history when our government did not have our best interests in mind. So, extrapolating, why should we trust the government on vaccines?

Distrust of the Medical Community

When Dr. ________ prescribed an anti-depressant it was after a routine visit where I complained about feeling sort of blasé and not being able to sleep regularly. She thought that maybe if I was regulated better biochemically, my body would sort of correct itself? It wasn’t necessarily a wrong conclusion, but I really did not enjoy the experience. Sure, I started feeling a bit better, but my insomnia didn’t change. What changed was that I, frankly, didn’t want to have sex and when I did, it was just sort of “ho-hum.” Now, this is not to say I’ve got a raving libido and want sex all the time because I don’t. But I do want to enjoy it when I have it. So, when she asked me if I wanted to continue using it, I was pretty emphatic in my rejection. If this is what it was going to take to not feel “so-so,” count me out. I’d take the lows if it meant that I got to experience the highs.

That is not to say that I’ve solved this problem, but Dr. _______ didn’t really know me very well. And rather than ask if I was being creative, fostering closer friendships, being active in my community, talking with my family, she jumped to the biochemical fix. And yes, I understand that under our system doctors don’t have the luxury of getting to know their patients very well but are expected to be able to address their concerns. Yet, my concerns were more existential than physical. I was depressed because I didn’t know my place in my community. I was depressed because I felt like I didn’t have anything to contribute or say. I was depressed because a lot of my relationships were superficial. Until I addressed those, I wasn’t going to feel better and the anti-depressant really just glossed over those existential issues such that they just didn’t matter anymore. And it sucked.

That was just my example of a medical community that really has a hard time wrestling with underlying causes and, frankly, is overworked. My appointment time with her was usually no longer than 20 minutes. Now imagine, if you were a patient, like my grandfather, that was dealing with chronic pain. One hundred years ago, the medical establishment didn’t have an easy way to deal with chronic pain, and my grandfather just dealt with it and, at times, drank too much. But in the ’90s, Purdue Pharmaceuticals and Johnson & Johnson promised doctors that they could help them deal with, what is no doubt, one of their biggest concerns: how do you treat a patient who is in chronic pain? The pharmaceutical companies promised them that their medical opioids could do the trick and they weren’t addictive: “…pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and healthcare providers began to prescribe them at greater rates. This subsequently led to widespread diversion and misuse of these medications before it became clear that these medications could indeed be highly addictive.” So, when it comes to vaccines, we are supposed to “trust” our doctor? Yet, these overworked doctors are the very same ones that trusted the pharmaceutical companies when they said oxycoton and oxycodon weren’t addictive. They were obviously wrong then. Is it much of a stretch to believe that they might be wrong now?

Healthcare for Profit

Its become a running joke among my Facebook friends but when _______________ posts anything critical of the pharmaceutical companies he’ll always preface it with, “I used to work in a for profit ________________ firm,” then go on about how you can’t trust any company where the motivation is making money, let alone trusting any healthcare or pharmaceutical company who’s main measure of success is profit. As a critic of capitalism, this argument feels right to me. Indeed, the recent revelations about the practices at Purdue Pharmaceutical reinforce this belief.

As a progressive, the answer seems pretty obvious: universal healthcare like they have in Canada and Great Britain. But that is not an answer that is mutually shared by a great majority of people and is also lobbied against by the very same industries that would lose the most, and they’re not going to go quietly. Many health insurance companies are for profit companies and are traded on Wall Street. As reported in the New York Times, they all have been experiencing record breaking profits during the pandemic. So what are we to do when the very industries we entrust our healthcare to have an incentive to maximize profit? One could argue that keeping us out of the hospital might be the quickest way for them to make sure they continue being profitable? But what if they are passing the cost of care onto their consumers and they make even more profit when we are hospitalized? Or make even more profit when we are forced to get a vaccine that we don’t really need? Never mind that the vaccines are free to the consumers, the companies are certainly billing the government for them.

What’s to be done

There are multiple reasons that people may not want to get vaccinated and they may not all be because they are opposed to the Biden agenda. There’s a lot that has built up to this critical moment we find ourselves in. But until we try and look at people who may be wary of getting that vaccine as something other than just deluded and stupid, I don’t think we’ll ever get out of it. We need to be a little bit more empathic and recognize that their experiences may not lead them to our same conclusions. Again, as I’ve written elsewhere, we need to build trust in our society; build a society that is accountable and has integrity. Until we do that, in my opinion, none of the strategies we’ve been employing thus far are going to work. We may get through this pandemic, but what about grappling with another pandemic, or the real challenges of tackling climate change?

September 18, 2021