“All things are subject to interpretation. Whichever interpretation prevails at a given time is a function of power and not truth.” — Nietzsche
As a medically-trained leader, I strongly believe in the COVID-19 vaccine’s effectiveness and have supported the immunization campaign to the best of my and my institution’s ability. How then, do I approach vaccine hesitancy?
First, I keep my anxiety in context. We are lucky to live in Massachusetts, with a vaccination rate high enough to prevent a devastating society-wide outbreak. It means our emergency rooms are available for other life-threatening issues; intensive care unit beds are there when we need them. The disasters we are now seeking to prevent are at a personal and family level. We can’t forget about other killers, still out prowling: cancer, heart disease, accidents, strokes, diabetes. Dead is dead. Losing a loved one to a car accident is scant improvement over losing them to COVID-19. If you are worried about new, vaccine-resistant and deadly variants emerging amongst the unvaccinated, you should be donating money and political support to COVAX, a global vaccine effort.
Second, I don’t consider those who are unvaccinated irrational or enemies of the State. As individual citizens and as a society, we daily make decisions detrimental to our health. We love fast food, we ride motorcycles without helmets, we have sex without protection, we don’t forgive and carry grudges for years, we binge watch shows instead of sleeping and we don’t get our 8,000 steps.
Lest someone point out that those are decisions with mostly personal consequences, let me add that we drive after consuming alcohol, we underfund education programs, we consume more than we need leading to climate change, we routinely deny the existence of problems — generally by defining those suffering as somehow unworthy — in our communities so we don’t face sacrificing for the solutions.
Those who have chosen unvaccinated status weigh risks and benefits differently from me and/or they see the world differently. Some reasons are straightforward: fear of needles, lack of trust in institutions that have repeatedly damaged or ignored those individuals or their communities, sheer contrariness, lack of understanding of the basic scientific paradigms such as immunology, genetics and infectious disease that underlie the vaccination campaign. Others are more complicated: belief in conspiracy theories (only bizarre if you don’t adhere to them, much like most religious dogma across world religions), primacy of perceived political implications of personal decisions. In short, their experienced reality is different enough to leave them on the “not yet” side of the COVID-vaccine ledger.
Third, I believe we can achieve higher immunization rates but not by “us” convincing “them.” It is no longer a question of presenting facts, shaming folks by labeling them killers or bribing the unvaccinated. Would a mandate work? Certainly, but that is a discussion quite different from discussing vaccine hesitancy, so I’ll leave that to another column.
We need to create opportunities to listen to those refusing immunizations and seek to understand the underlying reasons, to see if they move themselves as we help them engage with their fears, misgivings, and doubts. Every day, I encounter people who deny the reality of mental illness, the benefits of treating those in recovery as suffering from a chronic illness or that homelessness is a problem to which Lynn needs to constructively respond.
I rarely meet people who think they can float down after falling from 10 floors up. Gravity has a reality, an immediacy that those other issues do not.
Humans are social animals, and our reality is a communally-defined and shared experience. To achieve higher levels of vaccination, we need to strengthen the reality of private and shared benefits of vaccines. People don’t love the Red Sox because they hate the Dodgers; they love their team mostly because it’s their team. We need sustained media campaigns.
We, and I mean all of us, should tell stories about why we get vaccinated.
We should highlight our relatively-empty hospitals.
We should celebrate the freedom from fear we experience in public settings as compared to regions with low immunization rates.
We need to continue offering easily-accessible appointments, with plenty of walk-in capacity.
We should continue knocking on people’s doors, to engage with them directly.
We should gently probe ambivalence and hesitancy, guiding the conversation based on our interlocutors’ responses.
We should have bling opposing COVID, baseball caps expressing our love for the vaccine, ironic and superhero-themed T-shirts.
One of my mother’s most memorable quotes about the nature of reality: “In the U.S., you can behave however you like but there is a pressure for all to think the same. In the Congo, you can think whatever the hell you want, but your behavior is well defined.”
We are a “we.” With persistence, continued attention to barriers and deep respect for one another, we will get there, together, in all our glorious diversity of thought.
Dr. Kiame Mahaniah is the CEO of the Lynn Community Health Center and a practicing physician. He spent his childhood and part of his adolescence in the Congo.
