Daniel Kalla is the author of 12 novels – including his newest, Lost Immunity – and the head of the emergency medicine department at St. Paul’s Hospital in downtown Vancouver.
When we think of vaccines, most of us focus on how they will protect our families and ourselves. But the overarching role of vaccination is to protect the population at large, especially the most vulnerable among us, through herd immunity. If we think of viruses as raindrops, then vaccines work like raincoats for each person who gets one, while herd immunity acts like an umbrella for the whole community. In rough terms, 70 per cent of a population needs to be immune to an infectious threat – through vaccination or previous exposure – before herd immunity can be achieved. And since no vaccine is 100 per cent effective, we need to immunize even more than 70 per cent of the population to make the umbrella in our analogy waterproof.
Today’s vaccines have been shown to be among the safest medications on the planet. Still, there are people who reject these miracles of modern science. They are well-meaning, educated and often pillars of their community. And yet the vaccine hesitant represent one of the greatest threats to society.
Why are their beliefs so toxic? Because not only do they risk the welfare of themselves and their loved ones, but they threaten the health of the rest of us, too. In the midst of the COVID pandemic, it is more vital than ever to try to persuade the vaccine hesitant to do what most of us view as our societal obligation.
I meet them daily in my work in the ER. Parents who refuse tetanus boosters for their children. People with chronic respiratory conditions who wind up on ventilators after balking at their annual flu shots or pneumonia vaccine. And now, alarmingly, patients – and, even more disturbingly, fellow health care workers – who swear off the COVID vaccine. Often, there is a personal basis for their views. Many of them associate their own medical conditions and tragedies, or those of their loved ones, back to a vaccination event, even after such links have been scientifically debunked.
But one of the biggest drivers behind the fear of vaccination is the idea that mainstream medicine doesn’t take their concerns seriously. That sense of being unheard drives the vaccine-hesitant right into the arms of those who push anti-vax beliefs, who make them feel counted.
Like most physicians, I view vaccination to be among the greatest achievements of modern medicine. But it does no good to demonize the vaccine hesitant. I have found lecturing and disparaging them accomplishes nothing except to entrench their views and further the divide. I believe showing compassion and trying to understand the basis of their beliefs can accomplish as much to heal the rift as providing actual proof of vaccine safety. At the very least, the sense that they are being listened to is the first crucial step to winning them over to the side of science and reason.
The ER can be a hectic workplace, but to me vaccine hesitancy represents its own form of emergency. And when I encounter such people, I take the time to approach the subject from their perspective – to try to understand what drives their fear of vaccines and to acknowledge their concerns. Then I cite some of the miraculous advances made through vaccination, such as eradicating smallpox and banishing polio to the remote corners of the planet. I describe how the trusted scientific literature uniformly supports vaccination, and I explain the importance of herd immunity. I also tell them how committed I am to fully vaccinating my own family. If they have further questions, I refer them to trusted resources such as the CDC, the WHO or Health Canada websites. But I must admit, sometimes, when most exasperated, I have to fight the urge to ask if they would turn down a rabies vaccine after being bitten by a rabid bat.
I once saw a young mother in the ER who was so concerned about her toddler’s fever and rash that she broke into tears of relief when I told her the child did not have measles. She then sheepishly confessed that she had avoided getting the child vaccinated because her husband’s family was adamantly opposed to it. After a long discussion, she promised to reconsider. Coincidentally, I saw her six months later for an unrelated complaint, and I was so gratified to hear that not only had her child been vaccinated but she had also persuaded her husband’s sister to immunize her children, too.
I suspect that this anecdote is the exception and far more often my arguments fall on deaf ears. It is impossible to overlook the irony that we live in the greatest age of information accessibility and, paradoxically, during a time with such ready acceptance of misinformation. These beliefs are contradicted by any objective scientific standard. So instead, they rely on anecdotal stories – association with diseases rather than causation – and an echo chamber of their own belief system that rises to the level of religion. I see their approach as an offshoot of the tribalism that has caused conspiracy theories to fester across the planet.
In fairness, vaccine hesitancy is a broad term that encompasses a spectrum of heterogenous beliefs, from people who will accept many but not all vaccines to those who vehemently oppose any form of immunization. But the fiercest have their own equivalent of the “Big Lie” – the conspiracy theory that drove the insurrection on Capitol Hill in Washington. It boils down to one shameful study from the 1990s that falsely equated the measles vaccine with a higher risk of developing autism. The so-called findings of this fraudulent, academic tsunami have been disproven by multiple legitimate studies. Yet their Big Lie has persisted for decades, undeterred by facts.
I do not judge the sincerity or morality of the vaccine hesitant, but I am terrified of the damage they might inflict, particularly during this pandemic. And while I do not expect to change their minds or hearts in a single encounter, I believe we all owe it to society to at least try to sway them from their ironically infectious and unfounded beliefs. But to do so with kindness and respect.
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