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A Pfizer Paxlovid pill, the at-home oral prescription medication recently approved by Health Canada to treat COVID-19.thomas hansmann.fotograf/The Associated Press

In theory, not a single person who has so far refused a COVID-19 vaccine should be open to taking Paxlovid, the at-home oral prescription medication recently approved by Health Canada to treat COVID-19.

The medication is made by Pfizer, the same supposedly callous and greedy pharmaceutical company that has been pushing its vaccine on the world for more than a year. The new treatment has been tested and used on far fewer people than mRNA vaccines and the side effects the drugs may have on patients to whom it is prescribed are less well known. The concerns typically cited by those who are vaccine-hesitant when explaining their resistance to the COVID-19 shot should only, theoretically, be amplified when it comes to taking Paxlovid.

Yet, in reality, many vaccine deniers and vaccine-hesitant people will take the medication if and when they become ill and it is available to them. One reason for the inconsistency is obvious: Fears about unknown side effects and the like tend to dissipate when confronted with an actual diagnosis, as opposed to the prospect of receiving a prophylactic medical treatment. But the other reason may be more subtle – unconscious, even – and rests in the realm of the actual administration of the medical treatment.

Taking pills is something familiar to many of us. People do it every day, and the medication follows the natural metabolic pathway of the body. Many vaccine-averse people have enthusiastically embraced swallowing the anti-parasitic treatment Ivermectin or handfuls of vitamin C tablets to treat or prevent COVID-19, although there is little to no scientific basis for doing so. But receiving an injection, as is required of a vaccine, is not an everyday experience; it signals something different and exceptional, and it is an intervention that relies on another person to actually administer the treatment. You need to break the skin and inject a substance, which then becomes impossible to withdraw (whereas pills, for example, could be vomited up immediately if sudden and extreme regret strikes). It’s not a coincidence that anti-vaccine propaganda often features menacing, nefarious-looking needle imagery and emphasizes the supposed unnaturalness of the vaccination process itself.

This type of anti-vaccination propaganda can be traced all the way back to the administration of the first vaccines in the West. In 1796, British doctor Edward Jenner inoculated an eight-year-old boy against smallpox by taking pus from the lesion of a milkmaid infected with cowpox and scratching it into the boy’s skin. The boy remained healthy, and Dr. Jenner’s published report caused a sensation, but some skeptics warned of possibly dire side effects from the unnatural experiment. Dr. William Rowley of the Royal College of Physicians, for example, produced a pamphlet in 1805 entitled “Cow-Pox Inoculation No Security Against Small-Pox Infection,” in which he suggested Dr. Jenner’s method of vaccination would create man-cow hybrids, and that it was foolish to believe smallpox could ever be eliminated. “It must always be epidemic at certain seasons,” Dr. Rowley wrote, “unless the vaccinators have more power than the Almighty God himself.”

Some experts believe there is an evolutionary basis for apprehension around injections. American physician Dr. James G. Hamilton wrote a paper in 1995 describing how “the vast majority of violent deaths in our species’ evolutionary history have been caused by skin penetration from teeth, claws, fangs and tusks, and from sticks, stone axes, knives, spears swords and arrows,” which would either cause death by trauma or by secondary infection. Others cite traumatic experiences around vaccinations in childhood (most children don’t delight in the thought of needles, after all) for heightened anxieties around injections in adulthood.

But whereas only a certain proportion of the population suffers from what could be described as a clinical fear of needles (called trypanophobia), there still exists a more generalized skepticism of and heightened apprehension around injections and skin penetration in the wider population. This apprehension no doubt is fuelled by pop-culture depictions of injections (the famous scene in A Clockwork Orange where Dr. Brodsky straps Alex to a chair and injects him with drugs, for example), classical art and literature (Laertes’s poison-dipped sword in Hamlet) and historical trauma (Dr. Josef Mengele conducting horrific experiments at Auschwitz, where he injected children with chemicals and viruses). Although it may not be a conscious process, these influences undoubtedly affect how we receive the news of a needle that will protect us from severe illness caused by COVID-19.

It would be far too simplistic to suggest the millions of Canadians who remain unvaccinated resist only because the vaccine is injected. But it may be that the method of administration, and all of the negative connotations that come with it, contributes to the overall anxiety about receiving the vaccine. After all, if hesitancy was only about fears around safety, side effects and adequate testing, Canada’s to-be-acquired doses of Paxlovid would be left untouched by anyone who has declined a vaccine.

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