The ‘Universal Vaccination’ Chimera...

OPINION
COMMENTARY

The ‘Universal Vaccination’ Chimera
Tools for stopping variants are limited and, like masks and distancing, vaccines are not a panacea.

By

Joseph A. LadapoUpdated Feb. 4, 2021 6:15 pm ET



ILLUSTRATION: MARTIN KOZLOWSKI

Each stage of the American Covid-19 pandemic has been marked by a singular public-health message that crowded out all other perspectives. From early calls to “crush the curve” with shutdowns and pleas to stay at home, then to claims that face masks would end the pandemic, these messaging strategies have sowed unrealistic expectations and delayed public acceptance of reality. The most recent message is “universal vaccination,” an aspiration whose unattainability may further delay the country’s return to social and economic normalcy.

How did we arrive at this point in the pandemic? The media’s campaign to stoke fear about collapsing health systems, along with their portrayal of severe illness as the inevitable consequence of infection—despite a thousandfold difference in risk between old and young—contributed to an atmosphere of distrust. Animosity toward Donald Trump —justified or not—fueled this campaign. Health officials abetted the discord by abandoning longstanding public-health tenets that emphasize harm reduction and a nonjudgmental outlook. Instead, these experts promoted mandates for the healthy and public shaming of people who strayed from guidelines.

Now the fear and distrust have made a substantial proportion of the U.S. population unreceptive to a vaccine. While vaccine receptiveness might be expected to vary based on a person’s risk of illness, a January Gallup survey showed that a stronger predictor is political preference. More than 80% of Democrats are willing to be vaccinated, but only about 45% of Republicans are.

The long vaccination lines seen on television will eventually thin as Americans most worried about contracting Covid-19 receive their shots. Many of the estimated 100 million Americans who aren’t interested in vaccination are unlikely to change their decision voluntarily.

What also isn’t serving vaccination efforts: the lack of transparent communication from public-health officials that meets people where they are and sincerely acknowledges the concerns of millions who view Covid-19 vaccines with suspicion. Concerns have been dismissed or derided as “misinformation.” It’s true that serious adverse effects appear to be uncommon, according to Centers for Disease Control and Prevention reports. But responding to these worries by insisting more loudly that the vaccines are safe isn’t an effective strategy. A wiser strategy is to address these concerns with data about what is known, and honesty and humility about areas of uncertainty—such as vaccination in pregnant women.

The expert insistence that Covid-19 vaccination is a social responsibility, that getting vaccinated is “doing your part,” is a political philosophy and not a self-evident truth. The natural instinct driving most health behavior—much like wearing a mask last spring before mandates—is self-preservation. Altruism is a virtue and makes everyone better off, but it is foolish to rely on it as a public-health strategy. Moreover, while scientists argue that widespread vaccination will prevent variants from tayking hold, lessons from the past year should make it abundantly clear that our ability to stop the spread of variants is extraordinarily limited.

The possibility of Covid-19 vaccine mandates in schools deserves special attention. There are almost no data on the potential benefits or harms of Covid-19 vaccination in children, and no crystal ball to predict disease epidemiology in a future that will likely include high vaccination rates among teachers and vulnerable family members. Yet at least one school district—Los Angeles Unified, the nation’s second largest—has announced it intends to require the vaccine for students.

Even amid assurances from scientists, many parents will remain skeptical about vaccinating their children. This is reasonable, considering that a study in the leading journal Nature estimated the Covid-19 survival rate to be approximately 99.995% in children and teens. By contrast, measles leads to hospitalization in about 1 in 5 unvaccinated persons, according to the CDC. What school officials are asking these parents to do is give up their parental intuition and give way to “expert opinion.” These battles will be tremendous, and wiser leadership would avoid them by considering other options, such as symptom monitoring or periodic testing.

A sensible and sustainable approach to vaccine policy would focus access on two populations: Americans who are at high risk of severe disease, and Americans who may be at lower risk but feel they can’t live and work safely without vaccination. This will free up resources and attention for tackling other challenges, such as attrition among people who need a second vaccine dose, and virus variants that may blunt vaccine protection. Some 90% of deaths from Covid-19 are among those over 55; the death rate would be expected to plummet if the older and vulnerable were protected effectively.

Other forces pushing mortality lower: The CDC estimates that approximately 83 million Americans contracted Covid-19 through December. Reinfection risk is low for at least six to nine months following infection. There is also growing scientific evidence for outpatient therapies such as ivermectin, colchicine, fluvoxamine and the politically charged hydroxychloroquine, as well as better hospital practices.

A sharp decline in mortality will give rational thinking a bigger stage, allowing schools to reopen and social and economic activities to resume. It will also liberate American society from the fear-fueled decision-making that has dominated the pandemic response.

Dr. Ladapo is an associate professor at UCLA’s David Geffen School of Medicine.


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