In the fall, I contracted COVID and it was the sickest I have been in my life. Not being a member of the ruling class, I had to rely solely on my immune system to get through it. I obviously did not die but seemed to have some lasting effects: persistent fatigue and breathing issues. These made running challenging, but it is likely that my years of running contributed to my ability to get through COVID.
When the vaccines became available to older Americans, I waited my turn. Florida eventually made them available to educators, but the Governor pointedly excluded higher education faculty and staff. Like most faculty at public colleges, I was required to return to the classroom. I was not overly concerned; surviving COVID is supposed to grant long-lasting immunity and being fired would be far more dangerous than getting COVID again. Like everyone else on campus, I had to get bi-weekly COVID tests. Eventually the governor allowed everyone over 50 to get the vaccine, and I was able to get my first shot of Moderna at the community vaccination site on campus. I felt a bit rough after that shot. While waiting for my second shot, the possible issues with the Johnson & Johnson vaccine made the news and there were some worries about there being enough vaccines available. Fortunately, I was able to get my second shot. Unfortunately, I had most of the side effects. It was very much like a day and a half of having a rough case of the flu. But, having endured COVID, it was not bad by comparison. Within a few days of the second shot I was fully back to what passes for normal. It might be a placebo effect, but the lingering issues I attributed to my COVD infection improved. There is, however, some evidence that the vaccine can have this effect—which is yet another reason for some people to get it.
While I got my vaccine as soon as I could, some people are hesitant to take the shot. In some cases, people are hesitant for rational reasons: these vaccines were rolled out quickly by for-profit corporations and emergency use authorization were issued to allow their deployment. While testing was conducted, the timescale of the tests is very limited and thus we do not have an evidence about possible long-term side effects. Medical experts are making an educated estimate that the short-term benefits (not dying of COVID) outweigh any likely long-term effects. But these estimates are being made with many unknowns and it is rational to consider possible negative long-term consequences. That said, vaccines are well understood, and these vaccines are not crazy radical departures from the established science. Given what we know, the rational bet favors getting the vaccine—though this could turn out to be the wrong choice. To use an analogy, you might marry someone who seems great and wonderful now but end up going through a rough divorce twenty years later. Or you might end up having a great marriage that lasts until you die.
There are also people who are hesitant to take the shot because of ideological reasons. Trump and some of his fellow Republicans decided to politicize the pandemic for short term political gain at the expense of the well-being of citizens and the American economy they profess to love. While it is certain that some citizens would resist vaccination on ideological grounds no matter what the politicians did, Trump and his fellows fed and watered this view and thus increased the size and intensity of the resistance to vaccination. It also seems that vaccination, like mask wearing, has been made into a macho issue: real manly men might think that they do not need to be vaccinated.
At this point, the ideological battle is largely lost, and the Democrats seem to recognize this. Biden and others are wisely not trying to use the state to compel people to get vaccinated: they get that this would cause people to double or triple down on their opposition and would give credence to the tyranny narrative. Instead, the medical experts are trying to get employers, local doctors, and local leaders to encourage people to get vaccinated. While this means that the efforts might be piecemeal, these efforts might pay off by overcoming the ideological and macho resistance to the vaccines. Appeals to the public good might work, but the right seems to have abandoned this notion—at least to the degree that it involves people making some effort to contribute to the public good. While it is unfortunate that Trump and his fellows decided to exploit the pandemic, that is the reality of the situation and the wise deal with reality as it is rather than what they wish it were. And one part of this reality is that the Johnson & Johnson (and the AstraZeneca) vaccine has been linked to blood clots.
As of this writing, about 7 million people were vaccinated with the J&J vaccine. Six women between the ages of 18 and 48 developed cerebral venous sinus thrombosis (CVST) 6-13 days after getting their shot and one woman died. In response, the use of the vaccine has been suspended. Addressing this sort of situation is challenging. If you approach it with cold rationality and focus on the statistics, then you seem to be an uncaring monster—even when your objective is the safety and well-being of people. If you approach it emotionally and focus on the individuals impacted, then you seem caring and concerned: a warm, empathetic human being and not a cold monster. The downside is that making broad policy decisions based entirely on such warm empathy can lead to large scale suffering and death. The solution is to follow our good dead friends Confucius and Aristotle: to hit the mean between the two extremes. If we are too coldly rational, then we will be seen as monsters and our efforts to do good will face opposition. If we are too warm, then we can make very bad decisions that hurt the many from an emotional desire to protect the very few.
In terms of the cold facts, even if we assume that the vaccine caused the clots (which we do not know), then the odds of dying are (based on the available data) are about 1 in 7 million (for women 18-48). The odds of getting CVST are about 1 in 1 million (for women aged 18-48). These are objectively very good odds compared to other things that can kill you. The most sensible comparison is to the risk of death from COVID. While there are many factors that figure into your chances of dying from COVID, a person’s chances of dying from COVID are 36 to 78,571 times greater than dying from CVST from getting the J&J shot. There is also to cold fact that so far only women 18-48 have suffered from clotting, so people in other demographics might have effectively no chance of dying from the vaccine. As such, if the choice is between the J&J vaccine or nothing, then the rational choice is the J&J vaccine.
But it should be noted that there are zero deaths associated with Moderna and Pfizer, so it would be reasonable to choose one of those if they area available. That said, it is not yet known if the J&J vaccine was the cause of the CVST. In any large group of people (such as millions) there will almost always be some unfortunate occurrences and even deaths—this is exactly what one would expect when considering such large numbers. As such, the J&J vaccine might have no role in the deaths; it could simply be a case of post hoc, ergo propter hoc. But even if J&J can cause clots, one must also consider what risks are tolerable.
As others have done, it is also instructive to consider the J&J vaccine in the context of other medications. While the types of clots caused are not identical, the odds of getting a blood clot from oral contraceptives is 3-9 in 10,000. The odds of getting a clot when not on oral contraceptive is 1-5 in 10,000 women and the odds of a women getting one while pregnant is 5-20 in 10,000. Like all analogies, this comparison is imperfect—but it does illustrate that even common medications are not without significant risk. Even the ubiquitous NSAIDs can have very serious side effects including death. While it might be thought that all these risks are the fault of irresponsible and greedy corporations, risks can be due simply to the interaction between chemicals and human bodies. After all, people can die from reactions to naturally occurring foods such as nuts and shellfish. Because of the complexity of human biochemistry and the variations between people, there is almost always the risk that some small percentage of the population will have an adverse or even fatal reaction to a pharmaceutical product—even when due care is taken. This is not to say that we should simply tolerate dangerous medicines, just that we need to be aware of what are likely to be unavoidable risks.
As a final consideration, there are those who argue that vaccination is a personal choice—they should be free to decide. On the one hand, they are right: a person has a general moral right to refuse medical treatment and vaccination. However, this does not entail that they have a right to freedom from all consequences of making this choice. To use a very close analogy, a person can refuse to get the vaccinations that are required to attend college or travel, but this comes at the cost of not being able to attend college or travel. To use another analogy, a person has the right to own a car that lack working brakes, but they do not have the right to take it out on the road. On the other hand, the principle of harm would morally warrant requiring people to get vaccinated: the unvaccinated are reservoirs of the disease and “breeding grounds” for mutations. They could thus extend the pandemic significantly and thus endanger others and the economy. To the degree that they incubate new strains, they would also make it so that people would need to keep getting vaccinations against these strains. In short, this “freedom” would do a lot of damage to society, which is good grounds for limiting a freedom. But, as noted above, Trump and his fellows have made this a part of their deranged culture wars and a moral appeal will often fall on deaf ears. As such, imposing vaccines would be ineffective, though it would be as morally warranted as requiring people to have working brakes on their vehicles before getting on the road. As such, the state should not compel people to get vaccinated, but their should be restrictions consistent with established restrictions for those who refuse vaccination.
In closing, while the J&J vaccine might present a tiny risk to some members of the population, vaccination is what the experts have been saying: a safe and effective method of ending the pandemic. As such, you should get vaccinated—given the available evidence, this is the best choice.