During the last pandemic, 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 did not die but have had some lasting effects: persistent fatigue and breathing issues. These make running challenging and I struggle to get in over 40 miles a week, 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 Governor DeSantis 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 worries about vaccine availability. Fortunately, I was able to get my second shot.
While I got my vaccinations as soon as I could, some were hesitant. In some cases, this hesitation was rational: the 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 was limited, and possible long-term side effects were obviously a mystery at that time. Medical experts made educated estimates that the short-term benefits (not dying of COVID) outweigh any likely long-term effects. But these estimates were made based on many unknowns and it was (and is) rational to consider possible long-term consequences. That said, vaccines are well understood, and these vaccines were not crazy radical departures from established science. Given what we knew then, the rational bet favored getting the vaccine. Given what we know now, people should get the vaccine. Unfortunately, the current regime is appallingly anti-health and anti-science.
People also opposed getting vaccinated because of ideological reasons and this has only strengthened. Parents have, perhaps from the very best intentions, have condemned their children to illness and even death from preventable illnesses, like measles.
Trump and some of his fellow Republicans politicized the pandemic for short term political gain at the expense of the well-being of citizens. While it is certain that some would resist vaccination on ideological grounds no matter what politicians say, Trump and his fellows fed this view and increased the size and intensity of the resistance to vaccination. Vaccination, like mask wearing, also became a macho issue: manly men might think that they do not need to be vaccinated.
At this point, the ideological battle is largely lost, and disease is emerging victorious across the United States. Biden did not try to compel people to get vaccinated, understanding that this would have caused people to double down on their opposition and give credence to the tyranny narrative. Instead, medical experts tried and are still trying to get employers, local doctors, and local leaders to encourage people to get vaccinated. Appeals to the public good have been weakened and the right seems to have completely abandoned this notion in so far as it involves people contributing to the public good. But there are those who will, correctly, point out that vaccination is not without risk.
When I first wrote about vaccination, 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 vaccine was suspended. Addressing this sort of situation is challenging. If you approach it with cold rationality and focus on the statistics, then you seem 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. But making broad policy decisions based on such feelings 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 emotional, then we can make bad decisions that hurt the many from a desire to protect the very few.
In terms of the cold facts, even if we assume that the vaccine caused the clots, then the odds of dying are (based on the available data) were 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 no chance of dying from the vaccine. As such, if the choice is between the J&J vaccine or nothing, then the rational choice would have been the J&J vaccine. Likewise for other vaccinations, if we follow the cold calculations of survival.
As others have done, it is also instructive to re-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 peanuts and shellfish. Because of the complexity of human biochemistry and the variations between people, there is almost always the risk that a 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 still argue that vaccination is a personal choice and 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 an obvious analogy, a person can refuse to get the vaccinations that are required to travel to certain places, but this comes at the cost of not being able to travel. To use another analogy, a person has the right to own a car without 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 disease mutations. They could thus extend future pandemics 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 considerable damage to society, which is good grounds for limiting a freedom. But as vaccines are part of the culture war, requiring them is becoming increasingly difficult, though doing so is as morally warranted as requiring people to have working brakes before getting on the road.
In closing, while vaccines are not without risk, vaccination is a safe and effective method of reducing the risk of getting sick or dying of a preventable disease. This is not to say that people should accept all vaccines uncritically, that would be a straw man of my position.