The recommendation by the Centers for Disease Control and Prevention and the Food and Drug Administration to pause use of the Johnson & Johnson coronavirus vaccine — citing six women who developed serious blood clots in their brains after vaccination — could hardly have come at a worse time.
This news arrived just as vaccination eligibility was opening up and a whole new tranche of people were making the decision to either get or refuse the stick of a needle. Nearly half the eligible population has received at least one injection. Uptake is still limited by vaccine supply in many places. But as public health authorities try to reach the country’s second half — or at least enough to reach herd immunity — they will eventually be recruiting along a descending path of public enthusiasm. And any news that heightens the impression of risk makes their task harder.
As someone who received the Pfizer vaccine, it is easy for me to say that fears about the Johnson & Johnson version are exaggerated. But they are exaggerated. Your chances of getting this side effect are literally one in a million. The CDC’s and FDA’s seriousness about screening for even a minuscule level of risk should encourage confidence in the overall vaccination system. And the vast majority of shots in American arms have been with the Pfizer and Moderna vaccines, which have not displayed this side effect. There really is no cause for public panic.
It is the “almost” that creates problems. Taking these vaccines involves the chance of a temporary fever, headaches and muscle aches. It involves a very remote risk of more serious complications. And this raises the unavoidable problem of free riders.
Free riders are people who benefit from the public good but don’t have to pay or sacrifice for it. In the case of a pandemic, free riders are those who enjoy the positive result when other people get vaccinated — lower transmission of the virus and eventual herd protection — but refuse to take a tiny risk and get vaccinated themselves. The challenge comes, of course, when lots of people realize they can be free riders, and the public good is destroyed.
Charles Darwin wrote about this issue when dealing with the evolution of groups or tribes. It benefits a tribe when its members are cooperative, brave and concerned for each other. But each individual in the tribe has a natural predisposition to be a selfish individualist while benefiting from the social virtues of other members. So how does a tribe maintain its cooperation, courage and mutual concern over time?
Darwin pointed to a number of means. But a particularly powerful “stimulus to the development of social virtues,” he wrote, was that people are deeply concerned about “the praise and blame of our fellow-men.” Human beings avoid being free riders because it is shameful and they care about their reputations. Darwin added that religion gives to these duties the aura of sacredness.
Certain social virtues have become urgent during the covid-19 crisis. And this is testing our country at a weakened point. Many Americans have lost the sense that they share a common enterprise — that they are part of the same tribe. It will seem extraordinary to future generations that, amid a pandemic, some used health policy as a political weapon in the culture war.
Yet for most people hesitant to take the vaccine, the problem is not polarization or conspiracy theories. It is inconvenience, needle fears and a vague sense of personal risk. It is the voice of safety and selfishness in our ear: If we are headed toward herd immunity anyway, what does it matter whether I get vaccinated?
You probably will not hear this assessment from medical professionals, who are trained to be nonjudgmental. But being judgmental is pretty much my job description. So: If you are healthy and refuse to take the vaccine when your chance comes, you are a free rider. You are gaining the benefits of living in a community without paying the minimal cost. And, in the middle of a health emergency, this is shameful. During the past year, front-line workers — especially health workers — have taken far greater risks each day. Many have paid with their lives. Many are paying with symptoms of post-traumatic stress disorder. Next to this, the real risk of getting vaccinated is minimal. You are being a bad citizen if you don’t.
The reality, whether people like it or not, is that we do share a community. We owe much of our health and happiness to one another. And we have bonds of history and duty deeper than our differences.
Performing these duties is not without reward. There is a personal benefit in fulfilling a civic responsibility — a sense of pride and shared purpose. And being vaccinated brings a thrill of freedom, allowing you to move through the world with less fear. But the ultimate goal — the return of normal life — can be achieved only when we act together.
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