How Do We Get Enough People Vaccinated?

We’ve tried nothing, and we’re all out of ideas!

If you’d like to get so angry that you throw your phone across the room, I highly recommend this National Review article by Michael Brendan Dougherty. Dougherty argues that vaccine skeptics won’t be convinced if they feel condescended to. Though many parts of the article make me want to swallow live dynamite (so we’re the snowflakes, are we?), I agree with the basic point that berating people doesn’t win them over. My thoughts on the issue are best captured by this Perry Bible Fellowship cartoon:

But forgive me if I’m missing something: Who in the professional messaging world is doing this? I must have missed the CDC ad that begins: “Listen up, dumbasses…” I CTRL+F’d the White House’s Covid site for the word “fuckwit” and didn’t find anything. If Jimmy Carter used the r-word in filming this commercial, they edited it out. In New York, we get a single-shot commercial of a public health official speaking calmly about the vaccine’s benefits over light piano music that would accompany a Mister Rogers Neighborhood segment about turtles. Is that too confrontational?

Dougherty happens to address this commercial in his column. He argues that it misses the mark, citing several counter-arguments that I consider completely irrelevant (but judge for yourself). Dougherty’s description of the argument he thinks will work is interminably detailed and rests on the credibility of the government agencies he previously spent several paragraphs trashing. I appreciate his attempt to Don Draper this problem, but if a message exists that will convince vaccine skeptics, I don’t think we’ve found it yet.

The happy fun-time positive messaging approach seems to have hit a wall. Vaccinations in the US are leveling off. 68 percent of adults (and 56 percent of all people) have at least one shot, and though nobody knows exactly how many shots are needed to reach herd immunity, we’re not there yet. Maybe the public messaging campaign will find another gear, but if Dolly Parton -- who is roughly to Tennessee what the Dalai Lama is to Buddhism -- can’t convince her state to get vaccinated, I don’t have much hope. 

It’s time for a different approach. Probably the most convincing part of Dougherty’s argument is that not all vaccine-hesitant people are conspiracy theorists who think Bill Gates is trying to inject them with a microchip (which is insane -- when is Microsoft at the forefront of anything in the tech world these days?). Dougherty argues -- I think convincingly -- that some anti-vaxxers are engaging in a selfish risk/reward calculus. Which points to a way forward: We need to start thinking about changing the costs and benefits of vaccination. 

So, let’s start here: Not everyone who hasn't gotten the vaccine is a conspiracy-addled idiot. People are making choices. 20 percent of Americans who were once vaccine-hesitant have gotten their shot, so people change their minds. And vaccination rates increase with age, which proves that risk/reward calculus is happening: If you’re more at risk, you’re more likely to get jabbed. It’s telling that even though the median Fox News viewer is 109, most old people are vaccinated, because of course they are: When your mortality risks include “any food” and “a stiff breeze”, you sure as hell want to be protected from Covid. 

Source: Mayo Clinic

The problem -- as is so often the case -- is young people. Many seem to be persuaded by the argument voiced by Joe Rogan¹ of NewsRadio here:

“If you’re like 21 years old, and you say to me, ‘Should I get vaccinated?’ I’ll go no.” “If you’re a healthy person, and you’re exercising all the time, and you’re young, and you’re eating well, like, I don’t think you need to worry about this.”

There’s a logic to what he’s saying: Covid isn’t very dangerous to young, healthy people.² Of course, it’s an extremely selfish argument: Healthy, asymptomatic people can transmit Covid. People who aren’t worried about themselves should get vaccinated out of respect for other people. To which a vaccine-hesitant person might say: “Covid is over-hyped.” To which I would say: “Here comes some of my trademark annoying nuance.”

Is Covid over-hyped? Well: over-hyped by whom? On any topic, you can find some hyperventilating, self-righteous assbag who really puts the “twit” in “Twitter”. In the early days of the pandemic, many people acted like even considering anything except the maximum level of protection was gauche; Andrew Cuomo saying “we’re not going to put a dollar figure on human life” -- even though we do that all the fucking time -- comes to mind. I agree that some people on the left have a nanny-state mentality that’s annoying. So: over-hyped? Sure, by some people. But the Super Bowl is over-hyped; that doesn’t mean it doesn’t exist.

Covid is real, and we’re not out of the woods yet. I do respect a competent adult’s right to make choices about their own health. If you choose not to get vaccinated, I respect your right to make that choice. And if you get Covid, and you die...well, bummer, but you’re an adult (or you were) and I still respect your choice. Many people are making that choice right now. But you don’t get to choose to put other people at risk. And I see six risks -- the first three are small, but the last three are kinda-big: 1) Risk to people who can’t get vaccinated (mostly kids at this point); 2) Risk to people who are vaccinated but still end up getting sick, because no vaccine is perfect; 3) Continued economic damage, because we’re not completely up-and-running yet, and going backwards would be very bad; 4) Strain on our hospital system from people who "trusted their immune system" but were wrong (which is happening right now in Missouri); 5) Risk to people in countries where vaccines aren’t yet widespread, because borders are porous and what we do affects the rest of the world, and 6) Risk that the virus will mutate into a vaccine-resistant form, which becomes more likely the more it spreads. Number six is the really big one; if Covid becomes vaccine-resistant and we all have to spend another year inside trying to convince ourselves that Floor is Lava is a good show, I'm going to lose my shit. And I'm an introvert! People who enjoy the company of others will really be pissed!

If we assume that: 1) Vaccinations have plateaued, and 2) The spread of the Delta variant and the eventual end of summer mean that infection rates won’t stay low forever, then I see three possible futures:

1. We just let the virus burn through the population. The death toll will be lower than in previous waves because most old people are vaccinated. Deaths will be heavily concentrated among those who chose not to get vaccinated, and it seems that anti-vaxxers and I oddly agree: That's okay. It’s good to reach a consensus on something.

2. We continue to stumble forward with masks, restricted crowds, and other annoyances until we eventually reach herd immunity. This is basically the same as scenario #1 except it takes longer and involves a lot more avoidable bullshit.

3. We start making people show their vaccination card to get into crowded places. Either we do it, or we start talking about doing it, and the conversation is enough to convince people to get vaccinated. In which case we wouldn’t actually have to go through with the card-showing thing.

When Emmanuel Macron announced that cafes, malls, and trains would be off-limits to unvaccinated people, almost a million French people immediately queued up for the shot. Well, they didn’t queue -- it’s France, so they probably jostled to the front in sort of a piglets-rushing-for-a-teat-type behavior -- but the point is they got the shot. This proves once again that risk/reward calculus is happening and that changing incentives can change the choices people make. 

I have been asked to show my vaccination card fewer times (zero) than I have been asked if John Oliver enjoys roller coasters (one).³ I’m not the only person in this boat. Meanwhile, “honors systems” are as useless as a bag of dicks with no handle; when my gym lifted the mask requirement for vaccinated people, masks immediately vanished even though there’s no way that everyone is vaccinated. An honors system is a system to pretend that you have a system even though your actual system is to not do diddly shit.

I hope we don’t have to make people show their card. But if people won’t get vaccinated, and infection rates rise, it might be the least-bad option. Consider the three scenarios above: All involve restricting people’s liberties. In scenario one, people are exposed to unnecessary risk; in scenario two, they’re exposed to unnecessary risk and have to take extra precautions. Scenario three is the only one that at least puts the burden where it belongs: On the people who could end the pandemic but won’t. I respect a person’s right to not get vaccinated, but they need to respect my right not to raise my risk level because of their decision. We can restrict access to certain spaces if it’s necessary to protect public health; this is a principle that’s been established in American law for more than a hundred years. 

Some people will forge vaccination cards. Fine. If a few people think that the smart play is to forge a card and risk having a nightclub bouncer say “this looks fake”, thus turning them into a 17 year-old in the eyes of their friends...well, okay. Smooth grift, Mr. Bond. But other people will decide to just get the shot. The goal is to change the risk/reward calculus, and requiring a card -- and penalizing forgeries -- does that even if there are loopholes. 

Are the politics remotely workable? Maybe. We’ll only have to consider making people show their card if infection rates rise, and in that situation, people might be calling for action. Missouri and Arkansas are currently having outbreaks, and even though both states are deep red, events are being cancelled and restrictions are being put back in place. It might be true that scenario one -- the “let it all burn” scenario -- is politically naïve. If that’s true, restrictions will either be imposed on everyone or just on people who won’t get the shot. And with majorities of adults having already gotten at least a single dose in every state except one (way to stay on-brand, Mississippi), most voters might not be willing to alter their lives out of deference to people who can’t be bothered to get vaccinated.

Maybe vaccinations will tick back up and none of this will be necessary. Maybe we just need to find the right PSA -- have we tried street-wise hip-hoppers who can rap with today’s youth in their own “lingo”? What about someone sitting backwards on a chair, i.e. the universal signal for “Yo, here’s the straight dope”? Getting the soft-sell to work is still the best approach. But if that won’t do the trick, we need to consider other options. Dougherty has convinced me that some vaccine-resistant people are acting in what they believe to be their rational self-interest. Which means that we need to think about changing incentives so that their rational self-interest leads them to the vaccine.

1. I’m not saying “people believe this because of Joe Rogan.” I’m saying “people believe this”, and I’m citing a prominent person who expressed the idea succinctly. Also, for what it’s worth, Rogan has softened his remarks.

2. I said “a logic”, but not “sound logic”, because it’s pretty much a statistical slam dunk that getting vaccinated is the lowest-risk play. Plenty of people who “trusted their immune system” are dying right now. Still, I’ll grant that for a young and healthy person, the risk is very low in either case.

3. I assume that he does -- he’s not made of stone!