Friday, December 11, 2020

Let's Also Talk About Vaccine Hesitancy and Convincing People

 Let's start with the facts: any approved COVID-19 vaccine will be, for sure, safer than getting the disease.  Vaccination remains a public good.  I have told everyone I know they should be vaccinated, and I expect I'll have to argue my mother into it (WHY MOM, YOU ARE A LICENSED MEDICAL PROFESSIONAL).  Also, you don't want to infect your nearest and dearest!  That is not good!

However. If one more person tells me there's totally nothing to worry about and it's definitely 100% safe I will flip a goddamn table. 

First go read this article on all the shady nonsense the FDA has pulled since March, including approving therapies that actually raise the death rate.  

Then you can go read the entire Pfizer trial preliminary results (in two documents!).

First note that the median Phase 2/3 follow-up after the second dose is one month, for a total of two months.  Yes. Two.  When you hear people expressing concern over long-term effects- which there will be, there always are a few- don't bullshit them and say there's plenty of good long term data.  There isn't.  This is a novel technology not previously approved in humans.  But you are less likely to die, or kill others, if you get vaccinated.  There's your talking point. 

Don't tell people that just because the FDA approved something, it's safe and effective. (See above, also, any time these last 100 years.) Say that this disease is deadly, and the trials are pretty large, and COVID definitely will kill you faster than two months.  

When you hear people saying there were Bell's Palsy cases, that is true, and the incidence (over two months) was the same as the normal incidence over a year (though incidence varies widely by sex and age).  Don't bullshit people and say it's totally within normal range.  It may or may not be.  Say that Bell's Palsy mostly resolves, and also, it will not kill you. 

When you hear people saying there is insufficient safety data on people with previous infection, that is also true.  The Pfizer trial gave 670 people (see p. 28) with serological evidence of previous infection their vaccine.  Among these people, adverse events may or may not be more common.  (Also, the US is about to do an accidental trial on all the medical personnel who were infected and didn't know it, so adverse events will show up there.)  But also, please do not try to tell me, personally, that we know 100% for sure it's safe in people with previous infection. You can tell me that by the summer, we will have those data!  We do not have the data now.  But the vaccine still won't kill you.* 

And also, there were at least two credible reports- in hospitals, in medical personnel! - of anaphylactic or anaphylactoid reactions (the latter can still kill you).  The ingredients list is unconclusive as to what might have caused this- basically, PEG, the mRNA itself, or maybe one of the lipid components- but this is a legitimate reason to be concerned.  Again, we do not have enough data now.  For this one, I would say, don't dismiss the concerns of people with severe allergies; tell them to watch for more data.

So, overall: people are hesitant with good reasons.  Some of these reasons can be addressed.  By the time normal people can be vaccinated- in about six months- we will have enough data.  But please don't tell people who legitimately want more data that everything's fine.  That's how the FDA and CDC burned all that trust to start with

* There will, eventually, be a fatal adverse event, which will be a one-in-ten-million event.  On average, however, this will remain true.


  1. Having been on mommy boards, all I can say is that none of these numbers will matter. All that will matter is if the stories of bad Covid outcomes are more prevalent and graphic than the stories of bad vaccine outcomes. Women on the fence about vaccinating their kids will vaccinate when there's measles or whooping cough in the area, and they won't vaccinate if someone talks about the weird lump their kid got after a vaccine. It's all on the media and influencing/propogandizing organizations for this. Russia is going to be pushing those negative vaccine stories, so hopefully the new administration will be able to put a damper on that venue.

    1. True story! I was thinking mostly of well-informed people- like me! - who are not yet entirely convinced.

      I'm personally quite concerned about the allergic reactions- I've had reactions severe enough to be put on a biological, I carry an epi-pen, and I've had multiple one-in-a-million adverse drug reactions- but there will doubtless be more data eventually. I'm mostly annoyed at people trying to tell me there's nothing to be concerned about, which is manifestly untrue. People have hesitancy for bad reasons ("the vaccines will overwhelm my child's immune system!") but also for legitimate reasons.

    2. The thing that really gets me is that people with genuine concerns about vaccines *want* everybody else to get vaccinated so that people who can't be vaccinated benefit from herd immunity. It's the crazy crackpots who want attention who channel Jenny McCarthy.

      I also figure that by the time the vaccine filters down to regular lower risk people like my immediate family we will know a lot more about who is genuinely at risk and who isn't, and which vaccines are better for which risks. With Trump out of office, I will trust the process (and also will trust the processes in Europe). If Germany and the UK and the US think it's likely to be safe for me (who has never had an anaphylactic reaction, etc.) after it's been out in the field for months, then I'm not going to be worried.

    3. I am definitely all in on everyone getting vaccinated in general, it is true!

  2. Anonymous11:37 AM

    A colleague of mine will be the new CDC head - hoping she can restore some faith !

    1. I certainly hope so! But it will take.... time. More time.

  3. Anonymous6:23 PM

    Definitely not anti-vax and have always done what is expected for myself and daughter. But will admit it was difficult to hear about the severe reactions requiring epinephrine... daughter has severe food allergy requiring carrying an epipen but has never had a reaction to vaccines or other yeh it causes a pause there.

    1. Good news! By the summer, when there's enough vaccine for ordinary people, we'll have run a trial on 10+ million people!


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