As a Canadian, I find it interesting to compare US data to Canadian data on subjects like this. The only study I could find that looked at the reasons why Canadians are vaccine hesitant was COVID-19 Vaccine Hesitancy in Canada: Content Analysis of Tweets Using the Theoretical Domains Framework (J Med Internet Res. 2021 Apr 13;23(4):e26874.doi: 10.2196/26874. https://pubmed.ncbi.nlm.nih.gov/33769946/), which concluded:

"Vaccine hesitancy stemmed from the following themes: concerns over safety, suspicion about political or economic forces driving the COVID-19 pandemic or vaccine development, a lack of knowledge about the vaccine, antivaccine or confusing messages from authority figures, and a lack of legal liability from vaccine companies."

Notably absent are some of the reasons found in the KFF study: "worried about missing work", "difficult to travel to a vaccination site", "not sure how or where to get the vaccine" and "worried they will have to pay to get the vaccine."

I would theorize that this demonstrates that the absence of a universal social safety net cannot be overcome by a single effort, such as the US government's free COVID vaccine initiative. The effects of such things as job precarity and a lack of dedicated primary care physicians have consequences that impair emergency pandemic efforts, and which cannot be quickly remedied.

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This post made me think about how vaccinated people, including myself, complain about and attack the unvaccinated for not caring for others, for not being socially responsible, etc. But, of course, our own principal reason to get vaccinated was to protect ourselves, and it's only after having done so that we get the unearned virtue of protecting others.

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The story of the delivery man who was fearful of taking a sick day or a protracted lunchtime is heartbreaking. Just this week, Judd Legum’s Popular Information newsletter shined a light on new legislation in Texas that governor Abbott is sponsoring to address “a longtime priority of the business community that has failed in recent regular sessions: preempting local labor laws, such as mandatory paid sick leave.” How can you balance the need to earn a living with the need for vaccines?

The inherent inhumanity of such attitudes frustrates and angers me. It adds a human side to vaccine refusal different from a knee-jerk anti-vaxx response or even a knee-jerk ban on mask or vaccination mandates. Lost in “principle” is the humanist understanding that people are people.

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I did some volunteering at a vaccination clinic, and I had firsthand experience of folks who needed additional conversations with the clinic staff, even after they had made the effort to get to the clinic and wait in line to get the vaccine. I also had people ask me which vaccine the clinic provided (Moderna, in this case), and had them hesitate or reject it outright because they read that Pfizer provided a higher percentage of protection. This was in the early days of vaccine access (Mar-Apr), when we didn't have the luxury of going to Safeway to get the shot.

So yes, I understand that people will still have concerns, even when they know that the rational action is to get the vaccine. Also, I'm furious at the erasure of understanding of public service and goods in this country, which plays a big part in landing us in this huge mess.

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Is it true that "such immunity [from natural infection] is better than vaccination"? A recent study (https://www.cdc.gov/mmwr/volumes/70/wr/mm7032e1.htm) seem to suggest otherwise, though perhaps this is the one you're referencing, and the specifics here don't affect your main point of your argument.

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I really appreciate your emphasizing the point that “I have immunity because I already had the virus” is a conclusion motivated by entirely different thinking than that of political anti-vaxxers. And despite the tenderness of my empathetic, class-conscious, solidarity-loving little heart, in the back of my mind was the ugly assumption that both reasons are alike because they’re both indicative of “stupidity.” As in: Duh, you *should* know it’s better to be vaccinated against COVID than to rely solely on immunity from having the illness, just as you *should* know when you’re being lied to by hateful, self-serving grifters. I’m utterly ashamed to admit that such a condescending idea lived in the recesses of my brain, but in my view, the repentant disdainful are not all that different from repentant anti-vaxxers. We have to admit the ignoble impulse in the first place, acknowledge where it came from, and admit it aloud so that others see demonstrations of this kind of mental flexibility. Humility is in such grievous short supply these days, and me being smug will change exactly zero minds.

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Here’s hoping we’ll have a community discussion soon. I have a lot of questions. By the way, this particular piece generated a lot of insightful discussion for which I am grateful.

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Oh Zeynep, thank you, fulsomely and again, for providing not only great information but rational sanity.

It is really sad that even our important and trusted large news sources often succumb to the sort of story that used to be prevalent only the newspapers in the grocery store checkout line. Kudos to the LA Times for the story you excerpted, and the NYT for its recent story on why people got the shot.

I also appreciated you sharing Rob Zerwekh's tweet. I cringe every time I see one of these because the needle is making such a dent in the skin. Mine didn't hurt, but the pictures make it look like surely it must have. I have been thinking for some time how easy it would be to show smiling people walking out of the clinic with their vaccination card, and maybe being asked how they feel. Many would probably say they feel as my husband and I did, that as soon as they got out the door they were flooded by a sense of relief.

Again I have hope that the dark tunnel may end.

In the KFF data, the first thing I noticed was that the percentage of people in the Definitely Not category has never been higher than 15%. Add Only If Required and the total is 20%. If our population is close to 80% vaccinated, and half of the unvaccinated have had covid, we would be o.k. Of course, after we get the vaccine for younger kids.

The second thing I noticed was how much the Wait and See group has shrunk, even without the FDA full approval. There really is progress. If we could just switch to a positive message "We are almost at the goal line!" or whatever else may work. The messages loaded with guilt and expecting things that people don't feel, maybe because they are too busy struggling with things closer to them that matter, simply are not working.

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I know a couple of vaccine hesitant people who got COVID and now believe they don’t need to get vaccinated. Neither is political. They don’t vote and don’t really keep up with any news source conservative or otherwise. I wonder how many other unvaccinated fall into this category.

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I am in New England and in my relatively urban white collar world have run into many unvaxxed (trump allegiance as well as impact on reproduction seems to be common misconception among the vax holdouts) so I am not so sure that caricature is an accurate depiction.

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Here's an article by Sanjay Gupta from CNN in which he discusses whether the term "breakthrough infection" is a good one or whether it is scaring people more than necessary. The problem here though will be coming up with a new term that can make headline writers happy.


Here in Quebec, we're at about 73% vaccinated for the general age range of university students (18-24). Teenagers, who can be dragged to the clinic by their parents, are more than 80% vaccinated, and people above retirement age are more than 90% vaccinated. A lot of that is that vaccination isn't very politicized. It is seen as a way out of the pandemic and has been made very easy.

Where I come from in Texas, the vaccination rate is about 30% for the whole population, which is well below the average for the state. I've talked to my parents on the phone, and they know several people who say that they won't get vaccinated under any circumstances (in general the same people also refuse to wear masks), but there are lots of others concerned that they might have to miss a day of work because of side effects. I would imagine for younger people it translates to a combination that they don't feel that at risk, plus they equate being sick from the vaccine with being sick with Covid, plus none of their friends are vaccinated plus they think vaccination will be useless against the next variant anyway.

I wonder if this correlates with other things. In Texas, masking requirements have generally been dropped and government mandates are actually illegal, while in Quebec masks are generally required in indoor spaces, and we are moving towards requiring vaccine passports for indoor dining and movies. That sends some sort of message as to how serious the government considers the situation (or not). Also, in Texas, one message is coming from Governor Abbott, while people are hearing a very different message from the Biden administration, which mixes this up with a very polarized and tense political situation. What I've heard from my home town is that whether someone wears a mask is a fairly reliable indicator of how they voted in the last election.

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