Last week, Dr. Anita Sircar, an infectious-disease physician in Los Angeles, wrote a moving piece for the Los Angeles Times about how doctors are losing compassion for COVID-19 patients, almost all of whom are willfully unvaccinated. She opens the article with a story of a 40-something father of two she had as a patient. His excuse for not vaccinating? "I was just waiting for the FDA to approve the vaccine first. I didn't want to take anything experimental."
As Dr. Sircar notes, this is the same man who "started taking some hydroxychloroquine he had found on the internet," only to find it didn't work. In the hospital, she offered to treat him with Remdesivir, which had been under the same emergency use authorization as the vaccines "for most of last year and had not been studied or administered as widely as COVID-19 vaccines." While he accepted this much more experimental treatment, just as he experimented on himself at home, it was too late. He died.
To be clear, the man's actual objection was not, as he said, that he "didn't want to take anything experimental." No, the likely reason was a right-wing propaganda blitz that has convinced Republican voters that refusing the shot is the best way to stick it to President Joe Biden and the hated Democrats. These are folks who booed Donald Trump himself for promoting the vaccination. The "FDA approval" excuse was only rolled out because even Trumpers know that saying "I'm risking COVID-19 to own the liberals" out loud sounds dumb. But remember, these are the same folks who reject the FDA's advice against eating horse paste.
You are not a horse. You are not a cow. Seriously, y'all. Stop it. https://t.co/TWb75xYEY4
— U.S. FDA (@US_FDA) August 21, 2021
Yet far too many folks in government and media continue to confuse excuses for the actual reasons for vaccine refusal.
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On Monday, the FDA finally gave this much-ballyhooed full approval to the Pfizer vaccine, causing reports, such as the one in the Washington Post, that "public health officials are optimistic that a large swath of vaccine-hesitant Americans will be swayed" now to get the shot.
Sure, maybe some will. According to Dr. Anthony Fauci, only about 20% of the unvaccinated will be swayed. But the grim reality is that most of the people citing the FDA approval as an excuse were just concealing their actual, Fox News-and-Facebook-disinfo-based reasons. Despite the efforts of Republicans like Texas Lt. Gov. Dan Patrick to blame anyone else — in his case, Black people — for vaccine refusal, the reality is it's largely being driven by right-wing identity politics. In fact, recent NBC News polling shows the only group that isn't majority vaccinated is Trump voters.
A revealing breakdown of vaccine attitudes in America. pic.twitter.com/ajI44yBnep
— Sahil Kapur (@sahilkapur) August 23, 2021
Psychologist Doreen Dodgen-Magee recently explained at Salon how vaccine refusal is being driven by ego protection, both as "a desire to appear powerful" and an avoidance of having "to face the uncomfortable realization that we can be wrong." Conservative social mores probably make these tendencies worse. Right-wing media is constantly riling up their audiences with stories of "liberal elites" looking down their noses at them. So there's a lot of defensiveness on the right and an eagerness to prove that they know better than the actual experts. (This also fuels podcast host Joe Rogan's vaccine denialism.) Witness this recent CNN segment, which really showcases how much ego protection and a fantasy of being more knowledgeable about medicine than doctors is driving the right-wing response.
"I think it is time where God is separating the sheep from the goats....I'm a goat. Because I am not a sheep. I'm not doing what they tell me to do. I'm fighting against it (the vaccine)."
— Donie O'Sullivan (@donie) August 24, 2021
One can see a similar dynamic in the growing roster of stories from distraught family members of vaccine refusers.
Sociology professor Stacy Torres writes in the Washington Post of a younger sister who accused her of trying to "bully her" into the vaccine. In the piece, her Trump-voting, Arizona-based sister comes across as insecure and defensive, especially in comparison to her more educated sister who lives in San Francisco. Torres ends with a story of how her sister was like this at 10 years old, dangling "from a thin branch, refusing to come down" and how Torres "had to learn to walk away" because pleading with her sister only made it worse.
Yes, it's ironic that the way that conservatives try to demonstrate they're smarter than "liberal elites" and doctors is by embracing profoundly stupid ideas. But that's troll logic for you. And make no mistake — trolling the liberals is exactly why conservatives are doing this. And it's working, insofar as liberals are really, really mad about losing our freedoms because of the willfully unvaccinated. But conservatives are paying for this trolling with their own health, as COVID-19 tears through their communities, now killing over 1,000 people a day.
— Amanda Marcotte (@AmandaMarcotte) August 24, 2021
So no, the FDA approval isn't going to change right-wing minds because right-wing vaccine refusal is about identity politics, ego protection, and conservative propaganda. But that doesn't make the FDA decision worthless. As Jon Skolnik reported in Salon Monday, this approval is clearly what some employers were waiting for in order to finally move towards mandating the vaccine. "Chevron, the second-largest U.S. oil company, the Pentagon and New York City were among the first organizations" to announce new mandates, he reported. More will likely follow.
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Biden also used the FDA approval as an opportunity to push for more mandates, declaring, "I'm calling on more companies in the private sector to step up with vaccine requirements that will reach millions more people" during remarks on Monday. The mandates would be similar to those already in place in many schools and workplaces that people be vaccinated for diseases like the measles. Notably, however, Republicans do not show any interest in opposing those mandates.
Mandates work better than trying to scare people straight with stories about unvaccinated people dying, because of a peculiar trick of psychology that makes small-but-certain consequences weigh more heavily on some people's decisions than dire-but-less-likely consequences. It's why seatbelt laws and indoor smoking bans do more to shape people's behavior than threats of death from lung cancer or car accidents. Losing a job or being ejected from school or even being unable to go to a concert with friends are all less severe consequences than death. But with mandates, they are far more certain to happen, and therefore will be more compelling to unvaccinated people than distant-seeming images of people dying in the ICU.
Nor can we expect education or appeals to the common good to work on these folks. They reject education because it insults their egotistical belief they know more than the experts. They reject common good arguments, because again, their egos prevent them from seeing themselves as part of a society and having responsibilities to it. But avoiding the shame of being fired or thrown out of school or even rejected from a bar will have an effect on people who are so motivated by ego protection. In her Washington Post piece, Torres — who is literally an expert in the sociology of health care — agrees, calling on "the government to get serious about mandating vaccines," and arguing that mandates "could save my sister's life."
And that is the greatest irony of all: The people who stand to benefit the most from vaccine mandates are the minority of people who reject them.
Despite the hype over breakthrough infections, vaccinated people are both highly protected against catching COVID-19, and their chance of getting a severe case is incredibly small. The hospitals are overflowing with unvaccinated, not vaccinated people. Plus, mandates allow unvaccinated people to preserve their ego by saying they still don't "believe" in the shot while getting it anyway because they "have" to. Some will fight, but by and large, most will accept this face-saving opportunity. The beauty of a mandate is it doesn't ask people to change their minds. It just requires them to do the right thing, regardless of their dumb opinions.
It's not enough for Biden to call on others to mandate vaccines. There are still ways he could act — requiring vaccination to get on an airplane is the big one — that would start getting shots in arms faster. It would save lives, but it could also save Democrats in the midterms by wrapping up this pandemic before 2022. The time to act is now.