Tuesday, September 28, 2021

Can COVID Anti-Vaxxers Be Reasoned With?


I came across some crudely written graffiti recently, spray-painted on a pillar. It read, “ANTI-VAXXERS PIE.” I was like, huh? Another pillar a quarter mile away had the same thing but the vandal’s skill had improved: it read, “ANTI-VAXXERS DIE.” I guess this made a little more sense, but how persuasive was this presumed to be? (This graffito was itself vandalized before I return to photograph it.)

At the other end of the spectrum is an article I read recently in The Atlantic titled “Stop Death Shaming.” I found this article as annoying as the graffiti. In this post I explain my annoyance, and examine the larger question of how we might persuade holdouts to finally get the COVID vaccine.

 Stop Death Shaming

What a stupid title, clearly intended to be shocking so as to attract readers, like clickbait. Of course nobody is “death shaming” because the dead can’t feel shame and nobody is so clueless as to scold a corpse. Meanwhile, the article doesn’t actually provide examples of anybody shaming the non-vaccinated. It does go on to reasonably bemoan the lack of constructive dialogue between those who believe in the COVID vaccine and those who don’t. It also usefully recounts a poll that ranked the top reasons anti-vaxxers list for abstaining:

  • Potential side effects (just over half of respondents)
  • Don’t trust the vaccines (nearly 40%)
  • Don’t trust the government (a third)
  • Don’t feel they need it (just under a quarter)
  • Aren’t sure the vaccines are protective (22%)
  • Don’t see COVID-19 as a major threat (17%)

The author concludes that at least these people show “significant willingness to consider vaccination” (though I can’t figure out how she arrives at this conclusion), and describes a dialogue she had with her uncle about why he and his wife aren’t vaccinated. The uncle asks a few questions, puts his willful ignorance on display, mentions the “little bit of research” he’s done, and concludes, “We’re not, you know—we’re still thinking about it.” The writer wraps up this little vignette by saying, “I felt good about our talk.”

You know what? I don’t feel good about their talk. This guy, and anti-vaxxers like him, have had over six months to ponder this decision. When are they going to get around to their “research”? They’re dithering while people are dying, and this Atlantic writer seems to think that’s fine as long as nobody hurts anyone else’s feelings.

But what really irks me the most about the article is that this journalist misses the biggest point of all: she seems to think it’s perfectly acceptable to only ever expect people to act in their own self-interest. Her uncle, and people like him, are failing to understand or admit that this is a matter of public health. In fact, they are failing to realize that there’s even such a thing as the greater good. In short they are thinking selfishly. This is the real crux of the problem.


Now wait, you might be thinking. If somebody believes the vaccine works, and gets vaccinated because he or she doesn’t want to get COVID, isn’t that also acting in one’s own self interest? Yes, of course. But this is a situation where one’s self interest happens to coincide with that of the rest of the population. This is what makes it so frustrating when selfish people do the wrong thing to the detriment of themselves and everyone else. It’s a lose-lose.

I suppose you might also question whether selfishness is really the core of our dilemma. Given that all these people are fixating on outlandish fictions such as the risks of side effects, a nefarious government, or the idea that the vaccine is somehow unnecessary, isn’t the real problem that they’re all just as dumb as a sack of hammers?

Okay, now that is not constructive, and I don’t believe it’s even true. According to the New York Times, about thirty percent of the adult U.S. population hasn’t had a shot yet. I don’t think 77 million people actually lack the mental capability to understand that the vaccines do work, that there hasn’t been a rash of side effects, that COVID really is highly contagious, and that you can contract and spread it unknowingly. I think the problem is that people are so scared, as they struggle to adapt to this insanely bizarre new reality, that they’re simply not thinking clearly.

Neuroscience and the vaccine holdouts

Perhaps a shallow dip into the literature of social neuroscience can help illustrate what is going on here. According to this article by Dr. David Rock, a cognitive scientist, “Much of our motivation driving social behavior is governed by an overarching organizing principle of minimizing threat and maximizing reward (Gordon, 2000),” and “several domains of social experience draw upon the same brain networks to maximize reward and minimize threat as the brain networks used for primary survival needs (Lieberman and Eisenberger, 2008).”  When humans feel threatened in a social situation, the “resources available for overall executive functions in the prefrontal cortex decrease.… Due to the overly vigilant amygdala, more tuned to threats than rewards, the threat response is often just below the surface and easily triggered.… This discovery that our brain is inherently attuned to threatening stimuli helps explain many disquieting parts of life,” including “why the media focuses on bad news.”

In evaluating how this plays out in social situations, Dr. Rock focuses on “five domains of human social experience: Status, Certainty, Autonomy, Relatedness and Fairness” (which form the handy acronym SCARF).  Understanding how to approach these realms, he contends, is the key to motivating people, particularly when they’re facing the uncomfortable prospect of significant change: “For example, a perceived threat to one’s status activates similar brain networks to a threat to one’s life. In the same way, a perceived increase in fairness activates the same reward circuitry as receiving a monetary reward.”

So what does this have to do with trying to reason with anti-vaxxers? I would argue that just giving them their say, and being a good listener, as the Atlantic writer does, won’t change anything; nor will directly attacking their stated reasons for declining the vaccine (which are really just positions—you could even say excuses—rather than firm beliefs, not that they’re up for discussion). I think you need to cast the entire matter into a new light, that shocks the anti-vaxxer into a reassessing his or her status, certainty, autonomy, relatedness, and fairness.

How to reframe the conversation

So here’s what I propose, should you find yourself in a position to discuss the COVID vaccine with, say, an uncle willing to hear you out. Instead of denying the risk of side effects, assume that they’re real, and focus on the utter selfishness that the anti-vaxxer displays when letting other people assume this risk. “So let me get this straight, Uncle Clyde,” you could say. “You’re so concerned about side effects, and the possible meddling of our untrustworthy government, that you’re going to stand by and let people like me take that risk so you don’t have to? So you’re basically looking out for number one? So if you were on the Titanic, you’d be elbowing women and children out of the way to get to a lifeboat? And in an active shooter situation, you might avail yourself of a human shield?” This argument would certainly light up the status, relatedness, and fairness realms described in the SCARF model. I wouldn’t expect the dialogue to continue much longer from here, but you’ll have presented Uncle Clyde’s amygdala with a new series of threats, and he might just start to reconsider the clever stories he’s been telling himself about vaccination. At some point he might even knuckle down and enlist the support of his neocortex.

As for your utterly selfish cousin Clint, who maintains that he’s robust and healthy and could totally kick COVID’s ass, you could say, “Oh, I see … and the possibility that your immune system is so good you could be infected but asymptomatic doesn’t concern you, because spreading the virus to Grandma isn’t your problem? So, if you were a smoker, you’d be the kind who totally blows smoke in people’s faces, and if they don’t like it fuck ‘em? I guess this is fine, until Grandma dies of COVID and me and the rest of the family blame all you for the rest of our lives.” This seems like a pretty decent appeal to the Status and Relatedness realms.

Let’s move on to our brother Bill who conveniently sits out the fight against the coronavirus by pretending COVID-19 isn’t a major threat. “So Bill … If this were a war that killed 670,000 Americans instead of a disease, and you were young enough to be a soldier, would you enlist, or just hope that the evil dictator running amok calmed down and called back his troops because he changed his mind? Or would you find some excuse, like flat feet or microscopic testicles, to stay home and hide out instead of facing the enemy?” His sense of relatedness, fairness, and status would have to be reevaluated. Is this shaming? Yes, of course it’s shaming! But it’s not death shaming, it’s selfish asshole shaming. Shaming is required here because these anti-vaxxers are shameless.

Now, when it comes to the poll about why people were declining the vaccine, there was of course the elephant in the room that nobody wanted to admit to: the pressure to follow their political party’s lead. This wasn’t mentioned anywhere in the poll results, but as detailed here, vaccination rates track closely to political party. This is primarily a GOP thing, obviously, though I blame the extreme right wing media more than the politicians. After all, as the Times reports, Mitch McConnell is encouraging Americans to get the vaccine, as is Mitt Romney, and even Donald Trump says he’s a “big believer.” The anti-vaccine mania is largely the fault of heartless, soulless, utterly self-serving media shitheads like Tucker Carlson and Sean Hannity who understand that keeping their acolytes’ amygdalae in a state of perpetual frenzy is instrumental in creating the seething, hyperbolic division among Americans that keeps ratings high. I think it’s very telling in this interview that twice Trump brings up the vaccine, and twice Hannity completely changes the subject.

Vaccination behavior shaped by political party can also slop over into the Democrat camp. This article in the San Francisco Chronicle, discussing various reasons locals gave for avoiding the vaccine, describes one person’s viewpoint: “It was bad enough that she felt nervous about the vaccine’s side effects. But it also felt like former President Donald Trump was mixed up in it all. ‘Trump said, “The vaccine is here because of me.” And I was like, do I really want it if he’s behind it?’ Maggin said. ‘But people feel that people who don’t get vaccinated are Trump supporters!’” The article goes on to ask, “What’s a frightened liberal to do?” I’ll tell you want to do: stop worrying about political parties, stop being bullied by biased blowhards, and think for your damn self! That could do wonders for your sense of autonomy.

I’m almost done, but I want to take a little more time to consider fairness, the F in the SCARF model. I think people often do make fairness a priority; as Dr. Rock points out, it “may be part of the explanation as to why people experience internal rewards for doing volunteer work to improve their community; it is a sense of decreasing the unfairness in the world.” Consider how many people, surely yourself included, blithely exceed the speed limit, but how few would illegally park in a handicapped spot. Freeway accidents are one of the leading causes of accidental death in America, but that risk is abstracted so most of us don’t think much about it. But we can easily imagine a person in a wheelchair being inconvenienced because we wrongly took her spot. What would be more embarrassing to you: being pulled over for speeding, or getting caught parking in a handicapped spot?

So to appeal to the anti-vaxxer’s built-in sense of fairness, it would be useful to stimulate his imagination a little. “So, Uncle Bruce,” you might say, “is this pandemic inconvenient for you? Kind of a pain?” You could draw him out on the indignities of endless Zoom calls, etc. Invite him to share a story about the most awful thing that’s ever happened to him at work. Then say, “Hey Uncle Bruce, do you ever chew out flight attendants when your flight is delayed?” He’d say of course not. Ask if he’s ever stiffed a waiter on his tip. “Hell no!” Uncle Bruce would declare. You then reply, “Of course not, you wouldn’t deliberately cause trouble for a working person, you always show them respect.” Then you go on to say, “You might be aware that ICUs at hospitals across the country are filling up with COVID patients. Did you know many of them are straining under the burden of two to three times the normal number of patients? Did you know almost all of these patients need to be intubated? Do you have a sense of how gnarly a procedure that is? Do you know how hard it is to bring a patient back from that? Did you know doctors are having more patients die than at any other time in their careers, and that many ICU docs have now treated more patients for COVID than for any other malady? Can you imagine how hard it is for them to tell the family members of their patient that he isn’t going to make it? Look, I know you didn’t sign up for boring Zoom calls when you took the job with TechCorp, but these doctors didn’t sign up for  a brutal, endless onslaught of their ICUs being inundated with mostly doomed patients either. I’m sure you’ve read how unvaccinated people like yourself are 29 times more likely to be hospitalized with COVID … I just want to make sure you can kind of imagine how that pans out. Oh, don’t worry, these doctors would never shame anyone, though I talked to one who said he actually wished the fact of his patients’ non-vaccinated condition wasn’t in their charts because that just reminds him how huge a problem this is, and rubs it in how utterly avoidable all this would be if people just accepted the vaccine. And don’t get me wrong, when talking to the non-vaccinated family member of a terminal patient, a doctor would never say anything like, ‘This non-vaccination policy you have … how would you say that’s working out for your family?’ They have much more tact than that, they’re unfailingly polite despite being overworked and losing so many patients. And if you yourself did land in the ICU with COVID, and your doctor was telling me there’s not much more he can do, and I was begging him to do everything he can, he would never say anything like, ‘Would you say your Uncle Bruce did everything he could?’ Because doctors aren’t about shaming anybody. And I’m not either, believe me, I’m not trying to be a dick or anything, and I know you’re afraid of needles. But did you know that when an intubation goes sideways, a mixture of blood and saliva from the COVID patient’s throat can spray all over the doctor? I’m just sayin’. But hey, take your time deciding, it’s all good. It’s totally your choice, a deeply personal matter. And don’t worry, if you do end up dying of COVID, all of us family members who survive because we’re vaccinated will be very gracious at your funeral. Nobody will say, ‘It’s sure a shame about Uncle Bruce, though this could have been avoided if he hadn’t been such a selfish, stubborn old dumbass.’ We would never say that because that would be death shaming.”

More reading on the pandemic

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