Giving Up Our Shot: Dealing With the Unvaccinated

Dennis Sanders

Dennis is the pastor of a small Protestant congregation outside St. Paul, MN and also a part-time communications consultant. A native of Michigan, you can check out his writings over on Medium and subscribe to his Substack newsletter on religion and politics called Polite Company.  Dennis lives in Minneapolis with his husband Daniel.

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54 Responses

  1. fillyjonk says:

    “Walmart and Target were eventually able to compel their customers to don masks. ”

    *Laughs in Oklahoman*

    I NEVER saw good mask compliance here. Not early in the pandemic, not as vaccines were being rolled out, not now. Maybe in some of the bigger cities. (I wear a mask, I had a bad turn the last time I went into a store ummasked in March 2020 and some guy coughed in the same aisle I was in).

    I don’t blame the minimum wage workers at the stores for not enforcing it harder; I had about 90% good mask compliance in class but it got really old really fast constantly telling that one guy who pulled down his buff to pull it back up. I wouldn’t want to do that for $7.25 an hour PLUS risk someone taking a swing at me for it.

    I’ve heard some say “but working class folks can’t get to the vaccine clinics when they’re open, and they fear losing their jobs if they have to take a sick day after having the typical immune response to it” and I think that’s potentially fixable (24 hour stations in easy to get to places, vaccine buses, require employers to allow for paid time off). The people who are suspicious, maybe social-group/church/medical professionals they trust talking to them will help.

    But yeah. I got the vaccine as early as I could, I mostly continued masking up in public, was REALLY looking forward to a fall of teaching without a mask but NOPE. I absolutely share the frustration and even anger of other people over how we wound up with a stick in our bicycle spokes over this.

    I don’t really have any good solutions beyond increasing access for those who face some challenges timewise, maybe mandates at workplaces, and a big community push to encourage it. But for the people in hardened positions who refuse to vaccinate – yeah, keep ’em out of restaurants and theaters, and allow employers to tell them they either have to work 100% remotely or they are no longer working there.

    of course this excludes people with a genuine medical reason they cannot safely be vaccinated – and those folks are why the rest of us need to, to protect them.Report

  2. Pinky says:

    The implication here is that low covid vaccination rates among blacks are due to unavailability. But that’s not factually correct. Am I misreading this?Report

    • Philip H in reply to Pinky says:

      It is factually correct in many parts of the country. When Denis talks about structural barriers, he’s talking about communities with few physicians clinics, pharmacies or other locations that can dispense vaccines. He’s talking about communities that are only now – within the last couple of weeks, getting mobile drive clinics coming to them through church based charities. And he’s talking about the rural south where small community hospitals – which often were the only medical access for anyone in their county – have closed over the last decade leaving areas where multiple counties have little to no medical access in under an hours drive. And that’s assuming someone has a car, and gas money, and time to go get stuck.Report

  3. InMD says:

    I don’t buy the availability explanation at all. Every adult without a condition that prohibits it has made a choice. I think it’s patronizing to treat urban minorities as somehow more sympathetic than the Trumpkins in the hills. People have agency.

    That said I agree that persuasion is probably the best avenue we’ve got. I’ve never understood the doom and gloom approach to this. We’re all witnesses to a modern technological miracle. The message is and should always have been that the best way out of this mess is the vaccination. If you won’t do it for yourself do it for your loved ones. Do it for Halloween and Thanksgiving and Christmas. Etc etc etc.

    On that note they really should have unleashed Francis Collins instead of Fauci. I get it isn’t his area of expertise but he makes the case so much better. The friendly, eccentric grandpa comes off so much better than a hostile bureaucrat.Report

    • Pinky in reply to InMD says:

      Agreed. Fauci’s presence only appeals to the kind of person who would follow the next federal health spokesman, and it alienates people who could be reachable by someone else. You don’t need him in the room, and you definitely don’t need him in the front.Report

      • InMD in reply to Pinky says:

        Yea, whatever utility he may have had has long since passed.Report

        • Mike Schilling in reply to InMD says:

          The Right has successfully demonized him. It’s one of their few skills, but they’re very good at it.Report

          • InMD in reply to Mike Schilling says:

            I think there’s more to it than that. I don’t doubt Fauci’s expertise as an epidemiologist. But it’s no great insight to realize that the smartest person on a particular subject isn’t always the best messenger. He has been among the factors undercutting his own credibility.

            And of course the right isn’t blameless. Probably the most bizarre thing when it comes to shaping perceptions and politicization of the virus is the combination of the apparent success of ‘warp speed’ with Republican base hesitancy. There’s at least a surface level case to be made that widespread vaccine availability is a GOP success. Yet it’s treated with a kind of smug and paranoid ambivalence.Report

            • Mike Schilling in reply to InMD says:

              Fauci and his family got death threats at the level that he hired private security. And as Pinky points out below, there’s an active conspiracy theory that Facui created Covid.

              So we agree that the right isn’t blameless.

              On GOP vaccine hesitancy, I waver between blaming Trump for not supporting vaccination more than half-heartedly and thinking that it wouldn’t help because, unlike actual leaders, he never got hs base to do anything they didn’t already want to do.Report

          • Damon in reply to Mike Schilling says:

            Fauci started his own downfall. He lied about mask wearing-he admitted it on national tv. Anything demonizing the right did on him only added to situation. I expect politicians to lie to me. What I don’t expect is fed gov admins to do it to me, and a once lied to, I never trust the liar again. Of course, the CDC has had issues with lying before, so…..Report

        • Pinky in reply to InMD says:

          As the vaccination rate approaches 100%, the ratio of unvaccinated people who think Fauci created coronavirus increases.Report

  4. Brandon Berg says:

    “How do we make sense of the fact that some people won’t get critical medications, like their diabetes medications? Or that some people forgo necessary medical care even as they experience complications from chronic illness? It’s not that those individuals don’t want basic medical care! It’s that groups face structural barriers to accessing that care, including rural folks, underinsured folks, and Black folks in particular. Those structural barriers are likely at play for vaccinations too.”

    People like to tell just-so stories about structural barriers and structural oppression, but empirical evidence that these are a major driver of outcomes is a bit lacking. There was a recent study in Canada of the effects of free drug distribution on medication compliance. This was heralded in the press as a smashing success, featuring an insufferably smug quote from the lead author: “This is the first study of providing people with free access to a comprehensive set of medicines, and hopefully it will be the last one needed before policy change.”

    But if you actually look at the results it’s striking how little difference this made. One of the inclusion criteria for this study was answering yes to the question, “In the last 12 months, did you not fill a prescription or do anything to make a prescription last longer because of the cost?” All of the subjects were people who had missed doses for cost reasons, and the intervention group had the drugs mailed to their homes for free. Not only did they not have to pay, but they didn’t even have to go to a pharmacy to pick up the drugs for free.

    So we would expect this to make a huge difference in compliance with prescriptions, right? Well…not really. In the control group, 71.4% of participants missed at least 20% of prescribed doses of at least one medication over the next two years. In the group that got free drugs, that number fell to…61.3%. Overall, the control group took 66.6% of all prescribed doses, and the intervention group took 74.5%. Not surprisingly, there were no significant differences in secondary health outcomes like blood pressure, cholesterol, or HbA1C (a marker of poorly controlled diabetes). More than 80% of subjects were under the age of 65, so this was not just a matter of missing doses due to age-related cognitive impairment.

    Which is to say that among patients who explicitly cited monetary cost as a barrier to medication compliance, the combined monetary and time cost of obtaining medication accounted for only about 15-25% of noncompliance, depending on how you measure it.Report

  5. North says:

    This is one heck of a conundrum, agreed. When talking about around a third of the population of the country it’s obvious that the category can contain multitudes. Still I feel a certain sympathy with the rising exasperation of the vaccinated majority. At this point my understanding is that vaccines are available virtually at any drug store or other community area in the country with no appointment necessary. The arguments about the non-anti-vaxer unvaccinated folks just doesn’t make sense. If they are worried about symptoms they could just get the jab before a day off. It is unambiguously free- in no small number of states you’re even getting some carrots for getting the jab.
    The final category is simple inertia but this is where the wheels come off your post Dennis because if a large proportion of the unvaccinated are unvaccinated simply because they can’t be bothered then that’s a group that the sticks that’re being contemplated could be expected to be very effective with.

    As for the true anti-vaxers, well fish em.Report

    • Pinky in reply to North says:

      My sympathies are more with those who haven’t gotten the vaccine. I mean, based on the available information I think they’re wrong, but if we’re strictly talking about sympathies, yeah. For the past few months we’ve been told to get vaccines to get rid of the masks, get vaccines to protect others. Now we’re hearing about returning to mask mandates and indications that the vaccinated can carry around just as heavy a viral load as the unvaccinated.

      From the numbers I’ve seen, covid vaccination rates seem to max out around 70% even in the most cooperative jurisdictions. Given that some of those 30% have already been infected and carry some immunity, and factoring in children and those who can’t get vaccinated for medical reasons, that’s got to be close to the percentages that we’d been told would trigger herd immunity. And while cases are increasing in the US currently, it’s been mostly confined to Southern air-conditioned brutally hot states that saw the same increase last summer. The weekly number of covid deaths in the US is still significantly lower than it was last year at this time.Report

      • Damon in reply to Pinky says:

        And the delta variant…reading a newspaper article that said there was no current way to know if anyone has the delta variant since no test currently tests for that particular strain. So all this action taken due to the variant is based on what then?Report

        • Kazzy in reply to Damon says:

          From what I understand, the tests to see if you have it don’t check for strains. But those tests are then sent elsewhere and genetically sequenced to determine the strain.Report

          • Damon in reply to Kazzy says:

            That’s correct, according to the paper. But are they really going to sequence EACH test? No. According to the CDC, ““At this time, genomic sequencing is available for surveillance purposes only, not for individual diagnostic purposes,” Fulce told Reuters.”

            https://www.reuters.com/article/factcheck-genomic-sequencing/fact-check-covid-19-variants-are-monitored-by-genomic-sequencing-of-samples-idUSL1N2P91KW

            They are only testing 750 samples a week, max. So, the assumption that “everyone’s getting the delta variant” is a big ass assumption in my opinion. Either way, I’d sure as hell be pissed at my doctor if he said I had the delta variant and he was “assuming” from a positive generic test.

            I’m not an anti vaxer. Hell, I got my yellow fever shot before I went to China “just in case”, but this whole covid 19 thing stinks of misinformation, mismanagement, ulterior motives, and “doing something” so we can appear like we know what the hell we’re doing. It stinks from all get out.Report

            • Brandon Berg in reply to Damon says:

              It seems that it’s not just the CDC doing sequencing:

              She said the amount of sequencing by public health laboratories has “generally increased over the course of the pandemic, ranging from about 2,000 to 15,000 sequences per week.”

              That said, even 750 is fine for ballpark estimates of the most common strains. If 650 out of 750 random samples are delta, that tells us that there’s a 99% chance that 83-90% of all cases are delta.

              It’s not going to work as well for rare strains, of course.Report

              • PD Shaw in reply to Brandon Berg says:

                The sequencing isn’t necessarily random though. Could be, but a lot of what bubbles up to the surface and appears to be driving policy are retrospective case studies. There is an outbreak where a lot of people are gathering in densely packed events, public health officials go out and try to get samples of everyone.

                I remember a podcast in January with the Colorado public health official whose lab first identified the UK variant. Once they found it, they developed a screening tool that they could use to determine that a sample was probably the variant they were looking for, so they did not waste time and resources conducting full genomic sequencing on other variants.

                Not suggesting that’s all that is happening, but I’ve never had the impression the U.S. had a system in place for genomic sequencing anywhere close to the UK’s.Report

            • Pinky in reply to Damon says:

              There’s got to be a joke in here about genome sequencing. Like, a patient gets a CoronaVirusAncestry.com report: “Oh, look, my virus is 83% Delta! And it’s got a cousin in England!”Report

    • Brandon Berg in reply to North says:

      It’s all normative sociology. A certain type of person treats the assumption that self-destructive and/or antisocial behavior in anyone with below-average SES must be due to structural factors. From there it’s just a matter of trying to find the most plausible structural explanation, and never, ever conducting any empirical tests that might falsify this explanation.

      It’s the polar opposite of the fundamental attribution error. Rather than assuming that everything is due to individual traits and nothing to structural factors, they assume that everything is due to structural factors and nothing to individual traits.Report

      • North in reply to Brandon Berg says:

        A very classic liberal/leftist habit of though.Report

      • Philip H in reply to Brandon Berg says:

        Structural factors constrain individual agency. If you don’t have a car, or public transportation, its hard to drive an hour to the nearest clinic or hospital to get routine medical care. If you lack sufficient income to cover your basic needs for housing and food, you aren’t going to chose to get medical treatment, which means you have no doctor that you trust to talk to about things like the COVID vaccine.

        What Liberals and leftists OBSERVE is that agency only gets you so far when structure blocks you. We want structural barriers removed because it increases agency. Hell – Em just wrote a very cogent and persuasive piece about a guy in Hawaii who spend three years in a state mental hospital because “the system” wouldn’t listen to him when he said “I’m not the guy.” He was stripped of his agency by structure.Report

  6. PD Shaw says:

    The county with the lowest vaccination rate in Illinois is Alexander County at the southernmost tip (15.36% fully vaccinated), and it also the county with the highest percentage of African-Americans in the State.

    The explanation given several months ago is that people are distancing and wearing masks, so they don’t need vaccines:

    “The percentage of people here have really been paying attention to the COVID deal by wearing the masks, doing everything the right way,” he said. “And with the faith in all of us, if we live right and do right, and practice all the safeness that surrounds this COVID thing, I think we can get a handle on COVID.”

    They trust in each other, as opposed to distant institutions and risky technologies, which is unsurprising given high rates of poverty and educational deficits. When the Governor was asked about their low vaccination rates, he offered that rural counties were having trouble distributing their vaccine allotment without sufficient throughput given the particular requirements of the vaccines. Eventually unused allotments were reallocated to Chicago, and in the grand scheme of things, the million-plus unvaccinated in Chicago is probably more important than the 5,000 or so unvaccinated in a place few have heard of.

    My main concern is if people think getting a hold of this COVID thing means that the virus will disappear soon without their need to vaccinate. I think that’s a mistaken assumption.Report

  7. Doctor Jay says:

    Well, the thing is, CA is probably at 75 percent vaccinated now, and many of those left include groups like blacks, etc. She’s right, but she’s talking about CA.

    Her breakdown probably doesn’t apply to low-vax-rate states like Arkansas and Louisiana. Maybe to some extent, but who knows?

    My ire is not for the individuals, but for the public officials who spout lies and nonsense in defense of not getting vaccinated.Report

    • Brandon Berg in reply to Doctor Jay says:

      As of today, 63.5% of California’s population is fully vaccinated. I believe that this the the percentage of the eligible population (12+) that’s fully vaccinated, because the numbers imply a denominator of 34 million where as California’s total population is 40 million. Even among those over 65, only 71% are fully vaccinated. For comparison, 95% of people over age 50 in the UK are fully vaccinated.Report

  8. Oscar Gordon says:

    One interview of a doctor I heard said that the amount of misinformation created a lot of hesitancy, and PCPs had good success answering questions and overcoming that hesitancy. But, once they got a fence sitter off the fence, they had to jab them right away, so having doses on hand is critical.Report

    • Philip H in reply to Oscar Gordon says:

      And that only works for people with PCP’s they trust.

      Mississippi has 65.9 per 100,000 population active primary care physicians, with a U.S. state median of 90.8.

      Mississippi has 174.8 active patient care physicians per 100,000 population (2018)

      https://www.ompw.org/OMPW/About-Us/Mississippi-stats.html

      We don’t have enough doctors to go around, and most of them are in the cities. With 51.2% of our overall population in rural counties. Again, structure here is impacting agency – as it is in many southern states.Report

  9. Jaybird says:

    My vaccine hesitant co-worker who kept saying “I’ll wait for the FDA to approve it, thanks” GOT HIS FIRST JAB!

    When asked why he changed his mind, it had to do with an acquaintance of his who got it and it was an absolutely awful case of it.

    So… it’s kind of like gay marriage, I guess.Report

    • Brandon Berg in reply to Jaybird says:

      I wonder how many of those people who aren’t getting vaccinated because the vaccines aren’t FDA-approved are going to turn into people who won’t get vaccinated because the FDA approved the vaccine too quickly and without sufficient long-term follow-up data.Report

      • Philip H in reply to Brandon Berg says:

        I’d say the vast majority. Which means FDA approval won’t actually move the needle much.Report

      • Jaybird in reply to Brandon Berg says:

        Hey, I’m one of the “the FDA is some combination of inept, corrupt, and captured” people. My immediate inclination when I encounter a “I trust Government Organizations” person is to begin by ranting.

        But I try to tamp that down, at least in person, and explain that some huge number of people have gotten the jab without the FDA’s opinion and that the numbers seem to show protection from the ‘vid with a shot. (I have opinions on the mRNA shots versus the J&J but they include the J&J being better than nothing.)Report

    • Marchmaine in reply to Jaybird says:

      American Academy of Pediatricians to the FDA:

      “We understand that the FDA has recently worked with Pfizer and Moderna to double the
      number of children ages 5-11 years included in clinical trials of their COVID-19 vaccines. While we appreciate this prudent step to gather more safety data, we urge FDA to carefully consider the impact of this decision on the timeline for authorizing a vaccine for this age group. In our view, the rise of the Delta variant changes the risk-benefit analysis for authorizing vaccines in children. The FDA should strongly consider authorizing these vaccines for children ages 5-11 years based on data from the initial enrolled cohort, which are already available, while continuing to follow safety data from the expanded cohort in the post-market setting. This approach would not slow down the time to authorization of these critically needed vaccines in the 5–11-year age group”

      xoxoxo,
      Pediatricians

      Dropped (strategically?) on a Friday.Report

  10. Saul Degraw says:

    We are at a point where psychology, tribal signaling, and mood affiliation seem to matter more and it is depressing and perplexing.

    Almost everyone I know or everyone I know is vaccinated (at least this is my assumption) and signed up to be vaccinated as quickly as possible. Some of them are still acting like it is the bad days from last spring though. It seems to be out of doubt on the efficacy of the vaccines because our media doesn’t know how to report properly on breakthrough cases, lingering fear from when things were bad, showing that you are not a Covidiot, and or a concern for those who cannot be vaccinated in various combinations. Maybe even some are willing to save the unvaccinated from themselves.

    And then you have the GOP antics where not getting vaccinated now seems to be another way to own the libs and is coming from states that used to have very stringent mandatory vaccine requirements.Report

  11. Kazzy says:

    I was surprised to see that India’s Delta-driven spike was followed immediately by a precipitous drop. Their Vax rates are low (under 30% one dose, under 10% full).

    Did they achieve that through restrictions, lock downs, etc? Or something else?Report

    • North in reply to Kazzy says:

      When you have hundreds of thousands of deaths and millions of cases I think you get a drop off due to herd antibodies after a bit. India’s lost almost 500k iirc.Report

      • Kazzy in reply to North says:

        But weren’t our rates of infection higher at their worst? We never saw a drop like that until vaccines took off.

        I know it’s likely that their numbers were worse than reported due to testing limits, so maybe they did have worse rates.

        But look at their graph: https://www.worldometers.info/coronavirus/country/india/

        A 90% reduction (400K to 45K) in 2 months. Did we ever see anything like that? If not, what can we learn from their response to Delta since it obviously wasn’t “Vaccinate the unvaccinated.”Report

        • North in reply to Kazzy says:

          My only guess is their route is “get massively and widely infected and suffer huge casualties but have a lot of survivors” and I don’t think that’s a path we’d wanna take.Report

          • Kazzy in reply to North says:

            Do you think their numbers are that much worse than reported? Currently, they aren’t too far off than ours:
            US Cases: 36M
            US Deaths: 633K
            India Cases: 32M
            India Deaths: 428K

            Their population is about 4 times ours.

            It’s also possible that their population and case distribution is a factor. So this may be an apples and oranges comparison.

            To be clear, I’m not alleging any sort of conspiracy theory or anything. I’m just trying to make sense of it all.

            If India didn’t beat back Delta with vaccination, then it is possible they didn’t really beat it back but were just destroyed by it in ways that the numbers don’t reflect and it receded on its own. Or perhaps they had effective countermeasures. Or maybe there is something funky about Delta that makes it strikes fast and hard but for some reason doesn’t sustain.Report

            • Chris in reply to Kazzy says:

              Friend of mine in Bangalore suggested that, at least in the rural areas the deaths were 4-5 times higher than reported. He works for a non-profit that shifted from education to medical supplies for the rural areas, so he has some insight, but I don’t know if that is just in the area around Bangalore or across the country.Report

            • North in reply to Kazzy says:

              I don’t know for sure, which is why I am being careful to include “guess” in my responses but I saw a flurry of appeals during the big India spike where they were talking about their funeral system being flat out overwhelmed and you could see India’s overladen pyre fields from satellite images. Modi is a very insular leader- one part Orban, one part Trump but competent so I’m not at all confident in any numbers his administration puts out. I think the infections were a lot wider and more pervasive than they admitted.

              So my guess is that a widely more pervasive infection disaster, that they went to lengths to minimize and hide, produced a widespread wave of natural resistance, that they went to lengths to laud and talk up. That’s my guess as to why you’re seeing the pattern in India you are seeing but it is a guess.Report

              • Kazzy in reply to North says:

                @Chris and @North

                My hope was that maybe Delta was funky and somehow receded on it’s own. Given what you offer, that seems unlikely. Thanks.Report

              • Jenn Kovacz in reply to Kazzy says:

                Herd immunity continues to be a thing.
                If you believe Delta’s r0 is 8, that means it is likely to spread very quickly.
                If it doesn’t kill as many people (and leads to higher viral loads), then you have a cowpox-style vaccine.Report

        • Pinky in reply to Kazzy says:

          I haven’t heard any recent stories, but India’s initial, informal policy in 2020 was to have the police beat anyone who was in public. It proved very effective. It’s possible they’ve gone back to that.Report

  12. DavidTC says:

    You know what pisses me off?

    There’s a certain amount of the population that is extremely medical-adverse due to the random and unpredictable billing. Hell, I’m that way, despite having insurance for years. This is an entirely understandable reaction to the utterly random cost of our medical system.

    A lot of them haven’t gotten the vaccine, because they aren’t actually sure it’s entirely free. (This is not helped by some of the places that giving it collecting insurance information. Which they shouldn’t be doing, but they do anyway, because apparently a few of them try to charge insurance for the actual ‘procedure’, not the vaccine itself but the person injecting it…which doesn’t actually seem to be legal, and insurance companies won’t pay it, but that’s a bit irrelevant. The point is that some places are _acting_ like someone might have to pay something for it.)

    It seems like this is a thing that would be incredibly easy to clear up with some messaging. Making sure everyone understands the vaccine is completely free. You don’t need insurance, hell, _you don’t have to be a legal resident_. (Another category I’m suspecting is undervaccinated.)

    Have we done this? Have we made this clear? No.Report