We need to stop viewing “the unvaccinated” as a homogenous group, writes Abraar Karan, and instead understand them as individual people
In the United States covid vaccination rates have slowed down tremendously since the peak in April, while infections, hospitalizations, and deaths from covid-19 have all begun to increase once again. Amid this worrying reversal in our struggle against the virus, a public sentiment that is catching on is that “the unvaccinated” are at fault for not protecting themselves, especially with vaccines widely available.
As a physician, I am immediately struck by how harmful this stance can be to controlling the outbreak. Among all of the unvaccinated patients that I have cared for who became sick from covid-19, the most common feelings are ones of regret and genuine confusion. As one of my patients put it, “Doc, I was really confused with all the mixed messaging coming out. I’m going to wear my mask now.”
I spent most of last year working on the Massachusetts covid-19 state response and one of the most important lessons I learnt was that epidemics and pandemics are only overcome when we believe in protecting the community more than just the individual. That meant no one is left behind. That meant ensuring most people had access to and were wearing masks. That also meant preserving community trust sufficiently so that people could share with family and friends if they were infected, and would quarantine or isolate when sick. It meant supporting those who needed to continue working while others worked from the safety of their homes. We didn’t do this all perfectly—but over time, we began to realize that our health was only as good as the health of those living near us.
While earlier I had written about how pandemics are stopped by people, I have to say I was wrong. Pandemics are stopped by communities, not individuals.
Once vaccines arrived, the same community-mindedness was still needed, and initially we were able to increase our vaccination rates in the US to among the highest in the world, especially among our older population.
But since then, especially with the spread of the dangerous delta variant, attempts to protect unvaccinated people—for example, by indoor public mask mandates—have been met with resistance by many, especially those who are vaccinated. Some people in the latter group feel that they played by the rules, and now should reap the rewards, whereas the former group did not and thus deserves the fate which awaits them.
This “everyone for themselves” approach will leave us isolated, vulnerable, and destined to fail—even those who are now vaccinated. We must refrain from reverting to the reckless individualism that left us ill prepared against this pandemic to begin with.
Millions of people remain unvaccinated in the US. Yet “the unvaccinated” are not a homogenous group, although our tendency to group them as such may come from a place of needing to blame someone or something for what has otherwise been a lackluster vaccine rollout in the US. They are individual people who have, for many different reasons, not yet been protected from this disease. We must begin to think of them as vulnerable, whether to misinformation or to a lack of resources; this can be hard during a crisis, but it may be exactly what is needed to close the vaccine gap.
For some, the intense challenges of accessing a vaccine have truly precluded them, whether that was due to an inability to get time off work, difficulty in navigating online registration systems, or the absence of a vaccine site close by. For other people, the lack of appropriate information to assuage their fears and doubts once again has left them confused, afraid, and hesitant to engage with the medical system. And for many, the active barrage of misinformation from organized groups intending to prevent vaccinations has created an even more unclear picture of what to do—this was the case for some of the patients I have treated.
As it stands, the US is far behind in our vaccination campaign, and yet, shockingly and tragically, still millions of doses ahead of many countries in sub-Saharan Africa and South America. While our current vaccines are excellent, our current vaccine coverage is not (just about 50% fully vaccinated thus far)—and is in fact so insufficient that it cannot alone provide the level of community protection quickly that we need to control local covid-19 outbreaks. For this reason, places such as Los Angeles County have reinstituted indoor masking in public spaces. Unlike previous mask mandates, which seemed to focus on the outdoors (where spread is negligible), the new mandate focuses on high risk settings: those which attract crowds of strangers in poorly ventilated, cramped indoor spaces. Moreover, it is a reminder that winning against covid-19 is not about whether you are safe, but about whether your family, your neighbors, and your community are.
We know that the more the virus spreads among unvaccinated people, the more that viral mutations will continue and eventually threaten the health of vaccinated people as well. This is true on a global scale, where vaccine inequity poses an ongoing risk to us all, and it will be seen in the US locally as well.
As physicians and public health leaders, we must understand that those who are unvaccinated are not people who are hoping to get sick or die from covid-19. They are people who, for various reasons, remain vulnerable to this disease, as well as to the social and economic systems that have led to so much immense suffering and death in our country. Our job now is not to blame those who remain in harm’s way—it must be to protect them. Figuring out how to do this is our task at hand.
Abraar Karan is an infectious disease doctor at Stanford University and a columnist at The BMJ. Twitter @AbraarKaran
Competing interests: none declared.