Peter Brindley: An open letter to the unvaccinated

At the time of writing, the number of covid-19 cases in North America is rising sharply (yet again) and many doctors and nurses are profoundly frustrated. It really didn’t have to be this way. If we suffer a significant fourth (or subsequent) covid wave—and let’s still hope we don’t—then it will not only be mostly a “pandemic of the unvaccinated,” but largely courtesy of the unvaccinated. We are here because too many people are obsessing over their rights, while ignoring their responsibilities. This appeal is to anyone still unmoved and unprotected. The following may upset you, but this is too important to mince my words.

Many healthcare professionals are at a loss for words. Not only because we are exhausted, but because we simply can’t understand why so many of our fellow citizens refuse to get a simple vaccine. Simply put, the science is not in doubt. To paraphrase an exasperated colleague, “the skating scores are in, no need to await the Russian judge.” These vaccines are safe and effective, and people who are unvaccinated are substantially more likely to get covid, and severe covid to boot. Healthcare workers still care—obviously we do—but many of us are losing empathy, along with the ability to distinguish those who are vaccine hesitant from outright anti-vax. Loss of compassion, on both sides, is dangerous; everyone suffers if we retreat into “us and them.” Many commentators have highlighted how covid-19 created a shadow pandemic of poor mental health, but I’m similarly concerned about a pandemic of selfishness and science denial. We now appear to have an “I don’t care strain” alongside the delta strain. 

This really is not complicated, but it could be tragic and far reaching. In contrast, if enough people are vaccinated, then fewer people will die, and covid-19 should downgrade from a crippling storm to a more manageable swell. We would transition from pandemic to endemic, and while some people would still get sick, the numbers would be fewer, and their severity of illness far lower. In other words, I/you/we have the power to save lives, businesses, and even those overseas trips, but only if we work together. This would allow us to address everyone’s battered sanity and the perilous waiting list for medical care. Instead, it feels like some people want to punch a hole in the life raft, while expecting healthcare workers to keep on bailing. If you don’t care for maritime analogies, I can be blunter. Many working in healthcare now have compassion fatigue and plenty are ready to quit, right when you might need us. 

There have been plenty of reasons advanced for not getting the vaccine, but one of them is a simple refusal to be told what to do. I get where you’re coming from but not where you’ve ended up. I am also a stubborn bugger and somewhat libertarian. I support rights because I cherish them too. Again though, rights come with responsibilities . . . right? Moreover, I know how many people go to extraordinary lengths to help their neighbours, so why not do so now? It feels to me like a gigantic middle finger pointed our way. For two years, healthcare workers have not only worked exceptionally hard, but we have tried to engage, persuade, plead, and, yes, even scare—because this is scary stuff. We have done our compassionate best not to shame, but it hasn’t worked. We respect your ability to make choices, but choices come with consequences. With this in mind, let me share the reality of life (and death) in the covid ICU. 

Covid has been the most nihilistic disease I have ever faced in the ICU. Once we need to wheel in the machines, the horses have often bolted, along with your lungs. The goal still is to keep people out of ICU, because once you’re in, you may not come out. Covid has been a stark reminder of why exactly life support is called life support and not treatment. It maintains life, but does not make you stronger. In fact, it reliably makes you weaker. 

Covid care in the ICU consists of deep sedation, twiddling a few knobs, adjusting a few drugs, and clearing your excretions. We may put you on your front (aka proning), and may even try heart-lung bypass (aka extracorporeal membrane oxygenation). However, we definitely do not sprinkle magic dust. Moreover, you are the more important factor in your outcome, in that you better have the right immune system: not too hot, not too cold. Sure, younger, fitter people usually do better, but you cannot always predict how long motors will last when pushed to the red line. Statistically, the young should survive, but I’ve seen enough who have not. We are all bookies, not prophets. Fortunately, there is a great way to increase your odds: science.

Too many people claim to support science when what they are doing is scrambling for anything to support really shaky beliefs. That is not science and, with respect, you know it. I have also witnessed too many people reject science right up until they reach the hospital doors, and then suddenly demand science STAT. After all, the same scientific methods and principles that made vaccines also made the drugs, and tubes, and machines. I accept the science of medicine (imperfect as it is) because I also accept the science of gravity (indisputable as it is). 

None of us are really heroes or villains—that language is overdone. Occasionally though, life gives us an opportunity to make our corner of the world just a little bit better. Surely, that is something we agree on. Please just do the right thing, and let’s get back to living.

Peter Brindley, Department of Critical Care Medicine, Department of Anesthesiology and Pain Medicine, and the Dosseter Ethics Centre, University of Alberta, Edmonton, Canada. Scholar, Peter Wall Institute for Advanced Studies. Twitter @docpgb

Competing interests: none declared.