The Four Anti-Vaxxers: How to Discuss COVID-19 Vaccination with your Vaccine-Hesitant Relatives

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With Passover and then Easter approaching, as an increasing number of adults are getting vaccinated against COVID-19, we may anticipate family gatherings, both in person (hopefully, only in small groups consisting of vaccinated and other low risk people), plus, as last year, via Zoom. As adults in numerous countries are rolling up their sleeves for their shots, clinical testing of a few different COVID-19 vaccines in teens down to age 12 progresses, while Moderna began a phase 2/3 trial in children from 11 years down to six months of age on March 16. Whether your kids are in the younger group, or in the teen and pre-teen group, getting a spot in these pediatric trials is competitive, just as it took some effort for parents of the 1950s to get their children enrolled in clinical trials of the Salk polio vaccine. As a parent of a teen and a pre-teen who are eager to participate in such a trial to help save more vulnerable people and return school and other aspects of society to normalcy, I’m finding that one really needs some pull to get one’s kids into a study. But the United States also has an abundance of people who either plan to refuse COVID-19 vaccination altogether, or who already are exhibiting varying degrees of hesitancy.

At the extreme end of the spectrum are the full anti-vaxxers, those who don’t like any vaccines, or who believe that the COVID-19 vaccines are part of a conspiracy, involving the government, Bill Gates, George Soros, and the medical community, to inject people with tracking devices. Perhaps, you’ll have a crazy uncle at your Passover seder or Easter dinner who thinks this way. Or a crazy aunt; I don’t want to be sexist. But more modest kinds of vaccine hesitancy and conspiratorial thinking manifest in some responses that I have seen in social media to news about Moderna’s trial in young children, responses along the lines of: “What parents would let their children be guinea pigs when the risk of COVID-19 in kids is low?”, “Where are they getting the children?; are they manipulating poor, uneducated parents into consenting?”, and “Just a way for Moderna to get more money.” Then, there are people who aren’t thinking in a conspiratorial manner, but just that the scientific and medical community is inept in terms of safety checks. Even though all of the COVID-19 vaccines that have received emergency approval in North America and Western Europe, including the AstraZeneca/Oxford that received bad press in early March on account of blood clots that actually had nothing to do with the vaccine, were proven extremely safe in clinical trials, before they were approved for administration outside trials, many people did not get the memo on this. According to polling, there also are a lot of wait-and-see people, those who will accept a COVID-19 vaccine, but only after more of the population is vaccinated and shows that there are no dangers. Which means that they also didn’t get the memo that vaccination is about protecting the population as a whole.

In a very real sense, this situation mirrors the celebration of the spring holiday of my particular culture, which is Passover, and for a couple of reasons. First, while getting very hungry awaiting the meal, the tradition is that we tell the biblical tale of the ten plagues, each of which affects Egyptians as a population, including the tale of the Israelites putting blood on the door posts, which protects everybody in the house, not just the person who puts the blood on the doorpost. While many of us, including me, do not believe these to be historical events, over time, every generation that has recounted this story has found it useful for considering issues of its own era. And so, it resonates this year and last in the context of public health. Vaccination, social distancing, and masks are about protecting you, but they’re also about protecting the human population to which we all belong.

The second connection with Passover involves a metaphor, known as the four sons, or the four children. Also part of the traditional storytelling that gets everyone hungry during the Passover seder, the four children are supposed to represent four types of people. Known as the wise child, the bad child, the simple child, and child who doesn’t know how to ask a question, these four metaphorical types are distinguished by what each asks about the significance of the Passover story and those at the table are advised how best to respond to each. Now, you probably see where we’re going with this. We’re going to consider four types of vaccine-hesitant people who might sit near you at the holiday table, or pop up on the family Zoom celebration. They don’t correspond precisely to the wise, the simple, the bad, but not knowing which questions to ask is a problem underlying all science illiteracy and health illiteracy, including the effects and the technology of vaccines. Everything in science, from formulating an hypothesis, to designing experiments, to reviewing research of one’s scientific peers, depends on asking appropriate, thoughtful questions. If we don’t come up with good questions, we can’t do good science, no matter the capabilities of our devices. Consider, for example, questions that a trained scientist would ask in connection with a report of an 85 year-old man suffering a blood clot the day after receiving his COVID-19 AstraZeneca vaccine —questions like: “What are all the things that can cause a blood clot in an 85 year-old man?”

Contrasting with this, a self-proclaimed anti-vaxx “researcher” might ask questions like: “Siri, have any people ever developed a blood clot after a COVID-19 vaccine?” and may not ask “Siri, where do I learn how to perform statistical analysis and how to select what to compare with what?” This certainly falls into the category of not knowing how to ask a question, a category that encompasses every anti-vaxxer that you will ever meet, whether it’s Robert F. Kennedy Jr. or your uncle at the dinner table. But as with being vaccine-hesitant, there are degrees of ability and inadequacy in asking scientifically-minded, relevant questions, and that’s why you are likely to encounter different styles of resistance to these phenomenal vaccines against COVID-19 and the rapidly advancing biotechnology that has made them possible, so quickly.

There are the simple types; they simply don’t know what a vaccine is, and what’s in these COVID-19 vaccines in particular and might truly be looking to you to explain what you know.

There are people who are hesitant about these new vaccines, because they are thinking of something from the past related to new treatments. Although things are changing, due to community outreach, there has been some concern about African Americans being very hesitant about the COVID-19 vaccines as part of a more general hesitancy about accepting new treatments, because, still fresh in their minds, is the Tuskegee Study of the effects of syphilis on African American men, running from 1932-1972. For most of this period, penicillin was available to cure syphilis, but the participants were not informed.

There are the people that we mentioned earlier, who simply don’t think that vaccination is about the community. They say “You can get vaccinated, but I will wait.” We also may define adults of their mid twenties to mid forties (mid millennials down to very late GenXers) as a vaccine hesitancy category, based on a recent study, revealing that people in the mid twenties to mid forties age group are actually more likely to refuse a COVID-19 vaccine compared with older people, and even compared with those ages 18-24. For now, we can only speculate about the reasons. Maybe, it’s because they are young enough to continue feeling invulnerable to health issues, but not young enough to feel the effects of schools and university systems being disrupted by the pandemic. Whatever the reason, since this also comes down to a “I’m not in danger myself, so I’ll avoid it” attitude, I’m going to lump these mid-twenties to mid-forties together with people of any age who want to hold off. That way, we can include the most extreme cases, the crazy uncle or crazy someone else who thinks the vaccines are a conspiracy, as a category and still have four groups.

So how then to respond to any vaccine hesitancy that these different types of vaccine resisters may express at the dinner table? Firstly, while it might make you feel better, rebutting with a barrage of logical reasoning is not likely to convince any of our four anti-vaxxer types to run to the nearest vaccination center, if he/she is eligible, and happily receive a COVID-19 vaccine. To paraphrase astrophysicist Neil deGrasse Tyson, logic will not unconvinced someone of an idea that she or he didn’t use logic to acquire in the first place, or, in the words of Thomas Paine, “To argue with a person who has renounced the use of reason is like administering medicine to the dead.”

So what they to say? To the simple vaccine hesitant person, you can say that, from your reading of articles by experts, talking with your physician, and listening to scientists, you have learned that vaccines are among the medical advances that have saved the most lives over the past two and a half centuries. Vaccine technology, furthermore, has come a long way in recent years, as scientists have learned more about how immunity works and how molecules like DNA and RNA work in our cells. This understanding gave vaccine researchers a very big head start when the pandemic began a year ago, and that’s why you are confident that these new COVID-19 vaccines are safe and very effective, and why you are eager to be vaccinated.

To the one who is vaccine hesitant, because of a bad history with research studies on people, like the Tuskegee syphilis study conducted on African American men in the mid 20th century, you should note that the administration of the new vaccines under emergency use authorization is not research. Only people who already have volunteered as test subjects for the clinical trials have acted as “guinea pigs” and you don’t feel like receiving a shot of a vaccine with proven effectiveness and safety will make you a guinea pig in any way. Point out that the history of medical research has indeed been problematic and shady when it comes to particular genetic groups, not only in the sense of notorious tragedies like the Tuskegee study, but also because so many important treatment regiments for common illnesses have been devised on clinical studies that have been disproportionately waited for white men. You should note that inequities in vaccine distribution to particular demographic groups puts those groups at the greatest risk.

To the “I’m not in danger myself, so I’ll sit back while other people get vaccinated” people, you should say something like “Well, of course, it’s your right to make your own decisions about your health and I support you on that. I’m choosing to get vaccinated as soon as possible against COVID-19, not only to protect my own health so that I can continue working, supporting my family, and enjoying life, but also to help keep the virus from spreading to, and killing, more vulnerable people, and to help prevent the emergence of new variants that might be more dangerous to younger people like you.”

And what to say to the hardline anti-vaxxer conspiracy believer (your crazy uncle, etc)? As noted above, arguing is futile. Logical discourse is not going to work and with such people it tends to push them to hold even more tightly to their irrational beliefs, so the best tactic is probably to say as little as you can. It may not help, but you can try mentioning that former US President Trump himself has stated that the vaccines are great and that people should get them. But as with the other types, you also can lead by example. Emphasize that you feel confident in the doctors and scientists. If he or she says anything about the government and vaccine companies injecting microchip tracking devices, don’t bother even responding to that. If you have received your vaccine already, simply note that it seems to have gone fine for you and that you’re happy that the vaccines will eventually return us to a normalcy, where we can have family gatherings without everyone being so spread out, that you look forward to the days when we won’t have to wear masks in many public places.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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