A Matter of Life and Death: Winning the Fight for Vaccines

It seems increasingly likely that a real end to the COVID pandemic will require all but universal vaccination.[1] There are three challenges that need to be met:

• The development of much more effective strategies to work with those individuals who continue to hesitate about getting vaccinated.
• The development of a mass movement to defeat the proponents and organizers of COVID denialism and anti-vax intransigence.
• The production, distribution and administration of vaccines across the planet, especially for those people who have been victims of what has been called “vaccine apartheid,” without the interference or obstruction of the international pharmaceutical complexes.

Prelude

At the end of last summer (which now appears to be a very long time ago), my wife and I went to an old neighborhood bar around the corner from our house in Brooklyn. It’s in a building that still had a big Trump 2020 banner raised high near the roof. Since we hadn’t been there in a while, we weren’t sure what to expect. We had hoped to get dinner but the bartender said that the kitchen was closed. It turned out that the cook had just gotten his second vaccine shot and was feeling terrible. We turned to leave but a couple at the end of the bar, two of the only three other customers in the place, said, “No, please stay.” My hunch is that they missed the place as it had been before the pandemic when it would typically have been filled with regulars. On impulse, we did so and sat down at the bar.

We ordered a couple of drinks and the bartender asked for our vaccine cards (which, by then, were required for indoor spaces in New York). Miraculously, I had remembered to bring them. At the other end of the bar, the three customers were talking about the most important matter of the day—was there alternate side parking tomorrow. (For those outside of New York, cars need to be moved from a curb side on alternating days to allow for street cleaning machines to drive along the curb where the cars had been moved from. Sometimes the machines come; sometimes they don’t. Either way, if you’re parked on the wrong side, you get a ticket with a hefty fine. If alternate side rules are suspended, you don’t have to worry).  The cleverest participant in the conversation kept insisting that the city had changed the signs and you couldn’t be sure if you were on the right side.  The other folks would have none of it—even the prospect of a city ticket scam wasn’t enough to ruin their evening.

We sat and watched various sports channels, including the live broadcast of a Mets game where our son-in-law and three granddaughters were in the crowd. All in all, it was a completely ordinary evening. Not so bad after the year and a half before! Who knew that the end was far from near?

A few minutes after we sat down, a single guy came in and ordered a beer.  Once again, the bartender asked for his vaccination card. My wife then told the bartender how glad she was that he was asking. He responded: “It’s a matter of life and death. You have no choice.”  She nodded in assent.

What’s a Virus? 

The great unanswered question of the pandemic might still be “what’s a virus?” In everyday conversations, here in the US at least before COVID, when someone told you that he or she had a virus, it was assumed to be something that had come over them and made them feel more or less bad.[2] Usually, the bad feeling was located in the chest. Most of the time, most of us had no interest in pursuing the matter further. We just told the person that we hoped he or she felt better.

Unfortunately, this is one of those cases where everyday knowledge is not as good as it needs to be. Neither the short nor the long story about what a virus is will be found in a few paragraphs. But there are some things about viruses that are worth understanding—primarily to avoid any temptation to believe that no one really knows what’s going on.  Complicated it may be; nonsensical, it is not. A few starting points: 1) Viruses cannot live on their own; they need hosts—living things that will sustain them. 2) Viruses mutate when they move to new targets—they change their form and content unless and until they’re stopped; if they have no new targets, they die a cruel and lonely death (not really, it just sounded good). 3) Most of the variants that result from the mutations are of no great consequence (like having curly or straight hair); but others matter a great deal. 4) Of special concern are differences in transmissibility (meaning how many other people are likely to get infected by an infected person) and lethality (meaning how many people might die because of the infection) among different variants.

And Vaccines?

For the most part, vaccines have been developed to handle the specific challenges to life and health posed by viruses. Unlike other medications, vaccines rely on widespread compliance in order to achieve maximum effectiveness. In other words, if you have diabetes and you need to take insulin, the effectiveness of the insulin is entirely the result of taking glucose out of your blood.  What happens with other diabetics or other non-diabetics is of no consequence. Not so with vaccines![3] Their maximum effectiveness is achieved only when enough people are vaccinated that the virus has nowhere to go. Before that point, even vaccinated people can get infected and can infect others—although they are very unlikely to suffer the worst effects of the infection.

A doctor from Iowa, J. Stacey Klutts, summarized the underlying reasons for this somewhat puzzling reality by pointing out that a vaccine stimulates the production of a specific antibody response (called Immunoglobulin G (IgG).  That antibody circulates in high volume through blood and is easily detectable. However, a vaccine does not produce an Immunoglobulin A (IgA) antibody response in the throat. That antibody could “prevent the virus from ever binding in the first place.”  So, the virus is in the body but it cannot spread. As a result, infected people either don’t get sick or only have mild symptoms. The COVID vaccines are designed to prevent disease and death, not to prevent infections, although they also can do that. In a vaccinated person, the virus in the throat usually clears pretty quickly but, before that happens, a vaccinated person can infect others.[4]

Vaccine Hesitance

It’s worth listening to the reasons why people give for why they don’t want to get vaccinated. My wife and I have a son, a doctor who treats people with cancer. He told us about a 79-year-old woman who had been diagnosed with quite advanced cancer. He and another doctor went over the possible benefits of a serious course of chemotherapy with her and emphasized the quite severe side effects of the treatment.  In spite of the cautions, she willingly consented.  Almost as an after-thought, they asked her if she had been vaccinated.  She responded that she had not because she “was worried about the long-term side effects.” An older woman, with a life-threatening illness and a very short-term life expectancy, was choosing to participate in a very difficult and painful course of treatment with limited possibilities of success and side effects that would all but certainly become evident pretty quickly, but she was not willing to get a vaccine that promised a great degree of immunity against a terrible virus because of the all-but-non-existent possibility of long-term side effects. There has to be more to the side effects story than the side effects. And there is probably more to the other reasons why a good number of people have hesitated before getting vaccinated.

Fortunately, one researcher, Zeynep Tufecki, has paid attention to the complexity of the unvaccinated population.  On the basis of a good amount of empirical data, she argued that:

• Many people are vaccine confused and concerned.
• People who don’t have health insurance have been much less likely to get vaccinated than those who have it—because not having insurance usually means that individuals don’t have a regular primary health care provider who can answer their questions and give advice. By way of evidence of the positive effects of insurance, 95% of people over the age of 65, people who have Medicare, have been vaccinated—even though they are the prime targets for and consumers of Fox News anti-vaccine junk.
• People with serious chronic health problems are genuinely concerned about the possible worsening of their conditions if they get vaccinated; this concern is also evident among pregnant women who worry about possible adverse effects on a newborn child and among women who are hoping to become pregnant.
• Many people are afraid of needles. All those pro-vaccine ads showing people “getting the shot” may have been driving some people away.
• People adopt explanations for their hesitation that are “in the air” (like “long-term side effects” or “it didn’t get final approval”) as a way of making their concerns acceptable rather than articulate their own, possibly embarrassing or humiliating, reasons.
• While there were numerous reports of likely mass resignations if and when vaccines were mandated, when they were introduced, almost all those subject to them got vaccinated. “In fact, that’s exactly why the mandates may be working so well. If all the unvaccinated truly believed that vaccines were that dangerous, more of them would have quit. These mandates may be making it possible for those people previously frozen in fear to cross the line, but in a face-saving manner.”[5]

Tufecki also noted the existence of widespread vaccine hesitance among African-Americans, which she ascribed to their well-founded suspicions about governmental malpractice in the mistreatment of black Americans. Tufecki’s article was published in October of 2021. She noted that vaccination rates among non-white people in New York City were much lower than among whites. But, by January of this year, those trends had significantly changed. 84% of all people, 99% of Asians, 69% of blacks, 90% of Hispanics and 73% of whites had received at least one dose of a vaccine.[6]  The difference in rates between blacks and whites is small enough to suggest that the gap may be on the way to elimination. I have no special insight into what combination of circumstances and conversations changed the pattern but change it did! That’s reason for a degree of hopefulness. At the same time, there is little reason to think that lack of trust in the government has decreased in any significant way.  The increase in vaccinations among African-Americans and others has probably occurred in spite of their continuing distrust in the government.

What might further reduce vaccine hesitance? The way forward is not as clear as it should be. If many people are confused, how might their confusion be cleared up? More information is not necessarily enough of an answer. A recent article in The New York Times reviewed the patterns of HPV (human papillomavirus) vaccination for children of women who had had cervical cancer and of chicken pox vaccination for children of doctors. Vaccination rates were no higher for the children of cervical cancer survivors or for children of doctors for the respective vaccines.  It’s hard to imagine that either group of people didn’t already know more than enough about the values of the vaccines in question.[7]

Suffice it to say that changing minds is usually very hard. As has often been said, it’s easier to imagine someone changing their minds after changing their behavior than it is to imagine someone changing their behavior after changing their minds. The challenge, therefore, is to create multiple opportunities for individuals to work through their lives and choices in connection with others in similar circumstances.[8]

Vaccine Resistance and COVID Denialism

There is a difference between vaccine hesitance and vaccine resistance, especially collective resistance, organized on the basis of conspiracy fantasies, reactionary politics or some amalgam of both.[9]

Let’s step back a bit and think about individualism in US society. For all practical purposes, individualism has often been little more than the conviction that it’s your right to think and act just like more or less everyone else you know and, all the while, insist that no one is telling you what to think or do. It’s often accompanied by an exaggerated sense of the importance of relatively minor differences of opinion among that circle of friends and fellow believers—thereby providing support for the notion of their being independent thinkers and not being susceptible to manipulation.

The irony, of course, lies in the fact that various right-wing and far-right-wing organizations are all but completely orchestrating the efforts of individuals and groups active at local levels in efforts to accomplish all sorts of reactionary goals–restricting voting rights, prohibiting the teaching of topics related to racial oppression, preventing school districts from implementing mask mandates, and leading the widespread movement to create fantasy narratives about all the hidden dangers posed by the COVID vaccines.[10] All those local activists believe that they’re standing up for their “rights.”

Much of this growing movement of interconnected forces is a new version of “the Lost Cause”—a conviction on the part of many that “their” country is being taken away from them and a determination to fight against anything that threatens their apartheid-like sensibilities. It is also noteworthy that, among young anti-vaxxers, individuals have begun to characterize themselves as “pure bloods”–suggesting that opposition to vaccination is evidence that someone is a member of a presumably higher racial order and inherently separate from the rest of the worldwide human community.  For them, it appears that death is preferable to mixing.

COVID denialism is part cause and part effect of this complex social scene. Denialists typically claim that the COVID virus is no big deal; it’s just like the flu.  It only threatens those who are very vulnerable—especially the elderly with chronic illnesses. Those in power have been using it as a pretext for exorbitant profits (on the part of the health care and pharmaceutical industries) or for dramatically expanded forms of governmental surveillance and social control. Their “theories” range from the possibly plausible to the hilarious to the bizarre.

The COVID denialists have been producing their own social variants—against any restrictions on people’s daily activities, against masks, against the vaccines, against mandates. In the United States, they have effectively organized a political movement designed not just to avoid getting the vaccine but to defeat all of the measures that might end the pandemic.

Let’s go back to our neighborhood bartender who said: “It’s a matter of life and death. You have no choice.” It seems that a good number of people are convinced that they have a choice and they’re choosing death. More specifically, they are choosing a politics of death. I think they’re doing so because they believe that choosing a politics of life means choosing a politics of solidarity with all of humanity and some would rather die apart than be part of a common humanity. They, more or less intentionally, are trying to kill the vaccines by depriving them of the optimal conditions for success.

The organized movement to assassinate vaccination must be defeated. The charlatans must be exposed. Local organizing efforts against vaccination must be consistently and aggressively opposed. Social media nonsense must be met with social media good sense. Such a campaign would serve two purposes—the first, to advance us to the goal of universal vaccination; the second, to strike a blow against the ugly amalgam of right-wing and far right-wing, including fascist, forces that are actively engaged on different fronts to restore more or less harsh forms of white and male supremacy to dominance in the United States and analogous forms of reaction elsewhere in the world.

Universal Vaccination

While Europeans and Americans have been fighting over whether people should be vaccinated, people in much of the rest of the world were, understandably enough, worried if they would ever be able to get vaccinated. Today, more than a year after the initial introduction of vaccines, “In low-income countries, just 5.5% of people have been fully vaccinated, according to Our World in Data. In high-income countries, 72% of the population has been fully vaccinated with at least two doses.” Vaccination rates in some countries have barely moved above zero. By way of examples, Burundi’s rate is 0.04%; the Democratic Republic of Congo’s rate is 0.4%, and in Haiti, the rate is about 1.0%.

As I was finishing this article, it was reported that a vaccine producer, Biological E. Limited (BioE), in India had been authorized to distribute CORBEVAX, a vaccine produced by researchers at the Texas Children’s Hospital Center for Vaccine Development at the Baylor College of Medicine.  This new COVID vaccine is much easier to produce and store than the other vaccines already being used. Production can use existing manufacturing facilities, with already trained workforces.  And the vaccine can be safely stored in normal refrigeration. Most important, the new vaccine is not going to be patented—thereby making it possible for massive vaccination efforts, at very low costs, to be launched in poor nations in fairly rapid fashion.[11]

Universal planetary vaccination would not require the vaccination of individuals whose health conditions indicate that vaccination would be dangerous to them. In all likelihood, the number and percent of those will be very small. And they will benefit from the more or less total elimination of the virus among the vaccinated population.

The availability of the new vaccine establishes the preconditions for an effective international mobilization of millions of people, in both poor and rich countries, demanding that CORBEVAX be produced, distributed and administered as rapidly as possible.

The Need for Independent Organization

The states that currently constitute the political/governmental organization of the planet–whether they are more or less democratic, autocratic or dictatorial–are not capable of achieving that goal. In over two years, not one of them has been able to ensure the availability of sufficient numbers of health and other care workers to ensure infection control within and outside institutional settings and provide consistent effective treatments or demonstrate the consistent technical and practical knowledge and skill needed to maximize health and well-being or end the pandemic. They zig; they zag.  But state and party leaders cannot escape from the devil’s trap of navigating between pleasing their financial backers, ensuring the overall conditions for minimally necessary social reproduction (meaning that not too many people die) and making sure that there are still profits to be made by companies, small and large.

Therefore, we need an autonomous international campaign, independent of any elected government, political party, or governmental bureaucracy, to organize effectively for universal COVID vaccination and a real end to the pandemic.

To recap what I’ve written thus far, the priorities of such a campaign would be:

• The development and implementation of effective engagement strategies to enable vaccine-hesitant individuals to work through their misgivings about the vaccines without any undue pressure on them to change their minds. At the least, this could include popular education materials and lessons as well as imaginative propaganda, including old-fashioned street theater.
• The development of a well-organized campaign to defeat the political project of the COVID denialist and anti-vaccine movements in the United States. This would require continual mobilizations across urban, suburban and rural areas.
• The organization of a massive international mobilization to demand the immediate availability of full vaccination to all the peoples of the world.

The rich histories of the AIDS Coalition to Unleash Power in the United States (ACT UP) and the Treatment Action Campaign (TAC) in South Africa, both of which relied on the development of sophisticated understandings of complex medical matters by lots of people without advanced formal education and the frequent mobilizations of thousands to demand action, provide helpful models for us to imagine some new organizational beginnings.[12] But before organization, there’s a need for will. We can continue to sit by and watch the human catastrophe unfold before our eyes or we can decide to act to change the course of events.

***

[1] What I mean by a “real end” is the effective elimination of the virus in all the nations of the world and not, as is increasingly being hinted at, a “learning to live with COVID” approach that would all but certainly leave the poorest peoples of the world vulnerable to infection, illness and death. In other words, “learning to live with COVID” doesn’t mean the same thing in the United States or Europe as it does in Africa or South Asia. Universal vaccination is a deeply practical measure, but it might also create an opportunity to forge a renewed awareness of our common humanity. In 2014, Eula Biss presciently wrote about the wisdom of universalism: “However we choose to think of the social body, we are each other’s environment. Immunity is a shared space—a garden we tend together.” Eula Biss. On Immunity: An Inoculation. Minneapolis: Gray Wolf Press, 2014.

[2] This common-sense view is probably less common among those individuals and groups who have been directly or indirectly affected by HIV/AIDS over the last four decades.

[4] See “What we now know about how to fight the delta variant of COVID”, available at https://www.tampabay.com/opinion/2021/08/10/what-we-now-know-about-how-to-fight-the-delta-variant-of-covid-column/.

[5] Zeynep Tufecki, “The Unvaccinated May Not Be Who You Think” at https://www.nytimes.com/2021/10/15/opinion/covid-vaccines-unvaccinated.html.

[6] Data on race/ethnicity is self-reported and some individuals choose none.

[7] Annupam B. Jena and Christopher M.Worsham, “Facts Alone Aren’t Going to Win Over the Unvaccinated. This Might” at https://www.nytimes.com/2021/12/21/opinion/vaccine-hesitancy-covid-omicron.html.

[8]  This would probably be of special importance when it comes to the vaccination of children. Vaccination rates for kids, at least in the US, remain very low and the issue demands more serious attention than it has received. The worries of parents have a special place in any list of worries. We have six grandchildren—two of whom have received three vaccine doses and four younger ones who have received two so we have seen the situation unfold up close.  I know that the last thing in the world that parents want was for some “know-it-all” to tell them what to do. Any efforts to engage hesitant parents need to be carefully crafted and thoughtfully conducted.

[9] Another variant of vaccine resistance is what I’d describe as self-serving opposition to vaccines.  This is typified by the snake oil salesman, Gary Null, and the children’s health “advocate”, Robert F. Kennedy, Jr.  Gary Null is a prominent radio broadcaster who emphasizes weird theories of disease causation and even weirder theories of cures. Robert F. Kennedy, Jr. is an environmental lawyer who went off the deep end some time ago and became a leading anti-vaxxer. It’s hard to overestimate the damage they’ve done.

[10] See, for example, the report from the Institute for Research and Education on Human Rights at https://www.irehr.org/reports/facebook-and-covid-denial/. The anti-vaccination movement in various European countries has a quite different political character—with left-wing forces playing a more or less significant role.  See, for example, “The Denial of Reality and the Reality of Denial”, available at https://curedquailjournal.wordpress.com/2021/12/09/the-reality-of-denial-and-the-denial-of-reality/.

[11] See “A COVID Vaccine for All”, available at https://www.scientificamerican.com/article/a-covid-vaccine-for-all/.

[12]  For ACT UP, see Michael Spector, “How ACT UP Changed America,” available at https://www.newyorker.com/magazine/2021/06/14/how-act-up-changed-america. For the Treatment Action Campaign, see Mark Heywood, “South Africa’s Treatment Action Campaign: Combining Law and Social Mobilization to Realize the Right to Health,” available at https://academic.oup.com/jhrp/article/1/1/14/2188684.