The Next Phase Of The Pandemic: Discussing Medical Freedom Goes Mainstream

Though 2020 has been filled to the brim with challenges, we're starting to see a wave of optimism as we inch closer to the new year: With pharmaceutical companies and vaccine candidates Pfizer-BioNTech and Moderna nearing federal clearance (AstraZeneca, also promising, is still in Phase 3 trials1), there's a sliver of hope for an end to the COVID-19 pandemic.

With that optimism, though, many more challenges remain ahead. The 21 million health care workers and 3 million living in elderly care homes will be first in line to receive the vaccine, no doubt, but who comes after? Will certain employers require a vaccination? What about schools, airlines, or even concert venues? And what happens if you aren't sure about getting the vaccine when it is your time in line? 

As the distribution of a vaccine comes closer and closer to fruition, a growing number of people have expressed concern about whether or not to trust it should it become available. Needless to say, institutions and government agencies have not done a great job managing COVID, and people are hurting. As preventive cardiologist Ethan Weiss, M.D., notes, "We are at a critical point where trust in scientific institutions is at a low. It is everywhere." Perhaps that's why one study published in the journal Nature found that out of 13,426 people in 19 countries, 14% of participants would refuse a vaccine outright, with an additional 14% saying they would hesitate to take it2, demonstrating a "far-from-universal willingness to accept a vaccine for COVID-19." Another report from Harmony Healthcare IT found that out of 2,000 Americans surveyed, 14% said they would not get the vaccine, and according to another cross-sectional survey, approximately three in 10 adults were not sure they would accept the vaccine, and one in 10 did not intend to be vaccinated at all3. 

While these conversations were previously on the fringe, we're now dealing with and discussing the hesitancy in mainstream media. The term "vaccine hesitancy" has made its way into the COVID-19 lexicon, stemming from individuals of all backgrounds. "I'm hearing hesitancy even from groups I never thought I would hear hesitancy, like health care workers—people who are very pro-vaccine," says Purvi Parikh, M.D., an allergist and immunologist with Allergy & Asthma Network who is also a co-investigator with the COVID vaccine trials (both for Pfizer and AstraZeneca). "I don't think they're against getting it altogether; I think they're just worried about getting it right this moment." And health care workers aren't the only first responders to have hesitation: According to a recent internal survey, roughly 55% of FDNY firefighters said they would not get the vaccine. 

Parikh cites the speed of the clinical trials as the biggest point of concern: Because of the expedited process, people may be worried that crucial steps were haphazardly cut. It adds up: A survey conducted by a Gallup Panel found that of the reasons to choose not to be vaccinated against COVID-19, 37% of participants chose concerns about a rushed timeline as their main reason.

At this moment, accepting the COVID-19 vaccine or not is 100% your prerogative. We're not here to say whether you should or shouldn't get vaccinated—that's your own informed choice to make. Although, we should note that if you are hesitant enough to refuse the vaccine, it's possible you may become barred from certain services.

Take Australian airline, Qantas, for example: The company CEO recently stated that a vaccination will be required to fly for international visitors. Similarly, the idea of digital "immunity passports" has been circulating conversations in the U.K., where people could confirm certificates of immunity—verified using A.I. technology—to access workplaces, public buildings, airports, and more. The U.S. Department of Defense even released images of the first COVID-19 vaccination kits, which include a needle and syringe, alcohol wipes, a mask, as well as a "vaccination record card"—a written card individuals can slide into their wallets, documenting what vaccine they had and when their next dose is due. 

And travel won't be the only industry to weigh on these parameters. What about schools? Public events? Ticketmaster president Mark Yovich even told Billboard about the company's potential plan should a vaccine become available: After purchasing a ticket, fans would have to verify either vaccination status or whether they've tested negative for COVID-19 within 24 to 72 hours prior to attending the concert. They're only exploring such an idea, but it still raises the question: Even though getting a vaccine is up to your own free will, what potential consequences will you face should you refuse it? 

The answer is that there isn't one—at least right now. Yes, refusing a vaccine is your choice, but because your choice affects so many others' lives, you may lose certain privileges for the foreseeable future. What we can do now, though, is determine how to have conversations with people who are feeling hesitant in a way that doesn't feel degrading or holier-than-thou. People have valid concerns for vaccine hesitancy—that's OK! For myriad reasons: the warp speed, a history of medical mistrust within marginalized communities, medical freedom, and so on. For parts of the well-being community, in particular, though, a potentially mandated vaccine goes against what many individuals believe in—taking control of one's health by fortifying their immune system. 

These concerns won't be addressed overnight, of course, but preventive medicine specialist David Katz, M.D., says that verifying your immunity doesn't necessarily translate to vaccination (if you don't want it). "If you want to do X without a mask before date Y, you need evidence of immunity, either by means of antibody test or vaccine. That is quite reasonable and does not really impose vaccination on anyone," he tells mbg. "In other words, contextually specific mandates adopt a balance between public safety and personal autonomy." Meaning, you don't have to get a vaccine if you choose not to—you'll just have to verify your immunity in some other way, or you'll have to refrain from certain activities for the public good.

He also suggests approaching it from a risk-reward perspective: "Receiving a vaccine is higher risk than not receiving a vaccine because no medical procedure of any kind involves a risk of 'zero.' Neither, for that matter, does crossing the street!" he says. "What matters now for each individual is this: What is the lowest-risk, highest-benefit choice among the choices actually available? And how does that choice affect not just personal risk/benefit but also that same ratio for others in our network of loved ones and close contacts?" 

Realistically, the vaccine won't be rolled out immediately, either: As this New York Times interactive vaccine timeline shows, unless you fall within the older, at-risk population, have COVID-related health concerns, or work in a health care facility, you'll likely end up around 100 millionth in line. If you're at all concerned with the vaccine's effectiveness, you likely have some time before you're tasked with making a decision. And if you're at risk for severe COVID infection? Well, those consequences may outweigh any side effects from the vaccine itself. Take it from Katz: "COVID vaccines, though produced quickly, and even though we don't yet have long-term data, are overwhelmingly likely to be massively safer for most adults than taking chances with SARS-CoV-2." 

But if we continue to polarize the conversation, rest assured, we're not going to get anywhere. People are allowed to have doubts; they're allowed to have questions. At the end of the day, Parikh notes, "We need to look at it as a collective responsibility." Not to view it as side versus side but to carve a path forward with thoughtful, healthy discourse. Similarly, Weiss notes, "My personal approach is to refrain from telling people that there is one diet for all problems. Instead, I say that I hope we can all aspire to do rigorous and well-controlled clinical studies to help inform our future guidelines."