It’s hard to persuade someone if you don’t understand what they’re already thinking. There’s a strange debate going on in the media right now about whether the FDA/CDC’s “pause” on the Johnson & Johnson vaccine for COVID is likely to improve vaccine hesitancy or make it worse. As of now, there have been six serious blood clots among people who have had the shot, and one person has died. Proponents of the “pause” say that by confirming the safety of the vaccine, people will eventually feel more confident about it. Opponents say that this just adds ammunition to the anti-vaxxers stock.
As far as I can tell, people who think that this pause will increase vaccine confidence just don’t understand who they’re trying to persuade. Some media and academic types have observed that many anti-vaxxers right now are Trump voters, and this is true. But I don’t think I’ve seen much about what can be done to persuade them to get the shot. These are not typical anti-vaxxers; their objections are not necessarily about the safety of the vaccine. Rather, their objections are about the necessity and sufficiency of the vaccine.
Folks who work in public health are sort of by definition going to think differently than very populist libertarian types who think public health is at best meddlesome, and at worst a subtle (or not so subtle these days) means of illegitimate control. So consider this brief post an attempt to reconstruct the populist view, and then see if you think the pause will help convince these people to get vaccinated.
Because it’s necessary these days, let me pause <wink> and put some cards on the table. I think it is hard to conceive of any moral justification for the FDA/CDC’s decision. I grant that they have a reason to act as they did. But merely having “a reason” is not good enough. No moral theory or system that I can think of would justify this decision. (And yes, I do think I have the relevant expertise to say this.) I am also generally well-disposed toward public health efforts and good healthcare, and I think public health is a legitimate function of government. I am…not a fan of Trump.
For some data to support the following analysis, refer to this latest YouGov poll. (Yes I know it’s one poll; it’s just an illustration.) Yet most of my reconstruction below comes from actually talking to some of these people about this.
(Partial update: YouGov compared results from people who took the poll before the announcement vs those who took it after. There’s a big drop in confidence in J&J’s vaccine. I’d interested to see the demographics of the change. Even a question like “After hearing the CDC’s announcement, are you more or less confident in the safety of the vaccine?” I suspect Trump voters’ opinions aren’t the ones changing.)
These populist anti-vaxxers (PAVs) think that vaccines are unnecessary. They think that COVID in general has been overblown. The risk is no where near as high as the “liberals” in government have made it out to be. Most people who get COVID won’t get terribly sick, most sick people won’t infect anyone else, and the economic and social fallout from a year of tight restrictions will be far worse than the disease. (Note that these beliefs aren’t obviously false.) COVID has just become an excuse for the government to impose on citizens’ lives and to infringe on their liberties. (See poll question #6.)
The “pause” just boosts this belief. If the government were really worried about COVID, they would be doing everything possible to get shots in arms as fast as they can. But now they’re willing to stop giving one of the shots—the one that is the most convenient on several dimensions—possibly for a few weeks to assess the risks implied by one death.
If you’re disposed to think that this is really about government control, and that vaccines would end the pandemic and thus the political cover for that control, it is hard to see how the decision would do anything but strengthen your belief.
(Again, for clarity, I think these folks are wrong about the risks of COVID. And also unfair about the motivations of public health officials.)
PAVs also think vaccines are not sufficient. (Poll questions 22-24.) A decent number of Trump voters (and ideological conservatives) believe that it is not necessary to wear a mask right now. They also think that travel is safe. Some of these beliefs imply that the vaccines aren’t necessary. But it also shows that they think getting vaccinated won’t really change anything. The FDA, CDC, and other public health figures have not helped on this point. Refusing to describe an “end-game” to the pandemic has been a constant source of frustration to these folks. The goal posts keep moving. Remember “15 days to slow the spread”? Yeah.
So suppose that the CDC and FDA do the review, and determines that the vaccine really is safe still. Yay! (Does anyone really think that there will be a different result?) What has changed for the PAVs? Not much, it seems. They didn’t really doubt that the vaccine was safe. (See poll questions 11-19.) They just doubt that there’s any point in taking it, so what’s the rush? And look! The CDC agrees that there’s no rush!
The trouble throughout is that public health types believe that these anti-vaxxers don’t trust the vaccine. But that’s not right. They don’t trust the government, and especially the unelected federal bureaucracy.
So I think the “pause” will have little notable effect on populist hesitancy. (Though compare poll questions 14 and 18. It will be interesting to see how #18 changes in the next couple of weeks. And see this NY Times piece on the worldwide impact.) It won’t do anything to address their actual concerns. If anything, the pause will likely entrench their belief that their government really doesn’t have their interests in mind, and doesn’t really believe its own messaging. And honestly, I’m not sure how to show they’re wrong about that.