In June 2020, I wrote a short piece about the COVID vaccine that turned out to be prophetic. I said that the vaccine’s immunity might wane over time, that there might be bothersome side effects immediately, and that the public might ignore social distancing and mask-wearing once they were vaccinated. I worried that there would be political pressures to focus more on the economy than on public health.

And I wrote, “But wait, it could be worse. The coronavirus might mutate.” By June 2020, the coronavirus from Wuhan did, in fact, mutate as it spread across the globe. I also said that the virus could escape from whatever vaccine is finally developed, and then we will be in big trouble. That was my nightmare scenario, and that is where we are now with the Delta variant. Everything that I predicted has happened, but there was another nightmare that I did not anticipate.

In December 2020, I wrote that the success of Warp Speed is going to depend on the American public accepting the vaccine and believing that it is both safe and effective. I worried that people would refuse to be vaccinated. I take this personally, because I have a form of leukemia that prevents me from making antibodies. Despite my being fully vaccinated, I have no measurable antibodies against COVID. The vaccine deniers can kill me as well as killing all the other people who are immunosuppressed. And they can also kill one another and children too. That is what we are seeing in the ICUs in areas where there is vaccine hesitancy and refusal.

There are many factors that made it possible for vaccine refusal and hesitancy to occur. Since the 1980s, we have heard the slogan that “government is the problem.” When the government-funded Operation Warp Speed to develop the vaccine, people who do not trust the government automatically became suspicious. We have heard that professors are not to be trusted because they are liberals who are out of touch with society. When a professor of public health urges vaccination, s/he is doubted. When a renowned government scientist like Dr. Fauci warns that COVID is dangerous, he is vilified. When disadvantaged populations were advised to be vaccinated, the inequitable and poor medical care that they have experienced led them to distrust the advice. When the extremely rare side effect of anaphylaxis occurred, the stage was set for false information to invade social media. All these factors were amplified by scurrilous politicians who stoked doubt and mistrust for their own ends.

But wait, it could get worse. Everyone who is not vaccinated is a potential host who will facilitate a new variant. And there are billions of people around the globe who have not been vaccinated. Every one of them is also a potential host for the vaccine to mutate again. Coronaviruses have been mutating ever since the first human caught a cold. They can evolve to weaken the protective response gained from previous infections and from vaccines. That is why I think that we will be dealing with different variations of COVID for a long time. Therefore, we need to have a strategy for overcoming vaccine reluctance and refusal when boosters and new vaccines for new variants become necessary.

The first step is for trusted leaders to urge vaccination and public health measures vigorously and effectively. Every community leader, every health care professional, every scientist, every elected official, every pop star, and respected athlete should continue to speak out about vaccination and public health measures. But this approach has so far been insufficient to convince the reluctant and the refusers. My fantasy had been that Donald Trump could reverse the resistance to vaccination. It is not a coincidence that the states that voted for him are the states with the lowest vaccination rates. Unfortunately, after he said at a rally in Alabama, “I recommend: Take the vaccines. I did it – it’s good,” the crowd jeered. It demonstrated that the top-down strategy of leaders talking to the refusers, even by the leader most likely to be believed, does not change their beliefs.

My hope is that many things will happen. I hope there will be a gradual appreciation of the following: 1) vaccinations have worked; 2) vaccines for more than 150 million were safer than aspirin; 3) more refusers who know someone who is ill or who has died from COVID will be encouraged to be vaccinated; 4) friends and neighbors will talk to one another and help to modify the resistance; and finally; and, 5) as more refusers are infected, they will speak out about their illness to encourage vaccination. This is a person-to-person strategy, the opposite of the top-down strategy that has not worked. We still need to continue the top-down initiatives. The person-to-person strategy, while not dramatic, is what I think will work now.

David Galinsky is an internal medicine physician and emeritus staff, Lankenau Medical Center.

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