"You’re not going to get COVID if you have these vaccinations.
"If you’re vaccinated, you’re not going to be hospitalized, you’re not going to be in the ICU unit, and you’re not going to die." - Joe Biden
First off, I am not vaccinated now and the reason is that I have always intended to be vaccinated sometime in the future. Under the ancien regime I traveled for work—I have over a million miles on one domestic airline and tens of thousands, maybe hundreds of thousands, of additional miles scattered across a half dozen of its competitors. Like everyone else I assumed that there was at least the possibility of a return to normalcy, at least briefly, with the advent of the vaccines. For me that would entail a return to a schedule of flying every week and hence I devised my Cunning Plan:
Since my risk is low (I work from home and venture out only a few times a week to run errands or possibly see friends, I am not in a high risk group by virtue of age and BMI, etc.) a vaccine will do me less good now versus when I take to the skies again. Even a year ago there were rumblings about waning immunity and at that time there was zero discussion of boosters. “Aha,” I thought then, “Since decreasing natural resistance over time is a danger doesn’t it make sense to just hold off until I start flying 100,000 miles a year again? Right now the number of people I see in a week is a tiny fraction of the the people I used to come into close contact with at the airport, on the plane, in the taxi/car service/Uber/Lyft/subway, at the hotel, at the restaurants where I eat my meals every day, etc.. My need for protection right now in my home office is negligible compared to the risk I will be facing then. I’ll get the shot right before I start traveling again and hopefully by the time my immunity has faded I’ll be through the winter and into spring when the virus is less of a threat anyway.”
Then Delta arrived, Albert Bourla started talking about the need for new vaccines targeted at specific variants and I patted myself on the back. “Aha,” I thought to myself again, “If I had gotten that vaccination early that may have prohibited me from getting one that is specifically Delta resistant. Given how much worse Delta is than the original strain it’s a good thing that I waited.” Keep in mind that when I first came up with this plan that boosters were yet to be imagined and when Delta first arrived the idea of mixing and matching vaccines was also not yet born.
But then of course a program of boosters was announced. And there is still no Delta specific vaccine, much less one targeted at Omicron. I like to think that based on the knowledge I had at the time, with no ability to read the future, that I made a pretty rational decision at every step in the process. (Plus I ran the whole thing by the respiratory therapist I see at the dog park and he thought it was solid.) But the end result is that I am still not vaccinated. Yet I don’t think my personal circumstances are particularly complicated compared to what everyone else has to deal with and that’s the problem—it’s still pretty complicated. And complex realities defy simple solutions.
Look at the variables involved: the seasonality of the virus, waning immunity, a booster schedule, new variants, the relative ease/difficulty of getting vaccinated against new variants, my personal risk from the nature of my work plus my age and weight, and on and on. The consider how little we actually know about those variables. Are we going to get Delta and Omicron specific vaccines? How long do I have to wait between shots to get a booster or a new Delta/Omicron specific vaccine? How long is the wait going to be while the high risk groups get their vaccines first?
Keep in mind that I am not vaccine hesitant. My plan has always been to get vaccinated. But given the number of people I come into close contact with when I travel I think I have every right to try to maximize my benefit from that vaccine. And if I want that right for myself who I am to deny it anybody else?
Fortunately I have an alternative solution apart from vaccines for protecting myself. With the advent of Delta my return to my old schedule was delayed, and delayed, and delayed some more. I still work from home, venturing out occasionally for groceries or to visit the dog park. If I have been exposed I’m not aware of it. One of the other tools in the pandemic management toolbox—social isolation—is keeping me safe.
That’s the point. The old saw is that for the man with a hammer everything is a nail. It’s understandable why the powers that be would fall in love with the idea of a vaccine as the consummate solution for the pandemic. Lockdowns have wreaked havoc on the national economy. Even something as insignificant as masking is a fraught exercise: apart from the political symbolism masks have come to hold their mere presence serves as a visual reminder that the pandemic is still with us and that maybe it would be better to watch a movie at home rather than in a theater this weekend. The promise of the vaccine is that it addresses the pandemic without inflicting further economic pain. The failure occurs when the illusion is so beguiling that people cleave to it even as reality intrudes.
For the vaccines to really work in the way that Joe Biden hopes requires two preconditions:
Long lasting immunity
A virus that mutates slowly
Neither point is particularly descriptive of Covid to the same degree that they apply to something like measles, for example. Longer lasting T-cell immunity is currently poorly understood and it is completely obvious now that Omicron is largely vaccine escaping with respect to the current batch of vaccines. The news that at least with the Pfizer regimen that a third shot seems to be effective is really not that useful. For the unvaccinated crowd, such as myself, the idea is…what? Get a first shot, wait a month, get a second shot, and wait…how long? Six months? By that time the variant of the day will be Tau or Omega. Even for the currently vaccinated what should they do if their last shot was just a month or two ago? Skip the remaining four months and get the booster regardless? Because making it up as you go was not the way that society devised vaccine regimens in the before times. Or what if their booster was months ago? Do they need yet another booster? And how long after their last booster should they wait to get the next booster for Tau?
But if vaccines are less than complete protection here does that mean that the world is helpless? Of course not. There are plenty of other tools in the pandemic fighting toolbox but an exclusive focus on vaccines as the one true way has led to those other tools being thrown by the road side. How else to explain the spectacle of Jen Psaki pooh-poohing widespread rapid testing? And there is nary a mention of contact tracing anymore.
I wrote that vaccines represent a beguiling illusion. For the White House that illusion was the idea that the pandemic could be managed without inflicting further economic damage on the country, a potent lure given Biden’s current struggles in the polls. But for a wider audience vaccines held out the promise of an easy return to normalcy, one where the virus could be defeated without additional pain and sacrifice on the part of society at large. More to the point vaccines offer the illusion of control. The consensus of epidemiologists is that the course of the virus will proceed to endemicity but it is hard not to look at some of the rhetoric being hurled at the vaccine hesitant and wonder if at least some part of the population is hoping for eradication instead ala small pox. The idea of humanity playing whack-a-mole over the next few years as new variant after variant emerges is not a comfortable one. But surely clinging to a comfortable lie in the face of an uncomfortable reality is not a viable option.