Revisiting the Sociology Phase and Why People Not Getting Vaccinated Isn’t as Surprising as You Might Think
We have discussed the 3 phases of exiting the acute phase of COVID extensively noting it would require a scientific breakthrough, followed by a supply chain breakthrough, and finally a sociology breakthrough.
We entered the sociology phase in April 2021 when vaccines became widely available and wrote about entering that phase back then. When I went back to re-read that post, now 3 months later, a notable graph from the New York Times projected that 70% of adults would be vaccinated by June 12th and 90% by July 18th.
Unfortunately, we haven’t come anywhere close to that projection with only 59.7% of American adults fully vaccinated as of July 22nd.
In the past few weeks since Delta started dominating headlines, I’ve gotten far more questions about vaccine hesitancy than scientific/medical questions. “Do people just want to die?” or “Why would anyone who wants to live not get vaccinated?” seeming to come in on an almost daily basis.
And while I’m disappointed, we haven’t hit the 90% threshold that was predicted 3 months ago, I am not completely surprised that we missed the mark.
Why is that?
People taking actions incongruent with maximizing their health is not new.
I can appreciate how for those of you who have not taken care of patients may not understand how someone could take an action, such as not getting vaccinated, that knowingly puts their health at extreme risk of harm and potentially death.
But for those of us in the patient care space, this is just another day at the office. Patients routinely take actions that may not maximize their health and longevity. A patient with lung disease continuing to smoke, a patient with diabetes continuing to drink sugary drinks, riding bicycles or scooters without helmets, the patient with two coronary stents still eating red meat daily and not taking their prescribed medications, not wearing sunscreen and on, and on, and on.
People doing things that could jeopardize their health despite being aware of the risks happens every day.
Why does this happen?
It’s a multi-factorial issue that has plagued medicine and public health since the beginning of time but some lessons learned from my own personal experience as both a doctor and a patient include:
No One Thinks the Bad Outcome Will Happen to Them
It’s human nature to think that bad things only happen to other people. There are people I’ve spoken with about the vaccine who say they’re just not concerned the bad outcomes such as hospitalization or death will happen to them because they ‘don’t get sick’ or they’re ‘very healthy.’ Further, if the action they need to take interferes with their daily life and is inconvenient such as having to go get two shots and potentially feeling bad for a few days after each of them, it’s not as surprising that some people will continue to think ‘the bad stuff I read about on the news doesn’t happen to people like me.’
Beyond COVID-19, we see sad situations where something was ‘preventable’ before the catastrophic event occurs ALL THE TIME. A patient presenting with new colon cancer who never took the time to get a colonoscopy despite the recommendation from their doctor, a diabetic now having to have a foot amputated because their blood sugars remained uncontrolled, a person presenting with a stroke after having unmanaged high blood pressure for the past 15 years, and on, and on, and on.
Our healthcare system, for all its strengths, has always been lacking in the preventative care space (more on this in future blogs), and today we continue to see a system and a society that frequently devalues preventative action.
When a ‘preventable’ event sadly materializes, I can’t think of one time where the patient said ‘I knew the bad outcome would happen to me.’ Rather, they almost always say “Gosh I wish I took that medication, or got that colonoscopy, etc, before it was too late.’
The same sentiments are likely being echoed in many ICUs across the country where unvaccinated patients are critically ill.
It is not lost on me that COVID-19 (as compared to diabetes or coronary artery disease) is a transmissible illness that affects others and the community as opposed to the individual alone, however, the principle above still applies in my opinion of why we’re seeing folks bypass the vaccine.
If You’re Frustrated / Angered By This, It Is Orders of Magnitude More Frustrating When You’re the Doctor/Nurse/Etc Caring For These Patients
By now you’ve probably seen sentiments in the news or on Twitter of doctors, nurses, and other care providers venting their frustration, particularly in areas where hospitals are filling up again. I sigh every time I see these knowing how taxing it is taking care of a hospital unit / ICU full of COVID-19 patients.
Many of these healthcare workers have been doing this for months on end and while we all feel the effects of others actions, no one feels the brunt of the unvaccinated more than the front line folks who are working tirelessly to heal them.
I continue to worry about the long-term effects of the pandemic on the physician and nursing workforce and the levels of burnout and exiting the workforce we may see in the next few years.
The Messenger Matters More Than the Message
Humans are tribal. We only listen to people or groups we trust. If someone doesn’t trust us, we’re wasting our time trying to influence their opinion.
In medicine, we often fail at this. We think because we are doctors or are world experts in a field that someone will listen to us. For certain people, an academic degree and scientific accomplishments will influence them, but in many exam rooms and at the bedside in many hospitals, this strategy fails.
However, the same words said by someone else such as a family member, a friend, a politician, a journalist, a TV personality or a respected community voice can actually lead someone to change their behavior. It has been encouraging to see the increasing widespread positivity from all sectors to get vaccinated, but every time a respected voice doubts the vaccine or encourages folks to hold out, the fight becomes that much more difficult.
In summary, if we don’t have the right messenger, the message is irrelevant.
Emotion wins over facts.
Any good sales person will tell you this. People buy off emotion more than facts most of the time. And, take it from someone who has sat in an exam room and at the hospital bedside begging someone to stop eating so much salt, or cut back on alcohol intake, or take their life-saving medications at home knowing that not doing these things will almost certainly land them back in a hospital or even kill them.
One strategy that has failed over and over is reciting facts, statistics, and odds ratios on a person’s risk of death or bodily harm. They are valuable in scientific journals and abstracts, but only occasionally lead to behavior change at the individual level.
Put more bluntly, more ‘patient education’ is not a viable solution.
Yes, there are misinformation campaigns (which relates back to the point above of where your trusted source of truth lies), but few people are passing on the vaccine because they didn’t know a vaccine existed at this point. They just trust someone else’s narrative more than the people who are saying to get vaccinated.
Rather, many patients respond far more favorably to emotion and connecting how their actions take them away from what matters to them. Instead of quoting facts, we need more stories. We need people that were previously hesitant to talk to their friends about why they changed their minds and get those stories out there. My suspicion is some people have changed their mind based on seeing others they trust getting the vaccine or seeing someone they know become quite ill from COVID-19. We need to amplify those voices and messages.
Americans love choice and hate being told what to do.
Whether it be related to healthcare or any other aspect of our lives, Americans love choice. We see this play out in all aspects of our lives, and I see it frequently in other aspects of healthcare, particularly around patients wanting to pick their own doctors and hospitals. Americans are willing to spend significantly more money on an insurance plan to ensure they have a wide network of physicians as opposed to a narrow network and being told they can only see this doctor or go to that hospital (more on this in a future blog).
Changing people’s opinions, views, and ultimately converting this into taking an action such as getting vaccinated is hard, slow work. And, sometimes people may just be willing to die over the choice of not getting vaccinated.
Erik Frederick, a hospital leader in Springfield, Missouri, summed it up best in a recent Modern Healthcare article:
“We try to convince people, but it is almost like you are talking a different language," he lamented. “There is no way they are going to get a vaccine. Their personal freedom is more important."
He is right.
Sometimes people will risk death over caving to what ‘others’ tell them to do.
I guess, in hindsight, none of this is new. Patrick Henry said it best back in 1775, ‘Give me liberty or give me death,’ and now slightly amended 246 years the same theme applies to what we’re seeing with many vaccine holdouts, ‘Give me liberty and/or give me death.’
Stay safe,
Harry