January 23, 2022

Acqua NYC

Fit And Go Forward

Opinion | The vaccine scientists got the job done. Now the messengers need to do theirs.

“They did it,” I told her, and to my surprise, my voice broke and my eyes teared up. “They voted to give us the vaccine.”

Sorry for getting maudlin, but as you well know, it has been a long nine months.

The FDA duly followed suit over the weekend and authorized the vaccine for emergency use, which means it’s time to start preparing ourselves for the reality of a vaccine. It’s going to be amazing — but also, it’s going to be unpleasant. The unpleasantness is how we get to the amazing part. But if we’re not ready for it, it could instead derail us.

As my colleague Leana S. Wen has explained, the side effects of these vaccines can be considerable; many people will feel pretty sick for a day or two. That’s actually a good sign, because those side effects are your immune system running practice exercises against the dummy viral proteins. When the enemy actually shows up, your highly trained warrior cells will be ready to go all William Tecumseh Sherman on the virus.

But if the public isn’t prepared for the rigors of this training, panicked stories will circulate about the vaccines making healthy people sick. We got a foretaste of this when Britain announced that a couple of health-care workers had allergic reactions during the first round of shots, and social media lit up — even though allergic reactions to vaccines are not uncommon, Pfizer/BioNTech had indicated the small-but-significant risk in their application, and both incidents involved people who already carried EpiPens because of a history of allergies. Moreover, both people were quickly treated and, when last reported, were recovering well.

Another risk is simply statistical: Even if we were just giving millions of people a harmless shot of pure saline, some number of them would die of heart attacks or strokes or suicide or cancer a short time after their “inoculation.” Inevitably, some of their loved ones will conclude post hoc ergo propter hoc — the shot preceded the death, therefore the shot must have caused the death — and take to social media to rail against the vaccines.

Wen sensibly suggests that we need to combat this with better education. What worries me is that we’re not already doing this in the sustained way we need to build public trust in the vaccine. And more importantly, to maintain it after we start injecting people and the downsides become apparent.

We should already have heard about these risks so often that we’re bored of the discussion. When nurses start to give the warning, people should cut them off — “I know, I know, flu-like symptoms, allergic reactions, don’t freak out.” People who are bored with hearing it from public officials and journalists will be equally bored by overexcited rumors spreading on social media. But three things stand in the way of getting that message across as cleanly as we need to — or rather, three groups of people.

Public health officials have too often taken a “Mama knows best” approach that sometimes involves the strategic omission of salient facts. The early warnings against using masks (which were needed for front-line health-care workers) are, of course, the most famous example, though the World Health Organization’s “travel bans don’t work” edict deserves an honorable mention. The attitude behind both remains prevalent, and I’m worried experts will once again give into the temptation to manage public perceptions by downplaying the side effects. This might well backfire as disastrously as their earlier attempts at N-dimensional psychological chess.

Politicians, meanwhile, would very much like to tell you about the fantastic, lifesaving vaccine being handed out. They’d rather not dwell on how miserable these vaccines might make you feel for a day or two. So I’m worried that they’ll undersell the downsides and that dissatisfied customers will take their revenge.

Then there’s my own profession, which could do an immense public service, if we were willing to ignore the incessant demands of our audience for novelty, and just keep hammering the same points home over and over. There would be no reward for this sacrifice, except the quiet satisfaction of a job well done. No one is ever going to thank us for boring them.

I wish I could say that I am confident we’ll all do the right thing, but after the past year, my confidence in American institutions is at a pretty low ebb. On the other hand, after last week, I’ve at least remembered how to hope.

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