Vaccines, Guilt, and the Burden of the Individual in a Crisis

“Confess your passion, your secret fear/Prepare to meet the challenge of the new frontier” — Donald Fagen

I got vaccinated last weekend, in a process that took me completely by surprise. My mom, a lifelong smoker just under the age threshold in Minnesota, had gotten called in for a leftover dose last week. This stroke of luck put the idea in me and my sister’s head that maybe we could do the same. None of the pharmacies in my area had lists, but there was a Duane Reade down the street from where my sister lives in Bushwick that had one, so she and her boyfriend put themselves on it. I got a text on Sunday morning saying they had been called in, and then another one saying I should call because the doses expire at noon and there was nobody else on the list. Ten minutes later I was in a Lyft with my girlfriend to go get jabbed.

What struck me as I sat in the car was that in addition to feeling excited, I felt… guilty. Like I had done something wrong by getting vaccinated instead of, I don’t know, calling the zero elderly people I know in Brooklyn and offering it to them, not certain if anyone would even be able to get there in an hour like we could. This guilt got worse when we got interrupted in line by an old woman who was unable to walk unassisted and told us that she was here before us but couldn’t move from one side of the store to the other. We told her to go ahead of us, obviously, but what if there were others like her who could use it more than us? The reality was that they wouldn’t have been able to get there, and that we got it because the options were either for us to get the jab, or that it would expire. Plus, Gov. Cuomo’s Use It or Lose It rule meant that if this pharmacy didn’t get the jabs in arms, they would be ineligible for future shipments.

This was enough to make me feel better, but after I posted about us getting the doses, an incredible thing happened — people started reaching out to me about their own vaccine guilt. In a very short time it became apparent that even among people who had state-sanctioned reasons to get a jab, there was a tremendous guilt that they somehow weren’t worthy of it. One stranger told me that they weren’t planning on getting their second dose because of how guilty the first dose had made them feel, another faced the judgement of their peers for getting a dose. Issues that people had struggled with privately were tapped and flowed freely, making me believe this was an all-too-common occurrence, and the more I thought about it, the more this anxiety about receiving a small miracle made its own twisted sense.

Since it began almost a year ago, the burden of the pandemic in America has been thrust almost entirely on the individual. It was on all of us to understand the confusing and conflicting public health guidance, to weigh what we are able to do because the government is allowing it versus what we should be doing, and these things were frequently in conflict. The CDC warned everyone to maintain social distancing while state governments opened indoor dining. We were told that we had to stay home, but millions of people had to go to work to stay in their homes. Survival in the biggest crisis any of us had ever experienced felt a lot like trying to use a life preserver with instructions in a mix of English and Polish, which was upsetting enough.

What made it significantly worse was that there were a lot of people who would judge you Online if you didn’t read the Polish correctly, despite not being able to read Polish either. People were shamed repeatedly for meeting outdoors with masks on, something we know now is a relatively safe activity. I remember people telling me that it wasn’t safe for me to be running because of a particle simulation that misunderstood aerosol exposure as infection. We’ve normalized this culture of shame because we felt abandoned by the people who were supposed to protect us and decided to turn our rage on each other for not sorting through the mountains of information in the right way, and it persists to this day. The assumption among most people seems to be that getting COVID is a failing of the individual, that you’re to blame for putting yourself into a situation where you could get it.

A similar reasoning extends to vaccines, and it’s one that is directly endorsed by the state. States determine eligibility for vaccines, which has to be done because they’re still a very scarce resource (although that scarcity is quickly changing) and the only way to prevent problems with distribution is to gate-keep the supply. The criteria for access vary wildly from state to state, Connecticut is doing it entirely by age for example, but most states are in the business of deciding based on an individual’s worth to society. Essential workers and those whose age or health issues are deemed sufficient get access, while most are kept out.

I’m not here to argue that the state shouldn’t be acting as a gatekeeper, because it absolutely should be because of the scarcity, but I would like to point out that because we can only view the pandemic through the lens of individuals, this gatekeeping acts as a de facto decision that certain groups contain individuals who are worthy of a vaccine, and that others are not. What’s more, because we’ve lived with untrustworthy governments and a culture of scarcity and shame, there are a lot of people out there who don’t think they’re actually worthy despite legally qualifying, thinking that their lack of worthiness means someone more worthy won’t get the vaccine they need and deserve.

Medical ethicists disagree with this. In the New York Times in January, Melinda Wenner Moyer wrote:

…it’s entirely possible that the vaccination you decline will be given to someone at lower risk than you. Worse, it could get thrown away if it’s not injected into someone’s arm before it goes bad. Discarded doses do no one any good — which is why, after a freezer broke in a Northern California hospital, administrators violated state guidelines and offered the shots to everyone they could, regardless of eligibility.

So the belief that turning down a vaccination or waiting to get it will somehow benefit society — “I think it is just outright false,” Dr. Ferguson said. There’s a “delusion of moral purity and keeping one’s hands clean that’s at work when people are tempted to do that.”

If you turn down a vaccination based on the belief that you’re not particularly high risk, you might also be fooling yourself. It’s difficult for people to accurately measure their own risk level; research has shown that people underestimate their risk in all kinds of situations. These optimistic biases, as they are called, often lead people to perceive, wrongly, that public health campaigns are more relevant to others than to themselves.

The reality is that the most important thing you can do is get a jab if it’s offered to you, but people aren’t and it means that we as a nation need to shift the way we think about this pandemic.

A pandemic is definitionally a public health issue, which is to say that it’s an issue with the health of the public as a whole. Conceiving of it as an aggregate of individual actions and problems leads to people missing the point; it’s about everyone collectively. Americans have traditionally been bad at conceiving of anything as a collective action, and we’ve really swung and missed with this one. Take our mask usage as an example — the point of wearing a mask isn’t to protect yourself from the virus, it’s to protect other people from you if you happen to be sick. And yet the refrain from people who can’t see past themselves is that “I accept the risks of COVID, so I don’t want to wear one”. Good for you dummy, put one on to protect everyone else.

We’re seeing a similar thing with vaccines, which is people not thinking beyond themselves because we’re all wired to do that by default. If you ask why people should get the vaccine, the default answer is “so they can protect themselves from COVID”, and if you look at who’s sanctioned by the state to get vaccinated, that’s a reasonable assumption to make. However, this misses out on a lot of the impact of vaccines and helps drive people who should be getting them away. It’s not just to protect you, it’s to keep you from getting the old guy behind you in the grocery store line sick because you don’t know you’re an asymptomatic carrier. If you aren’t sure if your pre-existing condition is serious enough, just ask yourself if you’d like to run the risk of ending up in a hospital bed that someone else desperately needs. You may think its a slim chance, but eliminating that slim chance improves health outcomes for everyone. You aren’t just one person getting a jab, you’re breaking the chain of transmission and freeing up the scarce health resources that you might take someday.

We’re in uncharted territory now, but in the good way. We don’t know how quickly things are going to get back to normal, but we’re working toward it. Every needle that goes into a shoulder inches us closer, and if you got one you shouldn’t be ashamed, you’re helping out everyone. Not every decision has to be perfect, just good enough.