Sue Lani Madsen: To vaccinate or not to vaccinate

“To be, or not to be, that is the question: Whether ’tis nobler in the mind to suffer The slings and arrows of outrageous fortune, Or to take arms against a sea of troubles, And by opposing end them.” -Hamlet, Act 3 Scene 1

To vaccinate or not to vaccinate, that is the question. Where and when is the focus for those eager to receive one of the COVID-19 vaccines. What and why are the questions for the vaccine hesitant.

Enthusiasm and hesitancy are split along familiar fault lines, according to the KFF COVID-19 Vaccine Monitor project surveying public attitudes. Urban populations are more eager than rural. Black Americans are more hesitant than other racial groups. Democrats are more enthusiastic than Republicans.

But groups don’t make decisions, individuals will weigh the risks, benefits and ethical questions. The vaccine eager just need appointments, but the vaccine hesitant need information.

According to the Washington Department of Health’s COVID-19 Vaccine Planning Team, “fears are exacerbated by a perceived lack of transparency, lingering questions.” Its December 2020 community engagement report says those surveyed emphasized a desire to understand the science and a belief that DOH was the right place to go for information explained for the non-scientist.

Unfortunately, the WA DOH website takes a narrow view of what questions are worth answering and what information is useful.

Vaccine hesitancy for many hinges on the question of fetal cell use in the development or manufacture. Asking the WA DOH website “does COVID-19 vaccine contain fetal cells” turns up a brief reference buried in a Health Care Provider Discussion Guide focused on how to convince hesitant patients to take the shot. If questioned on ingredients, the provider is told to point out rumors on social media are “generally myths” followed by a short list of what’s not included.

It’s the opposite of transparent. While it’s true the Moderna and Pfizer vaccines do not contain fetal materials, it’s an incomplete answer to a lingering question.

Other states handle it better. Idaho’s Dept. of Health and Welfare provides a concise one-page handout. North Dakota’s DOH answers the question directly in their public FAQ list, plus provides a detailed three-page brief aimed at the non-scientist.

The two-dose Moderna and Pfizer vaccines do not contain fetal material, although two pre-1973 fetal cell lines were used early in the research and development to test the concept. The one-shot Johnson & Johnson vaccine has a more complicated story. Source and use of fetal cell lines is provided in detail for all three. Bioethicists from both the Roman Catholic and the Southern Baptist faith traditions as well as the firmly pro-life Charlotte Lozier Institute have studied the specifics and concluded receiving these vaccines is morally acceptable, but North Dakota provides the science and the links for you to make your own decision.

Immunization has been controversial starting with George Washington’s mass inoculation campaign in 1777. Washington considered smallpox, which typically killed a quarter or more of its victims, as a “potentially greater threat than the Sword of the Enemy.” Immunization at that time meant deliberately infecting a new recruit with the pus scraped from the pox of a sick soldier in hopes the viral load would be enough to activate the immune system without overwhelming it.

Not that anyone had any idea in the 18th century of the existence of the immune system, viruses or viral load, but they knew the risks and observed the benefit. George Washington feared an early death like his father, and maintained a healthy lifestyle. Wellness is still a major factor in resisting COVID-19, but now we have another tool. Immunization has progressed from inoculation using smallpox pustules to vaccination using weakened viruses or dead viruses. Now the mRNA vaccines use no virus.

New vaccines carry unknown risks, but what do we know about the newest disease? Washington’s DOH dashboard shows a death rate of 1.5% of cases or 0.07% of total population. Washington’s hospitalizations as a percentage of total population are less than 0.3%. Almost everyone survives COVID-19, unlike the dreaded smallpox. The immediate risk is minimal and there are logical reasons 22% of Americans are still in the “wait and see” category as of the February KFF survey, down from 39% in December.

But while we don’t have data on the long-term impacts of the vaccines, we also lack long-term data on the impact of surviving a COVID-19 infection. We don’t know what we don’t know. For comparison, post-polio syndrome doesn’t show up until ten or more years after a patient has recovered.

And that’s why this has to be an individual decision, taking into account one’s own risk factors and risk tolerance, the bioethical considerations for you as an individual and for the community. I did my own risk/benefit calculation and chose vaccination. Now you do yours. North Dakota and Idaho have excellent resources for the independent thinker.

Contact Sue Lani Madsen at rulingpen@gmail.com.

Useful links:

KFF Vaccine Monitor: https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-february-2021/

George Washington and Smallpox: https://www.mountvernon.org/george-washington/health/

WA DOH Dashboard: https://www.doh.wa.gov/DataandStatisticalReports/HealthDataVisualization/MortalityDashboards/AllDeathsDashboard

WA DOH FAQ: https://www.doh.wa.gov/Emergencies/COVID19/VaccineInformation/SafetyandEffectiveness#panel62102

North Dakota FAQ: https://www.health.nd.gov/sites/www/files/documents/COVID%20Vaccine%20Page/COVID-19_Vaccine_FAQ_General_Public.pdf

Idaho HW: https://coronavirus.idaho.gov/wp-content/uploads/2021/03/Addressing-Questions-Regarding-COVID-19-Vaccine-and-Abortion-Derived-Cell-Lines-031121.pdf