Getting things back to "normal" is probably just a shot away, so why are so many people hesitant to get one?
Worth a Shot
We are used to "band aid" medicine these days – the idea that, if we get a "boo boo", be it a scrape or a fractured femur, there is a single item or procedure we can get that will ultimately make things right again, even if it takes some time. In the world of infectious disease, that "band aid" takes the form of vaccines: get a shot in your arm every few years, and now you're "invincible". This, of course, is not really true – how often do we hear from our friends and colleagues that someone got the flu shot and then still got the flu? – and only one vaccination campaign in history has ever lead to the total eradication of the disease in question (smallpox). The difference between those other times and now is the disease we're trying to vaccinate against is, on the whole, more dangerous and deadly than any others that we've faced at a global scale in the last 100 years. In the light of this ongoing coronavirus pandemic, the usual caveats about the efficacy of vaccines sound a lot worse.
By and large, the past 12 months have seen more people learning about immunology, clinical trials, and healthcare logistics than at any other point in history. The problem is, this learning largely came in bits and pieces, fits and spurts, resulting in an incomplete, and sometimes inaccurate, picture of what was happening on the ground in the minds of non-scientists. As a result, upwards of 30% of healthcare workers were refusing the vaccine at the start of this year and around one-third of military members were as well (typically one of the most inoculated groups of people in the world). These people are anti-vaxxers, or disbelievers in modern medicine; their objections sound rooted in science and healthy skepticism, exactly what we'd typically like to see more of from non-scientists.
Vaccine alarmism, as the New York Times calls it, and the thinking behind it tends to go something like this:
"The coronavirus vaccines aren’t 100 percent effective. Vaccinated people may still be contagious. And the virus variants may make everything worse. So don’t change your behavior even if you get a shot."
This is all true, technically, but it is also a major case of "well, when you say it that way...". Essentially, the sentiment is that if vaccines won't take us back to normal, as was originally promised, than why get a vaccine at all?
The fact of the matter is, vaccines will get us back to normal, we just had the wrong idea of what "normal" looked like pre-coronavirus. We might think all of medicine is just "band aids" with various levels of sophistication, but that's almost never how it actually works. Drugs alleviate symptoms but rarely address the root cause of a disease, the broken bone held in place by a cast will never really have the same mechanical properties once it heals, and the human race is batting something like .0001 when it comes to the eradication of diseases. Despite a pretty lackluster performance when it comes to biomedical innovations, the human race has functioned more or less "normally" for the vast majority of human history. The same will be true following this coronavirus pandemic, so long as people come to the understanding that medicine isn't about hitting home runs, it's about hitting singles and doubles – steady, reliable, incremental progress towards victory. I have been fully vaccinated for over a month, and I'm still wearing a mask on the train and in the store, and I'm sorry to say that when you get vaccinated you probably will be, too. Once we're able to mitigate this disease as well as we've mitigated all the others, though, we'll have the chance to go back to social interactions as we knew them.
There's another, more nuanced, piece of this vaccine alarmism I also want to hit upon: efficacy, specifically efficacy in the eyes of the FDA. To scientists, it's obvious you can't test for every indication in a clinical trial, but to many laypeople it's clear those omissions of trial endpoints comes across more like product features that will never be included.
When these vaccines got emergency use authorization from the FDA, they did so under a very specific set of circumstances and with clinical trial results that told a very specific story. This isn't because the metrics reported in the clinical trial were the only things these vaccines were good at doing, it's because these were the easiest things to document, with the cleanest signal-to-noise ratio. Whenever you get FDA approval, you get it for something in particular – the drug or device in question has to be good at something in a very documentable way. That drug or device may also be good at a lot of other things, but you can only go to the FDA with one thing at a time. This is why spironolactone treats both heart failure and acne, and why a catheter meant for heart surgery can also be used for brain surgery.
In the case of coronavirus vaccines, the performance indicator easiest to document is whether or not someone gets a severe infection and/or dies from the disease. This doesn't mean the vaccines don't also protect against mild infections or disease transmission, it just means that data wasn't part of the package Pfizer, Moderna, or J&J submitted to the FDA to get approval. When all we pay attention to is the data package that got submitted to the FDA for approval, we miss all the other data that may not have as strong a signal-to-noise ratio, but tells an equally important story. The story this data is telling about the coronavirus vaccines is that they do reduce the risk that you'll catch the disease overall, and they even seem to reduce the risk of spreading the disease. Vaccines against SARS-CoV-2 don't seem to just keep people from dying, they seem to also allow society to return to its normal modes of interaction. The "seeing is believing" skepticism of science is something we usually wish more people had, but in this case it would probably be better if everyone had just trusted the real-world data we're now gathering was there from the start.
None of this means 100% efficacy, though, but we've never been able to (or needed to) achieve 100% efficacy in medicine anyway – there's always going to be risk, and the key is ensuring our world is constructed in such a way as to mitigate that risk. If believing that things won't go back to normal once you get a vaccine keeps you from getting the vaccine, then all you've done is construct a self-fulfilling prophecy. Maybe the "normal" we go back to won't even look exactly like the one we left behind – that's not necessarily a bad thing. We'll never get to see what post-coronavirus "normal" looks like, though, unless we all roll up our sleeves and give these vaccines a shot.