Affixing blame won’t fix the surge
Variant fueled by holdouts still a ‘collective problem’
The spiking infection rates and alarming climb in hospitalizations may feel familiar, but the deltafueled fourth wave of the coronavirus is unlike anything the United States has seen before as health officials scramble to contain the socalled “pandemic of the unvaccinated.”
In every part of the country, including California, infections are increasing rapidly among both the vaccinated and those not yet inoculated as the delta variant cements its foothold as the dominant strain. Yet the big picture obscures an important distinction: People who are not vaccinated are driving this surge — in some places being infected at rates five or six times higher than the vaccinated.
In Contra Costa County, more than 30 cases per 100,000 unvaccinated residents are being reported each day — the same rate as in early December, when the winter surge was just taking off, and six times the rate occurring among vaccinated people. California is reporting about 2 cases a day per 100,000 vaccinated residents, and 13 cases per 100,000 unvaccinated residents.
Rates among San Franciscans who aren’t vaccinated are nearly three times higher than among vaccinated residents, with the city’s overall cases approaching the peak of last summer’s surge, though hospitalizations remain much lower.
“Your choice to not get vaccinated ... comes at a real societal cost. We need to be more clear about that and we need to call that out,” said Gov. Gavin Newsom at a Monday news briefing, during which he announced that all state employees must prove that they’re vaccinated or undergo weekly testing.
“It’s a choice to live with this virus. And with all due respect, you don’t have a choice to go out and drink and drive and put everyone else’s lives at risk,” Newsom said. “That’s the equivalent of this moment with the deadliness and efficiency of the delta virus. You’re putting other people’s, innocent people’s, lives at risk.”
Drawing distinctions between the vaccinated and unvaccinated is key to helping people understand the importance of vaccination, especially with delta’s high level of transmissibility, health experts say. It becomes even more critical when looking at hospitalizations and deaths; people who are not vaccinated make up well over 90% of those cases, evidence of vaccines’ effectiveness at preventing serious illness.
But highlighting separate case rates is fueling a growing resentment toward the unvaccinated that may be counterproductive, other experts argue.
Blaming those who are not vaccinated for prolonging the pandemic is not necessarily going to convince people to get shots, said Dr. Rhea Boyd, a Palo Alto pediatrician who cofounded a national campaign to deliver vaccine information to Black and Latino communities. It may also keep some health officials from putting in place strategies like universal masking that would protect everyone.
“Blame is an incredibly ineffective public health strategy,” Boyd said. “When we separate out who needs to take those precautions (like masking and social distancing), it undermines the culture of protection that we need to be creating.”
People should approach the pandemic as a “collective effort,” said Dr. Abraar Karan, a Stanford infectious disease expert.
Separating vaccinated/ unvaccinated case rates and other data may provide useful information about how well the vaccines are performing, “but socially, you run the risk of dividing this into ‘my problem and someone else’s problem’ instead of a collective problem,” Karan said. “That’s where you see pushbacks against something like indoor masking. People say that’s not really my problem anymore.”
Boyd and others note that the unvaccinated are not a monolith, and the vast majority are not opposed to vaccines in general. Probably the largest contingent are children under age 12, for whom the vaccines have not yet been approved.
Also included are people with health problems who cannot be vaccinated.
Sometimes access to vaccines is still a problem — whether it’s transportation to a clinic or finding time between child care and a job. And among those who hesitate, the reasons are diverse and complex, Boyd said.
Many people are fearful of side effects, especially of potentially feeling so sick from the shots that they can’t work, Boyd said. Others have been given inaccurate information. To convince them the shots are safe and effective involves uprooting deeply embedded lies.
Newsom railed against the spread of misinformation in an unusually emotional rant Monday. He targeted conservative pundits for refusing to endorse vaccines or outright discouraging them. “We’re exhausted by the rightwing echo chamber that has been perpetuating misinformation around the vaccine and its efficacy and safety,” he said.
Dr. Robert Wachter, UCSF chief of medicine, said it can be difficult to maintain perspective — and patience — as to why people aren’t vaccinated. More assertive measures, such as vaccine mandates, may be necessary to reach them, he said.
“I’m feeling this odd mixture of exhaustion, sadness, discouragement and anger. And the anger is the most interesting one, because health care professionals, we don’t like feeling that way,” Wachter said. “But this disease is so clearly preventable. I think it’s natural to be pissed. But to a larger extent, it’s the overall political environment that’s creating this misinformation epidemic, and that part is tragic.”
Boyd said she hopes that vaccine holdouts can be gently coaxed to get the shots. Her concern is the time and patience needed — luxuries the delta variant quickly is taking away.
“People are carrying real fears (about the vaccines) and if we can lovingly attend to those real fears, people are movable,” Boyd said. “That gives me a lot of hope that we can move this needle. It’s just going to take more time.”