Since vaccines have become more accessible, Americans’ concern about serious illness from COVID-19 has fallen considerably. While some of the public takes comfort in the vaccine, around 24% of Americans say they will reject receiving the jab. Vaccine hesitancy has been discussed since the beginning of the pandemic even before COVID-19 vaccines were available, but the anti-vaccine movement has been alive for decades. Prior to the pandemic, vaccine hesitancy was already considered a top threat to global health by the World Health Organization. The COVID-19 vaccines have paved the way for a return to normalcy, but vaccine-hesitant individuals have sentiments that are worth trying to understand.

Although some people opt out of vaccination, now that the vaccine is available to the public, there is no longer a justification for the shaming of non-mask wearers as “grandma killers.” By now, grandmothers are likely vaccinated, or at least had the option of getting the vaccine earlier, and thankfully, hospitalizations and deaths for this age group have dropped considerably. Recently, the Center for Disease Control updated its guidelines to finally relieve vaccinated individuals from wearing masks. Currently, most people have access to the vaccine and can assess their own preference of risking infection or getting the vaccine.

Informed consent and personal risk assessments are crucial aspects of American health care. Contrary to what the bureaucratic government conveys, Americans are often capable of making decisions for themselves. For example, President Joe Biden chooses to wear a mask on a Zoom call, and this choice is just that: an example of his use of his freedom (however anti-science it might be for a vaccinated individual to need to wear a mask…on a Zoom call). 

Nonetheless, just as he has the right to get a vaccine and continue to wear a mask, Americans have a right to reject the vaccine based on their personal risk analysis and acknowledgement of others’ equal personal risk analysis in opting in or out of vaccination. In light of this, in Texas, where mask mandates have been lifted, there has not yet been a surge of cases, indicating personal choice for masks and vaccines is not an immediate threat to the health care system. 

Despite the new CDC guidance, wearing a mask is still being justified for the sake of modeling behavior for unvaccinated people or as a signal to avoid being labeled as conservative as mask-wearing has, to some degree, become a political signal rather than a public health strategy. However, according to current data, vaccinated individuals are not at risk from an unmasked and unvaccinated individual, and since most of those unvaccinated are choosing not to receive the vaccine, the burden of risking infection by not wearing a mask is their own choice. 

The “get vaccinated or wear a mask” rhetoric by the government is troubling and authoritarian in nature, and it implies that getting the vaccine is the only path to normalcy. Young people eligible for the vaccine, who are generally at a low risk of severe illness from COVID-19, are being told the vaccine is the passport to freedom and normalcy, both literally and figuratively. The government will give you your life and freedom back if you kneel to its bureaucratic demands of getting a new vaccine. 

If the vaccine is as effective as it is shown to be in the available data, people receiving it should not feel threatened by another person’s choice to refuse it. The argument might be made that herd immunity is necessary to eradicate a disease’s power and ability to mutate; however, the data has shown that the COVID-19 vaccine protects the vaccinated individual and prevents transmission. Thus, it is understandable why young, healthy individuals who are at much less risk for severe COVID-19 cases might not be in a rush to get the vaccine with unknown long-term effects and without FDA approval.

Of course, it would be disingenuous to ignore the exceptions to this logic. Those individuals who cannot receive the vaccine, but otherwise would, are still at a risk. These exceptions, such as people with severe allergies, tend to be at a higher risk for infectious diseases, making them particularly dependent on herd immunity. One prediction for herd immunity is around 80% vaccination, and considering nearly 70% of Americans already intend to get vaccinated, it is looking optimistic that the threshold will be attainable. However, 80% is just an idea and not a definite threshold, especially considering that some experts predict this virus will stick around and become a seasonal flu-like illness, requiring more vaccinations in the future.

Despite the messaging of safety around the COVID-19 vaccine, eating a free Krispy Kreme donut won’t spare a vaccinated individual from possible long-term consequences and side effects. While there are undeniable benefits to the Emergency Use Authorization, as it has likely saved many lives of those at-risk from COVID-19, especially the elderly, the vaccine is still new and in long-term trial phases. Furthermore, the vaccine companies and FDA cannot be sued for long-term effects or damages due to the vaccine. When it comes to fears of long-term effects, many right-wing vaccine skeptics point to the unsavory origins and funding of the vaccine (particularly by some population-control supporting billionaires) when defending their vaccine hesitancy. A year ago, these right-wing groups were mocked for discussing vaccine passports and monitoring. Now, vaccine passports are becoming a reality. 

Furthermore, several accounts of menstrual irregularities—even in women who have not received the vaccine but have been around someone who has received it—have led some women to fear potential adverse effects, which have been largely dismissed by mainstream outlets as disinformation. Some physicians claim it boils down stress and a lack of sleep, but for an already skeptical individual, stress might not be a satisfying explanation (especially after an unusually stressful year). While the media dismisses these anecdotes, the origin of the fear surrounding the COVID-19 vaccine and fertility are more complex than the mainstream media makes it out to be.

Issues related to fertility could be tied to population control rhetoric used by a major vaccine proponent and generous investor in Moderna, Bill Gates, who has openly voiced his support for population control and slowing population growth as a means of reducing carbon emissions and other environmental concerns. Many wonder where the fear associating Bill Gates with the vaccine originated. In a TED Talk, Bill Gates suggested that “new vaccines, health care, reproductive health services” are ways to slow population growth, often citing population control as a means of reducing poverty. Although many fact-checking sites point out this somewhat unsettling quote is likely misinterpreted and taken out of context, it is easy to see how any language about regulating fertility by a key investor in the COVID-19 vaccine development process would be worrisome to already skeptical individuals. 

Fear of infertility and other conspiracies are not the only reasons some Americans are choosing not to get vaccinated. Some minority communities are all too familiar with the fear of unsafe medical treatments given under guise of free health care. The Tuskegee Syphilis Study is just one example of the historic fears that underpin the vaccine hesitancy in African American populations. While this horrific study occurred just less than a century ago, the fear of experimentalism in the medical system has remained for many when deciding whether to get a COVID-19 vaccine. This tragic mark in medical history is not to say that such a horrific experimentation is happening with the coronavirus vaccines, but rather to show there are many reasons for vaccine hesitancy that require understanding and empathy instead of “shunning.”

Returning to the issue of individual choice in light of these fears, for a young woman, the possible long-term effects of the vaccine might outweigh the short-term benefits. However, for an elderly individual, this decision is a lot more straightforward. To this end, there are some ethical considerations for vaccinating minors, as the vaccine is currently available for individuals as young as 12. If the long-term effects are uncertain, should a 12-year-old girl be pressured to receive the vaccine? A minor has less of a say in her health care than a 20-year-old college student (that is, unless she goes to a college requiring students to receive the experimental vaccine). 

Parents should assess the risk of their child being infected with COVID-19 (which are likely pretty low based on the age group) and the status and risk of their household, as well as consider potential long-term harm that could result from the vaccine. As the mRNA vaccines continue to be studied, over time it is expected that, as with most medical treatments, some people will experience side effects. Recently, myocarditis and pericarditis have been identified in vaccinated children and are being investigated by the CDC. 

When making health care decisions, most individuals do not read the medical jargon associated with treatments and prevention, including vaccines. Instead, they often rely on their personal doctors and global health leaders to evaluate treatment options. While Dr. Anthony Fauci was once widely perceived as a relatively non-partisan, respectable doctor leading the pandemic messaging, over the past year, he has proven himself often unreliable. From his initial false messaging about mask-wearing to hypocritically recommending double masks to admittedly only wearing a mask only as a performative measure, it’s understandable that many would no longer trust Dr. Fauci’s inconsistent guidance, especially after the release of some of his emails from the beginning of the pandemic. He went from a public health leader to a bureaucrat unwilling to commit to a return to normalcy. The moving targets of pandemic guidance have Americans, especially Republicans, exhausted and untrusting of medical leadership. 

Just stay home for 14 days (or months). 

Just stay six feet apart.

Just wear a mask (for one year).

Just keep hospitalizations low enough (or maybe a bit too low).

Just slow the spread. 

Just close your shop for now (except for mega stores with big crowds like Walmart). 

Just take this $1,400 (of possibly your own money, costing approximately $16,800 per taxpayer).

Just get this vaccine (it’s new, but we will get long-term data eventually). 

The inconsistent guidance gave Americans whiplash, and 14 days quickly became a year.

Aside from the inconsistent public health messaging, the pandemic posed an opportunity for proposing misleading spending in the name of COVID-19 relief without living up to the title, further giving the public reason to distrust the government’s transparency. Vaccine hesitancy is not a sudden fear. It is a product of a year of unkept promises, misleading messaging from leaders, and blatant lies, making some feel unsure of the reliability, intentions, and integrity of the U.S. government. Regaining public trust is the first step in increasing COVID-19 vaccination rates, and the government needs to work to gain the public’s trust and rebuild its reputation, including holding public health leaders to high standards and rethinking using the pandemic as a trojan horse for unrelated spending. 

Furthermore, tightening the leash on the flow of information and dialogue surrounding the vaccine is only worsening hesitancy. Major social media platforms including but not limited to YouTube, Twitter, and Facebook, are supporting the bureaucrats agenda by limiting user access to vaccine information and content questioning safety of the vaccine. Flashing your “passport” is promoted and praised by social media users, but having a discussion online questioning vaccine safety is blockable and can be censored. Moderating conversations surrounding the vaccine will only perpetuate the skepticism.

To vaccine supporters, it seems unscientific and even unethical to reject the vaccine. However, it is important to reflect on the reasons behind skeptics’ hesitancy and examine their fears’ validity. For some skeptics, the fear is rooted in the novelty of an experimental vaccine, and for others, it is a fear of the origins and conspiracies surrounding the virus and vaccine. While historically many vaccine fears have been discredited, it is important to keep in mind the uniqueness of the rapid development and circumstances surrounding the COVID-19 vaccine that have led traditionally pro-vaccine individuals to opt out of this specific vaccine.

To be clear, this analysis is not condemnation of COVID-19 vaccine proponents, but an explanation to help pro-vaccinators understand the cautious subset of Americans. At the end of the day, the often quickly-labeled selfish skeptics rejecting the COVID-19 vaccine are not looking to revoke access to vaccines, nor are they denying that the vaccine has helped many at-risk people avoid the danger COVID-19 poses to them. They are solely requesting personal choice in the matter. Perhaps understanding and empathizing with the skeptics can help everyone to continue to encourage and embrace personal choice in health care and over time anticipate that more individuals will become comfortable with receiving the vaccine as the data and studies continue.