Why are Democrats fighting so hard to vaccinate the reluctant?

Question

Even though safe and effective COVID vaccines have been given emergency use authorization in the US, some people are still reluctant to receive them, over safety concerns, preference for "natural immunity," government distrust (whether rooted in misinformation or medical racism), or personal freedom concerns (AAFP).

Vaccination rates are higher in Democrat-led states, with Republican-led states like Tennessee and Florida firing important COVID officials.

Why are Democrats working so hard to protect the health of those who chose not to get the COVID vaccine? What, if any, is the public interest in strongly promoting societal choices to adult individuals?

Answer 1

Herd immunity* is one aspect.

Limiting mutations is another.

The Covid virus has shown so far a disturbing, and not totally expected, capacity to quickly evolve itself into more infectious variants (and possibly more lethal/harmful ones as well, if the impact of Delta on young people in the UK turns out to be actually worse). Any large scale population which the virus can reliably infect is essentially providing incubation services for further viral evolution.

This is why the "big, successful, mutations" are associated with countries that had either quite big populations (India) or had high rates of infection (Brazil, South Africa, UK - possibly due to being the first country to mass-sequence, India again).

Granted, denying those "incubation pools" to the virus in the USA will not avoid mutations arising elsewhere. But there will be only limited possibility of quarantine-by-travel-bans if a new mutation happens within any given country.

This is also why providing vaccines quickly to poorer countries is not just ethical altruistic behavior but also basic self-interest for rich countries.

Economic relief for businesses

Asides from places that have decided not to have restrictions at all, like South Dakota, most places have had to navigate between throttling infection rates with various operating restrictions and trying to limit damage to retail and service businesses.

Take my home province of BC, Canada. Our health authorities have walked a fine line between being too prudent for some and too permissive for others. We've not had any real hard stay-at-home orders, except for March-April 2020, but have had restrictions on restaurants, bars, cinemas, etc... and lots of businesses failed. Canada also didn't really have any high vaccine availability until March/April 2021. That time period coincided with a big spike, which most of the world experienced, for which we had to bring another, tighter, round of restrictions to keep rates from spiraling out of control.

I can tell you that everyone saw the needle start to move, quickly, once partial vaccination rates passed 40-50% in May/June. Now we are nearing 80%, with still about .1% extra first-shotters per day, doing their bit. It has made a huge difference and almost all restrictions on businesses and individual have now been lifted, without it seeming like much of a health risk tradeoff. That's a luxury that we are blessed to have, as a rich nation, and it seems inconceivable to waste it due to unconfirmed fears and rumors. What was it after all that a certain Lt. Governor of Texas said??? I want to live smart and see through this, but I don't want the whole country to be sacrificed.. Well, Dan, let's hear you say that again, for vaccinations this time.

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* Herd immunity, via infectious exposure, is apparently not a very credible outcome with Covid. Manaus, in Brazil, had supposedly reached that late in 2020, with very high infection rates as evidenced by antibody tests. Nevertheless, they got whacked again in early 2021 when new variants reinfected people. To over-simplify: Covid seems more like the common cold rather than measles with regards to keeping natural immunity after infection. (re. vaccine-based herd immunity considerations, see @JJJ's answer)

p.p.s. Why is it so important to vaccinate so many?

If you get the sense of moving goalposts, from 60-70% of vaccination rate like Fauci said was needed earlier to 80-85% now, you're not wrong. But there is a reason for that. R0, the basic infection rate is about how many non-immunized people a contagious person can expect to infect even when precautions are taken. It's the inverse of the vaccine requirements. If a person can infect 3 people (R0 at 3, covid in early 2020, without much restrictions) then if 2 of those 3 people are vaccinated, the virus only really makes 1 person sick and the rate is constant, neither increasing nor decreasing. If R0 is 5-ish, like Delta is suspected to have mutated to, then the proportion of people needing to be vaccinated is now 80%, not 66%, so that at most 1 person out of 5 gives the virus a new home. Just because of the darn virus' increased transmission rates. That's why measles (R0 18-20) needs 95% vaccination rates. If on the other hand Delta's R0 is now 8-ish (the upper range of estimates for it), then you'd need 87.5% vaccination rates to keep it down. Less than measles, but considerably more than the initial estimates before variants showed up.

The high claims of heightened R0 may seem a little bit alarmist, but consider that, in quite a few areas, variants established themselves as the dominant strains within 3-4 months of their arrival, which indicates considerably better performance at infection, compared to their older siblings.

Answer 2

Let's separate out two distinct issues...

First, the Biden administration is following epidemiological best practices. As more people get vaccinated, the disease spreads more slowly, the incidences of the disease become less severe, and the impact on medical services becomes less pronounced. A viral disease is a lot like a wildfire, and we have the same two options: try to contain it, or let it burn until it exhausts its fuel and dies off naturally. The problem is that the 'fuel' for a virus is human beings, and allowing it to burn itself out naturally can have catastrophic consequences. It's worthwhile to push people to get the vaccine — just as its worthwhile to push people to clear firebreaks around their houses — because in the end it benefits everyone.

Second, there is the normal and understandably hostile reaction people have to liars and grifters, which Democrats are feeling in spades. Most of the anti-vaccine rhetoric comes from a smallish group of Right-wing pundits, influencers, and politicians who have no interest whatsoever in the medical or epidemiological aspects of the issue. For them, this is a political tactic meant to undermine 'Leftists' and advance their own political power and influence, all at the expense of the health, wealth, and lives of (at this point) the people who most support them. It's a jaded and cynical con-job — no better or worse than the kinds of scams that trick elderly people into signing over their life's savings — and those of us who aren't fooled by the con have a natural revulsion to seeing other people fall for it. Democrats are pushing for the vaccine the way I might yell at my great aunt when she tells me about the nice email she got from that poor Nigerian prince. It's sad and infuriating to see people get suckered this thoroughly.

Answer 3

Even though I have sometimes thought that allowing the unwilling to be vaccinated to sicken and die is just an instance of evolution in action, I still realize that there are practical* reasons to encourage vaccination.

In addition to the herd immunity factor that has already been covered, there are problems of limited medical resources and costs. Have you forgotten the early days of the pandemic, when hospitals in hard-hit areas simply couldn't handle the number of sick people? (One local hospital had to turn part of its parking garage into an overflow ward for COVID patients.) That means people who need other types of medical care may have to wait for it.

Even if new infections don't rise to pandemic levels, they still impose costs on the medical system. Some or all of those costs are paid for from public funds such as Medicare & Medicaid. Even when they're paid by private insurance, the increased expense means insurance companies will need to raise rates, thus making medical insurance even less affordable. And then there is the cost to the general economy, when otherwise productive people are sick, sometimes for long periods. (See e.g. "long COVID".)

*I'm not even going to think about discussing ethical issues, since I don't have my 10-foot pole handy :-)

Answer 4

The epidemiological aspect mentioned in other answers are certainly correct, but on a more fundamental level this is a matter of ethical attitude. As an analogy, consider the case of encountering a suicidal person contemplating to jump from an otherwise deserted bridge. To (hopefully) a vast majority, just shrugging your shoulders and being on your way is wrong. We should at least attempt to talk them down.

Of course, not getting the vaccine isn't the same as committing suicide, but a few hundred people not getting the vaccine will probably kill at least one of them. But since we are considering large chunks of the population here, to me the ethical aspects are relatable.

Answer 5

This is not just about personal choice. There are two things that make you less likely to infect someone else:

1. You are vaccinated. Being vaccinated not only protects you, it protects everyone you come into contact with because you shed less virus particles and hence are less infectious.

2. You wear a facemask where appropriate (indoors / in crowds). Facemasks don't primarily protect the wearer from infection, they protect everyone else from being infected by the wearer.

Many people either can't have a vaccination or have compromised immune systems. For the latter group not only is the vaccine less effective but the disease, if they get it, is likely to be more severe. Examples are people undergoing chemotherapy for cancer and transplant recipients (who have to take immune-suppressing drugs for life to prevent rejection).

In addition, every person who gets the virus represents an additional opportunity for new and more virulent variants of the virus to emerge. It is no accident that most of the variants of concern emerged in times and places where Covid-19 was infecting lots of people. Hence by not getting vaccinated you increase the likelihood of a new and more dangerous variant.

Hence your individual choice to get vaccinated or not has a significant impact on many other people.

There is a great deal of precedent for laws that require people to do things in order to protect others. For instance we require drivers to carry insurance, be licensed and not drink alcohol in order to reduce the harm due to accidents involving innocent third parties. Requiring people to wear masks is much the same. Requiring vaccinations is more problematic; one has to balance the public good against the important individual right to refuse unwanted medical treatment. However there are plenty of measures (e.g. not permitting the unvaccinated to travel or work with the clinically vulnerable) which can meet a balancing test.

The public good is also a reason for the government to spend money on publicity to encourage people to get vaccinated and on programmes to make it quick, cheap and easy to do so.

Answer 6

Because vaccinations are not just about protecting those who get vaccinated but also about achieving herd immunity. As the Mayo Clinic explains it:

Herd immunity occurs when a large portion of a community (the herd) becomes immune to a disease, making the spread of disease from person to person unlikely. As a result, the whole community becomes protected — not just those who are immune.

According to the World Health Organization:

The percentage of people who need to be immune in order to achieve herd immunity varies with each disease. For example, herd immunity against measles requires about 95% of a population to be vaccinated. The remaining 5% will be protected by the fact that measles will not spread among those who are vaccinated. For polio, the threshold is about 80%. The proportion of the population that must be vaccinated against COVID-19 to begin inducing herd immunity is not known. This is an important area of research and will likely vary according to the community, the vaccine, the populations prioritized for vaccination, and other factors.

From a public health perspective, herd immunity is useful because:

• Some people might not be able to get vaccinated because they have such weak health that they cannot get the vaccine (I'm not sure to what extent this applies to the Covid vaccines but it does apply to some vaccines). If there is herd immunity, then they would be protected because they are less likely to come into contact with infected persons.

• The vaccines may also be less effective in immunocompromised patients.

• Even if you are vaccinated, there is a chance that the vaccine won't prevent you from getting sick. Indeed, the three vaccines used in the Netherlands (Pfizer, AstraZeneca and Janssen) are only 60-90% effective. In Thailand there are reports of medical staff getting sick after having received two doses of the Sinovac vaccine.

As such, it's in the public health interest that as many people as possible are vaccinated.

Answer 7

If coronavirus vaccines were 100% effective, and available to everyone who wanted them, you would have a point - we do not need to use the force of the law to protect people from themselves. And yes, this would be an instance of natural selection, i.e. "the natural weeding-out process" - people who made bad decisions would be more likely to die without reproducing.

However, they are not, and they are not. Even in areas with an excess supply of vaccines, some people are medically ineligible to receive them.

The reason people insist on everyone getting vaccinated is the same reason they insist on everyone wearing seatbelts and only driving while sober - when you don't do it, you're more likely to hurt yourself and other people. As a result, we have laws against driving drunk.

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As far as I'm aware, all "good" vaccines have a near-100% success rate at preventing you from serious illness as a result of COVID, but their success rate at preventing you from getting a mild infection and then transmitting the disease is relatively lower - somewhere around 75-90% (don't quote me on that). There is still some probability of randomly forming chains of transmission to vulnerable people. But they are good enough to completely kill off COVID-19 if everyone gets vaccinated (I don't know what the needed percentage is). In that case, there won't be any more COVID-19 and we won't even have to worry about those chains happening, except in rare cases where the chain starts from a traveller coming from a place where people aren't vaccinated.

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When Republicans talk about "weeding out," they might not be talking about letting unvaccinated people die, but rather letting people with weak immune systems die to improve the average genetic quality of humans. I hope I don't have to explain why this is a flawed concept. It's been tried in the past.

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As for "social control", social control is actually a cornerstone of human civilization. Social control is why most people don't steal, even in places with weaker police forces, for example - they'll be shamed, ostracized, perhaps shot. If you don't let a friend drive drunk (possibly because a TV ad told you not to) you are exerting social control. There is nothing inherently wrong with one person telling another person how they should behave.

Answer 8

Radio host Thom Hartmann has gotten several calls like this and explains it nicely. The Q is: isn't there some theoretical heartless Democratic strategist who thinks: "Republican governors seem to be trying to kill Republican voters. Why not let them? Fewer Republicans is good for us and can't bounce back -- we're on record as trying really, really hard to vaccinate everyone".

The problem with that logic is that lots of COVID deaths, overcrowded hospitals, travel restrictions ... is terrible for a state's economy. That's not-so-good for neighboring states, and bad for the US economy as a whole. And a bad economy is bad for the party in power. COVID in red states is bad for the in-power Democrats.

On a closer level, say half of a red state's population dies. That's no change, politically. They still get the same number of electoral votes and congresspeople. And with a terrible local economy they're even more likely to vote for the out-of-power Republicans in midterms. On the other hand, is COVID were wiped out there and the economy suddenly got better... .

So in terms of heartless political strategists, the Republican one would want to keep COVID going to hurt the economy, even if Republican governors have to be the ones doing it. While the Democratic one would want to eliminate it everywhere, as good politics.

Answer 9

People also need to know that this desire to make the reluctant do something like vaccinate for the greater good of the community didn't just start with the democrats. Since the dawn of human history, there were many people who refused to listen to doctors, from the 1800s to even all the way back to ancient Rome and the Golden Age. When many people ignore this advice, it reduces herd immunity and boosts the chance the virus can find new hosts before evolving into a more dangerous variant like what is happening with COVID-19. Also, many of the reluctant are people who spread misinformation due to ignorance or having one of the three mental illnesses generally associated with belief in conspiracy theories: Paranoid Personality Disorder, Schizotypal Personality Disorder, Narcissistic Personality Disorder. Vaccinating more people and showing how the vaccine doesn't cause autism or secretly destroy your free will helps to combat this misinformation.

Answer 10

The government - any government - ought to do what is best for the population of their country as a whole. So a government that believes not getting vaccinated is on average harmful to you, and harmful to others, ought to take steps to get more people vaccinated. And the current US government seems to be of the opinion that not getting vaccinated is bad for the population as a whole, so that's what they ought to do. (Obviously this would need to be balanced against any cost. If vaccinating all Americans would cost $10bn and would statistically save 3 lives, then those $10bn could likely save more lives if spend on something else). I could privately say "if they don't want to get vaccinated, just let them die". A government ought not to do that.

Now governments don't always do what they ought to do. If a majority of the voters, or a vocal minority of the voters, argue loud enough against vaccination, and a government feels they have the choice between saving lives and winning the next election, they might be tempted to do the wrong thing and not save lives.

Right now, the democratic government believes that convincing people to get vaccinated is beneficial for the whole country, so that's what they do. And some state governments believe that bribing people to do the right thing is also beneficial for the whole country, so that's what they do.

Now what would be totally, utterly and despicably wrong would be to try to convince people not to get vaccinated so that there are more deaths and illnesses, so the democratic government can be blamed for them. Right now I couldn't think of anyone sinking that low.

Answer 11

Since the "herd immunity" angle has already been covered, I want to add an answer covering the Realpolitik angle, aka what's driving the politicians to ensure their reelection happens.

NB: personally I'm 100% in favor of vaccines, so I lined up to get mine as soon as I was eligible back in April. I also plan to get booster shots for the rest of my life. Leaving this note here to avoid accusations of being "anti-vaxx" or something like that.

What, if any, is the public interest in strongly promoting societal choices to adult individuals?

First of all its important to note that the vaccines are not mandatory in any of the 50 states. Some colleges require vaccines on paper but if you look closely at the text of the requirement it will inevitably say something like:

unless they are claiming a medical, religious or philosophical exemption

Which essentially means that the vaccine is not in fact mandatory, even in one of the most liberal colleges of one of the most liberal states. And if they can't make it mandatory there, its unlikely to be truly mandatory anywhere in America. Hence while the Democrats love to talk about how much they want everyone to get the shot, they don't actually have the political will to enforce it on anyone, not even on government employees or prisoners.

Why is it so important to protect the health of the reluctant?

From a Realpolitik perspective it doesn't really matter. But keep in mind that the media and the political establishment have spent 16 months so far scaring everyone over "COVID cases" and how they're soaring/exploding/surging/skyrocketing in various location in the US and around the world. The original flatten-the-curve strategy only talked about healthcare capacity as the primary metric to worry about but nuance got lost over time and nowadays "cases" became the primary metric to go by.

So why do vaccinations matter in this case? The more people get vaccinated, the easier it is to avoid a surge in "cases". Such surges result in local officials enacting restrictions (as was the case in LA county recently) to cover their bases in case someone tries to shift blame on them, which in turn results in loss of jobs, shutdowns of businesses, cancellation of events, etc, which won't be very popular after spending more than a year in various stages of lockdowns. You could of course somewhat mitigate this by printing "free money" and distributing it around, but this is becoming more and more risky as hyperinflation concerns loom over the US economy.

So what actions could Democrats take to avoid "surges" of cases?

1. Shift public opinion into caring about hospitalizations/deaths instead. This was most recently done by the British government. If the gamble pays off and the British reopening amidst the Delta wave works out favorably, this will likely become the end game for all other Western governments too.

2. Nudge everyone into getting vaccinated. Democrats don't have the will to actually mandate it, so they're parading around on TV and newspapers talking about how important it is. This might convince some people to go get vaccinated and helps them look like they're "doing something"

3. Reduce testing capacity. This was attempted in at least one city but large queues for test sites would be noticeable so its hard to implement, even if it would quickly reduce the number of visible cases.

4. Get the public to stop caring about COVID altogether [update: this was successfully accomplished by summer 2022]. This will likely be the final outcome of the pandemic but it cannot be done quickly, especially as countries outside of US are still facing the virus heads on due to a lack of vaccines.

5. Shift the blame on someone else - the Republicans, the unvaccinated, foreign travelers, the lab in Wuhan, etc. Pretty easy to do but doesn't help you avoid the lockdowns, so other options are needed.

As you can see, Democrats are not pushing the vaccine for no reason. They have multiple political constraints to go by and vaccines just happen to be an easy tool in their arsenal. As soon as another solution is found to avoid the lockdowns altogether, the subject of vaccinations will more or less fade into the background noise.

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Responding to counter-arguments to this post as they arrive.

The fact that there is a strong correlation between political affiliation and vaccine hesitancy suggests that any of the 'side effects' of undervaccination are more likely to fall on Republican strongholds than Democratic ones. From the purported strategic standpoint you're trying to place this answer in, it would seem in Democrats' favor to not be pushing vaccination the way that they are.

While it is indeed true that Republican states are likely to see high COVID death rates in the future, this seems to be of little concern to Republican voters. As an example, South Dakota had one of the highest COVID fatality/case rates in the nation and yet Donald Trumps popularity there only increased since 2016. Surveys likewise show that Republicans care a lot less about COVID casualties than Democrats. If this wasn't the case, its unlikely that Florida or Texas would've been so resistant to lockdown measures as their governors are likewise tracking the public sentiment very closely.