Chapter 1: Personal Stories of Loss and Regret

"I never thought it could happen to us," Christina Lowe shared with NBC 7 News in San Diego recently. "We believed the vaccine was hurried, driven more by profit and power than by public health… We genuinely thought COVID was largely a political issue… Then it hit us, and regret set in."

On August 29, Lowe lost her 38-year-old husband, Mikel, to the virus. She recalls how, prior to his death, Mikel urged her to get vaccinated, promising he would do the same if he survived. While she received her vaccine, Mikel was struggling for his life in the hospital. The couple, parents to two young boys, had to bid farewell via FaceTime while Mikel lay unconscious. Since his passing, Lowe has become a vocal advocate for vaccination, cautioning others against politicizing the pandemic and underestimating the risks involved.

Such narratives have become alarmingly frequent since the rollout of the Moderna and Pfizer vaccines. As of December, 55.3% of the U.S. population has been fully vaccinated. However, a concerning trend persists among those opting out of vaccination. A July poll by FiveThirtyEight revealed that while the number of individuals wanting to "wait and see" has declined, the approximately 14% of respondents firmly stating they will "definitely not" get vaccinated has remained stable.

Hospitalizations and fatalities due to COVID-19 are now primarily seen among the unvaccinated. According to Carla K. Johnson and Mike Stobbe in an Associated Press report:

An analysis of government data from May indicates that "breakthrough" infections in fully vaccinated individuals accounted for less than 1,200 of over 107,000 COVID-19 hospitalizations — roughly 1.1%. Furthermore, only about 150 of more than 18,000 deaths attributed to COVID-19 in May involved fully vaccinated individuals, equating to approximately 0.8%, or an average of five deaths daily.

Research indicates that the hospitalization rate for unvaccinated individuals is significantly higher than that for vaccinated individuals, sometimes by as much as 30 times. Multiple CDC studies have shown that the unvaccinated are 11 times more likely to die from COVID-19 compared to their vaccinated counterparts. In Texas, for instance, hospitals have been overwhelmed with COVID patients since August, despite a slight decrease in overall hospitalizations.

In April, musician Ted Nugent, a prominent figure on the far right, revealed his COVID-19 infection after previously dismissing the virus as a "leftist scam" aimed at undermining former President Donald Trump. He described feeling so ill that he believed he was dying, yet later attributed his recovery to diet, vitamins, and hydroxychloroquine, indicating he may have merely been fortunate.

In recent weeks, a somewhat controversial website called Sorry Antivaxxer has emerged, compiling stories of preventable deaths among vocal critics of COVID vaccines. The site posts multiple updates daily, sourced from news articles, obituaries, and social media. While its existence has sparked outrage among some, the stark reality of unvaccinated individuals succumbing to the virus remains undeniable. This is indeed a tragedy, particularly for the families left behind, but for those invested in anti-vaccine narratives, it represents an inconvenient truth.

After the January death of her 27-year-old unvaccinated brother, who subscribed to vaccine conspiracy theories, Jennifer Dixon expressed frustration that friends and family who previously labeled the pandemic a hoax continued to spread the same claims. "I wish they could have witnessed his suffering in his final days," she told NPR. Similarly, Preston Zeller, reflecting on the loss of an anti-vax friend, remarked, "People will do what they want. It's sad and dangerous that their minds won't change."

Following the COVID-19 death of prominent Israeli anti-vaxxer Hai Shaulian, his supporters concocted conspiracy theories suggesting he was murdered by the government to silence his pandemic views.

A recent Pew Research Center study highlights a troubling correlation between the elevated risk faced by the unvaccinated and their reluctance to acknowledge it or respond positively to evolving health guidelines. Only 32% of unvaccinated participants expressed concern about contracting the virus and requiring hospitalization, while 38% feared unknowingly spreading it to others. In contrast, a striking 78% of unvaccinated individuals voiced skepticism towards updated health guidance, and 75% claimed it diminished their trust in public health officials.

Cognitive dissonance refers to the discomfort experienced when two beliefs or a belief and a behavior clash. The term, introduced by social psychologist Leon Festinger in the 1950s, explains how we strive to reconcile conflicting thoughts and actions to maintain a coherent and meaningful worldview. To resolve this dissonance, individuals often face the choice of either abandoning a contradictory belief or finding a justification for its persistence.

Elliot Aronson and Carol Tavris, social psychologists continuing Festinger's legacy, explore the implications of cognitive dissonance theory amid the pandemic. Many of us experience discomfort when desiring social interaction, family time, and a return to normalcy while also acknowledging the health risks posed by the virus. While some individuals have opted to isolate, wear masks, and adhere to guidelines, others have chosen to pursue their desires regardless.

As Aronson and Tavris explain, people still wish to perceive themselves as intelligent and virtuous when engaging in the latter behavior. Thus, rationalizations and self-justifications become necessary:

Some claim masks hinder their breathing, deny the seriousness of the pandemic, or assert that their "freedom" to act as they wish is paramount. "You're infringing on our liberties with these 'Communist-dictatorship' orders," a woman declared at a Palm Beach County commissioners' meeting. "Masks are literally killing people," another asserted. South Dakota Governor Kristi Noem stated that "more freedom, not more government, is the solution."

Cognitive dissonance theory elucidates why altering deeply entrenched beliefs can be exceedingly challenging, if not impossible. Political opinions exemplify this phenomenon; the greater the investment of time, money, and energy in a belief, the harder it often becomes to change one's mind, even in light of compelling evidence to the contrary.

An article in The New York Times discusses the diverse nature of the unvaccinated population in the U.S. Top concerns driving vaccine hesitancy include worries over side effects and a desire to wait for evidence of vaccine safety. Distrust in vaccines and government is also prevalent among respondents. Notably, the unvaccinated can be categorized into two distinct groups: those who are hesitant and those who firmly refuse vaccination. The latter group is often characterized as predominantly white, evangelical Christian, and conservative. A recent Gallup survey revealed that only 56% of Republicans are vaccinated, compared to 92% of Democrats and 68% of independents. Additionally, the survey revealed a stark contrast in vaccine efficacy perceptions: Democrats estimate vaccine efficacy at 88%, while Republicans estimate it at just 50%, with unvaccinated Republicans believing the efficacy to be 0%, in stark contrast to 73% among vaccinated Republicans.

This analysis does not imply that Republicans are solely responsible for vaccine hesitancy in the U.S.; however, in light of recent years marked by "alternative facts," misinformation campaigns, and attacks on education and climate science, it is unsurprising that we find ourselves in this situation and the role that politics has played.

Perhaps even more disheartening is the unwavering resolve of anti-vaxxers to propagate their message despite witnessing numerous deaths within their community. Reports have begun surfacing about anti-vax groups pressuring individuals to withdraw loved ones from hospitals and ICUs for the sake of the cause. Such behavior seems less indicative of a small group of concerned citizens than of an ideology — which, ultimately, is what the anti-vaccine movement represents.

While some individuals may be unaware of their ideological alignment, others may vehemently reject this notion. Nonetheless, the arguments against vaccination are neither new nor without historical precedent. Vaccine hesitancy and conspiratorial thinking have long coexisted, particularly concerning government-endorsed vaccination efforts. Dating back to the early anti-vaccine movement in Great Britain, claims such as "vaccines are ineffective," "vaccines cause illness," and "mandatory vaccination is tyranny" echo throughout history.

Can we engage in meaningful dialogue with those entrenched in anti-vaccine ideologies? Or is it possible to address the cognitive dissonance faced by well-meaning skeptics?

Derek Thompson suggests in The Atlantic that we should "make it more uncomfortable to remain unvaccinated." While he advocates for businesses and venues to deny service to those unable to show proof of vaccination, one could argue that if losing fellow anti-vaxxers and loved ones to the virus isn't sufficient motivation, denying service may prove ineffective. Conservatives and evangelical Christians, in particular, have sought to create alternative businesses and platforms perceived as less liberal, and in light of backlash against "cancel culture," such a response may elicit further resistance.

Aronson and Tavris recommend a more constructive approach. Rather than belittling the intelligence of the unvaccinated or engaging in behavior that provokes defensiveness, they advocate for tailoring messages to align with the beliefs and preferences of the individual. If addressing a Republican, for example, highlighting pro-vaccination Republicans like Senator Lamar Alexander could yield better results. However, as much as this approach may be more effective than insults, it can still fall short of persuading those deeply entrenched in their beliefs, especially given the current climate where dissenting opinions are often labeled as traitorous.

Professor Susan Michie, director of the Center for Behavior Change at University College London, reminds us that most unvaccinated individuals can be categorized as "hesitant" rather than a small but vocal minority who are "resistant." For the hesitant, maintaining open lines of communication is vital to avoid cornering them into rigid positions.

While some unvaccinated Americans are resolute in their opposition to vaccines, it is essential to recognize that not all are adamant in their refusal. The loudest voices often overshadow those who are simply hesitant. Treating hesitant individuals the same as unwavering anti-vaxxers may inadvertently drive them further into resistance.

Statistics and facts alone often fail to sway those grappling with cognitive dissonance. The manner in which information is presented can significantly influence how it is received. Understanding the audience is crucial; one segment of the unvaccinated may not respond favorably to evidence, as they continue to weave the deaths of their own supporters into conspiracy theories.

Conversely, another segment may require those open channels of communication mentioned by Professor Michie. These individuals may be silently observing as unvaccinated peers suffer from what they have previously labeled a hoax, a political ruse, or an exaggeration. They might even be contemplating, as many of us have — as Christina Lowe likely now contemplates — that the cost of insisting on being right is far too high.

The first video, "Beyond the Noise #35: Why did the anti-vaccine movement tilt to the right?" explores the political dynamics surrounding vaccine hesitancy.

The second video, "Dying in the Name of Vaccine Freedom | NYT Opinion," discusses the implications of vaccine refusal and its consequences.