I’m in my morning huddle at the hospital. The NICU nurse gives an update from the labor ward, running through names and details of expectant mothers, before moving on to a new part of the meeting that’s become routine since the start of the pandemic: the list of pregnant people with COVID-19 admitted to the general floor and the ICU.
Most are stable with a “quiet strip” (our verbiage for “a uterus not in active labor”). She wraps up her rundown with an update on the patient we’ve all been waiting to hear about: young, previously healthy, unvaccinated, pregnant with her first child. “Overnight, she was transferred from the floor to the ICU due to increased respiratory needs” the nurse sighs before pausing. “The ICU says she may not be stable enough to move, so we’d need to do an emergency delivery over there, should that become an issue.”
I feel the weight of her words in my chest as my thoughts turn to another woman who was in this very situation a few weeks prior. That woman went into complete respiratory failure, then rapidly progressive preterm labor, delivering an extremely premature infant in her ICU bed before being rushed to the operating room where she had a tracheostomy inserted in her neck. Both mother and child remain in critical condition despite maximal medical interventions — all of which could have been completely avoided had she received a COVID-19 vaccine.
Vaccine refusal is nothing new for pediatricians. The modern-day anti-vaccination movement — which began in the ’90s and early aughts, sparked by a now-discredited study by ex-doctor Andrew Wakefield that falsely linked vaccines to autism and was later amplified by celebrities like Jenny McCarthy — has now entered its third decade. During my residency years in Southern California, prior to becoming an attending pediatric hospitalist in 2016, I saw parents eschew vaccines, not for fears of autism specifically but out of concerns about “toxins,” i.e., mercury, formaldehyde, aluminum, and polyethylene glycol. By the time I started my first job, I had encountered parents who refused vaccines for even more reasons: They caused autoimmune diseases, neurological problems, paralysis, depression, psychosis, suicide. Even other recommended medications, like intramuscular vitamin K and erythromycin eye ointment (two routine treatments given to newborns to prevent catastrophic internal bleeding and certain types of bacterial infections, respectively), are refused more and more frequently by parents I encounter.
Most recently, vaccine refusal has coalesced around the concept of holistic, natural “wellness.” It was A Thing well before the COVID-19 pandemic but has since been exponentially amplified by the introduction of COVID vaccines. While of course not every person who refuses a vaccine is a yoga-practicing, adaptogen-consuming white woman on Instagram — there is a significant history of racism and ableism in Western medicine that has led to understandable vaccine hesitancy in marginalized communities — many of the vaccine-refusing parents I meet these days tell me they plan on supporting their children’s immune systems in more “natural” ways, usually through diet, exercise, vitamin D supplementation, exposure to sunlight and fresh air. (All of these things are, of course, demonstrably beneficial for all children, and all are recommended by the American Academy of Pediatrics in support of a healthy lifestyle for kids. They are not, however, medicine.)
Sometimes their rationale veers into moralizing territory — I’ve had parents refuse both the hepatitis B and HPV vaccines because they plan on teaching their kids to “make good choices with their bodies.” Sometimes it’s about “ethical wellness” and disdain for supporting Big Pharma; cries for “medical freedom” and the importance of “doing your own research” are also used as reasoning for refusing shots. The attitude toward the COVID-19 vaccines is more of the same, multiplied by a thousand. The vaccines are a highly effective preventative measure for a dangerous, novel, and currently rampant disease that is being refused by parents for themselves as well as for their eligible children, at a time when health-care personnel and resources are exhausted and 1 in 500 Americans have died of COVID-19.
Yet even among so much death and suffering of the unvaccinated, this group’s screed of “wellness” sounds on: I don’t need a shot because I have a healthy lifestyle (moralism); only obese people with underlying conditions get really sick (fatphobia, ableism, and also inaccurate); I’ll just keep my children safe, feed them nourishing food, let them run around outside, homeschool them (just about every form of privilege one can imagine); I healed my child’s eczema/food allergies/ADHD by using natural remedies (false equivalency, confirmation bias); I don’t trust pharmaceutical companies (until my life is on the line).
Let me be clear about something: We have a broken and deeply unequal for-profit health-care system, which often prioritizes corporate interests over the health and well-being of individuals and communities. And health outcomes are demonstrably worse for Black and brown folks in almost every health-care sector. So, yes, there is so much work to do. What, then, are these “wellness” advocates — mainly (though not exclusively) white, cisgender, heterosexual, able-bodied, and well-resourced — doing to address health disparities for the most vulnerable in society? Are they entering marginalized communities to help improve access to fresh produce, clean water, and green spaces? Are they advocating for funding to support Black doulas and lactation consultants, equal pay for women of color, universal free child care for working families, high-quality mental-health services starting in adolescence? Are they taking up the mantle of prisoners’ rights (the incarcerated being among the demographics hardest hit by COVID-19)? Sure, maybe some of them are doing some of these things, but on the whole, are they doing enough — or anything, really — that doesn’t center their own personal wellness journeys?
Sadly, anti-vaxxers’ motivations are not, it seems to me, rooted in improving health and wellness for all. Instead, they want to reap the benefits that modern society offers without ever feeling uncomfortable or challenged. Central to true wellness is the notion of community care, the proverbial village raising the child. (It’s a particularly apt metaphor for right now, when all of my patients under age 12 are not yet eligible to receive the COVID-19 vaccine.) Community care revolves around the sentiment that, for better or worse, we are all interconnected. The anti-vaxx wellness folks seem to me less a network of diverse contributors, feeling responsibility toward one another in pursuit of a greater whole, and more a crowd of individuals who all have landed on the same philosophy for themselves, for their own self-interests.
Absent from this ideology is acknowledging how someone they see as “the other” might nonetheless be affected by their choices, how an act as personal as getting or refusing a shot has profound repercussions on people they’ll never meet. We know with certainty that COVID-19 most severely affects low-income populations of color. Anecdotally, this has borne out in my pediatric populations as well — not just in medical COVID disease, but in the way it has torn apart families. Many children with COVID-19 that I have cared for had lost at least one parent or caregiver to the virus. Still others had experienced food and housing insecurity, domestic violence, sex trafficking, and myriad other horrors that arose when their social safety nets crumbled.
The unrelenting severity of COVID-19, however, has revealed the fragility of a movement grounded in “personal freedom” and not in science. The anti-vaxx movement may claim to be a community of like-minded folks, but their allegiance to the group is apparently tentative. Faith in “natural immunity” has been abandoned in the face of critical illness as unvaccinated people flock to hospitals, now willing to accept the innovations that modern medicine has to offer, and in some cases, begging for a COVID-19 vaccine. Still, there remain plenty of anti-vaxxers who will stubbornly cling to their right to refuse the shot, no matter how close to home the virus hits. I recently cared for a child who had severe COVID-19. He was too young to have gotten a vaccine, but both his parents were unvaccinated by choice and would remain that way. His mother explained that she knew people who had been hospitalized “because of the shot.” Natural immunity was better, she argued. I pointed out that “natural immunity” had left her child significantly disabled, and that he might have been even worse off had he not received multiple experimental treatments, medications she rightfully didn’t hesitate to give him when his life was on the line. She shrugged. “Can’t risk it,” she said. This was an extreme case, to be sure, but by no means my first.
Pre-pandemic, I periodically cared for kids hospitalized with vaccine-preventable diseases: usually seasonal influenza, but sometimes pertussis (“whooping cough”), measles, pneumococcal meningitis, and even rarer entities that doctors of my generation have only started to see again owing to the anti-vaxx movement. There was the 3-month-old infant with pertussis, intubated and ventilated, on antibiotics and breathing treatments, fed through a tube, and on the brink of death for weeks in the ICU before he regained enough of his lung function to come out to my service. He spent another two weeks in the hospital on oxygen, working with therapists to learn to eat again, to build strength and slowly work toward the developmental milestones he had missed while critically ill. I spent hours engaging his family every way I knew how, imploring them to start the childhood series for him and his siblings — even a single dose of DtaP, one of the standard vaccines given in infancy, could have prevented this prolonged hospitalization. They refused, saying vaccination still seemed too risky.
This ideological hypocrisy is enraging and depressing. Extreme obsession with the “natural” is a fetishization, an idea people excitedly toy with while enjoying rates of relative safety and security not seen in any other era in recorded history, made possible largely due to vaccines and other products of human scientific ingenuity. But when confronted with the possibility of no longer existing, no healthy person opts against true life-sustaining, effective treatment just because it comes in a vial. No parent, given the option of a human-made solution, chooses death for their child.
When death comes anyway (as is the natural consequence of unremitting disease), when vaccine skeptics or their children get sick and die from vaccine-preventable diseases, I don’t feel a sense of smug self-satisfaction or vindication; I feel gutted. I don’t agree that people who reject science should be made to die, because I don’t support willful cruelty, and dead people can’t grow and change. I often wish that anti-vaxxers could spend some time in my world, to see what their evangelism has perpetuated, all the ways that children and their families have needlessly suffered. I want them to see that their concept of wellness and the natural is so deeply flawed. I want them to feel the weight that my colleagues and I feel every day, so that maybe they could do their part to help shoulder it. No, anti-vaxxers didn’t cause COVID-19. But this could have been over already, and now it may never be.