When Americans began receiving coronavirus vaccines last month, people started fantasizing about the first thing they’d do when the pandemic ends: go back to work, visit family, hug friends. But the public discussion soon shifted. One news article after another warned about everything that could go wrong: Protection isn’t immediate; vaccinated people can still transmit the virus; vaccinated people might get mild infections that could become chronic; vaccines might not work as well against new coronavirus variants. “COVID-19 Vaccine Doesn’t Mean You Can Party Like It’s 1999,” one headline admonished. Can vaccinated people at least hang out with one another? Nope, masks and distancing are still required. “Bottom line,” another article concluded ominously: “You will need to wear a face mask after you’re vaccinated until COVID-19 cases become nearly nonexistent.” Although scientists are still learning about how much the two government-approved vaccines reduce transmission of the coronavirus, the evidence shows that their efficacy against disease is phenomenal. Although not zero-risk, close contact between two people is safer if one has received a vaccine, and safer still if both are vaccinated. For this reason, public-health experts elsewhere in the world are emphasizing hope. In a new social-media campaign, health officials from across the European Union stress that vaccination will help people get their lives back. “I’ll do it to protect my father and organise a big family weekend get-together,” declares Belgium’s chief scientific adviser. “I did it because I want us to live normally again,” says the chief coronavirus adviser in Romania. But in the United States, the prevailing message is that, because vaccines aren’t perfect, people who have received them shouldn’t let down their guard in any way—not even at gatherings with just a few other vaccinated people. “Based on science and how vaccines work, it certainly is likely that [such a gathering] will end up being lower-risk,” a pharmacologist from Johns Hopkins University told The Washington Post. “But right now, we just don’t know.” Government officials are no more upbeat. In response to the question of whether a vaccinated person needs to continue taking precautions, the CDC states that “not enough information is currently available” to say when—or even if—it will stop recommending the use of masks and distancing. The message that vaccines aren’t 100 percent effective in preventing disease, and that the data are still out on how much they reduce transmission, is an accurate and important one. Risk-mitigation strategies are needed in public spaces, particularly indoors, until more people are vaccinated and infections wane. But not all human interactions take place in public. Advising people that they must do nothing differently after vaccination—not even in the privacy of their homes—creates the misimpression that vaccines offer little benefit at all. Vaccines provide a true reduction of risk, not a false sense of security. And trying to eliminate even the lowest-risk changes in behavior both underestimates people’s need to be close to one another and discourages the very thing that will get everyone out of this mess: vaccine uptake. From the beginning, many government officials and media commentators have made a habit of blaming the pandemic on the public’s misbehavior. Concerns that vaccinated people will start throwing “rona raves” or exhibit other irresponsible behavior therefore come as no surprise. But people are likely to behave far more cautiously. Survey data from Great Britain suggest that a large majority of people there plan to continue following public-health guidelines after vaccination—albeit, for some, less strictly. Nearly a third of epidemiologists who responded to a New York Times survey late last year said they would be comfortable returning to more activities of daily life after vaccination, but these are likely to be baby steps, not leaps. Maybe a grandparent will decide to hold a grandchild for the first time in a year. Maybe people will send their kids back to school, fly to visit aging loved ones, socialize with a few other vaccinated friends, try to go on a date or two. Even if those decisions are unlikely to cause harm, they appear selfish if the goal is to eliminate the tiniest risk of spreading the coronavirus. But health is more than the absence of disease. The question of how vaccines change people’s individual and collective risk-benefit calculus has implications beyond whether vaccinated adults can have drinks together inside one of their homes. It also affects decisions about how crucial parts of society will function: whether unvaccinated children can go back to school after teachers are vaccinated, or whether an unvaccinated person can visit a vaccinated elderly relative in a nursing home. Those discussions suffer when experts and other commentators belabor the potential pitfalls of vaccines out of fear that some people will abuse their freedom. The anxiety about how people might behave when they are less afraid is all too familiar to those of us who work on HIV prevention. When the medication Truvada was approved in 2012 as preexposure prophylaxis (or PrEP)—a daily pill to prevent HIV—it sparked a debate about what public-health experts call risk compensation. The worry was that people who felt protected by PrEP would use condoms less often—potentially negating the medication’s effect and increasing their risk of contracting other sexually transmitted infections. PrEP has turned out to be far more effective at preventing HIV than condoms are, assuaging some of those concerns. But the emphasis on risk compensation was not solely about infection. True to America’s puritanical roots, it also reflected moral judgments about condomless sex; PrEP was described as a “party drug” and its users were called “Truvada whores.” That stigma has been profoundly detrimental: Uptake of PrEP remains low, and some clinicians still hesitate to prescribe it, especially to people who use condoms inconsistently and therefore need the medication most. Moral panic about risk compensation is misguided; it obscures the reasons some people change their behavior and what they could lose by not doing so. For some, the ability to have more physical intimacy is the whole point of PrEP—just as it is, for some, the whole point of birth-control pills. Likewise, some people are eager to get a coronavirus vaccine because they feel an intense need to be close to others. That’s why exhortations about unwavering vigilance after vaccination may have unintended consequences—not just dissuading vaccine uptake but also sapping the public’s hope. “The truth is that if I thought I was going to be living the way I’m living now for another 10 months,” the New York Times columnist Michelle Goldberg tweeted about the dour vaccine messaging, “I’d probably give up completely.” The early weeks of a sluggish vaccine rollout have given people many reasons for discontent. One is that people with the greatest need for protection have not necessarily been first in line for the shots. Prioritization plans have taken racial equity into account, but only nominally: Black and Latino people, who are at the highest risk of infection, have been the least likely to be vaccinated. Seeing those inequities, some commentators have suggested that vaccinated people should patiently wait to expand their lives until everyone can, just as people whose dinner arrives first at a restaurant are expected to wait to eat until all of their companions have been served. This bit of etiquette has a certain fairness to it. Vaccine FOMO is real. But I will feel no joy if vaccinated people wait to hug their grandkids until I am vaccinated, nor will that get me—or those at higher risk than I am—vaccinated any faster. Self-deprivation will not, in itself, prevent infection. And no one enjoys letting their food get cold. The pandemic is a bedeviling problem that vaccines alone cannot immediately solve. As long as the supply of doses remains limited and the coronavirus continues spreading at high rates across the country, public-health officials need to communicate that the greatest risk reduction comes from a combination of measures that includes good masks, distancing, and ventilation. And officials need to enable the public to take those measures—while recognizing that staying infection-free is not the only thing that matters to people. Public health isn’t merely the business of saying no; addressing people’s unmet needs is an essential part of the job, even during a pandemic. “I did it to enjoy life,” Malta’s top coronavirus adviser proclaims as part of the EU’s vaccination campaign. The vaccines are poised to deliver what people so desperately want: an end, however protracted, to this pandemic. Everyone’s focus needs to be on getting the highest-risk people vaccinated as quickly as possible, not on faulting vaccinated people for a few unmasked hugs. Source
