The coronavirus pandemic marches through its surges and plateaus, changing with congregating behavior, pandemic fatigue, and doubts about the seriousness of Covid-19 disease. At this writing in January, new virus variants are appearing with mutations that increase the efficiency of transmission, which means more deaths. The more transmission there is, the more the virus will mutate to escape immunity. The history of influenza is repeating itself. The distribution of two effective Covid-19 vaccines is far short of demand at this time. Even though production and distribution are solvable, practical problems, they are not getting the resources necessary. While cosmetics production remains at full strength in the U.S., vaccine supplies depend on imports. While the country continues to manufacture obsolete fighter jets, it has not built nursing schools to meet our pressing need for healthcare workers over the last fifty years.
A larger problem looms. Public hesitancy and refusal to accept vaccination threatens to prevent the U.S. and other nations from achieving the “herd immunity” threshold of 90% that appears needed to greatly reduce transmission. Lesser degrees of population immunity will slow transmission, but won’t stop the mutations that will require a new generation of vaccines. Hesitancy or refusal to get vaccinated is widespread; up to two-thirds of Black Americans say they will refuse it. This lack of trust is justified, stemming from a long history of racism and mistreatment of Blacks and minorities by the medical establishment.
What’s a citizen and a Quaker to do?
First, we must reconcile with the history of racial discrimination in the field of medicine. The Biden administration must admit clearly that legitimate reasons for mistrust remain. Trust is earned, not bestowed. The relevant horrors must be reviewed and then contrasted with the new, more ethical behavior that will be enforced today. Everyone’s trust in science must be restored. The current vaccines were developed and approved according to stringent criteria of safety. Vaccine makers need to open their laboratories and factories to leaders from all ethnic and cultural backgrounds and must transparently teach the public what good science looks like.
Second, we should help people understand that vaccines work by “educating” a person’s body, and we should avoid reinforcing common images of vaccines as “experiments.” Vaccines enhance our body’s own “immune vocabulary,” educating our immune cells to protect against very real threats. Vaccines work like teachers. We are all born with a few immune cells that can neutralize the Covid-19 virus, but we start out with far too few of these cells for adequate protection. The vaccine basically finds these few “birthright” immune cells and teaches them to produce thousands more antibody cells exactly like them. Without a vaccine, many people are vulnerable to severe infection because they can’t stimulate those birthright cells to reproduce fast enough.
Third, we must enhance our focus on the vulnerable. A First Principle of public health is: “The powerful have an obligation to the vulnerable.” Although we are all equal in “that of God” within us, we are not all equal in physical vulnerability. Science cannot predict exactly which individuals are vulnerable because the causes of vulnerability are varied: biological as well as social, including factors like poverty, racism, and inequality.
Regarding Covid-19, the notion of vulnerability is clear for the aged, the diabetic, the person on cancer treatment, and so forth, but vulnerability can also be much more subtle. About 1 in 1000 people have defects in their defense proteins that leave the body helpless against the new coronavirus. Such subtle genetic mutations probably explain why healthy 40-year-olds are dying of Covid-19. At the end of January, there were as many patients aged 20-49 with Covid-19 in British intensive care units as patients over 70. Our concepts of vulnerability need to be enhanced.
Fourth, we need to develop a renewed appreciation of community. We are each born into a community and grow up to absorb its language and spirit. Christianity builds the individual’s relationship with God, which often includes a mystical aspect. The modern Quaker theologian Thomas Kelly extended the idea of a personal relationship with God into “fellowship relationships,” whereby person-God-person triangles are built around shared ethics. From such fellowship relationships, Quaker meetings for worship are developed. Quaker meetings are safe places to grow in, but the larger community is more challenging.
In his groundbreaking bestseller, Bowling Alone (originally published in 2000 and revised in 2020), sociologist Robert Putnam famously documented that America has regressed since the 1950s from being a nation of “joiners” to a nation of isolated intellects. The anonymity of social media and its ambiguous relationship with truth have accelerated this trend toward human isolation. The shift from a “we” culture to an “I” culture has obscured our natural human need for connection.
Friends care for people in need, whether they return the favor or not. This ethic has made AFSC famous internationally. As the Faith and Practice of Intermountain Yearly Meeting puts it, “Friends carry their sense of community beyond the reaches of family and the meeting into their careers and political activities.” The current pandemic calls Friends to a renewal of community building.
For those with whom we disagree, we must first work to find values that we hold in common. Simply calling for unity is nice, but much more listening is needed before we can dream of unity. Next, we need to agree on a sense of shared reality; for instance, that the virus is an equal opportunity threat. Finally, we need to agree on a sense of shared fate, that our shared economy and society are bound too tightly together for us to ignore the reality that each of us depends on the well-being of others.
Suppose we change the image of vaccines from “protection of me” to “protection of us.” The vaccine does protect “me,” but it also decreases transmission, and therefore, protects “us.” Even though most individuals are not vulnerable, we can’t really predict who is. So, to protect both “me” and “we,” we must promote vaccination widely, use appropriate levels of distancing, and work to make masking a part of the community ethic. While our public health administrators, clinicians, pharmacists, nurses and everyone committed to vaccination at the state and local levels are accomplishing the impossible with inadequate resources, we can remind them to prioritize the vulnerable and find imaginative ways to make vaccination acceptable to the hesitant, as well as accessible to the isolated.
If we can let the virus teach us about immune education (vaccination) to end the pandemic, we might begin to realize that other, more permanent, acts of community and equality are possible. ~~~
Fred Koster is a medical doctor and virologist whose fifty-year career included vaccine development. He serves as Treasurer for Western Friend and is a member of Albuquerque Friends Meeting (IMYM).