Vaccine Refusers Risk Compassion Fatigue

After the horrors that health-care workers have endured during the pandemic, many are struggling to sympathize with people who won’t protect themselves.

On social media, I’ve been seeing sentiments that I never thought I’d see anyone express in a public forum. People who choose to be unvaccinated should not be offered lung transplants. What if people with COVID-19 who didn’t get the vaccine have to wait in the Emergency Department until everyone else is seen? Should unvaccinated patients just be turned away?

These are harsh, angry feelings. And some of the people giving voice to them are doctors.

I am an obstetrician in New York. I have been working with pregnant COVID-19 patients from the very beginning of the coronavirus pandemic, in a medical institution and city that have cared for thousands of patients with the disease. Health-care workers have suffered through a terrible year and a half—a period first defined by a lack of masks and gloves, and throughout by the very real fear of personal sickness and death. We have been afraid of bringing the disease home, of infecting our spouses, of leaving our children parentless. For about three months, I didn’t kiss my children.

Every day, my colleagues and I trudged past the temporary morgues in our hospital parking lots and the ICUs set up in the auditoriums and operating rooms and hallways; we signed too many death certificates; we washed our hands until they blistered before we let our families near us. We did that, every day, because we were trained to care for humans who needed us.

A lot of us went to work every day because the world needs to keep turning, and in that time, we were the ones turning it. Many others left medicine. One reason I didn’t was that humans needed help and I could provide it. But I also kept working because I needed to believe that, if I was ever in danger, other humans would come help me. Our comparative advantage as humans is that we can take care of one another and overcome adversity together. I did my part week after week, month after month.

Finally, in the depths of winter, during the week of my birthday, I received my first vaccine shot. Science had brought us a solution, and we could finally see the end of all those months of fear, exhaustion, and sacrifice.

But that’s not what happened. COVID-19 hasn’t ended. Instead, infection rates are going up. The Delta variant has taken hold, and hospitals are filling up again. But this time the suffering seems different, because it is avoidable. Optional. A choice.

The main reason the pandemic in the United States is not over is because people are not getting vaccinated. Some people may have good reasons for not getting a shot, but most people who refuse vaccination do not seem to be acting based on data or evidence. The refusals that we read every day seem more rooted in a general mistrust of government, or in a strong identity as “not that kind of people.” And those vaccine refusals mean people are getting sick, and will need care, and may die needlessly.

This is a fact that many of us in health care—all exhausted, all having given too much already—are having a hard time ignoring as we head into a new wave of COVID-19 patients.

When people make their personal decision about whether to get vaccinated, they are not thinking about the trauma their health-care providers have experienced since early last year. And I am not asking them to consider it. Professionalism mandates that physicians focus on the disease in front of them, not the behavior that may have contributed to it. When my colleagues diagnose chlamydia in a patient, their first priority is administering antibiotics, not delivering a lecture about asshole boyfriends. But once those antibiotics are prescribed, that same professionalism must include making sure that the patient knows how chlamydia is transmitted, and how to avoid ending up in this situation again.

That person may or may not listen to a doctor, and that’s understandable. However, the population-level rejection of COVID-19 vaccines is a different phenomenon—and one that’s much more personally threatening to my colleagues and me. By refusing the most effective intervention, people are risking not only their own life but the lives of many around them. That includes those who cannot get vaccinated—my children among them. Because of the choice that vaccine refusers are making, my job may again force me to avoid embracing my children.

“What makes me the maddest,” one of my doctor friends told me, “is that these people will reject science right until the second they need everything I have to keep them alive, and then they feel that they can come to our door and be entitled to that help and that hard work.” This friend is characterizing the inconsistency in the behavior she sees in people declining a vaccine but then demanding medical care based on the same science. That inconsistency feels, to her and to other dedicated medical professionals trying to survive this pandemic, very much like dishonesty.

Unlike during the pre-vaccine phase of the pandemic, the current upsurge of suffering isn’t one that humanity has to go through. People are choosing it. And intent matters. Intent is the difference between a child who goes hungry because their parent can’t afford dinner and the one who goes hungry because their parent won’t buy them dinner. Having the ability to provide relief but not do so is cruel. To many medical providers working today, the rejection of lifesaving COVID-19 vaccines feels like a giant “Fuck you” from 29 percent of American adults. We will keep providing the best care possible, but they are making our job much harder.

Not all health-care workers agree, of course. Plenty of hospital workers remain unvaccinated, and some have even staged protests against hospital-wide vaccine mandates. But most of us got vaccinated, and we’ll go to work tomorrow and the next day, no matter what. We will start IVs and give medicines and intubate patients no matter what bumper sticker is on their car. We are holding up our end of a bargain with society. But is society fulfilling its end?

The pandemic has taken away so much: millions of jobs, more than a year of education for tens of millions of children, more than 600,000 American lives. Amid this new, largely preventable wave of infections, some health-care providers are losing something else: the belief that all of us can come together as a people to solve a problem. Doing the work of curing human bodies is harder when some of one’s faith in humanity is lost.

What comes next? Future waves of COVID-19, probably; a widespread return to masking, perhaps; vaccine mandates in some limited settings, eventually. With time and common sense, the United States may get to a point at which infections subside. But it may not. I would argue that even if we do, Americans will have wasted time, energy, and lives. A year ago, we worried about dwindling N95-mask supplies and a limited ventilator inventory. Now we are burning through our most irreplaceable health-care resource: hope.