Why I'm in favor of anti-vax stigma

AP has a piece today questioning the "pandemic of the unvaccinated" storyline that has emerged amidst the Delta-fueled COVID surge. Some hospitalized people are vaccinated, after all, but the broader concern seems to be that some medical observers worry about stigmatizing the unvaxxed.

“It is true that the unvaccinated are the biggest driver, but we mustn’t forget that the vaccinated are part of it as well, in part because of the delta variant,” said Dr. Eric Topol, professor of molecular medicine at Scripps Research in La Jolla, California. “The pandemic clearly involves all people, not just the unvaccinated.”

Branding it “a pandemic of the unvaccinated” could have the unintended consequence of stigmatizing the unvaccinated, he added. “We should not partition them as the exclusive problem,” Topol said.

Instead officials should call out vaccine disinformation, said Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston. A sketchy stream of dubious arguments continues to undermine public confidence.

“We can say that the virus has reemerged in the southern United States, primarily among unvaccinated people, but it doesn’t mean we have to blame the unvaccinated,” Hotez said. “The people we have to target are the purveyors of disinformation, and we have to recognize that the unvaccinated themselves are victims of disinformation.”

Well, yes and no.

I'm all for calling out the purveyors of disinformation, but it's probably important to recognize there's an audience out there for the disinformation. People make choices not just based on correct information, but how they feel about things, and one of the factors that shapes those feelings is whether something is broadly understood -- by the culture, by community, by neighbors and friends -- to be good or bad. 

What's more, the medical community understands this and has used it to further public health goals in this country. Have you seen an anti-smoking ad in the last few years? They can be gruesome beyond belief. 

There is information being conveyed here, yes. But some of the information is designed to make smoking seem, frankly, unnattractive. You don't just see this ad and want to protect your health. You want to make sure you don't end up looking or sounding like this poor woman. The point here is to create visceral disgust -- to create a stigma against the act of smoking.

And these efforts, along with increasingly stringent regulation over decades, has worked.

Adult smoking rates dropped from 42% in 1965 to 14% in 2019, according to Centers for Disease Control and Prevention. The CDC has not released last year's data but the Quitline report cited U.S. Treasury Department data showing cigarette sales increased 1% in 2020 after dropping 4 to 5% each year since 2015.

"Pandemic of the unvaccinated" is admittedly a broad description, but it also seems to capture the heart of the problem facing the United States: 

By late July, a total of about 26 adults per 100,000 vaccinated people had been hospitalized for COVID-19. That’s compared with about 431 hospitalized people for every 100,000 unvaccinated individuals — a rate roughly 17 times as high as for those who were vaccinated. The data come from 13 states, including California, Georgia and Utah.

So I'm fine with continuing to use the label, despite AP's objections. I don't love "stigma" generally. But sometimes it has its uses.