There’s been a lot of miscommunication and conflation going on about the COVID-19 vaccine in America— and many in the American public have been misled by, both, false or incorrect government policy and nefarious or ignorant forces in the media.
The truth is that most of the public hesitancy towards vaccination stems from a deficit in public education about immunology and inadequate perspective on environmental risk.
I’ve been thinking about these issues for some time — both as an immunologist with a deep grasp of vaccine science and as someone who has spent the last 8 years thinking about risk management and how “minority harm” is born and sustained in America and how to minimize it.
Here I write to share what I know is a precise analogy to the COVID-19 vaccine from a risk space, which almost every American can relate to and has daily experience with: Automobile seatbelts.
With rare exception, almost every American wears an automobile seat, nearly every day. The history of this risk mitigation device is well known and documented — all the way from invention of the seatbelt, to its required design into every American car by federal law, to incorporation of its mandated use by drivers and passengers in most US states.
The automobile seatbelt is an engineered device that is designed to prevent or minimize the risk of injury when a car is involved in an accident.
In this way the seatbelt is conceptually analogous to vaccines, which are designed to prevent or minimize the risk of harm from infectious diseases.
The physical or immunological principles upon which both these safety devices are engineered are quite precise and well established.
In the case of the seatbelt, the principles of basic mechanics are used to mold a mitigation device around human anatomy to minimize the risk of harm in a collision.
In the case of the vaccine, the principles of basic immunology are used to induce production of IgG antibodies and primed T-cells, to minimize the risk of harm from an infection.
These are both safety devices that rely on established scientific principles applied by American scientist and engineers to protect lives from harm in different environments.
Both these devices are operational in their own unique and distinct spaces. Where auto seatbelts operate in the vehicular transportation space on roads and super highways, vaccines operate in exposed public environments in which bacteria and viruses compete for hosts to successfully infect.
And just like seatbelts become highly relevant risk mitigation devices on high traffic and high speed road, vaccines become highly relevant in populated public environments and especially at times of epidemic or pandemic outbreak.
Furthermore, just like a vaccine is literally applied into the human body to generate a protective response, seat belts conform onto the human body to protect from injury any time a person in vehicular transport.
On the downside, both seatbelts and vaccines expose the user to an intrinsic risk of harm.
Though the ubiquitous use and familiarity with seatbelts might make many readers want to dismiss my analogy to vaccines as being inaccurate, every surgeon can tell you about a category of traumatic injuries, some deadly, known as “seat-belt injuries”. Like vaccine injuries, seatbelts cause horrific injuries too.
These seatbelt injuries can range from rib fractures, to carotid vascular injuries in the neck, to thoracic aortic transections, cardiac contusion, bowel injury and pancreatic injury, to name a few. And some of these are quite severe. Some are even fatal.
And there is no question that over the past 80 years, the seatbelt technology and its adjunctive accoutrements have evolved to become safer, more effective and less intrusive.
But, despite the intrinsic rate of “seat belt injuries”, it is well established that the overall risk-benefit equation favors the use of seatbelts by every driver and passenger in automobiles. Seatbelts save more lives and reduce the severity of injuries far more frequently than they harm drivers and passengers. Certainly the public’s familiarity and education about seatbelts leave very little doubt in any American minds about the importance of using them routinely in the driving environment.
Similarly, vaccines have an intrinsic rate of injury associated with their use. There is no question that many people have experienced very unfortunate, and some tragic, complications and injuries associated with vaccines.
These can range from neuropsychiatric injuries, to allergic/anaphylactic injuries, to autoimmune diseases, to critical hyperinflammatory reactions, to name a few. And some of these are quite severe. Some are even fatal — like seatbelt injuries.
And there is no question that over the past 80 years, vaccine technology and its adjunctive accoutrements have evolved to become safer and more effective. Of course, there is also no question that medical science is nowhere near finished with perfecting vaccines — and certainly our federal regulations government vaccine litigation pose a serious threat to litigation of errors in design and administration.
But despite the intrinsic rate of “vaccine injuries”, it is well established that the overall risk-benefit equation favors the use of vaccines in public arenas in order to control the uncontrolled spread of epidemic and pandemic viruses and bacteria. Most vaccines save more lives and reduce the severity of infections far more frequently than they harm people.
When it comes to the COVID-19 pandemic and the COVID-19 vaccine, the correct risk calculus is exactly the one we subconsciously accept every day when we put on a seat belt in our car: There is an intrinsic risk of harm from the seat belt itself in an accident, but this is far outweighed by its benefit both at the personal and societal levels. But, in America, because of a combination of poor public messaging from the United States government and inadequate public education in immunology, we are unable to apply this risk calculus.
Nevertheless, it is a scientific fact that neutralizing IgG antibodies and primed T-cells are radically effective at preventing progression of infections by transient bacteria and viruses, such as SARS-CoV-2.
Are seatbelts perfectly capable of eliminating harm in a car accident? NO!
Are vaccines perfectly capable of eliminating harm from infection? NO!
Do seatbelts themselves cause an intrinsic risk of injury? YES!
Do vaccines themselves cause an intrinsic risk of injury? YES!
The analogy between seatbelts and vaccines is precise. The biggest difference is a perceptual one that has to do with our long-term familiarity with the seat belt and basic grasp of its physical properties — whereas with vaccines there is a lack of public education in basic Immunology, and especially with the COVID-19 vaccine, a lack of familiarity with the mRNA vaccine technology itself. This unfamiliarity and hesitancy is sustained and stoked by bad government policy and it is exacerbated by nefarious or ignorant forces in the media. Mistrust in government and bad media information are a deadly combination.
The bottom line is that, like the automobile seatbelt, the efficacy and benefit from COVID-19 vaccination to the individual and to the whole of society is far outweighed by the risk of injury it poses on a population or individual level. Yet this is NOT to say that vaccines ought to be applied in a “one-size-fits-all” fashion or to demographic subsets at low risk from infection. Just like seatbelts need to be used judiciously and with added caution in certain populations (e.g., kids and infants), so should the COVID-19 vaccines.
As a final juxtaposition, it’s recently come to light that the majority of COVID-19 infections are occurring in already vaccinated people — though in vaccinated populations the absolute number of infections is logarithmically decreased. Some claim this is evidence that the vaccine is NOT working. My only response is that on any given night in trauma bays across this nation’s hospitals the vast majority of injuries from automobile accidents happen to drivers and passengers who are wearing seatbelts. Does this mean that seatbelts are NOT effective at preventing injury or reducing the severity of injury? NO!
My position on the COVID-19 vaccine in this pandemic is very basic and I hope that every citizen reading can find him- or her-self able to follow my recommendation that: every adult who does not have pre-existing immunity against SARS-CoV-2 from a prior infection consider getting immediately vaccinated. Just as every person exposed to vehicular traffic in an automobile ought to wear a seat belt.
Imagine, if we lived in a world where drivers mistrusted government policies about seatbelts and in which nefarious or ignorant media forces were stoking irrational fear in drivers. Driving would very quickly become an enormously costly and deadly public health disaster.
What do seatbelts and vaccines have in common? Almost EVERYTHING!
Think quickly and with care America — our nation’s survival is at stake.