What if the unvaccinated cannot be persuaded to take the shots?

If policymakers want to change their minds, they have to raise the costs of remaining unvaccinated

Anti-vaccine protesters outside Madison Square Garden ahead of a show by rock band Foo Fighters, which required proof of vaccination to enter, in New York City in June.
Anti-vaccine protesters outside Madison Square Garden ahead of a show by rock band Foo Fighters, which required proof of vaccination to enter, in New York City in June.PHOTO: REUTERS

(NYTIMES) - I hate that I believe the sentence I'm about to write. It undermines much of what I spend my life trying to do. But there is nothing more overrated in politics - and perhaps in life - than the power of persuasion.

It is nearly impossible to convince people of what they don't want to believe. Decades of work in psychology attest to this truth, as does most everything in our politics and most of our everyday experience.

Think of your own conversations with your family or your colleagues. How often have you really persuaded someone to abandon a strongly held belief or preference?

Persuasion is by no means impossible or unimportant, but on electric topics, it is a marginal phenomenon. Which brings me to the difficult choice we face on coronavirus vaccinations. The conventional wisdom is that there is some argument, yet unmade and perhaps undiscovered, that will change the minds of the roughly 30 per cent of American adults who haven't got at least one dose. There probably isn't.

The unvaccinated often hold their views strongly, and many are making considered, cost-benefit calculations given how they weigh the risks of the virus, and the information sources they trust to inform them of those risks. For all the exhortations to respect their concerns, there is a deep condescension in believing that we're smart enough to discover or invent some appeal they haven't yet heard.

If policymakers want to change their minds, they have to change their calculations by raising the costs of remaining unvaccinated, the benefits of getting vaccinated, or both. If they can't do that, or won't, the vaccination effort will most likely remain stuck - at least until a variant wreaks sufficient carnage to change the calculus.

You can see the weakness of persuasion in the eerie stability of vaccination preferences. The Kaiser Family Foundation has been surveying Americans about their vaccination intentions since December. At that time, 15 per cent said they would "definitely" refuse to get vaccinated, 9 per cent said they would get a shot "only if required", and 39 per cent wanted to "wait and see".

Six months later, Kaiser asked the same question. By then, most of the wait-and-see crowd had seen enough to get vaccinated. The only-if-required crew shrank, but only by a bit: 6 per cent of Americans were still waiting on a mandate.

But the definitely-notters had barely budged: they numbered 15 per cent in December and 14 per cent in June.

I don't want to overstate my case. There was movement between groups. Some people who said they would definitely refuse a vaccine in December had got one by June. About a quarter of those who intended to watch and wait decided firmly against getting vaccinated. But the surprise in Kaiser's data is the consistency of people's views.

In December, 73 per cent of American adults said they were eager to get vaccinated or were at least open to the possibility. Today, 69 per cent of Americans over the age of 18 have got at least one shot. "Most vaccine behaviours match what people planned to do six months ago," Kaiser concluded.

With Delta supercharging transmission among the unvaccinated, the debate now is how to persuade them to get a shot (or two).

I'm sympathetic to most of the ideas people have offered. The Food and Drug Administration should give the vaccines full approval, not just emergency authorisation, as the agency's absurd process has created mass confusion and fed mistrust.

We should respect people's concerns and their intelligence. We should admit that the medical system has failed many of us before, and treated black Americans with particular callousness. We should be honest that many are making a risk calculation for themselves, rather than indulging a conspiracy theory.

We should also, of course, do everything we can to make vaccination frictionless. It's easy to get a shot in a big city, but many people still live far from medical providers and cut off from the Internet.

Others lack transportation, or have jobs that make it hard to take a day off to recover from the fluish side effects, or have physical or mental impairments that make treatment difficult.

But I suspect all of this will change a depressingly modest number of minds. There are no speeches more powerful than the fear of disease and the grief of loss. That's evident in the vaccination data now. Delta does appear to be driving a surge in vaccinations.

But is this really our strategy? More deaths will lead to more shots in arms?

One of the most heartbreaking stories I've read lately came from a Facebook post by Brytney Cobia, a doctor in Alabama. She wrote: "I've made a lot of progress encouraging people to get vaccinated lately!!! Do you want to know how? I'm admitting young healthy people to the hospital with very serious Covid-19 infections. One of the last things they do before they're intubated is beg me for the vaccine.

"I hold their hand and tell them that I'm sorry, but it's too late. A few days later when I call time of death, I hug their family members and I tell them the best way to honour their loved one is to go get vaccinated and encourage everyone they know to do the same. They cry. And they tell me they didn't know.

"They thought it was a hoax. They thought it was political. They thought because they had a certain blood type or a certain skin colour they wouldn't get as sick. They thought it was 'just the flu'. But they were wrong. And they wish they could go back. But they can't. So they thank me and they go get the vaccine."

Mr Phil Valentine, a conservative radio host in Nashville who said he wouldn't get vaccinated and made parody songs about "the Vaxman", caught the virus, and his condition quickly turned critical. He's now in the hospital, on a ventilator.

"He regrets not being more vehemently 'pro-vaccine', and looks forward to being able to more vigorously advocate that position as soon as he is back on the air," his radio station said in a statement.

This is one problem with trusting our rationality: The choice we make now, before we catch the virus, may not be the choice we will wish we had made once we get sick.

Then there's the stubborn fact that individual decisions have collective consequences. It may indeed be the case that a healthy 19-year-old American has little to fear from the coronavirus. But his immunosuppressed grandfather has much to fear from him.

Whether it is a more severe imposition on liberty to ask someone to get vaccinated or regularly tested than to ask all immunosuppressed people in the country to effectively shelter in place for the rest of their lives is a collective question that demands a collective answer.

Other countries are offering that answer, and seeing results. French President Emmanuel Macron proposed a law requiring either proof of vaccination or a negative test result for many indoor activities. The mere prospect of a vaccine mandate set off mass protests. It also led to a surge in vaccinations.

On July 1, 50.8 per cent of the French population had got at least one shot - putting France 3.5 points behind America. Last Sunday, 59.1 per cent of France had been at least partially vaccinated, putting it 2.7 points ahead of us. A number of American employers are following suit.

Last Thursday, the Biden administration announced a directive requiring all civilian federal workers to get vaccinated or face routine testing and restrictions. California and New York will require proof of vaccination or routine negative test results for all state employees.

New York City is imposing the same requirement for its public employees. Around 600 college campuses have announced that they will require vaccinations for students returning in the autumn.

There's no hard count of how many businesses are requiring vaccinations or test results to come back to work, but the anecdotal answer appears to be "a lot".

There is nothing new about this. We do not solely rely on argumentation to persuade people to wear seat belts. A majority of states do not leave it to individual debaters to hash out whether you can smoke in indoor workplaces. Polio and measles were murderous, but their near elimination required vaccine mandates, not just public education.

The objection I find most convincing to any kind of vaccine mandate is that we have not built the infrastructure to make it work.

What if someone who received a vaccine has lost her card, or her information was wrongly recorded when she got her shot? If we try to carry this out through smartphones, what if you don't have a smartphone, or you lose it?

If you want to choose frequent testing, how do you get access to those tests, and who pays for it, and how are the results recorded? If you have a problem, who do you call to solve it? How long are the wait times when you call? What if you need an answer quickly?

I covered both the debacle of the HealthCare.gov launch and the multi-decade failure to transition to electronic medical records. We just watched state unemployment insurance systems nearly collapse under the demands of the pandemic. Perhaps we don't have the capacity to do this well.

But with so many public and private employers mandating vaccination for their workforces, we'll know soon enough. Either they will build models that can scale or they will fail spectacularly enough to settle the question. And either way, this suggests a step the government could take right now: funding, building and deploying an excellent vaccination passport infrastructure - backed up by ubiquitous rapid-testing options, for those cases when the passport fails - that private and public employers can use to implement their own policies.

Though I'd like to believe otherwise, I don't think our politics can support a national vaccination mandate. The places that would most benefit from a mandate would be those most opposed to following one, and deepening partisan divisions here would be catastrophic (this is a problem that also afflicts the Centres for Disease Control and Prevention's new masking guidance).

A high-stakes showdown between, say, the federal government and the state of Florida over a mandate would be a distraction we don't need. Quickly building the records and testing options for individual employers to take the first steps seems like the right middle ground, at least for now.

Making it more annoying to be unvaccinated won't persuade everyone to get a shot. But we don't need everyone. According to Kaiser's data, 16 per cent of American adults are still in the wait-and-see or only-if-required categories. If they all got vaccinated, we'd hit herd immunity in most places.

If more of the unvaccinated were routinely getting tested, that would help, too. And if cases then fell, the restrictions could lift. The Delta strain is fearsome enough, but if we keep permitting the virus to dance across the defenceless, we could soon have a strain that evades vaccines while retaining lethality, or that attacks children with more force.

Over and over again throughout this pandemic, the same pattern has played out: We haven't done enough to suppress the virus when we still could, so we have had to impose far more draconian lockdowns and grieve far more deaths, once we have lost control.

For this reason among many, I urge those who object to vaccination passports as an unprecedented stricture on liberty to widen their tragic imagination.