Seven years ago now I wrote a blog post about vaccine hesitancy, back when the vaccine in question was the MMR vaccine. It was a timely post, and it’s been gratifying to see that my proposals were taken up by the public health community, thus averting another social paroxysm surrounding vaccinations.

No, of course I have instead the colder comfort of seeing that my analysis then was basically correct. Every issue surrounding COVID-19—masks, vaccination, social distancing—has become a partisan political issue (overlaying, or being overlaid by, the cultural divides in our country). There is plenty of blame to go around, but I put the blame largely on the policymakers and opinion leaders, who by now have learned the limits of Proof by Condescension in a country as diverse as the United States, and who I hope will learn the limits of enforcing public health decisions.

I think it’s reasonable to expect policymakers to understand that there is a subset of the population who would fight any requirement simply because it is mandated. Does anyone doubt that if some arbitrary activity were mandated by government—whether visiting the elderly, or exercising for 30 minutes three times a week, or reading War and Peace—then some group would form in opposition to that mandate? (One of my favorites: When the Swiss Voted to Ban New Minarets, This Man Built One.) And I don’t think it takes a PhD in sociology to predict that going after that small percentage will provoke a yet larger percentage of people to support the fringe position. And at some point, even mainstream publications are going to start asking questions about why the masses can’t be trusted to read Dostoyevsky instead of Tolstoy.

For some reason, however, these things are not evident to government officials and the media. Some of these people must have toddlers, or must have had toddlers at some point. Can you imagine what bedtime is like at their houses?

(The original blog post was memorable for another reason, in that I brought up some of these ideas in a conversation with a doctor soon after I’d written the post. I evidently somehow managed to convey (incorrectly) that I am an anti-vaxxer­—which was unfortunate, but which indirectly sponsored a meeting in our community about the importance of vaccination.)

I would like to expand the original post, however. In the earlier post I observed that an X% chance of death is incommensurate with a Y% chance of becoming autistic: there is simply no principled way to decide where to make the cut-off, neither with science nor with your gut. (And again to be clear, this was all for the sake of argument; I do not believe there is a correlation between vaccination and autism.) The quantities can’t be directly compared, and therefore we are never going to have consensus on how to balance those risks. Here I would like to point out two further incommensurate quantities.

The first incommensurate quantities are the risk of taking action and the risk of not taking action. We could jump right to COVID-19 vaccines, but let’s start more abstractly. What if there were an injection that carried a 33% risk of instant death, but a 67% chance at immortality? Would you administer that injection to your child? If you approach the decision in terms of expected payout, you give the injection, no question. But would you feel comfortable doing that as a parent? What if the odds were 50-50? What if they were 10-90? How low would they have to be before you could ignore the risk that something you did would result in the death of your child? Economics does not help us here.

The second incommensurate quantities are known risks and unknown risks. I believe the risks of dying or becoming seriously ill from COVID-19 are pretty well established by now. We’ve certainly have as large a sample size as we might desire. But the long-term risks of being vaccinated against COVID-19 are… wait for it, this is a bare statement of reality and not a polemical position… unknown. There’s not a person alive who can tell you what the health outcomes of COVID-19 vaccination will be two years after vaccination, because no one has the data yet. Now, intelligent and educated people believe there will be no problem. As far as I can tell they’re right. But I don’t know that for certain, and neither do they. So what we all have to do is decide how we feel about that unknown risk. And, the fun part about being part of society is that there are all sorts of people with peculiarly contradictory beliefs. In the present constellations of political and cultural beliefs, there are plenty of people who are eager to inject a genetically engineered virus into their bloodstream, who would become be very nervous if a similar virus had been injected into their corn. Vaccines: not scary. GMO crops: scary. And vice versa. There is of course no logic to any of this. It’s simply people responding idiosyncratically to unknown risks. (Of course “idiosyncratically” is generous; more likely they’re responding tribally.)

There’s a blend here of sympathy and antagonism for various views here. At the interpersonal level, my point is simply that there are many things that we cannot decide mathematically, or scientifically, or indeed in any principled way. This calls for patience and grace. (It’s probably not a coincidence that these questions become political, as politics is suited to people who lack principles.) At the government/public-heath level, one hopes that in the future there will be a somewhat better articulated messaging campaign. Eschew condescension; don’t pretend that ‘science’ offers greater certainty than it does; pick some brand ambassadors who are respected in their respective communities. Persuade, woo, etc. And as I noted previously, explain statistics and scientific reasoning. We have enough things to fight over in our society. Let’s try to keep public health issues out of it.