Issues & Insights
Cpl. Jackeline M. Perez Rivera

The Dire Implications Of COVID-19 Vaccine Hesitancy


The seven-day moving average for COVID-19 deaths in the United States is around 1,800, the same as in early December 2020, before any vaccines were authorized for emergency use. How is that possible, 10 months after safe and effective vaccines began to be administered? 

It’s due to a combination of three interrelated factors: the Delta variant’s increased transmissibility and virulence; the degree of immunity in the population, which is a function of both the efficacy and durability of the vaccines; and the decisions of individuals and policymakers. Peoples’ reluctance to get the COVID-19 vaccine – what’s known as “vaccine hesitancy” – has played a large role in the nation’s failure to reach herd immunity. As of Oct. 6 the U.S. population is only 56.4% fully vaccinated, which makes us 41st most vaccinated in the world, despite being the headquarters of vaccine development for all three FDA-approved vaccines.

Over the course of the pandemic, the goal of COVID-19 vaccine has evolved; originally it was intended to prevent symptomatic infections (the criterion for efficacy in the clinical trials). With widespread vaccination, we are now seeing so-called “breakthrough” infections (mostly mild) in vaccinees, but the vaccines have been highly effective at preventing hospitalizations and deaths.

Misinformation is rife and has its roots both in domestic political activism and insidious foreign propaganda. Much of the anti-vaccine sentiment is the product of what can only be described as an industry, the principal protagonists of which are an organized group of professional propagandists. As reported in the science journal Nature, they are people “running multi-million-dollar organizations, incorporated mainly in the United States, with as many as 60 staff each.”  Some of the most prolific were identified by the Center for Countering Digital Hate, which found that a small number of people, the “Disinformation Dozen,” produce 65% of the shares of anti-vaccine misinformation on social media platforms.

Some of the misinformation about vaccines comes from an unobvious source: the Russian government’s propaganda apparatus, which seeks to promote misinformation in the United States via social media. This preceded the COVID-19 pandemic. A study published by academics in 2018, “Weaponized Health Communication: Twitter Bots and Russian Trolls Amplify the Vaccine Debate,” found that thousands of Russian social media accounts were spreading anti-vaccine messaging. From an examination of almost 2 million tweets posted between 2014 and 2017, the researchers found that Russian troll accounts were significantly more likely to tweet about vaccination than were Twitter users generally. They noted that Russian tweets like, “Apparently only the elite get ‘clean’ #vaccines. And what do we, normal ppl, get?!” seem intended to exacerbate socioeconomic tensions in the United States.

Russia is at it again now, in earnest. Using online publications to raise concerns about the rapidity of the coronavirus vaccines’ development and their safety, they have been conducting an aggressive campaign to undermine confidence in the Western coronavirus vaccines. Although it’s unclear what percent of online anti-vaccine propaganda and resulting vaccine hesitancy stems from Russian interference, its impact is very real in prolonging the pandemic and causing morbidity and mortality.

A frequent trope of this propaganda is that a pandemic whose infections have a 99.7% survival rate isn’t a big deal – but even a small percentage of deaths is significant when the number of cases is huge. The U.S. passed 700,000 deaths a week ago.  

Moreover, there is a high incidence of persistent symptoms after the acute COVID-19 infection. A poorly understood and poorly defined syndrome called Long COVID can result even following mild cases of the virus. The costs of preventable COVID hospitalizations are huge, as will be the downstream costs of treating millions of people for persistent post-COVID symptoms and, especially, Long COVID.

Every COVID infection is marked by viral replication and the appearance of new mutants which are then tested for “evolutionary fitness” – that is, higher transmissibility – by Darwinian selection. Therefore, as unpleasant as mask and vaccine mandates and other strictures may be, in order to curb the current pandemic and prevent the emergence of a new, worse variant(s), we need to continue to “flatten the curve” of infections with aggressive vaccination and non-pharmaceutical interventions (NPIs).

The current surge in COVID cases has also strained hospitals, which were already overburdened after a year-and-a-half of an ongoing pandemic. With intensive-care units in COVID-19 hotspots operating at maximum capacity, people who come to emergency rooms for things such as heart attack, stroke, appendicitis, or after trauma, can find themselves without a bed. An Alabama man with heart failure recently died after 43 hospitals turned him away due to lack of ICU bed space. Public health officials in Alaska have activated the state’s emergency crisis protocols, allowing 20 medical facilities to ration care if needed.

One unobvious issue that concerns the shortage of ICU beds is that some hospitals are significantly over ICU capacity. How does that happen? They’ve converted their step-down units, which normally have monitoring, etc., for people such as post-heart attack patients, to makeshift ICUs: putting ventilators, sophisticated monitoring, and other equipment in them, but lacking adequate staff. Thus, with ICUs overloaded, the quality of care overall suffers, with the doctors, nurses, respiratory therapists, EKG techs, and other specialists all spread much thinner than normal.

Beyond the impacts of the COVID-19 Delta surge in our hospitals and social media accounts, there are also longer-lasting effects on the U.S. economy. For example, with globalized supply chains disrupted due to local COVID outbreaks, semiconductor production has slowed, halting car manufacturing at automakers around the world. In other industries, such as durable goods, the replenishment of depleted inventories is slow due to delays at ports.  Many Americans are so concerned about the availability of merchandise for Christmas shopping that, according to a survey by, 27% of holiday shoppers planned to begin buying gifts before the end of September – and that includes 13% who started or planned to start in August!

Early on in the pandemic, Federal Reserve Bank Chairman Jerome Powell predicted that the full recovery of the U.S. economy would hinge on COVID-19 vaccine uptake. In April of this year, he added that global vaccination efforts are “not only the right thing to do” but “also the smart thing to do.”

With hospitals and global supply chains strained, and no end of the pandemic in sight, vaccine uptake is a critical part of reaching a post-pandemic world in which the SARS-CoV-2 virus and COVID-19 become endemic – that is, persisting in the population, but at a manageable level. We’ve previously written about the need for health communications messaging that addresses people’s core values and speaks directly to their concerns, but also convinces them to do what’s in their – and society’s – best interest.

Sheeva Azma, a freelance science writer and editor, digital content strategist, and communications professional, is the founder of science writing company Fancy Comma, LLC.  Henry I. Miller, a physician and molecular biologist, is a senior fellow at the Pacific Research Institute. The co-discoverer of a critical enzyme in the influenza virus, he was the founding director of the FDA’s Office of Biotechnology.

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  • Remember, this is the same guy who back in March said to take ANY of the vaccines because:

    ” The Johnson & Johnson efficacy rate is 66% overall and 72% in the United States in preventing moderate to severe cases of COVID-19, while the two-shot regimens of the Pfizer-BioNTech and Moderna vaccines are about 95% effective at preventing symptomatic infections.

    However, those numbers are not directly comparable, and context is critical to understanding the significance of these numbers. First, all three of the approved vaccines have been shown to be fully effective in protecting against the most important outcomes of COVID-19 – hospitalizations and death. ”

    Given that “he was the founding director of the FDA’s Office of Biotechnology” we can conclude he’s a vaccine shill.

    These people are beyond silly anymore. Having to play the “Russian” card is a sign of desperation. They’re losing, which is good. But man, oh man, a desperate people can create a lot of havoc in their defeat.

  • hi I&I, I can’t believe you published this tripe. Russia Russia Russia? seriously?

    and not one mention of the immunity from previous infection?

    and then the 43 hospitals fake news?

    this will be the last time I visit this site.

  • Seriously?? The writer needs to contact the more than 500 doctors that are against this mass injection trial that passes for a vaccine. 99+% treatable and curable. Tired of this institutional authoritarianism. All information should be shared. Phony or otherwise. We are adults and can make our own decisions. Extortion by threat of losing your livelihood is the worst kind of tyranny. All this is plainly against the Nuremburg Code.

  • I have my doubts about the veracity of this article. While it starts out more or less truthfully, it drifts off into conspiracy theory. It then uses “ain’t it awful” propaganda about deaths, some 94% of which occur in people who were already sick with morbidities, often multiple. It claims a man in Alabama died after being turned away by “43 hospitals.” I doubt if there are 43 hospitals in the entire state! I’m not so sure that I&I wasn’t conned.

  • Unusual to suddenly see I&I pushing the “get vaccinated” message with such a one-sided perspective. Why does this submission contain no discussion of natural immunity for the previously recovered – not even to say it’s not being considered for this article? No mention of hundreds of thousands of unvaccinated illegal border crossers entering the country and their effect on our overall protection rate. No mention of the natural reservoir of virus propagation as it’s been found in wild animal populations that will not be culled or vaccinated (wild deer positive in Michigan, zoo animals that have tested positive, etc). No mention of adverse reactions – not even dismissal of VAERS data. No mention of UK data about breakthrough hospitalizations and deaths.

    I’m not even arguing against your perspective – just the rigor of it. Very unusual, I&I… Not up to standard.

  • Vaccine hesitancy is due to one fact— it is experimental and it’s long-term effects are unknown. Case in point, Iceland now joins Finland, Sweden, and Denmark banning Moderna’s Covid vaccine for all ages over heart inflammation concerns, yet it is still under EUA here in the states. None of the Covid-19 vaccines are true sterilizing vaccines. Even vaccinated, you can still contract the virus and still spread it. Therefore, it should be left up to each individual, and their doctor, to ascertain their individual risk level for the virus and determine whether taking the “vaccine” is worth it or not.

  • There was no mention in this article of natural immunity, gained by surviving a Covid-19 infection. Vaccines are developed to simulate natural immunity. The science says natural immunity to Covid-19 is superior to vaccine immunity, which is why thousands of medical professionals quit rather than take the shot.

    The suspicion is the delta variant is going to spread regardless of vaccination rates. It’s now going through highly vaccinated blue states, clogging hospitals and killing people just as fast as it did in red states.

    Further, the introduction of Russian propaganda seems suspicious. Previous history of Russia Hoax fabrications makes this assertion suspect.

    Overall, this article reads much more like socialst propaganda “science” than actual science. I can read articles like this on censored news and social media anytime. I think I&I should be better than this.

  • So much misinformation in an article that puts significant focus on misinformation.
    People can see political bias and theater more clearly than those on stage realize. I believe in the vaccine even less after reading cherry picked information while leaving out critical info.

  • Messrs. Azma and Miller proffered arguments for universal US SARS-CoV-2 (COVID-19) vaccination are as illogical as the arguments for the “vaccine passports” now deployed in most of Europe — both of which are fundamentally logically flawed. It does not require an advanced degree in bioscience to understand this logical problem. Most people understand modern medical immunizations (vaccinations) to be preventative in nature; i.e., a given immunization (vaccination) prevents a given infectious disease, to a greater or lesser extent. Some current infectious and communicable disease immunizations (e.g., diphtheria, pertussis, polio, yellow fever) are understood to be fully-preventative; i.e., once immunized (vaccinated) against the communicable infectious disease in question, one can be closely exposed to either not-immunized (unvaccinated) persons, or even actively contagious persons, without any significant contagion risk to oneself. This is the long-accepted modern immunological definition and biomedical understanding of fully-preventative immunizations (vaccines).

    However some current immunizations (vaccinations) for common communicable infectious diseases (e.g., influenza), are not fully-preventative, but rather only generally preventative of severe disease, and not mild disease. Most are no doubt aware that the current influenza immunization technologies are not fully-preventative of influenza contagion, but are nevertheless advisable because they do statistically prevent severe dangerous influenza infection which can possibly lead to hospitalization. Moreover, current influenza immunizations (vaccinations) because they are not fully-preventative of contagion, are by extension also not fully-preventative of communicable disease transmission. As many probably know from experience, if an influenza immunized (vaccinated) person becomes slightly ill from a mild influenza infection, that person is then also capable of transmitting the influenza contagion to others, even unknowingly, since a very mild influenza infection may be no more noticeable than a slight common cold, or allergies. We all have experienced this phenomenon in office settings, for example.

    The same partially-preventative immunization (vaccination) situation now appears to be also the case for the current first-generation SARS-CoV-2 (COVID-19) US licensed immunizations: none of the three currently US licensed SARS-CoV-2 immunizations (vaccines) appear to be either fully-preventative of disease, nor do the current SARS-CoV-2 (COVID-19) immunizations (vaccines) appear to be preventative of communicable disease transmission. This conclusion has now reached biomedical consensus among US public health officials; e.g., former FDA chief and Pfizer board of directors member Dr. Scott Gottlieb “The vaccine doesn’t make you impervious to infection. There are some people who are developing mild and asymptomatic infections even after vaccination.” Or, “Among the 469 cases in Massachusetts residents, 346 (74%) occurred in persons who were fully vaccinated.”

    Like the partially-preventative of infection influenza immunizations, the current SARS-CoV-2 (COVID-19) immunizations may nevertheless be advisable for high-risk category persons because they do appear to statistically lessen severe dangerous infection possibly leading to hospitalization. However, like the influenza immunizations (vaccines), the current SARS-CoV-2 (COVID-19) immunizations also not fully-preventative of communicable disease transmission. Which means, logically, that persons immunized (vaccinated) against SARS-CoV-2 (COVID-19) are capable of transmitting the SARS-CoV-2 contagion to others, even unknowingly, since a very mild infection may be no more noticeable than a slight cold, or allergies.

    Therein lies the logical fallacy of the concept of both universal immunizations and “vaccine passports” : because the current SARS-CoV-2 (COVID-19) immunizations (vaccinations) appear to be only partially-preventative of disease, and not at all preventative of communicable disease transmission, it follows logically that SARS-CoV-2 (COVID-19) immunized (vaccinated) persons are in fact a contagion risk to SARS-CoV-2 (COVID-19) not-immunized (unvaccinated) persons. Current immunological and epidemiological clinical evidence — including that from CDC publications — clearly shows that SARS-CoV-2 (COVID-19) immunized (vaccinated) persons are in fact a contagion risk to SARS-CoV-2 (COVID-19) not-immunized (unvaccinated) persons, to exactly the same extent that SARS-CoV-2 (COVID-19) not-immunized (unvaccinated) persons can be a contagion risk to SARS-CoV-2 (COVID-19) immunized (vaccinated) persons. Specifically, because the current SARS-CoV-2 (COVID-19) US licensed immunizations (vaccinations) are only partially — and not fully-preventative — of disease infection: in other words, the current US licensed SARS-CoV-2 (COVID-19) immunizations (vaccines) are imperfect, or “leaky”.

  • Umm, has the author of this piece ever heard of, or looked at the CDC VAERS database? That alone, beyond many of the good comments here, should have resulted in a vaccination “pause”. The person that wrote this I would say likely has financial interest in the vaccines, like so many others in government and healthcare.

  • There’s too much misinformation and disinformation in the previous comments to warrant individual responses, but here’s a good article from the University of Nebraska Medical Center: The beginning of it is cut-and-pasted below:

    If you’ve had COVID-19 before, does your natural immunity work better than a vaccine?

    The data is clear: Natural immunity is not better. The COVID-19 vaccines create more effective and longer-lasting immunity than natural immunity from infection.

    — More than a third of COVID-19 infections result in zero protective antibodies
    — Natural immunity fades faster than vaccine immunity
    — Natural immunity alone is less than half as effective than natural immunity plus vaccination

    The takeaway: Get vaccinated, even if you’ve had COVID-19. Vaccine immunity is stronger than natural immunity.

    “Natural immunity can be spotty. Some people can react vigorously and get a great antibody response. Other people don’t get such a great response,” says infectious diseases expert Mark Rupp, MD. “Clearly, vaccine-induced immunity is more standardized and can be longer-lasting.”
    A third of infections don’t get any protective antibodies

    Some people who get COVID-19 receive no protection from reinfection – their natural immunity is nonexistent. A recent study found that 36% of COVID-19 cases didn’t result in development of SARS-CoV-2 antibodies. The people had different levels of illness – most had moderate disease, but some were asymptomatic and some experienced severe COVID-19.

    “Vaccine-induced immunity is more predictable than natural immunity,” says Dr. Rupp. The COVID-19 vaccines provide great protection from severe disease, hospitalization and death.
    Natural immunity fades more quickly than vaccine immunity

    Natural immunity can decay within about 90 days. Immunity from COVID-19 vaccines has been shown to last longer. Both Pfizer and Moderna reported strong vaccine protection for at least six months.

    Studies are ongoing to evaluate the full duration of protective immunity, including the Johnson & Johnson vaccine.

    Real-world studies also indicate natural immunity’s short life. For example, 65% of people with a lower baseline antibody from infection to begin with completely lost their COVID-19 antibodies by 60 days.

    What about that Israeli study suggesting natural immunity is stronger? Infectious diseases expert James Lawler, MD, MPH, FIDSA, carefully evaluates the study design of the retrospective Maccabi Health System study in his Aug. 31 briefing. In the briefing, he identifies two concerning sources of error that were not corrected for: survivorship bias and selection bias.
    Natural immunity alone is weak

    One study compared natural immunity alone to natural immunity plus vaccination. They found that, after infection, unvaccinated people are 2.34 times likelier to get COVID-19 again, compared to fully vaccinated people. So vaccinated people (after infection) have half the risk of reinfection than people relying on natural immunity alone.

    “Studies show that the vaccine gives a very good booster response if you’ve had COVID-19 before,” says Dr. Rupp.

    Furthermore, there is no country on the globe in which natural infection and natural immunity has brought the pandemic under control. In countries like Iran or Brazil very high levels of natural infection have not prevented recurrent waves of infection.

    [Article continues at

    • So an antibody test, for both natural immunity and vaccine immunity, would be a logical way to test for vulnerability. That would be following the science. Instead, mandating the shots is a authoritarian way way to emphasize the unconsistutional power of the federal goverment to mandate vaccines. The emphasis is on “do my bidding,” not on the science. This is an abuse of power, no matter what the “science” says.

      The rule of law is being scrificed to the rule of “experts.” Progressives and the woke consider government by the consent of the governed obsolete, because they think the people are too ignorant and stupid to be able to give informed consent.

      Democrats are the party of dictatorship and lawless mandates. Democrats think that 48 Senators are a majority. Democrats think that as long as there’s a plausible argument for vaccine benefits, mandates for vaccines are justified, laws be damned.

    • Despite Dr Miller’s oddly self-assured claim that clinical research data proves without any question that vaccine-induced immunity trumps natural pathogen-induced immunity for sars-cov-2/covid-19, this fairly complex technical bioscience question will no doubt in fact be vigorously debated for years to come in diverse scientific journals. Which, as Dr Miller surely knows, is precisely how the enterprise of modern scientific inquiry progresses, both in the natural and social sciences: reasoned evidence-based academic debate conducted in the public space of peer-reviewed journals and scholastic institutions. For readers interested in the rather complex technical immunological details of the vaccine vs natural immunity question, these review articles from prestigious scientific journals and referenced peer-reviewed research may be helpful and

      However the salient question probably more germane to readers of this l&l forum, is why in the first place Dr Miller is even bothering to share his presumably erudite subject-matter-expert views with forum participants for whom he apparently has frank contempt: “There’s too much misinformation and disinformation in the previous comments to warrant individual responses…”. The likely answer to that mystery seems to reside in Dr Miller’s co-author, Mr Azma, who apparently is “…a freelance science writer and editor, digital content strategist, and communications professional, is the founder of science writing company Fancy Comma, LLC” . For those readers novice to the subject of pharmaceutical medical marketing — or even to seasoned cynical marketing communications professionals from other industry verticals — it may come as a bit of a surprise to learn that journalistic placement of essentially pharmaceutical advertising promotional viewpoints is a well-known, if somewhat controversial, tactic of pharmaceutical industry medical marketing practices. An enlightening perspective published in 2008, obviously well before the current pandemic event: and (Interestingly, most of Wyeth’s assets — presumably, their medical marketing group as well — were acquired by Pfizer in 2008). But while the topic of journalistic placement of medical marketing promotional views may likely be somewhat eye-opening to l&l readers — and possibly to l&l editorial staff as well — it probably will not be so to Dr Miller, as an apparently long-time industry veteran

  • The author is overlooking two other large contributors to vaccine hesitancy. One was the consistent messaging during the 2020 primary and presidential campaign by Mr. Biden and Ms. Harris stating for months to the American public that they would not take any vaccine undertaken under President Trump’s watch. I think this created a large degree of hesitancy.
    Secondly the inconsistent messaging on masks, no masks, virulence, danger to children, school opening and closings, etc. that injected sufficient doubt in the minds of millions of regular citizens that they began to lose confidence in what they were being told.

  • Sorry I&I, but if this is the best you can come up with it is going to disappear from my daily reading list.

  • You refer to an anecdote that purports to demonstrate that hoards of unvaccinated people are preventing true emergency room cases from being treated, resulting in large numbers of deaths. (1) your citation is Newsweek, which has not been a reliable source this century, (2) most, if not all, of these anecdotes have been debunked, and (3) according to your own description of how hospital manage ICU capacity, the admitting hospital or one nearby could have admitted the man. I refer you to the editorial “How About Some Data COVID-19 Transparency?” by the I&I Board for the need for data transparency and honest reporting.

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