Explaining the Current Anti-Vaccine Hysteria

In an X article titled "The Two Rituals: What Leviticus Knows About COVID, Fauci, and Measles in Lancaster County," physician Amesh Adalja considers events from the Covid pandemic to the current return of measles outbreaks to a nation that had once eliminated the disease. In doing so, he relates them to the current rise of anti-vaccine (and even anti-medicine) hysteria on the right.

His ancient starting point is startlingly apropos:

These are, on their face, two different problems. Leviticus 13 concerns an affliction of the body. Leviticus 16 concerns transgression against a deity. But both are impurity, both threaten the population, and both are the same leader's responsibility. What Leviticus offers is not a theory of disease but a system for handling contamination -- and that system has exactly two operations. Examine the afflicted, at length, and reach a determination about what they actually have. Or gather the pollution onto a designated carrier -- a scapegoat -- and drive it out. The second method is fast and requires no real objectivity. [bold added]

While one might regard bringing up scapegoating as the prelude to a defense of Anthony Fauci, such a conclusion would be only partly correct, for Fauci is just one of the scapegoats in the analysis, which goes on to explain how vaccination and even the entire field of medicine ended up also being scapegoated.

Along the way, Adalja also looks at what each of our nation's political tribes got wrong in their responses by choosing the second, easier ritual and the unanimity/illusion of certainty it provides:

The refusal [by lockdown proponents] to consider risk stratification, risk calculation, and harm reduction was a failure. The honest answer to COVID-19 would produce different guidance for different people -- and different guidance is unusable to anyone who needs a universal rule. The immunocompromised patient deserved a real conversation about their specific residual risk and the additional tools available to them. What they got instead was conscription into an argument about everyone else's behavior.

The mirror image runs the other way. The disease is no worse than the flu. The vaccine does not work, or works so briefly it doesn't count. The vaccine's harms are catastrophic and concealed. And doing nothing costs nothing at all.

This is not inquiry, which would be welcome. What happened instead was that every one of the four questions above was answered in advance by a conclusion already held, and the answers moved as needed to protect it.

The four unasked questions?

1. How dangerous is the disease (does it cause death, hospitalization, healthcare utilization?) and to whom?
2. How well do the medical countermeasures (treatments, vaccines, post-exposure prophylaxis) work, if any are available? And for whom?
3. What does the medical countermeasure strategy cost?
4. What is the cost of inaction?

But Trump started the lockdowns! you might correctly remember. Adalja addresses that and explains why the right has memory-holed that fact and why vaccination was ripe for scapegoat status:

I have written elsewhere about where the anti-vaccine movement's epistemology came from -- the postmodern critique of scientific authority, the flattening of expertise, the treatment of consensus as a species of power. That genealogy explains how people acquired the confidence to disbelieve expert claims. It does not explain why vaccines became the object. Nobody organizes against statins. Nobody holds rallies about dialysis.

The answer, I think, is that vaccination is the one medical intervention routinely justified to the patient as an obligation to other people. Get it to protect the immunocompromised. Get it for your grandmother. Get it for herd immunity. Every other intervention in medicine is offered on the grounds that it will help you. This one, uniquely, is pitched as something you owe.

That framing is well-intentioned and largely true. It is also precisely what made vaccination available to a critique about bodies being conscripted for collective ends. When a field argues its case in the language of what you owe the collective, it should not be surprised when someone predisposed to see medicine as social control finds the evidence in its own words. And there is a second cost: by making the case in terms of what you owe others, public health left the benefit to you underemphasized for decades. [bold added]

In addition to noting how this messaging made vaccines ripe for goat status, Adalja explains why this eventually happened -- in short, because scapegoating doesn't really work.

I am not sure I have done the piece justice here, but I hope I will have motivated someone to see how Adalja ties this all together, and manages to explain how so many people who seemed to understand the value of vaccination five minutes ago are now its hysterical opponents.

There is lots to unpack here, but this is the kind of knowledge it will take to fight for the selfish value of vaccination and medicine.

-- CAV