Why do people avoid vaccination?

It doesn't feel hard for me to understand. People have been lied to in various ways over the course of the pandemic and some of them were either severely harmed by lookdown policies or had their friends severely harmed.

The establishment lost a lot of credibility for saying that it was okay to demonstrate unmasked in the BLM protests right after lookdown and then afterward telling people that wearing a mask outdoors is very important. 

I have a friend who explained her being unvaccinated with three of her friends committing suicide during the lockdown. While it's not rational behavior given that vaccines and lockdown are two different issues, I find her position understandable, such experiences polarize people. 

People lost jobs and businesses and faced serious hardship because of lockdown policies.

An unspoken theme is arguably being in possession of relatively little information (like, what’s going on with the person who is still waiting to find out if the vaccines are effective? And do people just not know that the vaccine reduces the downside of covid, even if it is still possible to get it? Or do all of these people know things I don’t?).

Those people know that the establishment tells them those things, but lack the ability to tell which of the claims from the establishment are actually true, so they are effectively in the possession of relatively little information.

I wonder if much good could be done in this kind of situation with some kind of clearly independent and apolitical personal policy research institution, who prioritized being trustworthy and accurate.

In a climate where people lie and censor to get people to do what they want you can't be apolitical and independent. You will take stances that get people to attack you politically.

If I wasn’t in such a position, I feel like I’d pay a decent amount for someone to think about such things for me. 

Normal people who get operations are not willing to pay to get information about which hospital is best at doing a given operation. After Hanson, a lot of health decisions are made around showing that one cares and not through a good analysis of the available information.

I noticed an emotional shift in myself after mandates were put in place. Before hand my mood around the vaccine was pride at scientific civilisation and eagerness to join in. Afterwards anti-domination instincts kicked and I could not help feeling resentment that my vaccination had given the bullies what they wanted even though it was still in my best interest.

One potential explanation is needle phobia, and people invent rationalizations on top of this. I don't find it prima facie implausible that people strongly dislike violations of their bodily autonomy. This is, after all, the reason why we have laws against non-consensual touching and sexual assault. 

This theory has the advantage that it explains why people seem less skeptical of government coercion for other things. My sense is also that I find relatively little resistance to the idea that we should take emergency-approved medication if we're hospitalized with COVID-19.

Wikipedia states,

It is estimated that at least 10% of American adults have a fear of needles, and it is likely that the actual number is larger, as the most severe cases are never documented due to the tendency of the sufferer to avoid all medical treatment. The diagnosis criteria for BII phobias are stricter, with an estimated 3-4% prevalence in the general population, and this also includes blood-related phobias.

Prevalence of fear of needles has been increasing, with two studies showing an increase among children from 25% in 1995 to 65% in 2012 (for those born after 1999). Augusta University professor Amy Baxter attributes this increase to an increase in administration of booster shots around the age of 5, which is old enough to remember and young enough to be more likely to result in formation of a phobia.

As for myself, I find it somewhat disturbing to be stabbed with a needle. I can cope with vaccines, but in the few instances in my life in which I needed to draw blood, or have a drug administered intravenously, I remember feeling extremely queasy. It's overall not a fun time.

I thought about writing this when the vaccine trials were wrapping up, but was slow, and by the time I had it ready, I saw SSC say the overwhelming majority of people in this sphere were vaccinated so I figured it would be a waste of time.

I didn't get one of the three vaccines available in the USA, if I were in a higher risk demographic/lifestyle/less lazy, I would have made the radvac. I would be willing to get novavax or soberana. I have no needle anxiety (if it's relevant). I have studied this stuff on my own since well before the pandemic and am decent enough in the lab that I could probably do a lot of the work of making a recombinant vaccine with the correct equipment

I tried the inside view/outside view method of forecasting and am satisfied with the result.

Some things I view as the outside view: -early years of mass vaccination campaigns are usually associated with disasters (1850-70s cowpox campaign, cutter/wyeth during polio, swine flu in the 70s, pandemrix in 2009, many others) -the FDA is bad at evaluating new technology (they approve things that shouldn't be, and block things they shouldn't); as an example, it took five years to pull thalidomide. -vaccines are safe drugs not because of anything inherent to the class, but due to the stringent standards to which they're usually held

I saw nothing inside this situation which gave me unusual confidence about this particular mass vaccination campaign. I did see an apparent relaxation of the stringent standards usually applied to vaccine approvals.

I figured I'd wait a month, and if anything unforseen happened, I'd wait another month, looking for signs of toxicity of the payload, toxic vehicle effects, OAS, ADE, and more data on the estimated risk to me from catching covid. I saw the j&j pause for VITT, the pfizer data on 'it has more of an antibody response than we expected', then later the aspiration studies, the legislation making it hard to get side effects compensated (if it were safe, there would be the opposite, and people with visible side effects would be celebrated as heroes), the pulling of medical licenses of doctors who were public about the side effect risks...eventually I was just out, I'm not expecting data on booster #4 to persuade me to start the potentially multi year course of treatment for a pandemic that may be mutating away from them or winding down.

My standard for 'this vaccine is safe enough' is 'more safe than the windrawn limerix vaccine', which was pulled in part due to a 1/25000 probability of cardiac issues, and in part due to lack of success in the market (I'd have taken it). I'd view something with a side effect profile as bad or worse than that as unacceptable to me. I believe that there is enough data suggesting that the side effect profile of most of these is at least that bad, and that the true safety state is obscured by rigid suppression of negative information in the western world. I know it isn't great, and assess that it's probably worse than it looks.

I have plenty of reasons which have strengthened my opinion that not getting one of the three available shots was the correct decision, though I have some doubts about my laziness about making the radvac.

All in all, I'm not expecting to change my opinion, or regret my decision. I fully expect governments to back off the mandates and for side effects to get just as much public attention as the cancers SV40 contamination of 1960s polio vaccines caused, meaning zero.

I'd love for someone to tell me why my reasoning sucks, I'll freely admit that I'm probably overly conservative about side effect risk, but for my demographic and lifestyle (I haven't caught any of the strains yet and don't expect to), I think that conservative approach makes sense.

Edit 2023: I am more, not less confident in my decision, I have not had covid symptoms or a positive rapid test at any point, and am not restricting my lifestyle in the least. I did not get any vaccine.

Edit April 2023: https://twitter.com/US_FDA/status/1648315659825160192 my choice was the correct one, the vaccine was not necessary for my situation.

When I write it out like this it doesn't seem insightful at all, but basically people are doing a cost/benefit analysis with different inputs. A lot of the objections boil down to "it doesn't seem worth it to me", which can be broken down into (1) "there isn't enough upside" and (2) there's too much downside. This isn't exhaustive but the reasons given are mostly about:

Insufficient upside:

• Don't trust that it will protect from getting COVID (no/low personal upside)
• Already at low risk (no/low personal upside)
• Don't trust that it will prevent transmitting COVID (no/low altruistic upside)
• Don't really care that much about living anyway

Too much downside:

• Receiving vaccines is unpleasant (needle phobia)
• The (normal, expected) side effects are unpleasant
• Traveling to get the vaccine is hard or aversive
• There are too many people at the vaccine site and you're afraid
• Getting an appointment is hard or aversive
• The vaccine is actively dangerous (serious side effects, death/depopulation, tracking devices), or could be (too many unknowns)
• Bowing to the vaccine mandate is a slippery slope to totalitarianism
• Social cost to bowing to the vaccine mandate (tribalism)

IIRC old people are mostly getting the vaccine regardless of tribe, because their risk is potentially very high and they feel that viscerally. My upside was very high because I was in a semi-self-imposed prison and because if I didn't get vaccinated no one would let me hang out with them, and my downside was low (among other things, I'm not afraid of needles, and even if heart inflammation side effects are a thing, I have no relevant risk factors).

But looking at it like this, I actually find it hard to fault people whose cost/benefit analysis came out the other way. All of the downsides make sense to me as things that would deter me from getting the vaccine (I don't believe that the vaccine is actively dangerous in expectation, but if I believed that were true, it would definitely deter me). In conclusion, ¯\_(ツ)_/¯

Not trusting authorities seems like a really critical one, and is a reason I'm not sure that, as bad as they have proven to be, publicly shouting about how bad the FDA and CDC are is net-positive.

There are way more balanced discussion in EU compared to US, see https://world.hey.com/dhh/after-two-weeks-with-no-covid-restrictions-in-denmark-923dd9a2 or google “why norway does not recommend child vaccination”. Overall data demonstrate vaccination doesn’t slow spread and approx around ~40 years of age there is a flip in risks - you have higher chance of complications from vaccines than from COVID if you are younger. I believe it shall be personal choice which everyone weight for themselves and I am particularly concerned about “booster” philosophy - if you architect the systems which shall be re-build every 3-4 months you would be asked to go back to drawing boards to address longevity of the system. I don’t see that ask being projected into pharmaceutical companies. Also you are framing discussion negatively from the title, why people vaccinate voluntarily will be example of negative framing in other directions, more balanced and suitable for rational community discussion would be more balanced about pros and cons.

Why did these vaccines produce close to 1000 cases of heart and pericardium inflammation in young men while flu vaccines do not?

What if we make covid vaccines with older technology, the way we make flu vaccines. This is not being done. No one can choose older tech vaccines over newer tech vaccines. 

When I've asked my Red Tribe friends their thoughts about the vaccines, they've generally given similar answers to your survey how they don't trust the government, media, big pharma, etc. But I think the main underlying reason is just signaling which tribe they belong to. Early in the pandemic, Trump's messaging was that covid was no big deal, just the flu, it will go away soon, etc. and this became the party line. For relatively young, healthy people, choosing to get the vaccine might be seen as disloyal to the tribe. So when they weighed these social costs against the seemingly negligible risk of death or serious illness, they chose their social identity over getting vaccinated. And as Matthew Barnett mentioned, they could easily come up with plausible sounding rationalizations like the ones from your survey.

... and the impression that the vaccine doesn’t work. (I wonder how much that one is relative to an expectation of ‘very occasional breakthrough cases’ that one might also trace to someone’s questionable communication choices.)

I didn't follow this part. What is "questionable communication choices" referring to? And how is it related either to someone's expectations around breakthrough cases or their impressions of vaccine effectiveness?

Is this about what media sources they're exposed to? (It seems like that's probably not what you meant by "communication choices", but I'm having trouble coming up with other hypotheses.)

The question I would ask is whether the marginal utility of a dollar spent in convincing this long tail of people is actually worth it, compared to other uses of the money. It's obvious that some of us needed no convincing at all, we were just desperate for a vaccine. Other people were ok with getting vaccinated if it were easy or convenient. Some must have been on the fence or mildly against it, but could be convinced with some nudging (see vaccine lotteries and other interventions). So now you have a minority that is stubbornly against getting vaccinated. Let's say it's 10% of the people, and perhaps you could convince one in five of those people at some cost. Now you have 8% of the population who won't get vaccinated, and you spent a significant amount of money or resources on going from 10% down to 8%.  Are the public health gains significant enough to warrant the expenditure? Is there anything else with more impact that you could have done instead?

Reminds me a bit of how it feels to have social media pressure to share political content on nonpolitical channels. It’s a relatively small ask compared to the enormity of the issue. Yet it feels disproportionately obnoxious to have it demanded of you over and over again.

In fact, in the face of such pressures, it makes sense to bypass fielding such requests individually, and have a policy of ignoring requests to share.

Likewise, if you have that reaction to being asked to do various unpleasant and inconvenient things by the government - things that are physical impositions, hurt, and cost you money - then you might make a policy for yourself of resisting all such impositions, regardless of the rationale.

I know that it was frustrations like this that originally got me interested in the EA/LW communities. Here was a group of people trying to find a more systematic way of separating effective ways to help from ineffective ones, and that gave me permission to say no to nonsense.

Pure speculation, but I wonder if people in the anti-vax cluster will develop a demand to create their own version of a rationality and EA movement? I imagine the originators would be religious family types, hard workers, who are frustrated with the symbolic nonsense on their own team but also have stridently different values from liberals. They’d create some sort of vision and institutions to build and transmit knowledge about how to create the brand of conservative nationalism that they actually want to live in.

There are a couple of Poe's law candidates in that list, but if anyone here knows (or is) a smart sincere covid vaccine conspiracy theorist, I'd like to know how they reconcile a) their belief in the level of coordination and competence and sheer power required to pull off that kind of conspiracy, with b) their apparent belief that they have some chance of defending themselves against the conspirators by refusing the vaccine. 

Do they think that ~all world governments and their respective health bureaucracies are working together on this plot in secret, or that there is some shadowy group behind the scenes that has managed to dupe all of those same people? If I thought either option was plausible, I can only assume I'd also think that resistance was futile.

You'd have an easier time getting an answer to your question if you came at it from a perspective of improving epistemics overall instead of looking for one tiny specific answer. You're automatically assuming your reasonable sounding understanding is correct and focused on finding reasons why the other people's reasonable sounding, yet different understandings are wrong. I don't believe that will get you a lot of information.

You'll know more about why people believe X and why X is wrong by just trying to become more knowledgeable on X ~X and a variety of related issues as a whole.

I had always been very pro-vaccination. Both me and my kid were fully vaccinated on the standard schedule. The situation around COVID vaccines prompted me to think critically about vaccines in general for the first time.

In absence of vaccines, how many serious diseases a human body was supposed to have seen throughout its life? Probably one or two, then you'd mostly be dead.

With our usual vaccination schedule, we now routinely prime our immune system against twelve diseases, if I'm not mistaken. Plus now COVID. As an engineer, I would be extremely worried if I did something like this to a legacy system. Yet we seem to only look at each vaccine in isolation and short term, and approve based on absence of visible side effects.

Take the difficulty in tracing side effects of COVID vaccines. For all the attention, good information is very hard to find, because it is genuinely difficult to produce. Now imagine same level of difficulty, plus no attention - because when was the last time anybody worried about side effects of a flu shot? 

And that is before we mention politics, mandates, and trust in institutions.

For context, I did take the original COVID vaccine.