Groups long marginalized by health systems continue to have limited access to vaccines and this is heartbreaking. But what about those—as many as a third of the US population—who can be vaccinated easily, but simply do not want to. How do we understand their vaccine refusal?
Herman Melville’s 1853 short story “Bartleby the Scrivener” reckons with the possibility that freedom can be realized through a refusal to submit. Bartleby is the hard-working, dutiful scribe of a Wall Street lawyer, who, at a certain point, refuses to do the tasks that his life demands. When he is asked to do his job, he responds, “I would prefer not to.” Thereafter, he refuses everything, eventually food and water, until he dies of starvation.
“I would prefer not to” haunts the story because Bartleby (and Melville) offers no reason for his refusal. We want to know why we would prefer not to, but there’s no reason. He doesn’t need to give a reason.
In addition to the 15% of Americans who avoid all immunization, Covid-19 refusers continue to claim there is not yet enough real-world experience (despite hundred of millions of doses administered), or that any new vaccine could produce late side effects we don’t know about, or that Covid-19 is mostly a mild disease, or that they will be fortunate or careful enough to avoid infection. But none of these reasons are in and of themselves sufficient explanation.
A century and a half after its creation, Melville’s story still holds an unsettling truth about some of our neighbors: there is self-gratification in refusal. Covid-19 has revealed the inexplicable, powerful, triumphant feeling that we all have the ability to opt out, even against our better judgement. It looks like madness, and perhaps it is, but it is my madness, the unvaccinated person thinks; she knows exactly what she is doing. The simple refusal to act on behalf of one’s obvious self-interest is defiance, and to some defiance is courage. Bartleby’s emphatic and unexplained “No,” was an act of volition, life-affirming. In 2021, Americans have several vaccine choices, but they can do exactly as they please, even if it leads to self-destruction. The unvaccinated feel they are entitled to freedom.
But in this case, it is not so simple. We are inextricably bound to neighbors who, while disregarding what is obviously in their own best interest, compromise the best interest of others. Is this enough then for the rest of us who are willingly vaccinated to refuse the refusers’ right to refuse? For the vaccinated, the attempts at self-defense—with distancing, with masks—has not been enough; the robust protection of vaccines needs to be widely accepted to make Covid-19 more manageable. Should we then require the vaccine everywhere? Making vaccination a requirement for military service, entry to schools, workplaces, airplanes, even gyms and restaurants will increase the number of vaccinated people in the United States further, and move everyone closer to the life they remember from before 2020. But it will also take away the autonomy of refusal for the increasingly few who would prefer not to have their wishes denied. Perhaps, at some point, society simply has to say, on this one, you cannot refuse.
Michael Stein & Sandro Galea
As we re-emerge from the pandemic, 2021 stands to be a turning point year for public health. In The Turning Point’s weekly essays, we reflect on what we learned during 2020, and what we are learning during 2021, that can guide us to the creation of a better, healthier world.
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