Should you take the shot or should you wait?

It was late in the evening when I stopped at a diner in Long Island, N.Y., for a takeout meal. Despite being fully vaccinated against COVID-19, I still wore my mask as a precaution. My son, who wasn’t yet vaccinated, waited in the car for his food. Real-world research from Israel showed I was almost entirely protected against this disease, and very unlikely to spread it. 

As I waited I became fast friends with the restaurant’s manager, Archie. I asked him if he had had the vaccine yet. He said he hadn’t because he and his future wife, a nurse at the local hospital, were planning to have a child within the next year. 

What came next startled me. He asked, “Don’t you think we should wait before getting the vaccine?” His fiancé, a frontline worker, hadn’t been vaccinated. She isn’t alone in that. 

I find it difficult to believe the latest Kaiser Family Foundation and Washington Post survey that nearly half of frontline health care workers still aren’t vaccinated — and Archie’s soon-to-be wife was clearly one such example. 

“Your [future] wife is a nurse who could encounter COVID in the hospital. If she gets COVID, she could spread it or have a bad pregnancy outcome, including preterm birth,” I responded. “On the other hand, having the vaccine not only protects her, but would offer some passive immunity to an unborn child. She should take it.” 

Archie then repeated what was probably a rumor he had heard: “What about genetic problems from the vaccine? We are nervous that this is brand new technology that was rushed out.”

“That’s not true,” I explained. “The vaccine is based on technology that’s been in the works since the 1990s. It is well-suited to this virus. The mRNA vaccines, the Pfizer or the Moderna, don’t go inside the cell. They just signal some cells to make the virus’s spike protein to trigger the immune system. The body gets rid of the genetic material in a day or two. It has now been shown to be safe and effective in over 100 million people in the U.S. alone. A new study shows it is safe during pregnancy. It also clearly decreases the risk of your harboring the virus and spreading it to others.” 

He liked the idea of trying to protect others, and it is his job to take care of people, to make sure his patrons are well-fed and happy. But when it comes to the vaccine, he said he was going to take direction from his nurse-fiancé rather than me, although he said he would relay to her what I had advised.

I felt like I had moved the needle a bit with my new friend, but I also know that he is part of a large group of people at risk for COVID-19-related complications who are nonetheless reluctant to take a vaccine that is far less risky than the virus it was designed to protect us all against. 

With new rapidly spreading variants emerging, it is only a matter of time before one predominates which is at least partly resistant to today’s vaccines. The South Africa variant includes a problematic mutation that is also found in the new New York strain B1526, which is now being found in a majority of COVID-19 patients in parts of New York City. Ongoing research is suggesting that the vaccine still protects you somewhat against this variant, at least sufficiently to keep you from becoming very ill.  

We have done a poor job of incentivizing the act of getting vaccinated, which liberates those who do so to once again go to restaurants, to gyms and shops, or to travel with far fewer restrictions, even if they might still wear a mask for a while. Such incentives should help to improve vaccine compliance, besides being in keeping with good public health. In fact, being vaccinated is a far more predictive indicator that you don’t have COVID-19 and can’t spread it than is random testing, which can frequently be inaccurate.

Despite our prodigious vaccination rate, now averaging close to 3 million shots per day, we will never reach complete herd immunity the way we are going because we are about to encounter a wall of vaccine resistance, albeit for a myriad of reasons.

Some Republicans are much less likely to take a COVID-19 vaccine than Democrats, in part because they don’t trust many of the current governmental leaders, just as some Democrats were skeptical during the previous administration. Minority groups are much less likely to take it because of centuries of mistreatment by the medical establishment. This is particularly problematic because Blacks and Latinos are more at risk for severe COVID-19 due to late diagnosis, inadequate treatment and a higher amount of other associated health problems such as obesity and diabetes. We have done a poor job of reaching out to these communities and a poor job, so far, of overcoming their resistance.

Outreach must be accomplished not by governmental decree or guideline but by word of mouth, doctor to patient, and involving religious and community leaders.                                           

We must talk to the Archies of the world individually before it’s too late. We are slowing the virus dramatically by vaccinating close to a majority of those over 65, decreasing hospitalizations and deaths. But to completely stop the novel coronavirus in its tracks, we need to do better. 

Send the more easily stored Johnson & Johnson or Moderna vaccines to doctors’ offices around the country — we primary care doctors administer approximately half of all vaccines — and we will discuss the pluses and minuses with our patients, one by one. 

We have rarely had weapons this powerful and this safe in the fight against a deadly virus. Smallpox, polio and measles come to mind. Yet, in order to break the back of this virus, we need to all join hands and take our preventive medicine.

Marc Siegel, M.D., is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent and author of the new book, “COVID; the Politics of Fear and the Power of Science.”