Why personal choices about COVID-19 vaccines are not always that personal

Over 30 million adults have opted to take a pass on the COVID-19 vaccines, including around 3 million people over 65 years-old. They are exercising their personal choice to remain unprotected against the virus through vaccination, choosing to accept the associated risks. 

Yet, risk does not exist in a vacuum.   

To illustrate this point, when people choose to travel 600 miles by automobile rather than take a two-hour flight, they may be avoiding the risk of an airplane crash, but they are also assuming the risks associated with driving. In 2021, no less than 42,000 people died in automobiles accidents, with hundreds of thousands more injured. By comparison, all the commercial airlines combined had just 134 deaths in 2021. 

Independent of the cost differences and focusing solely on fatality risk, those who opt to drive rather than fly may be overestimating their flying risk and underestimating their driving risk. This often occurs when risk and control are confused. Just because one has control over a situation does not mean that it is less risky.  

With every decision, there are unavoidable risks. There are also benefits. This is particularly true with the COVID-19 vaccines.   

When a person chooses vaccination, they gain the personal benefit of health protection against severe disease. They also assume the personal risk associated with vaccine short-term side effects and the unlikely long-term effects that have yet to be uncovered. To date, the preponderance of vaccine side effects have been benign or treatable. Deaths and disease attributed to the vaccines have been rare, based on data reported to the Vaccine Adverse Event Reporting System (VAERS).  

When a person chooses to remain unvaccinated, they gain the personal benefit of avoiding any short or long-term side effects of the vaccines. Prior infections provide some protection benefits, but prior infections with vaccination provides the most durable protection benefits. They also assume the personal risk of becoming infected (or reinfected) and having a severe case that lands them in the hospital. 

Focusing solely on personal risks and benefits is appropriate when the decision is isolated and only affects the individual, such as smoking alone, away from others. With a highly contagious infectious disease like COVID-19, that is not the case. 

Anytime a person becomes infected, there is a risk of requiring hospitalization. For healthy 18-49 year olds, that risk is small, but not zero. For those 50 and older, the risk increases with age.   

What has shown to reduce that risk are the vaccines, particular two doses and a booster. Each person who chooses vaccination is not only reducing their personal risk, they are reducing public risk, namely the risk of overwhelming scarce health care system resources for treatment as part of a surge in demand.   

That is why the omicron surge has been such a strain on hospital systems. The soaring number of cases over a short time horizon in some areas has created overwhelming demand that exhausts available resources.  

When a person chooses to remain unvaccinated, they are increasing public risk, since they have a, increased likelihood of requiring the need for health care system resources. If they develop a severe case and voluntarily choose to not use such resources, then that public risk evaporates. The fact is many who remain unvaccinated and become severely ill also seek medical care, effectively overwhelming healthcare system resources. 

The takeaway from this risk analysis is that COVID-19 brings with it both personal and public risks. The vaccines reduce personal risk while offering personal and public benefits. They also carry with them a low level of personal risk associated with rare side effects. For public risk to be reduced, an individual must make a personal choice, either by being vaccinated or foregoing medical care if the virus makes them sufficiently sick to require hospitalization. 

It seems no amount of emotional appeal or logical reasoning will convince anyone who wishes to remain unvaccinated to change their stance. They should be entitled to make personal choices — when such choices have no public impact. The problem occurs when personal choices have public ramifications. That is why there are laws that forbid people from smoking indoors in public places and why we have traffic laws. These are personal choices with public benefits.  

Anyone who remains unvaccinated should be entitled to assume that personal risk provided they are willing to simultaneously agree to eliminate the associated public risk. This means not seeking medical care if they are one of the unfortunate people who requires hospitalization or other medical care. That is one way their personal choice and personal risk can remain personal, and not public.  

Sheldon H. Jacobson, Ph.D., is a founder professor of Computer Science and the Carle Illinois College of Medicine at the University of Illinois at Urbana-Champaign. He applies his expertise in data-driven risk-based decision-making to evaluate and inform public health policy.