Assuming one becomes available to you and/or your loved ones sometime soon, should you, or shouldn’t you, roll up your sleeve for a COVID vaccine? Please indulge me in a thought experiment on our shared way to my conclusion, and recommendation.
Imagine two teams of engineers- let’s call them teams A and B. One, Team A, is, arguably, the best that even the most vaccine reticent could possibly wish. Membership is reserved for the most monumentally experienced, wise, and venerable. The team is methodical, meticulous, and infinitely patient. As for their portfolio of accomplishments, let’s just say their products are completely dominant in the world, and their track record of success- although ascribed to various origins by different groups- is recognized, respected, and celebrated by all.
The other team, B, is comprised of much younger, less experienced members. To be fair, however, these engineers are all highly and appropriately trained, and so far as we know or have cause to wonder, dedicated, smart, and caring. They are experienced, but much less so than the other team. They are, if anything, impatient- rather in contrast to their counterparts. While Team A occasionally surprises, their methods, efforts, and ends tend to follow a mostly reliable and often predictable pattern. Team B also relies on precedent, and builds on prior successes. However, Team B is more prone to shop for epiphanies, and engender surprises. Team B, we might say, operates with fewer rules; they are the “cowboys” of the engineering world.
We can stop there, and pull back the curtains to reveal identities. Team B is made up of scientists- and in the specific instance of the COVID vaccines, the scientists working for BioNTech and Pfizer, those working for Moderna- and other such groups around the world.
Team A is…nature. We can anthropomorphize to facilitate the comparison, and say Mother Nature (she/her). We could detail the roster of members- evolutionary biology, natural selection, adaptation, mutation, etc.- but perhaps the “Science Team” versus the “Nature Team” will suffice.
Perhaps you are thinking, almost reflexively, that you will go with Nature, thank you very much. You might be thinking that simply because, like me, you have an abiding reverence for the natural world, and see great prowess and wisdom in its working. In my case, and perhaps yours, that reverence is entirely secular. Or, perhaps your convictions are fueled by a more spiritual version of faith in Nature, perceiving marching orders from an even higher authority. Either way, you favor Team A, and are all the more vaccine reticent as a result.
Trained and board-certified in both Internal Medicine, and Preventive Medicine/Public Health, and thus thoroughly schooled in relevant topics from epidemiology (the health of populations) to patient care, evidence assessment to iatrogenics (the inadvertent, but quite abundant harms of Medicine) - I have a long, unwavering, and unapologetic history of defending the profound, clearly established net value of vaccines to public health. That said, I do understand and empathize with a naturalistic longing. For years, I directed an Integrative Medicine Center, working alongside colleagues trained in natural medicine (and, by the way, committed to scientific evidence)- and we cared for those who favored natural treatment by disposition, or who came to seek it after conventional medicine’s greatest hits failed to fix what ailed them. That is, alas, far from uncommon. And, Nature’s allure may be enhanced for us all as our technologized, modern existence puts her at ever greater remove. The grass, as they say, is always greener on the other side of the 5G tower.
So, I appreciate your inclinations toward Team A. But before you cast your lot there, which in our current plight might mean favoring your chances without a vaccine- let us push our thought experiment in one more direction.
Imagine, if you would, an injured impala. The injury in question is to a leg, is not too serious, would heal fully in time- but for now, is seriously affecting speed.
The remedy of science for this scenario would likely be an animal rehab center. The animal, if detected and a target of our ministrations, would be tranquilized, transported, and treated, then given time to strengthen and mend. After that, it would be returned to the wild where it might well thrive for years, and produce offspring.
Nature, too, has a remedy for an impala with an injured leg: a hungry cheetah.
Nature’s method is decisively brutal for the impala, but swift and certainly effective. The injured leg ceases to be anyone’s problem, and proves to be the cheetah family’s boon. If I may indulge in a quip: Cheetahs do indeed prosper when fate is unkind to impala.
You see the point? Sure, nature is a fabulous engineer. So, sure, you might prefer her products to our own. But as often as not, she is working for the other side.
Nature- natural selection- designed the extraordinary defenses of human physiology. But she also designed rattlesnake venom that undoes them. She designed the remarkable array of lymphocytes that patrol our inner byways of lymph and blood- but she also designed HIV that has been deluding, defying, and decimating those lymphocytes for the past 40 years. The remarkable intricacies of our immune system are all to her credit. So is SARS-CoV-2.
If you favor Nature over the machinations of our own science, I have no argument with you. In time we may mature in both knowledge and wisdom to compete more favorably, but we are not there yet. Overall, to date, our science has done more harm than good to the elegant balance of the natural world we were bequeathed. Nature is the better engineer.
Our own, still maturing efforts are, however, occasionally quite brilliant- and there is certainly cause to trust, and employ their products at times. Because Nature’s greater aptitude comes with a casual indifference to the fate of individuals. Her engineering is not directed to the contestants, but to the contest; not to a winner, but to equilibrium. One imagines the venerable engineers of natural selection, observing the wins and losses of impala and cheetah alike, saying: “nothing personal.”
If it is your faith in nature that calls up your reticence about science in general, or the COVID vaccines specifically, you are right about her prowess, but wrong about her patronage.
Mother Nature harbors no bias for predator or prey. If she did, her favorite would multiply at the expense of its counterpart, and that would be the doom of both. If she can be spoken of in terms of favorites at all, Mother Nature favors balance- the elaborate equilibria detailed in all their mathematical glory by Richard Dawkins in The Selfish Gene. She reliably prefers neither predator nor prey, but rather the close-run contest between them- as only that ensures the survival of both, in the balance of her dominion.
We Homo sapiens are long accustomed to being the predator. In the pandemic, however, we are prey. The predator in this instance, too small to see, stalks our cells. Mother Nature incubated those cells in her “lab.” She incubated SARS-CoV-2 there as well.
So now, the matter of your vaccine- or for that matter, mine. Yes, I will certainly be vaccinated against COVID when that opportunity reaches me (I am not seeing patients now, so I am far from first in line). I will film the experience and share it so you needn’t take my word for it.
I will be vaccinated not because I think the vaccine carries zero risk- I know the opposite to be true. And, sure, I would really like to have data about the long-term effects (i.e., years) of the vaccine first. But we don’t have years-long data about the virus, either, and for all we know there could be late consequences of infection. Let’s be clear, the only risk-free pandemic option is not to be in a pandemic. Once in one, our options all involve risk. The lesser risk is the best we can now do.
The adjudication of that risk is neither stable over time, nor a one-size-fits-all proposition. As for time, the virus is currently so widespread in the U.S. as I write this, as to situate COVID, temporarily, at or near the top causes of death for those over age 35. The greater the risks of unprotected exposure, the greater the relative merits of vaccination.
Those risks do vary, however, by age and health status- the very point I have been hammering at from the start of all this. Vaccine distribution policies are predicated on stratified risk (it’s about time something to do with our pandemic response is!), and your decision making might quite reasonably be, as well. If young, healthy, and not prone to interact with, and thus potentially transmit SARS-CoV-2 to, anyone without those same advantages- you might safely defer vaccination. But few are those islands among us, and the scales of relative risk tip the other way for most of us. After all, the best available expertise has been directed at minimizing any potential harms of vaccination; the same cannot be said of SARS-CoV-2.
To reiterate, I have always championed the general merits of vaccination. I was dubious that COVID vaccines would arrive in time to do us much good, and accordingly emphasized other aspects of pandemic management I still believe and maintain could have much mitigated the collective toll we have suffered. But here we are- those opportunities mostly behind us, vaccination- directly ahead. Our current choices between here and the pandemic terminus distill substantially to taking chances with the virus, or choosing immunization against it.
Taking Nature’s chances may appeal, just because they issue from nature. But let’s concede that Mother Nature is not reliably on our side; it’s our job to be on hers. Uniformly favoring the engineering of Nature fails to consider the nature and objectives of her engineering. The pandemic harbors many lessons on that very matter - climate change, many more. We ignore those, in any context, at our peril.
We rely on Nature’s engineering to save us, or even necessarily serve us, at our peril, as well. Yes, we are beneficiaries of Team A’s extraordinary engineering prowess. But in that, we are not alone. Team A, after all, engineered the virus, too.
David L. Katz, MD, MPH, FACPM, FACP, FACLM, is the Founding Director (1998) of Yale University’s Yale-Griffin Prevention Research Center, and former President of the American College of Lifestyle Medicine. He has published roughly 200 scientific articles and textbook chapters, and 15 books to date, including multiple editions of leading textbooks in both preventive medicine, and nutrition. He has made important contributions in the areas of lifestyle interventions for health promotion; nutrient profiling; behavior modification; holistic care; and evidence-based medicine. David earned his BA degree from Dartmouth College (1984); his MD from the Albert Einstein College of Medicine (1988); and his MPH from the Yale University School of Public Health (1993). He completed sequential residency training in Internal Medicine, and Preventive Medicine/Public Health. He is a two-time diplomate of the American Board of Internal Medicine, and a board-certified specialist in Preventive Medicine/Public Health. He has received two Honorary Doctorates.