EPISODE 42: VACCINES
[Instrumental of ‘These Dark Times’ by Caged Animals begins to play.]
Dylan [VOICEOVER INTRODUCTION]: Hey! Welcome back to Conversations with People Who Hate Me, the show that takes conflict and turns it into conversation. I’m your host, Dylan Marron.
If you are listening to this episode somewhere close to its release date, which is in the year 2022 for all you future humans out there, then I would love to invite you to join me on my book tour. It starts on March 28th—the day before my book comes out—and ends on April 8th. This book tour includes virtual events that you can tune into from anywhere in the world, and there are also two in-person events in the NYC area, and I would love to see you virtually or physically, whatever is possible or right for you. All of the info is available on the book’s website which is linked below, but for good measure, it’s dylanmarron.com/book
And if you’re listening to this after the book tour is over, then how cool that you’ve stumbled upon this little time portal. Hello from the past. It is an honor to speak to you in the future.
Okay. Onto today’s episode…
Not too much of a complicated setup here. I think you probably guessed from the title exactly what today’s chat is about: and yeah, it is about the COVID vaccine.
As this is a show that tackles the difficult conversations of the day, I have long been trying to figure out how to make an episode about vaccines. After all, I know that this is a conversation that many of you are having with your families, your friends, your loved ones, your coworkers, and your doctors. And I also know that it can get… shall we say, heated.
A little while ago a listener named Michael emailed me that he was hesitant to take the vaccine and he wanted to come on this show to talk about it.
I said yes but, I am not a medical expert and it would feel unethical to make this episode without one.
So I thought about it for a bit. I mused. I considered. Other synonyms for “thinking.” And there was really only one person I wanted to connect him to: and that is my doctor, Keith Roach.
Let’s get something super clear right off the bat: this is not a debate about the vaccine’s efficacy. This is not a consideration from both sides about whether or not it’s good to take the vaccine. This episode is unabashedly pro the COVID vaccine. I am pro the COVD vaccine. I feel compelled to come right out with that information right at the top, just so we’re super clear about it.
That being said, this whole Conversations with People Who Hate Me project has never been about shame. In fact, I call this show a proudly anti-shame show. So this is not an opportunity to humiliate or mock Michael… or anyone else who is not-yet-vaccinated but instead to provide a safe space for conversation. And, most importantly, information.
First we’re gonna get to know Michael, then I’ll briefly chat with Keith, and then they will speak to each other.
Now, their group call is minimally edited. So it’s gonna be a little longer than the other group calls you’re used to. Why? Because this episode, unlike others, is specifically meant to be more of a resource than a story. A glimpse of what a calm conversation about the vaccine can look like… and hopefully a toolkit to help you have these conversations too.
So, no matter what side you find yourself on in these kind of challenging conversations, I hope you know you have a spot at the table here.
Alright. Let’s get started. Here is Michael.
[Music fades. Conversation begins.]
Michael: Hello?
Dylan: Hey, can you hear me?
Michael: Hey, yeah!
Dylan: Oh, my God! Look at us. (Michael laughs) So before we get into what we're here to talk about, I know you're anonymous here but with as much detail as you're willing to provide, tell me about you.
Michael: Let's hear, where do I even start? I got a dog!
Dylan: (laughing) That's a great place to start! (Michael laughs) Wow.
Michael: She's adorable, she's sleeping right next to me right now.
Dylan: We love her.
Michael: Mm-hmm (affirmative).
Dylan: Okay. (laughing)
Michael: Let's see here. I am an aspiring writer-
Dylan: Love.
Michael: And hopeful film producer one day. I'm working towards getting into a film college right now.
Dylan: Amazing.
Michael: And yeah, those are all the things I can think of right now.
Dylan: And you just got off of a work shift, where do you work?
Michael: I work at a retail store. I work in retail.
Dylan: Okay, I love it. So, okay. You have a dog, you work in retail, and you are working towards getting into a film college, I celebrate all of these things. So we are here to talk about vaccines and you wrote to me that you are... Would you call yourself a vaccine skeptic?
Michael: That's close to what I would call myself. Yeah, that's in the ballpark.
Dylan: Okay, in the ballpark. But rather than me saying it, what would you call yourself?
Michael: Scared, I guess. I'm not against the vaccine but I'm also not for it. When the vaccine was announced, I was so excited because I was like, "Finally, we're done. We're out of this."
Dylan: Right, right.
Michael: Obviously, not the case.
Dylan: So you are not vaccinated?
Michael: No, I am not.
Dylan: Okay. Not vaccinated.
Michael: And then I mean, if I can just kind of get into it.
Dylan: Let's get into it.
Michael: I did not want to get the vaccine until it had full CDC approval and it did not for a very long time. And now it does have CDC approval.
Dylan [VOICEOVER]: So Michael just said that he was waiting for “full CDC approval” what he meant to say was full FDA approval. I confirmed it with him after the interview. While I’m here, let me give you a little more context: in December of 2020 the FDA granted what’s called “EUA”—Emergency Use Authorization—for the Pfizer and Moderna Vaccine. Then in February of 2021 they issued Emergency Use Authorization to the Johnson and Johnson vaccine. They do this when the situation is dire, which, as we all know, it was. But to get Emergency Use Authorization these vaccines still had to pass three phases of clinical trials. Months later the Pfizer and Moderna vaccines were granted full FDA approval. Okay, little sidebar is over. But again, throughout this episode you’ll hear Michael talk about CDC approval, when he really means FDA approval. It’s an honest mistake. I mix it up, too. Three letter acronyms. So confusing. Okay let’s get back to it.
Michael: But within that timeframe of me waiting for CDC approval and it actually getting approved, I had seen a lot of stuff happen that scared me.
Dylan: Tell me, I'm all ears.
Michael: So the big one is that a family friend of mine, older gentleman, older gentleman, he went and got the vaccine and the next day he died of COVID.
Dylan: He died the day after getting the vaccine?
Michael: Yep.
Dylan: Whoa, that feels like a rare case. I mean-
Michael: It does! Like, full disclosure. I do not see any of the stuff I've experienced as specifically because of the COVID vaccine.
Dylan: Totally. But they were close enough in time that it spooked you.
Michael: It spooked me and it has made me skeptical on the whole vaccine as a whole. And it's frightened me.
Dylan: Yeah. Are there other cases other than this family friend dying suddenly?
Michael: Mm-hmm (affirmative). Family friend of ours, who was pregnant and got the vaccine while she was pregnant and the baby came out very, very deformed and that scared me. All of this can be just coincidental flukes, I'm fully willing to admit that. Part of me is like kind of beliefs that they're flukes, but if they're not and I'm wrong, then what? Like I keep saying, it's frightening and I wish I could trust it. And I want to trust it because I want this to be over and I want everyone to be safe and healthy and I just can't find it in me to go, I don't know, stick a needle in my arm. (laughs)
Dylan: Are you generally afraid of needles or is it this specific thing?
Michael: It's this specific needle. I wish we had a different term for it because I'm very sick of being called an anti-vaxxer! Because that's not what I am! Because vaccines are fine! And healthy! It's just this thing is weird! (laughs)
Dylan: Are there people in your life who share this position with you?
Michael: Yeah, I will come right out and say it, I lived in a very Republican household.
Dylan: Got it. Okay.
Michael: Yep.
Dylan: So are the other members of your immediate family vaccinated?
Michael: My immediate family, no.
Dylan: And how do you identify politically?
Michael: If you want my thoughts on politics, I'm against it.
Dylan: Okay, (Michael laughs) against politics as a concept.
Michael: Yeah. I dislike politics.
Dylan: So apolitical, proudly apolitical.
Michael: I would say so, yes. Which is why I hate the fact that this has become so politicized because I wish it wasn't, I wish it was just a thing that we all could've just get over! (both laugh) I wish we could just get over it and I know the way to get over it is for all of us to get the shot, but I don't... It's stupid, it's so stupid. I hate the world. (laughs)
Dylan: So here's helpful nuance, which is that you agree that COVID is real.
Michael: Oh, yeah. I've had it.
Dylan: You've had it?
Michael: Yes.
Dylan: And what was your experience?
Michael: It was horrible. Don't get it.
Dylan: Horrible. Okay, that's your PSA. (both laugh) Okay, COVID is horrible, don't get it.
Michael: I was bedridden for, I think about roughly week. I was coughing up a storm, I was throwing up and it wasn't great. I had a horrible, horrible headache, horrible stomach ache. It's genuinely the closest I've ever felt to like, "I think I might die," like, straight up. It was not fun. It's something very serious and I think it's something that we should all be taking a lot more serious than some of us have.
Dylan: And you believe in masks?
Michael: Yes. Yes, I absolutely do believe in masks. I was wearing masks before it was a mandated thing to do.
Dylan: Oh, wow.
Michael: Yeah. Once it was started being like a thing that was suggested, I had the mask on. (laughs) I mean, I was even wearing gloves at one point.
Dylan: No, listen. Nothing sounds weird here. (Michael laughs) We all experienced the same thing.
Michael: Well, my primary fear is here and I don't know if I'm jumping ahead, but like my primary thing that scares me here is that I don't know. I don't necessarily believe that there is some horrible conspiracy behind all of this. I don't necessarily believe that something terrible and horrible is going to happen if I get this vaccine. And right now, while I'm unvaccinated, I have a choice in the matter. And once I get the shot, I no longer have that choice. I no longer have a say in it and that's the part that scares me.
Dylan: And yet you still reached out to me knowing what this podcast is and you were interested in a conversation.
Michael: Yeah. Thank you so much by the way, for allowing me to come on here.
Dylan: Oh, yeah.
Michael: Because I cherish this opportunity to get to discuss this and hear other opinions because I know personal anecdotes don't mean much in the whole wider scope of things. I know that. But they are personal and they are my life and they are what I've seen. And yeah.
Dylan: So what are you looking to get out of this conversation?
Michael: I guess I just want to understand it better because that's the underlying fear of it all, is that I don't understand and I don't know what it is. And I've tried, I have tried to look into it as much as I can and a lot of it doesn't make sense to me sometimes. I would love, I would love and honestly, I really do, part of me just wants the whole mess to be over and just get the vaccine. There is a very large part of me that is just like, "This is stupid. You should stop questioning all of this, you should just get it." But then it goes back to that thing about once I do, if there's something that I'm not understanding here, then I can't turn back.
Dylan [VOICEOVER]: Alright. Now that I’ve spoken to Michael, it’s time to have a brief chat with Keith.
Keith: Hi Dylan.
Dylan: Oh, my God, look at you! It's so good to see you!
Keith: Thanks. It's nice to be here.
Dylan [VOICEOVER]: So, I just wanna set the scene for you: this is happening on zoom and I think that this is the first time I’ve ever seen Keith outside of a doctor’s office setting. And I gotta tell you that it has very strong seeing-a-beloved-teacher-at-the-supermarket vibes. It’s amazing.
Keith: Okay, I'm going to start recording.
Dylan: Okay, amazing.
Keith: I don't know what the quality of the recording is like, but it's pointing right at my mouth and it's only about eight inches away. So hopefully that will work.
Dylan: Okay. We are set up.
Keith: Excellent.
Dylan: Hi.
Keith: Hi Dylan.
Dylan: Do I call you Keith or Dr. Keith, Dr. Roach. What do you prefer on this podcast?
Keith: So I would like to reduce barriers. I would like for Michael to feel comfortable and so if Michael wants to call me Keith or Dr. Keith or Dr. Roach, there are all fine. I generally prefer Keith.
Dylan: Okay, great. So, that is great. Moving on. So this is just a quick chat, you and me. I would love- and I don't even know that I know this answer as a patient of yours, but how did you get into medicine? What's your medical history?
Keith: Hm.
Dylan: (laughing) I don't know, I don't need to know your medical history.
Keith: Right.
Dylan: What is your history in medicine?
Keith: So the shortest possible version is that I started off career expecting to be a scientist. I have my degree in molecular biology, I was planning to get a PhD and an MD and to set up a lab and to see patients. And then medical school came along and I enjoyed patient care and clinical medicine so much that I never went back to my gels (Dylan giggles) and never was interested in being a bench top researcher again.
Dylan: And you've been seeing patients for many years now.
Keith: Yeah. So I graduated from medical school in 1990. I finished residency in 1993, I joined the faculty at the University of Chicago where I trained and then in 2000, I came to Cornell.
Dylan: Wow, okay. And now that's where I met you and now look at us. Okay. So this is wonderful. So I assume in your work that you have encountered people who are hesitant or resistant to the vaccine.
Keith: Yes. Both of those people.
Dylan: And what is your approach? How do you even begin a conversation with one such person who is hesitant, skeptical, scared?
Keith: So I tell them that all of those feelings are reasonable and rational. That it's perfectly understandable to be hesitant about the vaccine and I want to make it clear that I'm not going be attacking them for the concerns that they have. One, that's counterproductive, two, it's antithetical to how I like to interact with people. And three, you're just going to get a lot more people who are going to come around if you spend the time to find out why they have the concerns that they do.
Dylan: Yeah. I love that and I totally agree. So what I can share with you is that Michael has had...
Dylan [VOICEOVER]: Now, At this point in my conversation with Keith I’m gonna pass along the details Michael shared with me in the interview you just heard so let’s skip ahead a bit to my final question for Keith.
Dylan: So you are of course, about to talk to Michael, how are you feeling?
Keith: I feel fine. I've done this a lot and I know that there are some people who can be convinced and some people who can't be convinced right away, and I'm not going to get angry or upset if he chooses to think about things a little bit more, that's his right to do so. But if he is open-minded about things, I think we can have a really nice conversation. We can both get to a little bit better place of understanding with each other.
Dylan [VOICEOVER]: Okay, now that I’ve spoken to each of them separately, you know what it’s time for. I’m going to connect them to each other.
Dylan: Michael, are you there?
Michael: Hello?
Dylan: Hi! Can you hear us?
Michael: Yeah. Yep.
Dylan: Keith, can you hear Michael?
Keith: I can. Hi, Michael! How you doing?
Michael: Hi! I'm doing well.
Dylan: Oh, my god! Look, we're all here. (Michael laughs) So Keith, where would you like to even begin this conversation?
Keith: I guess I would begin by saying that I'm glad we're having this conversation. I honor you for having an open mind about things and I understand perfectly why you would be scared about the vaccine. Having had two people that you know, who have had bad outcomes after the vaccine, has got to raise your suspicion about things. One thing that Dylan told me was interesting and I don't want to get too much into that, but he said that you hate politics. And I wondered if you could tell me a little more about that.
Michael: Yeah. First of all, I just want to say thank you for your kind words, it really does mean a lot. Yeah. Politics have never really been my thing. I mean, I grew up in a very sort of... Politics has always been sort of the conversation piece a lot of the times and it is quite honestly, it's exhausting. And I'm honestly gotten to the point where I'm kind of numb to it. Like, I'll hear about this thing or that thing happening and I can't bring myself to care, even though I know a lot of times I should care, but it's just like such a constant berating of this talk of like doom and gloom, that every time I hear about it's like one ear out the other, which is why I just generally, if I can avoid politics, then I will. But my distrust of the vaccine doesn't come down to any political issues. It just comes down to just general not knowing and just looking at what I'm seeing from the world and things that have happened that have led me to be skeptical of it.
Keith: Sure. So I also hate politics and I get tired of political talk, but I think at the very least we can agree tonight that any of the political arguments about the vaccine, either pro or con, let's just kind of toss all of those out of the window, because most of the people who are making those kinds of statements are uninformed about the science and the data of the vaccine. And either they want to score political points or they have some other political agenda. So let's just forget about all the political debate about the vaccine and let's just concentrate on what we know and what we don't know about out the vaccine as we go forward. Is that cool?
Michael: Oh, you are speaking my language Keith. (Dylan and Keith laugh) Yeah, I won't lie, some of what I believe about the vaccine may unbeknownst to me be informed by politics.
Keith: Yeah.
Michael: So I can't avoid that, but I don't intentionally want to bring politics into this...
Keith: Okay.
Michael: ... because I don't want anything to do with them.
Keith: Good. All right. So we'll recognize that we may have these unconscious biases that relate to what people have told us and that what some of the people who are telling us those things may have an agenda other than trying to help us and trying to help society. And while we can't help our unconscious biases, we'll try to move around them and look squarely at, as I said, what we know and what we don't know about the vaccine.
Michael: Sounds like a plan to me.
Keith: So let's start off with fear because fear, as I said, as entirely rational. Unless you're an expert at making vaccines, which I am not, then you sort of don't know everything that's in the vial that somebody's about to give you. And that's just a scary thing, we all like to have as much control as possible over our own bodies and our own destinies but of course, we never have complete control. And so we're left with trying to make a decision based on imperfect information and as a little bit further background about myself, my degree in college was in molecular biology. And so I learned a great deal about mRNA and how mRNA goes off to the ribosomes and makes protein segments. And I know a great deal about how protein segments can start the immune response going. So I'm really comfortable with the basic mechanism of how these vaccines, the new vaccines, the Pfizer vaccine and the Moderna vaccine work. Nonetheless, when it came time for me to get it back in December of 2020, I will freely admit right here for the world to listen, I was scared. And when I got the shot, I wigged out just a little bit. (Dylan laughs) And there was a line of about an hour of my colleagues—physicians, both attending physicians and resident physicians and nurses and respiratory therapists—and everyone was in line to get the vaccine because we wanted to get it. And so there I am in a room with about 100 people, some of whom are my colleagues and friends. And so I've now gotten the vaccine and (begins to laugh) I started to feel a little dizzy, a little lightheaded (Dylan giggles) and I'm sweating and everyone around me is high fiving each other like, "Yeah, this is great. We got our vaccine, we're protected." And I'm like, "Man, I got to sit down or I'm going to pass out." (all laugh) So irrational fear is entirely understandable even when you have a lot of knowledge about something. And even when you believe, as I did, that the benefits of the vaccine greatly outweighed the risks. So we can't help to have some degree of irrational fear. So I'm with you there on the being scared and I went ahead and did it. I admit there was a little bit of peer pressure to look smooth with all of my colleagues around. It wouldn't be cool if I passed out on the floor.
Dylan: We would've supported you, Keith, we would've supported you. (Michael laughs)
Keith: Thank you, Dylan. So I get the fear aspect of it. Now, the next issue that you mentioned was that you'd had a couple of people who have had bad outcomes after the vaccine. And I want to be really clear that they had a bad outcome after the vaccine, but that doesn't necessarily mean the vaccine caused it. And that is something that's really hard for people to get sometimes. You get something that happens in your life that is different and then something else happens, it is human nature to connect those two events and say, "Wow, I had that vaccine on Monday and on Wednesday, I got a headache. That vaccine caused the headache." But if you think back and say, "Well, how often do I get headaches? I get headaches once a week, once every two weeks." So it's not that crazy that I would happen to get a vaccine and that it would be coincidence that I got a vaccine and then developed a headache. So the only way to be sure whether there is a causal link between two events like that is to look at enormous numbers of people and to see, is there a correlation between someone getting the vaccine and then some subsequent bad thing happening? And the worst thing of all that can happen of course, is death. So you had somebody that that had the vaccine and then died. So that's as bad as it could be and as I said, it's human nature to wonder, could the vaccine have had something to do with this? And of all of the things that we've studied, that one we have studied the closest. Now when we were all starting to get the vaccine at the beginning, we prioritize the people who are the oldest and the sickest, and who are most likely to die from some other cause, they're old and they've got a heart condition, they're possibly likely to get a heart attack at any time. And so it's not unreasonable to see some number of heart attacks just by chance after the vaccine. And there are statistical methods that look at this and I'm just going to have to say, you're going to trust me on this one, that I've looked at the numbers and the number of bad events like death that happen after the vaccine are exactly what we would expect them to be from chance. If the vaccine was making it more likely for people to have a bad outcome—death or a heart attack or pneumonia or something that could lead to a bad outcome like that—there would be a statistical signal that would be easy to see once we had a fairly large number of people who have taken the vaccine and that signal just doesn't exist. There are some bad outcomes that are more likely after the vaccine, you sound like you're a relatively young guy and younger men are at risk for development of a heart condition called myocarditis after the vaccine. So that's something that we know is an accepted risk of the vaccine. The good news is, it's still really quite rare and the better news is most of the cases of vaccine associated myocarditis still do well. So even though that is a known bad outcome after the mRNA vaccines, it's still something that hardly ever happens and most people get over pretty well. As far as the other friend that you had that gave birth to somebody with marked physical changes and deformities, those happen during an early stage of development. So major physical deformities generally happen in the first trimester. So if the person that we're talking about had the vaccine at a time that they were four, six, eight, 12 weeks pregnant, that would be something to be concerned about. But again, we haven't seen a signal of that at a large enough level that we think that it's a major risk in the population. For any given individual, we cannot ever be 100% certain. I cannot tell you with certainty that either your friend, the person you know who died, or the person who had the birth defect, that at 100% wasn't from the vaccine. We don't know enough to ever be able to say that. But we can say that it was really unlikely. So I've been talking for too long already, and I want to stop and hear what you're thinking so far.
Michael: Yeah, I will say I haven't actually looked at the death certificate or anything, but from what I am told, it was COVID that they died from. I understand that can be a complete freak accident and I understand that both of these can be complete freak accidents. The pregnancy one, part of me expected it to just have been a freak accident because a baby being born with deformities, it's not unheard of. And I don't know when she got the vaccine, I'm not sure but it just... I really, really, really, really appreciate all of this. I just can't say that enough because I keep thinking it. (laughs)
Dylan: We feel it.
Michael: Yeah, it's a scary thing. I don't know.
Dylan: Michael, on our solo call, when we spoke one on one, you were talking about like the general fear of the possibility of something going wrong. You described getting the shot and not being able to go back. And Keith, when you were saying this, you were saying, there's no way to ever say with a 100% certain anything and this is just true. This is what every scientist will tell you, what every doctor will tell you. So we are welcome to talk about the specifics and the data behind the safety of these vaccines, of this vaccine. But I want to take on this bigger question with you guys, which is Keith, how do you feel safe knowing that you can't ever guarantee something 100% in your work? That's a... Admittedly, that's a scary thing, and this is something scary beyond the field of medicine.
Keith: Yeah. So I'm going to take a detour to this.
Dylan: We're ready.
Keith: And this involves a colleague of mine who is a co-resident with me, very lovely, very accomplished young woman who's off doing great things now. And she did fine, but she was in clinic seeing patients when all of a sudden she had a neurological event and was not able to speak and wasn't able to see out of one eye, and this happened in the hospital. So she was brought over to the emergency room within minutes and had an imaging study that showed that there was a blockage in one of the main arteries in her brain. And the physician who saw this, the neuroradiology fellow had a decision to make: Do we give a medicine to dissolve blood clots and stop this stroke from happening? But there's a risk that could cause a bleed inside the brain that would cause irreversible damage.
Michael: Mmm-hmm.
Keith: And he had to make the decision whether to take that risk, but the numbers were on the side. We know that the risk of a bad outcome with giving these clot-dissolving drugs is maybe 1% and we knew that it was pretty much a certainty that she was going to lose brain function if we didn't do something. So the neuroradiology fellow went ahead and instilled the clot dissolving medicine into the artery in her brain. Within seconds, her sight and ability to speak came back and she has done well the entire time. Now the kicker to that story is that the neuroradiology fellow on call, the person who had to make that decision at that time, because there was nobody else and minutes counted, happened to be her husband.
Michael: Hm.
Keith: And that puts, of course, all kinds of pressure on things. And I told you that story to tell you this, it is human nature to regret what we do more than what we don't do. If we do something to somebody and something bad happens, we blame ourselves. If we make a choice for ourselves and we do something and it totally backfires on us, then we are kicking ourselves for days, weeks, month, years, depending on how bad it is. And we're not so hard on ourselves if we decide to let it go, we're not going to take the chance and we're just going to see how things fall out naturally. To some extent, that feels an easier thing to do. But to a scientist, we can't look at things that way. We have to say, what's the risk of doing it and what's the risk of not doing it. And when the risk of not doing something greatly exceeds the risk of doing something, you do it and you just recognize, "Yep, some of the time I'm going to screw up and something bad is going to happen. But if I don't do something now, then it's a lot more likely that a bad outcome is going to happen." And we, as physicians are constantly trained to think about risks and benefits of what we do. And in the case of COVID vaccine, and we're going to get back there eventually, the risk of giving a COVID vaccine is so much less than the risk of not giving a COVID vaccine, that for almost everybody, it is worthwhile to get the vaccine. And there are certainly a lot of people who have had bad outcomes with the vaccine. And I read the reports and there's a place in the CDC, Centers for Disease Control, where you can read all of the bad outcomes that have happened that have been reported rather, with the COVID vaccine. But by the same token, you can also look on the front page of the newspaper and see how many people died from COVID, close on a million, and how many people have had long-term bad outcomes, bad organ damage, bad persistent symptoms after COVID. And that's numbered, at least in the hundreds of thousands, if not the millions. So from a scientist perspective, it's really easy to say, at the population level, people are going to do a whole lot better if they're vaccinated than if they aren't vaccinated. And I think Michael, that's where you are getting some of this idea that you are being judged if you're not getting the vaccine, because again, at a population level, it's really easy but we're not a population. We are one person and you could be the one person that something bad happens to. And you could say, "God, why did I ever get that vaccine?!" (Dylan laughs).
Michael: (laughing) Right.
Keith: "Why did I listen to that idiot Keith on that podcast to get the vaccine?!" And unfortunately that's just a risk you have to take. But the flip side of the equation is I had a colleague wrote an editorial a few months ago where she described how, when people come in with COVID and they get sick and they get sicker and they get sicker still, very often, the last thing that they say right before the breathing tube goes in is, "Can I get the vaccine now?" And the answer of course is, "No, it's too late now." And their very last thing that they regret is not getting the vaccine.
Dylan: You know, Michael, we are under no illusion that you can change someone's mind on a phone call or that like you are now going to b-line right to the closest 24/7 vaccination spot and get a vaccine. But at the risk of asking the simplest question in the world, what are you feeling right now with all this information?
Michael: Gosh, that sounds like such a simple question, but-
Dylan: (laughing) No, it's a trick one. (Michael laughs)
Michael: To be upfront and honest.
Dylan: That's all we want.
Michael: Kind of more worried (Dylan laughs, then Michael laughs).
Dylan [VOICEOVER]: And with that inspiring midway checkpoint, let’s take a quick break.
[BREAK]
Dylan [VOICEOVER]: Okay we are back. And, we return to Michael explaining why he’s actually more worried about the vaccine.
Michael: Well, okay. So there have been a lot of things that have worried me about this vaccine, even beyond the fear of that 1% chance happening. Like, one of those things is how hard it was pushed before it got CDC approval.
Dylan [VOICEOVER]: Again, Michael means FDA approval, not CDC approval.
Michael: ... and that is strange to me. And I can't think of a reason why that would be, and the fact that it is, as far as I'm aware, a very new thing. And this might be a misconception, but as far as I'm aware, it is a very new thing that has been introduced at least active production and research into it, which I've never heard of a vaccine with a booster shot until recently. And the fact that it was pushed so hard with a lot of ads before it was approved by the CDC and that, I can't shake that. I mean, the scientists and the people making this have nothing to do with the advertising, so that's not on them. And I think the one thing that will convince me that this thing is okay, if nothing else, if nothing else, it's just time and waiting to see how the population reacts. And I know we've had a lot of time, but in my heart, I almost feel like there hasn't been enough because we're still getting new variants and we're still getting new shots and new boosters all the time. Yeah, I think that's a good summary of how I'm feeling.
Dylan: It felt accurate and I appreciate the honest answer. Keith, what are you thinking?
Keith: Yeah. I think these are all reasonable things to be concerned about. I think Michael's point about this being pushed before approval and the ads and some things that Michael didn't say, there were incentives to get people vaccinated. There was money, there was free tickets, the things and you could get free donuts and Krispy Kreme. I mean, there was all of this saying, "Please go out and get the vaccine, look at all of these wonderful things you're going to get." And I think that it backfired to some extent, to some people who are saying to themselves, "If this vaccine is so great, why are they offering money? Why are they shaming people who aren't getting it? Why do we need all of this if the vaccine is so great?" And that's a very reasonable question and I think that has a lot to do with the fact that human nature is very different for different people and what works to get some people to go out and take the vaccine is going to backfire for other people. Let me respond to the idea about the booster shots because there Michael, if you got the full dose, you had five doses of diphtheria, tetanus and pertussis. You had the rotavirus and a booster for that. You had two boosters for H flu, maybe three boosters, three boosters for the pneumonia vaccine and polio, you had four doses off. I want to spend a minute on polio, because the experience with polio, I think generated a great deal of the, "Hurry up, we've got to get things done," movement from the powers that be, from the CDC and from the other health departments, because the polio vaccine stopped the polio epidemic in its tracks. And tens of thousands of kids would get really sick from polio. And by really sick, I mean that the virus that causes polio, poliovirus, essentially everybody got that every year in the summertime, you were exposed to it in the water, and most people would get it and do fine, they'd have a couple days of not feeling great and then they would go on their merry way. But somewhere around one person per thousand, who got polio virus had a bad complication from it, where it would get into the nervous system and cause something called poliomyelitis and tens of thousands of people per year, hundreds of thousands of people overall, had complications from poliomyelitis sometimes requiring an iron lung, sometimes killing people outright and sometimes causing, and this was most common, permanent neuromuscular deficiencies that kept people from being able to walk, grow normally and do lots of things. If you look at the number of people, even now who suffered from poliomyelitis, you'd be shocked at the number of people—famous people—who have had to overcome their disability due to poliomyelitis. So once a vaccine was available for poliomyelitis, the parents who essentially lived in terror every summer that their kid would be the one who would be struck, would line up. I mean, line up for blocks and blocks and blocks to get the vaccine, because they knew that that was the best chance of preventing this rare complication from polio. Unfortunately, the polio vaccine had its own problems. The live vaccine caused polio, actual poliomyelitis in about 16 people per million who took it and there was even a bad batch of the polio vaccine that was made. You can read up about this, it's called the Cutter Incident. And instead of it being a safe vaccine, it was a bad batch that was just as bad as getting regular polio. And people got terrible complications from that batch of the vaccine. So the vaccine certainly wasn't perfect and it caused lots of problems. I've personally had a patient who had vaccine-associated poliomyelitis and who lived his entire life with almost no muscle in his calf. So it's an imperfect vaccine. Nonetheless, within a few years of the vaccine being developed, polio went away in this country and now there's almost no polio in the world. And we keep saying we're a year or two away from completely eradicating polio from the planet. And so the scientists and physicians who worked on polio and saw the tremendous success from the vaccine said, "Okay, we got COVID now, it's analogous in some ways, because a lot of people are getting just mild cases, they're sick for a few days and then they do fine. And a few people get this terrible lung complication and end up being intubated, this is a lot like polio. We've got a good vaccine that's 90 plus effective at keeping- 90% or more effective at keeping people from getting this bad complication. We have to get it out to everybody as fast as possible." And so I think that you're dealing with people who lived through something that you didn't Michael, and who made the decision that absolutely anything that we could do to get a few more people vaccinated was going to be a net positive but not really thinking through that some people with a different opinion or hadn't lived through that are going to have that entire thing backfired and saying, "Why are they pushing this before we really know that it's safe?" Which is exactly where you are and I understand perfectly why you're there. But I think that the reason that was done comes from the fact that the scientists making decision have lived through epidemics like this that were cured, that were entirely stopped by vaccines but we have to remember that didn't happen overnight. And I can look back right now and two years ago saying, "Okay, we'll get to the vaccine and we're going to go back to normal." Well, we're not back to normal yet, we're not going back to normal anytime soon, we may never go back to the kind of normal that we had before, where people are out wearing masks. I predict that for years, decades, maybe forever, we're going to be seeing people wearing masks during cold and flu season just the way that people in Southeast Asia are routinely wearing masks, having lived through several bad epidemics. So yeah, we were kind of lied to, but weren't really lied to, people were making their best judgments at the time. And as you say, things have changed over time and we have a better understanding, but we were hopelessly naive at the beginning. And I think that there were some questionable decisions that were made by public health officials. And even though I have incredible respect for the physicians and scientists at CDC, they haven't done as good a job as they could have about getting us the information right off the bat. So again, I've talked too much and I'm going to listen again.
Michael: Yeah. First of all, that story about the polio situation, that was honestly very informative. And I would like to say thank you for informing me about the booster shot situation, how that is a normal thing. That is just something I was ignorant of. So thank you for that.
Keith: You bet.
Michael: But to be entirely honest with you, the story about polio and how these people live through this epidemic and how it was stopped by this vaccination, it kind of makes me wonder if that epidemic might have caused a sort of knee jerk sort of reaction with the proceedings with COVID and the vaccine, which led to maybe a... Like I said, it's a very new thing and coming up with the solution as we go, I would feel a lot safer if I was at the tail end of that, I guess.
Keith: Yeah. You want somebody else to be the first person to get it and you can benefit from the knowledge that we get later on.
Michael: Yeah.
Keith: So I get that. There's something I should have said at the beginning that I didn't. That first polio vaccine, the one that causes the problem, that's what we call live vaccine. So we give essentially poliovirus but we weaken it so that it's not able to do as much damage. So it goes into the body, it acts like polio virus, it grows for a little while but it's so weak that it's not really able to cause these bad side effects and your body still learns to be able to recognize the virus. And so next time around when the actual virus comes around, it's able to kill it. That's the idea of how it works. And it was very effective, even though it caused these rare side effects, it was nonetheless very effective and essentially stopped polio from existing in this country after a very short period of time. Now, fast forward a little bit, they came up with a different polio vaccine that was a killed vaccine. It wasn't quite as effective and it couldn't be passed from person into person the way a live vaccine version of polio did. But on the other hand, it couldn't cause any long-term complications because it's a killed virus. To the best of my knowledge, and I've read a lot about this, there has been no vaccine other than a live vaccine that has ever been associated with long-term complications. So live viruses, absolutely. Sorry, live vaccines can cause long-term complications, any vaccine can cause short-term complications, you get the vaccine, you pass out, you get the vaccine, you feel terrible for a while and you get the vaccine and you can get an immunological reaction that can cause some problems like maybe the myocarditis, the heart problem that happens after the COVID vaccine. But the current COVID vaccine is not a live vaccine and there is no reason to expect that there are going to be long-term side effects. So the fact that we now have hundreds of millions of people who have been vaccinated and have been followed very carefully and who have not developed long-term side effects is very, very strong evidence that it is now vanishingly unlikely that there are going to be long-term side effects that we're going to come back and say, "Too bad we vaccinated all these people," which is I think, where we started off this conversation, Michael, that you're worried that, "I got it and now we see that there were problems, I wish I had never gotten it." That's just not likely to happen. I can't say it 100%, but it's very, very unlikely simply because of the nature of the vaccine. You get the mRNA, the mRNA turns into a protein, the protein gets looked at by the immune system that learns to recognize it and be able to attack it if it comes back again. So this is... It is new technology from the standpoint that there hasn't been a commercial vaccine that has been made with this. There have been a couple of, shall we say, experimental vaccines, like the Ebola vaccine that have been made using this technology, but we've certainly known about mRNA technology for decades and the advantage to the mRNA technologies that it became very easy to adjust the formula for the different variants and to rev up production so that they're able to make a large amount of vaccine. So there are some good reasons to use the mRNA technology, even though it's relatively new. And the way that mRNA is normally degraded in the body is, makes the vaccine in theory, very, very safe and in practice, with all of the doses that we've given and all of the study that has gone on, including in me, I signed up with the CDC to follow in. So for every week and every two weeks and then every month, I've been giving them reports on any side effects that I might have had from the vaccine. So there's lots of good surveillance that has been done from people who have had the vaccine. And at this point, with so many people haven't gotten it, I would say to you, "you know, I think you're at the tail end of it at this point. I think it is now safe for you to go out and get it." I can't say it 100%, we'll never be able to say it 100%, but right now we can say it at 99.999%, that it is far more safe to get the vaccine than to not get the vaccine.
Michael: That does... I mean, yeah, that makes a lot of sense. I don't know what to say really. Everything you've said is very informative and it's helped me quite a bit to get a better grasp on the situation, which is something I did not have at all before, to be entirely honest with you. I don't necessarily know if I'm like 100% on board with the idea.
Keith: No, I wouldn't expect you to be Michael. You've been hesitant coming up on two years now and talking to one guy for an hour is, as Dylan said, it's not likely to change that.
Michael: Right.
Keith: But you've got a little bit more background on history of vaccines and how these things work. And I hope a little bit more perspective on the safety of the vaccine. And I would encourage you to think about it and read about things a little bit more. I will warn you that there's a great deal of misinformation out there and I would look very carefully at the sources that you're getting and recognizing that there are people who are profiting off of misinformation that is killing people. As I said, right at the beginning, I honor you for coming on and talking to me about the reasons that you're hesitant about this. I respect that and I'll talk with anybody for as long as they're willing to listen to me (all laugh) about why I think that these things are generally good for most people. And I didn't say this, but there are some people in whom the vaccine probably isn't appropriate for, people who have had lots of side effects who are more likely to have an allergic reaction to things or people who are just at low risk for getting the virus, because they're not interacting with people. Maybe they live a long way, far away from everybody and they're just not seeing anyone. There's no point getting the vaccine if you're never exposed. But the people who are profiting off of misinformation, those people make me very, very angry and I'm going to say no more about that, except to warn you to look very carefully at the source and think, "Is this person profiting? Do they have a store on their website that's going to tell me that I can buy something that's going to be as good as the vaccine." Because when you see that be very, very careful.
Michael: Mm-hmm (affirmative). I mean, yeah you've certainly given me quite a bit to think about, I'll say that much. There are some things I didn't touch on. I'm having problems within my family, with people at risk of losing their jobs over the vaccine. And that's another thing that has worried me.
Dylan: About losing your job?
Michael: Not my job, but family members who need that job.
Dylan: Gotcha. Yeah.
Keith: Yeah.
Michael: I mean, that's a lot to wrap your head around.
Keith: Absolutely. And from a psychological standpoint, when someone's saying, "You take this or you lose your job." It's going to make you pretty angry at the person and angry at the message that you're saying, "Why are you forcing this down my throat? There must be something wrong." So I get that. I hope I've explained why that they're doing it to try to motivate some people to get the vaccine when they otherwise wouldn't. And so we've tried carrots and we've tried sticks. But Americans as a rule, and any person really can say, "You try to force me to do something, I'm just going to push back." And I'm afraid that is happening far too often.
Michael: Mm-hmm (affirmative). It's just a very big thing. It's a very big issue, I think. And it's a lot to wrap your head around and the reason I wanted to come on here in the first place, the reason I suggested this topic was first of all, because I wanted to get a better grasp on the situation and hopefully be able to talk about these things. And the other reason is, I don't know how many other people there are out there that have the same mindset that I do. But the general stigma around not getting a vaccine is... It does no favors. It does no favors to inform people of what it is and what they should consider going into it. It only creates a bigger divide and I really wanted a chance to talk about what it's like experiencing that from this side of it and why it's, in my opinion, very, very harmful.
Keith: Yeah. Public shaming is... I just don't think that's an effective technique. And it's a shame that is happening because it's not effective for a lot of people. So I don't know where you live, Michael, but if you're anywhere near New York and you have time, I'd be happy to have you come sit down, we could talk through things a little bit more out of the camera lens, so to speak. And I can answer any of the questions that you have.
Michael: I mean, that would be awesome. Unfortunately, I don't live near New York, but if I ever stop by. (laughing)
Dylan: You just come right up for a doctor's appointment, (Keith and Michael laugh) and you can go right away. And that's actually what this whole podcast was all about, is just getting you a doctor's appointment Michael. (Michael laughs) Well, Michael, you did come to the right spot. I hear you on the shame and this is a strongly anti-shame show, as you know, you're a listener. It's not about shaming people for what they write online necessarily, it is about holding people accountable, but this is of course, a different episode. (Michael chuckles) This is A Very Special Episode of Conversations with People Who Hate Me, but it's still holding onto the core tenets, right? It is an anti-shame show and this has been an anti-shame space. And listen, my incentive for getting you on here and getting Keith to talk to you was—to talk with you, excuse me—was because I think this is a reflection of a lot of conversations that a lot of people are having all over the country, all over the world. And even if you are not rushing to go get vaccinated tonight or this week or this month, a lot of people will see their reflection in you or hear their reflection in you and it's just a way to show how these conversations can go. So I really do appreciate you coming on here. Are there... I'm trying to think of a final question, but I feel like we've kind of answered them all already. I love reading it in feelings and Michael, just to take the heat off of you, I've asked you about feelings this whole call. Final questions, but Keith how are you feeling at the end of this call?
Keith: I actually feel really good. I'm so glad that Michael was brave enough to come on and talk about this, recognizing that there is a stigma about it. I hope I've addressed the fact that I don't think we ought to be stigmatizing people who are concerned, who are hesitant. I think that's a very reasonable place to be. As time goes on, and as we get more knowledge with and more comfort with the vaccine, and more and more certainty that the vaccine is safe and effective, that more people like Michael will feel comfortable eventually in going and getting things. So if I've done a little bit in addressing some of the fears and maybe some misinformation that Michael might have heard, that I'm feeling pretty good about things. So I certainly don't expect people to rush out and get the vaccine in droves, having listened to this. But maybe they'll be a little bit better able to recognize when somebody is trying to give them an argument that is coming from an insincere place and also a little bit better understanding from the people who are doing their best to make an argument from a sincere place but not doing so, using the right words for them.
Dylan: Michael, how are you feeling?
Michael: Really good. Yeah, you said, if you did a little bit to help me, that'd be awesome, but you have done a whole lot to alleviate a lot of the stress and push away a lot of the fog. And like you said, Dylan, this is a kind of a weird episode because unfortunately I do not hate you, so this is a-
Dylan: No one hates anyone on this call! (Michael laughs) It's a call of love. Yeah, that's all it is.
Michael: Yeah. So I might be a bad fit for this show, but I'm-
Dylan: No! (Michael laughs) Also, beautifully, I'm, again, no shame, but you beautifully misinterpreted my words. I said, "This is a Very Special Episode of Conversations with People Who Hate Me." And you said, "It's a very weird episode." And I say, "no, no! Very Special." (Michael laughs)
Michael: Well, I misspoke. I apologize.
Dylan: Yeah. Yeah.
Keith: No, no. People who are weird are special. (laughs)
Michael: You know what- That's- yeah-
Dylan: Yeah, look at that!
Michael: ... true.
Dylan: Yeah. Okay, great. Correction to both of us. Well, thank you both so much for doing this. Thank you for coming on here.
Michael: Thank you.
Dylan: Michael, I really appreciate you proposing this episode. Keith, you are a font of wisdom and I am honored to have you as my doctor and now my podcast guest, this is so fun.
Keith: It has been fun. Thanks, Dylan.
Dylan: Well, thank you both so much. We understand that we cannot do everything on one single phone call and one single conversation, but Michael, we will keep in touch and Keith, I think I'm due for an appointment, (Michael laughs) so I will see you soon.
Keith: I look forward to it.
Michael: All right.
Dylan: Okay. Bye guys.
Michael: Bye-bye.
Keith: Bye-bye.
[Conversation ends. The drumbeat from ‘These Dark Times’ by Caged Animals kicks in.]
Dylan [VOICEOVER CLOSING CREDITS]: If you have an idea for a conversation for this show, head on over to www dot conversationswithpeoplewhohateme dot com and fill out the brief submission form.
Conversations with People Who Hate Me is part of the TED Audio Collective.
This episode was mixed by Vincent Cacchione, the theme song is “These Dark Times” by Caged Animals, the logo was designed by Philip Blackowl with a photo by Mindy Tucker, and this show is made by me, Dylan Marron.
You can preorder Conversations with People Who Hate Me the book by following the link in the description of this episode, or you can buy it wherever you buy books.
Thanks so much for listening. And guess what? We are weekly now! So stay tuned next week for a brand new conversation and until then, remember: there’s a human on the other side of the screen.
[Chorus of ‘These Dark Times’ by Caged Animals plays.]