So much has been written about this that I have hesitated (no pun intended) to address it. However, the consequences are so huge as to public health that I feel a moral imperative to write. The Greeks got this right with their word dilemma, δίλημμα, two sides or even “two horns” (a meaning that was adopted even to the uterus). Most of us in the biomedical field are stunned by the position of the antivaxers. However, it is always best to try and understand the opposition's belief system. As to those who are suspicious of medical advice and “technology,” I think of my late father-in-law, a western Pennsylvania steel mill foreman. He was not college-educated and yet intelligent in many ways (meaning he sought to understand, as the word intelligent means). He never saw a doctor or took a pill but had his own pharmacopeia of natural herbs. He died from a condition that could have been treated. His loss was a poignant lesson, to me, of the power of one's thinking as to medical science. The various causes of COVID vaccination hesitancy or resistance have been widely discussed. For African Americans in particular, a factor has been the history of unethical medical experimentation and now an irresolute suspicion about vaccination among many in this community. This situation is a shameful reflection, among many, of enduring racism in America and also resonates with horrific disparities in healthcare access.1 Sadly, there are many in America who may now be moving toward COVID vaccination and yet lack easy access. For those diehard antivaccinationists, I ask if we in the biomedical profession could have done a better job in educating the public. I think we could have. The recent authorization of the Pfizer vaccine is a case in point, where I think we were at fault for not making it clearer that “emergency use” is a term than does not mean “unsafe” or “unproven.” It is heartening to see that a large proportion of COVID-vaccine-hesitant Americans have now agreed to move forward. Another example of where we, and the media, may not have been clear enough is the use of the term “encapsulation” to describe the packaging of the mRNA vaccines (necessary to enhance delivery). I had not realized this until recently, when it became apparent that this word is why some people think the term “capsule” means that a chip will be put into their body. In some extreme forms of this angst, it is believed this “chip” will enter the brain and allow the government control over the person. We should never laugh at this. It is our fault if we have not done a better job of reaching the public.2 The remaining opponents hold firm beliefs about their rights to their bodies as well as passionate views on the limits of government on their lives. Another group holds certain religious beliefs. For the former, I would stress the importance of our continued efforts to educate the lay public, as we can try.2 For the latter, I think that religious beliefs are outside the bounds of science, and we should respect these. However, in many religions, there is the sanctity of life, whether believed as a gift from a god and/or something so cherished as to be never put at risk. For example, in Judaism, this is codified in a doctrine, whereby certain laws can be overlooked if their deployment might impair saving a life. The legal stalemate over vaccination brings us to the US Constitution, whose principles we adopted from a Frenchman, Montesquieu. Thanks to the architects James Madison, Alexander Hamilton, and others, it grants to the states considerable autonomy. This is why the governors of several states have not supported mask mandates and think they will prevail. The courts will see these cases now, and we can only hope medical science weighs in, as it always should. Some ardent constitutional scholars have argued for the Constitution's amendment, while others hold that it is a sacrosanct structure that should not be brought before the forum of changing times. We shall see how this debate ends up.
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