What Does “Pro-Vax” Even Mean?

I joined Twitter earlier this year and began tweeting about covid policies in August. My bio has undergone many permutations over the months since, as I’ve explored the purpose of my account and refined how I want to present myself to the world.  At first, I included “pro-vax” in my profile. I did this for a few reasons, including the fact that I do genuinely believe, based on the available data, that covid vaccines are preventing serious illness and death among at-risk populations. But I am not sure that’s really what I meant by “pro vax.” When I reflect on it now, with a few months’ distance, the real reason I included it in my bio was as a virtue signal and marker of credibility. I may as well have written, “I have concerns about covid policy and I hate masks, but I’m vaccinated and not a covid denier MAGA insurrectionist” – which would have taken up too much valuable real estate in a bio with a 160-character limit. But in that sense, the “pro-vax” label has little do with my actual beliefs, and more about how I am worried others will see me. I don’t want to care about that anymore.

At other times, I have described myself as “pro-vax but anti-mandate.” But that, too, is an oversimplification that ignores many layers of nuance.

First of all, what does “pro-vax” even mean? I take Tylenol when I have a headache and it works great. But I don’t publicly identify as “pro-Tylenol.” As my friend Jennifer Sey recently pointed out to me, why is our allegiance to a pharmaceutical product suddenly becoming a huge part of our identities?

Moreover, do these labels offer room for nuance? Can I be pro-vax if I also have serious questions about these vaccines, how well they work, what side effects they may cause, and how they are affecting the overall course of the pandemic? Can I be “pro vax” if I publicly acknowledge the indisputable fact that Pfizer is making billions of dollars from these vaccines, and stands to make more money the more vaccine it sells? If I think “boosters” are not necessary for most healthy adults, am I still pro-vax? Can I be pro-vax when I observe that friends who are experiencing serious adverse reactions are being censored and gaslit, often by their own doctors? Is it pro-vax to wonder why so many vaccinated people seem even more scared about covid than they did before they were ever vaccinated? And do I have to relinquish my “pro-vax” status when I share studies demonstrating that covid cases continue to rise in highly vaccinated regions?

I am a little more comfortable with “anti-mandate,” but this shorthand label still oversimplifies my complex positions on covid vaccine mandates, and the myriad of concerns underlying why I oppose various types of mandates – many of which are shifting as we accumulate more and more data. 

For example, I oppose covid vaccine mandates in the employment context because they provide no exemption for natural immunity, the vaccine is non-sterilizing and does not prevent transmission, and nobody’s job should be contingent upon a private medical decision.  As a practical matter, because vaccination rates are far lower in many black and latino communities, I also think vaccine mandates and passports have a racist impact and I object to them for this reason as well.

In the broader scheme of things, I think vaccine mandates undermine principles of bodily autonomy and medical privacy, which are some of my core personal values. Finally, the vaccine (and subsequent “boosters”) do come with risks of serious adverse effects, including death. While adverse effects appear to be rare, they can be severe and are clearly being underreported.  Given the availability of effective treatments like monoclonal antibodies, the decision regarding whether to get one (or many) covid vaccines becomes even more complicated, and should be an individual decision made by the patient in conjunction with his or her physician.

But none of this is to say that I could never approve a limited mandate. For example, if a sterilizing vaccine became available, which prevented transmission and had a strong safety profile, I would probably support a vaccine mandate for health care and long term care workers, so long as there were an exemption for the naturally immune.

I oppose vaccine passports for similar reasons: given we know vaccinated people spread the virus, vaccine passports are punitive, discriminatory, and coercive. Any connection to public health is tenuous at best, and it violates my moral code to ban people from society due to a medical decision that they alone have the right to make for themselves.

My opposition to vaccine mandates for children is even more robust. In my view, this vaccine is unnecessary for all but the very few high-risk children. This view was validated by members of the FDA’s vaccine advisory committee, who expressed concerns that mandates would result from their Emergency Use Authorization but nonetheless voted for authorization so that the vaccine would be available for those who need it.  Healthy children, like healthy adults, are extremely unlikely to experience poor outcomes from covid infection. Indeed, by many estimates, 50% of children in the United States have already recovered from covid, many not even knowing they were infected, and now enjoy durable natural immunity.  The cost-benefit analysis for healthy children tilts against vaccination, at this point, particularly given that the clinical trials for children were small and underpowered to detect serious adverse effects, and the long-term risks of mRNA vaccines to children are unknown and cannot be ruled out. Furthermore, mandating a vaccine that is not even FDA approved yet and is only approved under Emergency Use Authorization – which Los Angeles Unified School District is doing by imposing a vaccine mandate for all students age 12 and above – is unconstitutional and reprehensible. Finally, to the extent that vaccine mandates are justified by pleas to the “greater good,” this is unethical; no society should ever ask children to take a medication solely to benefit others. The idea of putting children at potential risk to benefit adults is antithetical to another one of my core values; namely, that children are our future and we must prioritize their needs above all else. “Pro-vax but anti mandate” in this instance is too measured, too hedged, and does not encapsulate my true feelings about mandates for children, which can be most politely described as “are you fucking insane?”

The real issue I have with “pro vax” or its infamous counterpart, “anti vax,” is that these belief systems should not be absolutist or immutable, especially given that the science and policies are evolving every day.  Furthermore, it’s not possible to encapsulate all these views within a Twitter bio that only allows 160 characters of text.  But I’ve decided that “pro informed consent” comes pretty close, so today I made room for it in my bio.