COVID-19 cases are surging throughout the United States, particularly in the South and Northwest. Hospitals are under heavy strain from the rapid rise in cases. Staff shortages, lack of available ICU beds, and dwindling resources exacerbate the problem. A recent article from the Onion, a satirical publication, captures the present situation with some exaggeration: “Apologetic Nurse Informs Man Having Heart Attack There’s about an Hour Wait until Next Covid Patient Dies.”

There are over 39.8 million total cases and 644,000 total deaths in the United States. There are millions more worldwide. What these data do not capture is the humanity of each case. Each death is a loved one that families will never see again. Children without their mothers and fathers; neighbors, colleagues, and communities without their friends. Fortunately, many do not die. Yet, individuals who recover from the virus may have long-term complications requiring additional and costly treatment.

Entire communities have been devastated by the virus. The disproportionate impact that COVID-19 has had on people of color, low-income communities, and other structurally disadvantaged groups is well documented. Moreover, structural inequities in our healthcare system reflect the class struggle. Those with service sector jobs, i.e., those who could not stay home and work remotely, were more likely to contract COVID-19. Politicians pushed to “re-open the economy” but without simultaneous measures to protect the health and well-being of workers, such as contact tracing and systematic testing, guaranteed PPE, or workplace sanitation protocols. The message of monopoly capital was clear throughout the pandemic: “Your sacrifice is acceptable and necessary to ensure continued profit for me.”

Anti-vaccination is as old as vaccination itself.

Overcoming vaccine hesitancy has been a challenge since development of the COVID-19 vaccines started. The World Health Organization (WHO) defines vaccine hesitancy as “delay in acceptance or refusal of vaccines despite the availability of vaccine services.” Hesitancy is multifactorial. Access issues (e.g., transportation, language barriers), fears of deportation over immigration status (COVID-19 vaccines are free for all U.S. residents, regardless of immigration status or access to insurance), and lack of healthcare infrastructure and resources also factor into vaccine delay or refusal.

The current environment of vaccine hesitancy or outright anti-vaccination sentiment is not unique to COVID. Anti-vaccination is as old as vaccination itself. Yet, the story of disgraced physician Andrew Wakefield is helpful in better understanding the present debate around anti-vaccination, COVID-19 vaccines, and public health measures to minimize and control the spread of the virus.

The entire modern anti-vaccination movement is based on a fraudulent “study.”

Andrew Wakefield was a British physician who published a “study” in the prestigious British medical journal The Lancet in 1998 that claimed to show a link between childhood immunization against measles, mumps, and rubella (the MMR polyvalent vaccine) and the subsequent development of “autistic enterocolitis” and autism. Importantly, Wakefield originally did not oppose vaccines. In multiple interviews at the time, he called for discontinuation of only the polyvalent vaccine and recommended three separate monovalent vaccines. The reason for this recommendation would become clear later.

The conclusions of the study and its entire methodology soon came into question. Other researchers were unable to reproduce Wakefield’s findings. Subsequent reporting by investigative journalist Brian Deer uncovered fraud and abuse. It is important to know that Wakefield was hired by attorney Richard Barr to “research” MMR vaccines because Barr was interested in pursuing a class-action lawsuit against MMR manufacturers, despite no scientific evidence on which to base the lawsuit. Regarding his recommendation for separate vaccines against measles, rumps, and rubella, Wakefield submitted a patent for a measles vaccine the year before the study was published in The Lancet. By 1999 Wakefield was the director of several biomedical businesses and sought investor capital for production of his patented measles vaccine as well as for development of diagnostic testing for “autistic enterocolitis,” a fictitious diagnosis he invented.

Additionally, Wakefield altered the medical records of the children in the study to create the illusion of a temporal connection between the MMR vaccine and autism. The children were harmed and abused, subjected to numerous invasive and unnecessary procedures in an effort to establish a link between his fabricated diagnosis and autism. The informed consent handout that Wakefield provided to the children’s parents never disclosed possible risks associated with these procedures.

The entire modern anti-vaccination movement is based on a fraudulent “study” perpetrated by an unethical physician with clear financial motives. This movement has real consequences, including the suffering and death of children by entirely preventable illnesses.

Medicine has been instrumental in building and perpetuating white supremacy.

Not all vaccine hesitancy is a reflection of misinformation. Throughout American history, even to the present, minority communities have suffered from unethical treatment and abuse, lack of care, and systematic discrimination from healthcare workers and medical institutions. Medicine has been instrumental in building and perpetuating white supremacy. Intergenerational racial trauma and suspicion of medical professionals and institutions is a rational consequence of systematic dehumanization.

For example, the “father of modern gynecology” J. Marion Sims performed surgical experiments on Black female slaves without anesthesia. He later moved to New York City and opened a women’s hospital where he started treating white women, but with anesthesia. Another example is the long history of forced sterilization of poor, minority, and incarcerated women. Female inmates in the state of California were being forcibly sterilized as recently as 2010, and immigrant women were subjected to sterilization and denied reproductive healthcare at ICE detention facilities just last year.

Additionally, most Americans are likely familiar with the “Tuskegee Study of Untreated Syphilis in the Negro Male” (now referred to as the “USPHS Syphilis Study at Tuskegee”) that started in 1932 and continued until 1972. Penicillin became the treatment of choice for syphilis in the 1940s, but study participants were not offered treatment. The participants and their descendants waited until 1997 for a formal apology.

Brutal mistreatment and exploitation from medical professionals and public health institutions also extends to Native Americans. Thousands of Native American women were sterilized without their knowledge or consent by the Indian Health Service in the 1960s and 1970s. Estimates suggest that this was performed on one out of every four Native American women at the time. Another example is the 1950s iodine-131 experiment on Alaska Natives conducted by the United States Air Force. Radioactive iodine was actively administered to Alaska Natives without any medical indication or prospect of benefit. Participant selection, authorization, and consent were also unethical.

These examples highlight the intersection of race, class, white supremacy, and medicine. Current hesitancy in some communities about COVID-19 and public health efforts are partly born from this legacy. Automatic labeling of understandable suspicion as foolish only serves to deepen mistrust. The same is true for blanket dismissal of vaccine misinformation as reflective of individual intelligence or political and ideological identification. Correcting misinformation is challenging but can make a positive difference in advancing public health.

The data do not support ivermectin for the treatment or prophylaxis of COVID-19.

Ivermectin has become very popular during the pandemic. It is used to treat parasitic infections in both humans and animals and is effective at doing so. Clinical indications for drugs sometimes change during their development, and researchers do find new uses for old drugs. Ivermectin’s use as an antihelminthic does not automatically preclude its possible use in other situations.

But the data do not support ivermectin for the treatment or prophylaxis of COVID-19. Much of the evidence is weak and inconsistent. Moreover, at least two of the papers heavily cited by proponents seem to be the result of fraud, data fabrication, and unethical research conduct. Unfortunately, tremendous damage has already been done, similar to the Wakefield study. Politicization of COVID and public health measures to mitigate the virus’s spread and severity undermined our response. Reliance on small and poorly designed ivermectin studies worsens the situation. Rigorous, well-designed, peer-reviewed, and ethical medical research is essential because it directly affects clinical practice, public health policies, and even individual actions.

The COVID response here in the United States has been a collective failure. COVID-19 is real and quickly spreading. Social distancing and proper health and hygiene protocols are important tools to help stop the spread of the virus. But more importantly, we can get vaccinated and encourage our friends and families to get vaccinated too.

Vaccination also plays a part in the class struggle.

Vaccines represent one of the greatest public health achievements of modern medicine. Vaccination also plays a part in the class struggle. As tweeted out by the Retail, Wholesale, and Department Store Union (RWDSU), “Getting vaccinated is a safe, free, and effective form of worker solidarity.” Vaccination keeps both yourself and members of your community safe, especially vulnerable children and adults.

Vaccines help reduce risk: risk of contracting a disease, risk of suffering serious symptoms and complications of the disease, and risk of spreading the disease to others. Side effects are possible, but the possibility of experiencing a side effect of the vaccine has to be compared to the possible dangers of not vaccinating. Not vaccinating against COVID-19 significantly increases the risk of multiple serious adverse events. No vaccine is perfect, but they don’t have to be. Vaccination campaigns successfully eliminated polio in the United States in 1979 and the WHO is hopeful that it can be eliminated worldwide. In 1980 the WHO certified the eradication of smallpox, a disease that, as recently as 1967, “threatened 60% of the world’s population, killed every fourth victim, scarred or blinded most survivors, and eluded any form of treatment.”

Collective action is required to overcome COVID-19. Addressing climate change, combating police repression and violence, and struggling for our democratic rights similarly requires the full power and unity of the working class. Only solutions that strengthen trust, and in so doing build unity and solidarity, will be successful.

Community health systems need to be empowered and provided necessary resources.

Outreach programs that center the specific needs and concerns of communities in their efforts have demonstrated success in building trust and unity, despite the legacy of medical experimentation and exploitation of minority communities. Community-based organizations increased vaccination rates in Black, Hispanic, and Native American communities by using trusted sources to correct misinformation, providing flexibility in how to distribute the vaccine, and respecting cultural values. Community health systems need to be empowered and provided necessary resources to deliver accurate information and social support.

Vietnam and China are examples where a proactive and multifaceted response has been successful at reducing total cases and deaths. National and local governments provide mass testing, vaccines, and even meals and other amenities to those who need it. Comprehensive public education is an integral part of the response. The COVID pandemic requires a coordinated global effort, and it is likely to continue without equitable vaccine distribution. The most vulnerable worldwide are still waiting for their first dose at the same time that pharmaceutical companies lobby for large-scale booster vaccination campaigns. Boosters may be beneficial for specific patient populations (e.g., immunocompromised individuals), but there is little evidence, and even less of an ethical argument, that their widespread use is needed now. Current vaccines remain highly effective against severe disease and death and must be extended to all. Concerns over corporate profit are justified. The solution is to nationalize the pharmaceutical industry and remove profit from the equation.

A comprehensive and preventative public health strategy is possible. The Biden administration’s recent extension of vaccine mandates is a welcome first step. But vaccine mandates are just one part of the larger collective action we need to take. An effective pandemic response includes mask mandates and free high-quality masks provided to everyone, universal and accessible testing, contact tracing, and access to affordable healthcare. An effective pandemic response is also broader in scope than just medical interventions. It must include decent wages for workers, safe working conditions, stable housing, paid leave for those who need to be quarantined, investments in local school districts so children’s education can continue safely, and meaningful improvements to the training and working conditions of healthcare workers.

This is a working-class fight. The virus does not discriminate, but the legislators and public officials who represent monopoly capital do. Overcoming the pandemic requires working-class unity in advancing demands that center health equity, public health, and the safety and prosperity of our communities.

Image:  New York State MTA (CC BY 2.0).

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