Can you Compare Vaccine Hesitancy to other Bad Health Choices?

At least as I begin writing this, it is September 22nd and I'm in Alberta. The ICU capacity in my province is bursting at the seams, and doctors are speaking about the upcoming need for triage of incoming patients. Alberta is the least vaccinated province in Canada, and the surge of ICU patients is overwhelmingly driven by the unvaccinated. Even the cases of vaccinated patients in the ICU are probably because of unvaccinated yahoos on a Safeway safari. The question: If you're a vaccinated Albertan whose brain surgery has been delayed twice because the beds are full, are you allowed to call these people sons of bitches?

I think you can evaluate that fact on its own, but I want to know how it compares to other groups who make bad health choices. There are a lot of possible comparisons with differing links to health, differing levels of agency, and where the group boundaries are more or less absolute. There is smoking, drinking, lack of sleep, junk food. I probably like narcotics use the best, just because you can talk about whether or not people are jabbing themselves with needles. I might hop around a bit when needed though. If I can trust my own levels of introspection, I don't actually know where I'll end up through the process of writing this, but I imagine there will be certain rules of thumb for when we look down on health vices.

Is a heroin user a sumfabitch? The first thing I'll note is large inconsistencies in my perceived left/right answer to this question. I'd say that roughly a progressive person will rank vices from least sympathetic to most sympathetic roughly: anti-vax, smoker, drinker, narcotics user, bad eater. The line more or less passes through neutral at drinking, while a very bad eater (okay, the more controversial and to the point version is an obese person) gets overwhelming support and protection, and antivaxers are worth nothing but derision. I would say that a conservative might have the opposite ladder of respectability. There's variation, of course, but these seem like mainstream positions.

Is either position logical? The most obvious give away is probably comparing drug use to smoking. Left wing politicians, notably the current US Democratic party, will loudly campaign against the war on drugs, while simultaneously banning the sale of flavoured cigarettes, for example. You'd be damned hard-pressed to argue that menthols are more dangerous than crack, and criminalization of cigarettes can absolutely have the same pernicious effects as for drugs, see Eric Garner. On the flip side, you will absolutely find prominent conservatives decrying the dangers of marijuana amongst their cigarettes smoking friends. If I'm simplifying, I think it still drives home the point.

Perhaps a lot of our decisions for which health vices to dislike comes down to who participates in those vices, nothing else. Conservatives are less likely to get vaccinated, but probably much more likely to smoke and a bit more likely to drink. Hard drugs have traditionally gotten more attention as an inner-city problem with minorities who swing left, and obesity somewhere in the middle. This explanation is convincing me less these days, because the left has continued to appear more sympathetic to an opioid crisis mostly afflicting conservative demographics, and obesity tracks lack of education, whereas liberal politics fly the other way in the US and Canada.

I think there are two main reasons a liberal cites to defend the vax/smoke/booze/drug/obese escalator or judgement. One is quite good (if overused), the other is pretty weak. The reaction to the weak argument might double as the conservative defence and I'll start with that first.

I think a lot of liberals implicitly order their judgment based on how hard it is to not do the bad thing. It is legitimately very easy to get the vaccine, and very hard to lose weight or quit taking opiates. It's a totally valid argument, but liberals tend to overplay their hand. It is easy to get a vaccine injected into your arm, but how hard is it really to never inject heroin into your arm? I'm 27 and I've somehow managed to never do it once. I can honestly say that I find not injecting myself with heroin 100 times easier than injecting myself with the Moderna vaccine. Now, obviously, it would be harder to avoid heroin if I were born to a poorer family in a neighbourhood filled with drugs. But I'd also find it harder to get the vaccine if my milieu kept sharing believable articles about their vaccinated aunt who died two weeks later. I think both cases are perfectly comparable, i.e. peer pressure is a bitch. And we actually have more evidence that heroin is dangerous than that the vaccine is safe.

For obesity, expand the vaccine question to consider following non-pharmaceutical interventions, such as mask-wearing and self-isolation. It IS very difficult to lose weight, and loving people will rightly point out that it becomes much more difficult given the wrong job or the wrong genetics. If I grant that, liberals can grant that it is very difficult to follow mask wearing and isolation for, say, a single mother of four who's youngest is deaf. But now let's admit that for many people it's really difficult to lose weight because being active is hard and ice cream tastes great. While Covid interventions are hard to follow because we're social creatures who like hugging each other and reading our faces. Both cases require massively changing your life and your lifestyle, and the claim that one change is easy and one hard seems incorrect and very subjective. A huge complaint that I foresee to this analogy: Is one of these a much more bad thing than the other? It all depends on the degree of obesity vs. social distancing, but yes, a sufficiently obese person can absolutely be doing as much damage to their own body as a smoker or a partier - through mechanisms like cancer, diabetes, and of course Covid-19. (Too lazy to cite, sorry, sift through the studies if you really want)

I think the much better argument a liberal might make is related to your effect on others. In this sense, I think both progressives and classical liberals would probably be on the same page. Refusing to vaccinate yourself is uniquely bad because you risk infecting other people. I trust the reader to get their facts on breakthrough infections and related topics elsewhere, but let's agree that the social evil is much larger in the case of a careless cough than that of a bag of Doritos. One of the main levers for enacting anti-smoking regulation was in reference to second hand smoke. Dissuading smoking overwhelmingly benefitted those that smoked directly, but the policy discussion used non-smokers breathing it in to make their case.

Two nuances before I close. The main social benefit of reducing smoking or encouraging seat-belts is actually through complicated interactions with peer pressure. This would apply to vaccine mandates (if your family got vaccinated for work, and feel fine, I presume you will be more willing to get jabbed yourself), but it would also apply to anti-obesity programs, complicating the picture. Secondly, I'm not sure what to make of the problem of hospital beds. Obviously you might take up a hospital bed if you overdose on fentanyl. I think whatever conclusion you reach re: blame should be equal between antivaxed covid patients and fentanyl overdoses on a case by case basis. But maybe the marginal blame on the unvaccinated person taking up Alberta's 200th ICU bed is much higher. That implies a non-zero blame on drug users (and everyone else) for EVER using healthcare resources for avoidable reasons, and I think I'm comfortable with that. If we were cancelling brain surgeries because hundreds of opioid overdoses were filling the ICUs, I think we're allowed to get frustrated.

So that's my conclusion. The vaccine hesitant are usually allowed to be called sons of bitches because their lack of action is particularly bad for others in the general case, and extremely dangerous for others at this particular time in Alberta. Other vices with this general pattern earn their users the Sumfabitch badge, such as drinking and driving. Other vices with a negative social outcome in a particular time and place earn the badge too, such as getting black out drunk after a tornado has wiped out hospital capacity.

Thank you for helping me to work that out.