Updated December 5, 2021

COVID vaccination, especially vaccine mandates, is a polarizing issue for much of the United States. This has resulted in conflicts among politicians and political parties, families — especially divorced parents, parents and teachers, employers and employees, and vaccinated and unvaccinated people. It is such an emotional issue that many of the confrontations involving opposing viewpoints have been bitter, angry, and even violent. Reasons for these differences have been discussed in previous articles — Myths About COVID Vaccines and No End In Sight for COVID.

A common rationale among those who refuse the COVID vaccine is ‘my body, my choice.’ While this is true, there are repercussions to consider. For COVID, those consequences go beyond the significantly increased risk of unvaccinated individuals getting and dying from COVID. They extend to infecting many of those around them — especially the elderly, the immunocompromised, and young children — prolonging the pandemic, taking up medical resources, and the likelihood of new possibly more contagious and virulent variants of COVID-19.

Most of this is unnecessary due to the many facts and reality that clearly COVID-19 is a public health crisis and that vaccination is an extremely effective method of preventing severe COVID disease or death. This article will look at what is known about the consequences that choosing not to be vaccinated has on those individuals, those around them, and the current COVID situation.

Individual Consequences for the Unvaccinated

At the beginning of the COVID-19 pandemic, it was people over 65 and/or people with underlying medical problems that were at the highest risk for severe COVID disease including hospitalization and death. Fast forward 21 months, and now the vast majority of those experiencing COVID illness, hospitalizations, and deaths are 11% of those who are partially vaccinated and 29% of those who are unvaccinated.

From April 4 to July 17 (most recent 3 month data available), partially vaccinated and unvaccinated individuals accounted for 87% of all COVID cases, almost 70% of intensive care unit (ICU) admissions, 90% of hospitalization, and 91% of COVID deaths. They are five times more likely to become infected with COVID-19, 29 times more likely to be hospitalized, and 13 times more likely to die as a result. Most of this — including about 90% of the deaths — could have been prevented if these individuals had opted to be vaccinated.

After a mild flu season last year — most likely due to masks and social distancing measures taken to slow the spread of COVID — this year’s flu season is predicted to be much worse as these measures have been relaxed or actively discouraged in parts of the country. This creates the possibility of getting COVID and the flu at the same time, a so-called twindemic, which is a much more serious and deadly situation.

Another consequence is the number of unvaccinated who have had serious complications after choosing to use unproven and dangerous measures, such as hydroxychloroquine, ivermectin, and iodine.

Some survivors are even developing post-traumatic stress disorder (PTSD) as a result of COVID-19.

Consequences for Others Due To the Unvaccinated

Going unvaccinated would not be an issue if the consequences were limited to those individuals who made that choice, but they don’t. The consequences affect their families and those around them, the duration of the pandemic, the nature of the COVID virus, access to medical care and resources, and overall medical costs.

Although children and vaccinated individuals can spread the SARS-CoV-2 coronavirus, it is the unvaccinated who are most responsible for spreading the disease. Those most affected are those on chemotherapy or have other causes of immunodeficiency that prevent immune response from vaccination, the elderly, and those with pre-existing conditions that affect immunity who may still be susceptible to severe COVID-19 and death. COVID-19 could only affect children under 5 years old after November 3^rd when the vaccination of those aged 5-11 years began.

The number of infections, hospitalizations, and deaths is not trivial. The result of having 139,000,000 unvaccinated individuals in this country is estimated to be an additional 166,800 COVID infections, 12,500 COVID hospitalizations, and 1,100 COVID deaths per day. Since 68,000,000 of those are currently eligible to be vaccinated, those who choose not to be vaccinated are responsible for almost half of that number.

Having such a significant number of unvaccinated individuals will continue to prolong the COVID-19 pandemic. There are major consequences from prolonging the pandemic that will affect everyone.

1. As discussed in the article ‘No End In Sight for COVID,’ ongoing coronavirus mutations will produce new, potentially more dangerous, variants that are more contagious or more harmful. The likelihood increases the longer the pandemic drags on.
   1. The Delta variant mutation is much more contagious than the original COVID Alpha strain, quickly overtook this strain after it got to this country, and is currently responsible for 99.9% of all COVID cases.
   2. The new Omicron strain has now reached the United States and may even be more contagious than the Delta strain. At this time it is uncertain if or how quickly the Omicron variant will overtake the Delta variant and what protection the available vaccines offer. However, it is likely that having had a COVID with the current strains will offer limited protection against the Omicron variant.
   3. The likelihood of more significant mutations increases the longer the pandemic drags on.
2. Aside from all the medical issues that have resulted, the COVID pandemic continues to take a significant toll on the mental health of people in our country, especially increased depression (7% to 30.2%) and anxiety (6.1% to 35.9%). Some of the most significant include depression, stress, and burnout in medical care providers, grief and depression over a loved one’s death from COVID, anxiety of parents with school children, moderate to severe anxiety in young adults (69% of women and 54% of men aged 18-29 years), and disproportionately higher rates in women and minority communities. There have also been reports of increased rates of insomnia, substance abuse, domestic violence, and suicide.
3. The number of people severely ill with COVID-19 are still taking up medical resources — especially emergency room and ICU beds — that those with other conditions need and creating ethical situations for emergency care providers. As insurance companies resume charging COVID-19 patients for copays and other out-of-pocket expenses, they are increasing all of our overall medical costs. Since no one is going to (as suggested by some) make unvaccinated patients pay for their COVID-related medical bills, we all share some of this cost when our premiums and out-of-pocket expenses increase.
4. The restrictions on visits to pediatric healthcare providers has significantly reduced the rate of routine vaccinations in children and subsequently increased for those diseases. See ‘COVID in Children Is Not Insignificant’ for additional information on the consequences of COVID in children and adolescents.
5. The COVID pandemic continues to have an adverse effect on the economy. Many economic indicators use unemployment and jobs creation numbers to assess the health of our economy. While traditionally these numbers have been attributed to the economic policies of the current administration, it is the COVID pandemic that has been the major determinant in the current job market, including the record number of job openings. Consequences for individuals include lost jobs and income. For numerous reasons, unemployment continues to remain high even after the pandemic unemployment benefits expired, including: 
   1. Fewer jobs and less interest in low-wage/high-risk jobs in the retail and restaurant industries due to workers and customers wanting to avoid potential exposure;
   2. People who have needed to quit their jobs to take care of their children due to school closures and lack of daycare;
   3. The many businesses that failed during the pandemic;
   4. Burned out healthcare workers no longer able to endure their jobs; and
   5. Workers quitting as a result of vaccine mandates.
6. The need for protective measures such as masks, social distancing, limited social events, and plastic shields will persist until the pandemic is under control, which may not be for years.

A problem that will most likely emerge is the novel coronavirus becoming resistant to existing forms of treatment. As has been seen with antiviral treatment for the flu, resistance ultimately reduces the effect of treatment and the return of more severe disease. While the cause with the flu is overuse of oseltamivir (Tamiflu) in patients that wouldn’t benefit from it, the resistance to COVID-19 will most likely result from the sheer number of cases that will be treated in the unvaccinated. The more that monoclonal antibodies, antiviral medications, and even the upcoming Merck antiviral pill are used to treat and prevent COVID-19, the more opportunity there is for the virus to become resistant.

Another problem that might emerge is limited supplies and high cost of COVID treatments. This is already occurring with ventilators, but if the COVID disease rate continues, manufacturers of anti-COVID medications may not be able to keep up. This could result in rationing or prioritizing the medications to those at risk for or with severe COVID-19 or those who can afford them.

Many who refuse the vaccine do so based on misinformation. While this may be seen as an individual issue, many of these people spread this misinformation in an attempt to convince or coerce others to remain unvaccinated.

Assigning Blame

Most unvaccinated individuals consider their reasons to avoid the vaccine to be valid, such as lower levels of concern about the effect of coronavirus on them, concern over the side effects of the vaccine and skepticism about the benefits, guidance from politicians, or a willingness to risk COVID-19 for a sense of personal freedom, so they are surprised when they are being blamed for much of the current situation with the ongoing pandemic. Whether it is called blame or a consequence of their decision, it is crucial for those who choose to remain unvaccinated to understand that their decision has a significant impact on others. This is especially true for young children, those who are not able to be vaccinated, and many who have already been vaccinated.

Even if someone is reluctant, they need to acknowledge that vaccination is not a political issue. If they expect others to respect their decision, they must respect the choices made by others to have the vaccine. Anger, protests, and violence will only make the situation worse. Additionally, they should not prevent willing family members from being vaccinated; when all other family members are vaccinated, an unvaccinated person has a significantly reduced risk of contracting COVID-19. There may be options for children to get vaccinated even if their parents don’t grant permission. 

I find it curious that a country that has accepted other mandatory public health measures to protect fellow citizens such as mandatory seat belt use, bans on indoor smoking in public spaces, laws making driving while under the influence and discharging a firearm in public places illegal, restrictions from playing music above certain volumes or at specific hours, and even many other vaccines, has drawn a line for this particular issue. It’s past time to stop the rhetoric that is drowning out scientific facts and common sense, and for those who have rejected vaccination to accept that they are a danger to others and assume the same civil responsibility for COVID as they have for past public health mandates.

The NeedyMeds website has a database of over 100 nationwide resources for those who have been impacted by COVID-19. For those looking for information on receiving a coronavirus vaccine, search online for your state’s requirements, area’s locations, and appointment availability.