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Vaccines and the Cognitive Conundrum That is Prevention

In the years prior to 911 congress and the FAA were working on legislation to improve security for commercial airline cockpits. The FAA is a notoriously slow organization and there was much debate on not only fortifying the cockpit doors but to what degree. Pilots and flight crews argued that further fortification would limit the ability for staff to respond to emergencies in the cockpit. For example, if a co-pilot locked the captain out of the cockpit to take over the plane, or if there were a medical emergency with one of the pilots the flight crew would be locked outside.

There was also the issue of cost. The proposed fortification of the doors was going to cost between $7000-$12000 dollars per plane. The airlines would be responsible for the cost. The law was to require not only new locks with electronic keypads, but also fortification of the door itself, doorjamb and surrounding walls. The estimated total cost to the airlines would be between $93–120 million dollars. Obviously, there was some opposition to this “unnecessary cost.”

Then there was the issue of attention. Who would really care about this? If you were a member of congress that proposed this bill and pushed it through the house, and senate would you tout this as an accomplishment. On the campaign trail when the constituents asked “what have you done during your term to help?” How would they respond to… “I worked on the issue of improving cockpit security during commercial flights.” Likely with little enthusiasm. Prior to 911 no one cared about this issue. In fact, cockpit doors already had locks on them, and no one was allowed in the cockpit except the pilot and co-pilot during take-off and landing. Why would you need further fortification?

President Clinton and the NSA were warned by the CIA and other foreign diplomats that terrorists were planning to highjack commercial airlines. They did not know for what purpose at the time. Who would’ve imagined the plan was to crash the plane into two of the most iconic skyscrapers in the world? The failure in this case, was the failure to imagine.

Think of all that has happened since 911. The TSA didn’t exist prior to 911. You could pack your shaving kit in your carryon bag. You didn’t have to worry about waiting an hour at a security checkpoint. Airports had to spend 100’s of millions of dollars since this time on extra security measures and personnel. Much of that cost is in the form of municipal bonds and tax increases. In 2002 congress passed the above legislation above costing the airlines the $120 million they were lobbying against. But Don’t worry about them, American Airlines alone allocated $12.5 billion in cash to stock buy backs from 2010–2019.

Nobody would’ve known the significance of the legislation without 911. There would be no fanfare when it was passed. It would probably be noted in one paragraph on page 8 of USA Today. There’s a possibility that a plane would’ve been hijacked at some point, and it probably would’ve been a big story. But nothing like 911. Life would’ve just continued on completely oblivious to the potential world of travel we live in today.

One of the most common responses I get when I ask someone if they want a vaccine is, “Why would I want a vaccine? I’m never sick. I’ve never had the flu. Do I really need it?”

This is a common cognitive trap. It is partially due to the fact that from a reward perspective its backwards. You put forth effort in the hopes that nothing happens. The human mind has difficulty with this concept. We are rewarded far greater for solving problems than preventing them. We have been solving problems since our existence began. Our species is neither strong, fast, or ferocious. On the African plains we were prey, not predator. We solved the issue of night-time ambushes from insanely large cats with the invention of fire and shelter. We solved the issue of starvation with the cultivation of crops. We’ve stamped out disease through clean drinking water, removal of waste, and the pasteurization of milk. And then further with the discovery of antibiotics and immunology. In fact, Edward Jenner (the father of immunology and inventor of the smallpox vaccine) is thought to have saved 530 million lives from small pox alone. He is responsible for many more since his discovery became the foundation for many more vaccines.

Even with that impressive statistic, prevention of disease remains a cognitive conundrum. The fact that its confusing makes sense. Let’s face it, when you get a vaccine nothing happens. Actually a few things happen. First, your arm gets stabbed by a needle, which hurts. Then your arm is sore for a couple of days after that. You may get a headache, or a fever, or feel fatigued, or all three for 24–48 hours. Then nothing happens.

If you are bringing your child in for their yearly health check with their pediatrician, it’s even more traumatic. The child doesn’t want the vaccine. He/she knows it’s going to be painful. They kick and scream bloody murder. You have to hold them down to get the vaccine. When it’s over they pierce through your soul with blood-shot tear filled eyes, and a crushing look of betrayal. Then the kid feels lousy for a day or two after the vaccine. Then nothing happens.

That’s the idea. Nothing happens. The reward for the effort is not seen, and the degree to which you are rewarded is not known. An unseen, unknown threat, is extinguished with little-to-no fanfare.

Most of us do not spent time imaging what life would be like if your child was lost to an infectious disease. Particularly a preventable one. How something like that could rip your family apart. It’s hard to imagine what your life would be like if you became very ill, survived, but could no longer work to provide for your family because you’re just not healthy enough to do so. There are so many other unknowns waiting for you in life. Many of them are out of your control. Many of them are tragic. So, when given the opportunity to prevent your life from being derailed, to remain in the status quo, you should take it.

When it comes to the COVID vaccine there are several things that are probably true. First, you are probably going to feel fine the day you get the vaccine. Second, it will probably make you feel lousy the next day. Third, your arm is going to be sore. Finally, if you’re like me, relatively young and healthy, your risk was low to begin with so you may think you have little to gain, so it’s not necessary.

A day or two after you get the vaccine, nothing is going to happen. When you think, “Why did I get this?” Remember the regulators and congressmen working on cockpit security measures for commercial airlines, and how they’d wish to have that opportunity back. Then be thankful that “nothing” is going to happen.

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