Matt Wynter, a 42-year-old music agent from Leek, Staffordshire, was working out in his local gym in mid-August when he saw, to his great surprise, that his best friend, Marcus Birks, was on the television. He jumped off the elliptical trainer and listened carefully.
The first thing he noticed was that Birks, who was also from Leek and a performer with the dance group Cappella, looked terrible. He was gasping for breath and his face was pale. “Marcus would never usually have gone on TV without having done his hair and had a shave,” Wynter says.
Breathing heavily from his intensive care unit bed at Royal Stoke university hospital, Birks told the BBC interviewer that he had been wrong about Covid-19. “If you haven’t been ill,” he said, “you don’t think you’re going to get ill, so you listen to the [anti-vaccine] stuff.” He spoke of his regret at not being vaccinated. “First thing I am going [to] tell all my family to do is get the vaccine and [then] anybody I see,” he said. “And as soon as I can get it, I am definitely getting it.”
Birks had rejected the vaccine because he thought it had been rushed through. “He thought it was an emergency vaccine,” says Wynter, “and he wanted to wait it out a little bit, before taking it.” Birks was the sort of person who was always “very anti putting anything in his body at all”, Wynter says. He wouldn’t drink or touch drugs – he wouldn’t even take paracetamol for a headache. And besides, Birks was a fitness enthusiast, going to the gym five times a week, so he figured that if he got Covid, he would most likely be fine.
Watching his interview, Wynter had never been so proud of his best friend. “It takes a lot of balls to stand up there and admit that maybe you made the wrong decision and had the wrong views,” he said. He texted Birks straight away. “I’m really proud of you mate, you’re a hero.” Birks responded from his hospital bed: “Thanks man, that was mad.”
Birks never got a chance to get out of hospital and get vaccinated. He died on 27 August, aged 40. He left behind his wife and musical partner, Lis, who is pregnant with their first child. (Wynter is speaking with Lis’s blessing.) “I have never experienced grief like it,” says Wynter.
In the UK and other developed nations such as France and the US, Covid-19 has become a pandemic of the unvaccinated. Last month, Prof Chris Whitty, England’s chief medical officer, tweeted that: “The majority of our hospitalised Covid patients are unvaccinated and regret delaying [their vaccines].” About 60% of all hospitalisations due to Covid in the UK are of unvaccinated people. An Office for National Statistics report published on Monday says that in the first six months of 2021, Covid was involved in 37.4% of deaths in unvaccinated people – and just 0.8% of deaths in fully vaccinated people.
While 80% of the UK adult population is fully vaccinated (and 89% have received a first dose, indicating they will go on to be fully vaccinated), vaccine uptake rates have been tapering off in virtually all regions of the UK. For months, healthcare professionals have been sounding the alarm about the unvaccinated people they’re treating for Covid-19. “What we are seeing right now,” says Dr David Windsor, a critical care consultant working with Covid-19 patients in south-west England, “is a large number of unvaccinated people coming into hospital – far more than we would expect.”
Windsor tells me that he hasn’t had a single death of a vaccinated person in his unit in the past month. “I’ve seen hundreds of patients,” he says, “who would normally have succumbed to Covid, who have survived because they’re double-vaccinated.” By contrast, the unvaccinated patients he’s treating are sometimes in their 20s and 30s, and desperately sick. “It’s emotionally a really hard thing,” Windsor says, “when you know this disease can be prevented. Especially for the nursing staff, who are with these patients for 12 hours at a time. It’s heartbreaking.”
For the most part, when an unvaccinated person dies of Covid-19, their families grieve privately. It is not hard to see why: the internet is a callous place. Social media trolls greet the death of unvaccinated people with jubilant celebration, as if they themselves never made a bad judgment call. Trolls congregate on the Facebook page of an unvaccinated Bournemouth solicitor, Leslie Lawrenson, who died of Covid-19 after uploading videos claiming that Covid-19 was “nothing to be afraid of”. “The world is a slightly better place now,” one user writes. “Would you look at that!” crows another. “Natural selection.” There is even a Reddit community, r/HermanCainAward, named for the former Republican presidential candidate who died of Covid-19 after opposing mask mandates. Its 138,000 members swap stories in triumphalist tones about unvaccinated people who died of Covid-19.
Birks, too, has been the subject of online sniping. “Anti-vaxxer musician dies from Covid” read a headline on Mail Online. “People need to show empathy for the situation,” Wynter says. “Just because someone has an opinion on something doesn’t mean they deserve the worst thing to happen to them. There are thousands of people who don’t agree with vaccinations. That doesn’t mean this should happen to them. I never met a person who would put people before himself more than Marcus. He was the one person who would be with you through thick and thin.”
Despite the gloating misanthropes, some people are speaking out about the deaths of their Covid-sceptic friends and relatives, in the hope of encouraging unvaccinated people to ignore social media misinformation and get vaccinated. “If even a few people get vaccinated because of what I say,” says Wynter, “then it’s worth it.” It is, after all, what Birks would have wanted. “I know,” Wynter says, “the reason he did that interview was because he wanted people to see how serious it was, and how real it was, and he had no pride in admitting that he should have taken the vaccine. And he didn’t want anyone else to make the same mistake that he did.”
Jaden (not his real name), a 44-year-old business owner from the West Midlands, wasn’t an anti-vaxxer, even if later in life he would sometimes associate with them at the anti-lockdown rallies he attended before he died of Covid-19. “He was a gentle giant,” says his wife, Priti, 41, a commercial director. “Caring. He’d listen to people. He wouldn’t necessarily agree with them, but he’d listen.” They had been married for 20 years, and had two sons. (At her sons’ request, Priti is speaking under a pseudonym.)
Jaden was a loving, free-spirited, family-oriented man. He practised yoga and meditation, seldom drank alcohol, and ate a mostly plant-based diet. “I don’t want to call him a hippy,” Priti says, “but he was edging towards it.” He once took an online quiz to determine his political beliefs and came out as a libertarian.
When the pandemic began, Jaden’s counter-establishment beliefs widened from a hairline fracture into a vertiginous fissure. A major reason for his disenchantment with government policy was the fact that he was excluded from most support, as was Priti, because they were limited-company directors. “It impacted him heavily,” Priti says. “We’d worked forever and paid loads of taxes and didn’t get anything.” This, says Prof Karen Douglas of the University of Kent, is a routine driver of conspiratorial beliefs. “Feeling alienated and disenfranchised is associated with greater belief in conspiracy theories,” she says. “People tend to believe in conspiracy theories when they lack power, are part of a minority group, or are disadvantaged.”
On social media, Jaden began to post anti-lockdown messages. In May 2020, he described the lockdown restrictions in a Facebook post as the “worst interference in personal liberties [in] our history”; in September and October, he attended anti-lockdown protests alongside figures such as the conspiracy theorist Piers Corbyn. “Electrifying energy!”, he captioned a picture of the crowd at the protest.
Jaden refused to wear a mask, meaning that Priti did the shopping. “He was an anti-masker,” says Priti. “I’m not going to lie.” Jaden felt the government didn’t have the right to make people wear masks, and that it had equivocated on its position on mask-wearing. (After initially disputing the evidence on masks, the government made face masks compulsory on public transport and in NHS hospitals in England and Wales on 15 June 2020.) “One of the most important factors in social influence,” says Douglas, “especially when a smaller group is trying to persuade the majority to do something, is to be consistent in the message. When inconsistencies creep into an argument, it’s less likely that the masses will be persuaded.”
Jaden did believe the pandemic was real. “But he didn’t approve of the masks and the chopping and changing by the government, and being told what to do,” Priti says. Jaden believed that if he got Covid-19, he would be fine. Priti does not think he would have taken the vaccine, had it been offered to him. (He died before the rollout reached his age group.)
After Jaden fell ill with Covid-19 in January, his perspective shifted. One day Priti found him on the sofa, browsing face masks on his phone. “He said: ‘This Ted Baker mask looks nice, I’ll get this one,’” remembers Priti. On social media, Jaden was repentant. “For the past 10 months,” he wrote on Facebook in January, “those of you that have stayed connected to me have seen posts that can now be described as grossly wrong on the subject of lockdowns, masks, and restrictions … I apologise to all those that I have offended and argued with. If you are still in the Covid-19 hoax or Covid overreaction camp, please believe the virus is painfully real.”
Jaden died of Covid-19 in February 2021. Priti believes that, had he recovered, he would have had the vaccine. She is talking with me in the hope of encouraging others to get the jab. “He was scared,” says Priti of his final days. “He didn’t want to die.”
Being young, fit and health-conscious; politically engaged; a free thinker; excluded from government support; headstrong and opinionated. If there was a bingo scorecard for the type of people likely to reject mask mandates and vaccinations, Jaden and Birks would get a full house.
“What tends to underpin conspiracy theories and beliefs,” says Dr Susannah Kola-Palmer, an expert in health psychology at the University of Huddersfield, “is that they come from a place of strong emotion, be that resentment, discontent, or fear.” She tells me that anti-vaxxers or vaccine-hesitant people tend to be far-left or far-right politically, have lower trust in authority, get most of their Covid information from social media, and score lower on civic responsibility tests.
Another crucial reason why people may reject vaccinations: “They have lower benefit perceptions,” says Kola-Palmer, “meaning they are less likely to believe that the vaccine will be beneficial to them.” It is not that men such as Jaden and Birks believed the fruitier (and often antisemitic) conspiracy theories. They did not think that Covid-19 was a hoax, or a scheme by evil overlords to microchip the global population. But they did fatally miscalculate the risk-benefit ratio of vaccination versus non-vaccination. “When you’re young, fit and healthy,” says Wynter, “you think you can get through anything. You don’t realise how fragile life is, and how it can be gone so quickly.”
Jaden and Birks exhibited optimism bias: our tendency to believe that negative events in the future are less likely to happen to us than the real-world data suggests. “People tend to take in and encode positive information about their own future more than negative information,” is how Prof Tali Sharot, a cognitive neuroscientist at University College London, puts it.
Imagine that you are a 60-year-old woman and you read online that women are less likely to fall ill from Covid than men. “You think to yourself,” says Sharot, “well, my likelihood is not as high as I thought.” But if you also read that people in their 60s are more vulnerable to Covid, you discount this information, telling yourself that you work out and eat healthily and are unlikely to get sick. “It’s not that you’re totally ignoring the negative information,” says Sharot. “It’s just that you’re putting less weight on the negatives than the positives.”
There is a reason that about half of the 20% of the population who do not exhibit optimism bias are clinically depressed, and the other half probably have a predisposition to depression, but just don’t know it yet. Optimism is a protective carapace that shields us from the chaotic unpredictability of the world. It is the mantra that bad things can and do happen, but not to me, or the people I love. Optimism bias enables us to embrace all of the things that make life worth living – falling in love, having children, going on holiday, swimming in the sea – without becoming consumed by the certainty that our partners will die and our children will be abducted by paedophiles and our plane will be hijacked by terrorists before we are finally eaten by sharks. “Optimism bias is necessary,” says Sharot. “It keeps us healthy and keeps us going.”
Optimism bias is a gift. Optimism bias keeps us happy, healthy, and sane. Optimism bias keeps us alive – most of the time. But for Jaden and Birks, optimism bias was a fatal miscalculation.
Optimism bias can help explain why some people reject vaccines. But this is not to say that we should entirely let these vaccine-refusers off the hook. There are many people who can’t get vaccinated for health reasons, and every healthy person who rejects vaccination imperils the wellbeing of others, by further enabling the virus to spread. Priti is vaccinated, but she defends the rights of others to reject vaccines – some of the people in her life aren’t vaccinated, even after knowing what happened to Jaden. “It’s their personal choice,” she says, sounding fatigued. “I can’t be bothered to be angry with them. Because what’s the point? It’s not going to make me feel better.”
There is clear daylight between vaccine-hesitant people such as Jaden and Birks, and full-blown anti-vaxxers. When anti-vaxxers fall ill with Covid-19, the public’s reserves of sympathy are justifiably limited: these are, after all, people who often proselytise misinformation about vaccination to impressionable people, encouraging them to reject medical science in favour of quack cures such as ivermectin or bleach.
In the US, the influential podcaster Joe Rogan has touted the controversial ivermectin as a treatment for Covid-19, while people have been hospitalised after drinking disinfectant at the suggestion of Donald Trump. Closer to home, the anti-vaxxer conspiracy theorist and ex-nurse Kate Shemirani has suggested that NHS staff should be executed like Nazi war criminals for their role in carrying out vaccinations, has shared antisemitic misinformation about the origins of the pandemic, which she puts down to a shadowy global cabal seeking to control the world population, and has compared public health restrictions to the Holocaust. GPs have faced abuse from bellicose anti-vaxxers who turn up at surgeries to confront staff providing the vaccine, even going so far as to accuse them of war crimes, and BBC reporters have received death threats and been harassed in the street by people who think Covid-19 is a giant hoax.
But it is the stories of these hardened anti-vaxxers that can possibly do the most to shift perceptions among their friends, family and peers. “We know some good will come out of this for sure,” says Mark Valentine, a 65-year-old trial consultant from Wendell, North Carolina. His brother, the Nashville, Tennessee-based conservative radio talkshow host Phil Valentine, died from Covid-19 in August, aged 61. “We have had dozens of people who have written in to tell us they got vaccinated as a result of what happened to Phil.
“People would love nothing better than to dance on his grave because he was an anti-vax person,” adds Mark. “But there’s no evidence to support that.” Now it is true that Phil did suggest that people with underlying conditions should get vaccinated, but this nuance may have been lost on his listeners, who heard Phil rail against mask mandates, compare the vaccination status badges worn by medical personnel to the yellow stars pressed on Jewish people in Nazi Germany, and even perform a parody song, Vaxman, set to the tune of the Beatles’ 1966 song Taxman.
However, before he died, Phil repented. He sent a message to his brother from his hospital bed, asking him to undo his calamitous legacy. “He recognised the fact that, as an influential media person, a lot of people probably didn’t get vaccinated because he didn’t,” says Mark. “And he regretted that until the day he died. That’s why he asked me to go out and do what I could, to fix it. He said: ‘If I could go out there right now, I would tell people I made the wrong decision. I should have had the vaccination and I didn’t.’”
“Anecdotes and personal narratives are emotional appeals, and as such they can be helpful,” says Kola-Palmer. In general, she adds, people don’t respond well when you put the fear of God into them, or bombard them with data. What is better is “trying to meet a person where they are. Finding out if there are fears or worries that underpin their attitude, finding common ground, and building a dialogue from there.”
Mark is a gregarious and charming presence who is sincerely doing his best to clean up his brother’s mess; he tells me that he knows of at least 20 people from his local community who have been vaccinated as a result of Phil’s death. But speaking with him also demonstrates how partisan the vaccination issue is in the US. An August NBC News poll found that only 55% of Republicans are vaccinated, compared with 88% of Democrats. “The whole thing is politicised,” says Mark. “And it’s costing people their lives, most recently, my brother.”
But he refuses to condemn Republican lawmakers who have pushed anti-mask policies. He repeatedly references the inaccurate claim that illegal immigration on the southern border is to blame for exponential growth of the highly transmissible Delta variant, alleges the US Centers for Disease Control and Prevention is putting out inaccurate data, and tells me that “Biden has spread more Covid … than anybody on Earth”. A well-meaning person in a vortex of misinformation, Mark illustrates the real-world difficulties of extricating an entire cohort of people – only 46% of Trump-supporting Republicans are vaccinated – from what increasingly resembles a death cult.
Mark, at least, got vaccinated after his brother’s death, and is urging others to do the same. But there are some people who will never come out of the misinformation whorl, not even on their deathbeds. “I asked him,” says Kayleigh Michelle Stein, 22, a waitress from Erie, Kansas, recounting a conversation she had with her father, Michael Stein, as he lay in hospital, “‘When you pull through this, will you get the shot?’ And he told me that he would not.”
Kayleigh is newly orphaned. Michael, who was 53 and worked as a truck driver, and his wife, Michelle, also a 53-year-old truck driver, died of Covid-19 on 13 August. Both were unvaccinated. Before he died, Michael had described Covid-19 as “one big sham to keep us all in fear” in a Facebook post, and shared offensive memes about vaccination. “He believed that it was the government putting the tracking chip in people,” says Kayleigh. “And he was worried about it making him sick.” He had absorbed these messages on long truck journeys down rural roads, often late at night. “Pretty much all he did was drive down the road,” Kayleigh says, “listening to news stations on the radio.”
Michael had underlying health issues – he’d had heart attacks – and, as someone in his 50s, he was exactly the sort of person the vaccine was designed to protect. “It was political, pretty much,” says Kayleigh. “He was a full-blown Republican.” Nothing could disabuse her father of his anti-vaccination views, not even impending death. He is an extreme example of how some anti-vaxxers will die in the service of their beliefs, steadfastly rejecting medical science even as their breath grows more laboured and the look in their doctors’ eyes more grave.
“We definitely see a lot of regret,” Windsor tells me, of his patients in south-west England. “People who regret not being vaccinated when they come in. But not everybody feels that way. There are some people who disagree with us. They refuse to believe they have Covid. They put their shortness of breath down to other conditions. They say that they don’t need to go on ventilators, because they’ll be fine. We know that won’t be the case.” Attempting to remonstrate with these people, says Kola-Palmer, is a futile endeavour. “Those who are very entrenched in anti-vaccine beliefs,” she says, “we may never reach. But for those who are unsure or hesitant, with empathic listening and correction of misinformation, you might get there.”
Who is to blame for this mess? The social media companies, for not doing enough to stamp out misinformation? National governments, for not better communicating the importance of mask-wearing and vaccination? Conspiracy theorists who push dangerous misinformation for the dopamine rush of online validation and peer-group affirmation? Or individuals, for making bad choices that imperil the health of others? “There’s more than enough blame to go around,” Mark observes, correctly. Kayleigh is sanguine. “A part of me is mad,” she says. “I wish my parents were here, of course. But I also believe in not making people do things they don’t believe in.”
When everything is said and done, when the jeering online commenters drift away and the anger dissipates, all that is left is sadness. It is the emotion in unvaccinated patients’ eyes as doctors prepare to intubate them; it is the hand-wringing in waiting rooms as relatives prepare for bad news. “My biggest regret is not realising how sick he was,” says Wynter. “I could have been there more. That goes through my head a lot, if I’m honest with you.” Phil spent his last days consumed by terror that the damage he had done could not be unwrought. “He was full of regret,” says Mark of his brother. “He got it wrong and he should have got the vaccination.”
He sighs. “That’s why I’m trying to mitigate the damage.”