@VentMonkey I'm spending my day taking care of ICU COVID patients. Kind of hard not to think about it.
Not yet, of course. There isn't enough available now, and the vaccine is being administered under EUA. But what happens when more is available and full approval has been granted?
Not only is there not enough available, but mandating an EUA drug or vaccine is not kosher (unless you are the military). At the point of full FDA approval there will be orders of magnitude more safety data to go with it. In the meantime, you are hand-wringing about what people might maybe possibly do in the future... maybe. It is completely irrelevant to the current choices that Phase 1 recipients have... actually to anyone in any Phase until there is some sort of government mandate, which I don't expect. As far as private company requirements, as a good libertarian, I assume you are on board with "their business their rules," and a fully approved vaccine wouldn't be any different than influenza, varicella, MMR, Tdap or Hep B requirements by an employer. But at this point and in this thread, the topic is really just a speculative nonsequitor.
Surprisingly good amounts of information available to who? The average Joe Citizen who does not regularly peruse JAMA or NEJM?
To the Phase 1 recipients who are not average Joe Citizens! That is who is getting the vaccine now. That is who is in this thread. People who work in healthcare or public safety who typically have good access, if they want it, to information and experts.
The amount and quality of data means nothing to them. To most people, a decision like this comes down to whether or not they trust the source advising them to do something. I suspect that the large majority of reasonable folks who care enough about their own health to have a regular relationship with a primary care provider will eventually take the vaccine once reassured by that PCP. But in the minds of many people, the public authorities who right now are taking to the media to implore us all to take this vaccine as soon as possible haven't exactly done a lot to earn trust lately. We can easily think of several times in recent memory that the authorities did not seem to know what they were doing, and many more that they generally did not appear to many to have the best interest of the public at heart. Even seemingly unrelated political issues have bearing on people's general trust in what the government tells them. People might reasonably wonder why they should believe these officials on the necessity of getting this vaccine when they have such good reason to distrust them on so many other issues.
This is a well stated summary of some issues facing our society. I'll reemphasize your point about trusting PCPs. Studies suggest they are the most trusted source for the individual on the matter of vaccines.
they also know that as convincingly positive as all the trial data may be, there is still NO knowledge of the long-term efficacy and safety of the vaccine.
I've outlined why this is not an accurate statement. There is knowledge and strongly suggestive data. There is NOT incontrovertible proof. There IS a difference between those things. You know this. Many do not. When healthcare professionals conflate these things, they create unrealistic expectations that cause people to default inappropriately to their innate precautionary principle.
So an individual who is young and healthy and who doesn't work in healthcare or regularly have contact with high-risk individuals could very reasonably wonder, "Why should I rush out to get this? All the people likely to get really sick with COVID will be vaccinated soon as will their healthcare providers, so what is the harm in me just passing on it at least until it's been around for a while?". You can blame that skepticism on cognitive biases or external influences if you want, but that thinking seems quite rational to me.
The young healthy people who aren't involved in healthcare or high exposure are not going to even have a chance to get the vaccine until probably May or June. By then, 100s of million of people will have been vaccinated and there will be a year of data. The vaccine might even reach full FDA approval next summer or fall.
The reasonableness of the wonder should be easily answered by the very reasonable response: even for the lowest risk group for getting COVID, the cumulative chances of getting COVID are high!
The risk of negative outcomes from COVID for the lowest risk adults is still orders of magnitude lower than the risk of negative outcomes for receiving the vaccine. The benefit of the vaccine is still strong for the low risk individual and the community.
The fact that there may be large amounts of wonder remaining is all about the attention bias from distortions perpetuated by loud authoritative non-experts, social media, and inherent distrust (which you well discussed above) even of actual experts, and the various other biases I have mentioned plus more. Biases can lurk, or they can shine like a bunch of spotlights at tinsel town gala. You've even mentioned several in your posts... it seems odd that you find them well reasoned.