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Matt Morgan: Caring for unvaccinated patients

BMJ 2021; 374 doi: (Published 17 August 2021) Cite this as: BMJ 2021;374:n2022
  1. Matt Morgan, intensive care consultant
  1. University Hospital of Wales
  1. mmorgan{at}
    Follow Matt on Twitter: @dr_mattmorgan

As some intensive care units fill up once again, the patients with covid-19 feel almost familiar. Not all, but many, of them are overweight; similarly, many have diabetes or high blood pressure. The difference this time, however, is that another common factor has been added to our lists: patients who are unvaccinated. Certainly not all, but many. How does it feel to care for someone at the edge of life when you know that it didn’t necessarily have to be this way?

Some health professionals may feel angry at having to care for patients who have made unwise decisions. But we all make poor choices at some points in our lives. You may eat too much, you may have texted while driving, or perhaps you drank too much at the office party. And perhaps you got away with it. Through luck rather than judgment, you didn’t crash your car or break your ankle. We are so much more than our worst decisions, and so are the patients who made poor choices and were less fortunate.

Many of the people who turned down having the vaccine are thoughtful and intelligent. Yet the world is full of bad ideas and bad incentives, and people are often influenced by them. Untangling the net of influence is difficult, and often the harder other people try to help, the tighter the knots become. Even exposing bad science to help explain the faulty logic behind it can reinforce those very same false beliefs, through quirks of human psychology that are hard to understand.

And so, what should we do? How should we feel about it all? For one thing, we should continue to explain how the vaccine is safe. We should say that, even if you accept the vaccine’s potential risks—which may have been inflated through bad science—the vaccine is still far safer than actually having covid.

We should also say that choosing a disease filled with risks and uncertainties over a vaccine with far fewer risks and far less uncertainty is still an individual choice, but it’s a choice I find impossible to understand when viewed in this way. However, we should resist continually poking fun or shaming bad science or bad ideas, even if we do so only to expose them. In this increasingly polarised world, repeated exposure only serves to strengthen beliefs, even after they’re dismantled through logic.

And yet, I still feel angry and cheated. But not at the patients; rather, at the people promoting, fuelling, and exploiting the bad ideas and bad incentives that influence so many people. I am angry with the liars, not those who have been lied to.


  • Competing interests: I have read and understood BMJ policy on declaration of interests and declare that I have no competing interests.

  • Provenance and peer review: Commissioned; not externally peer reviewed.

  • Matt Morgan is an honorary senior research fellow at Cardiff University, consultant in intensive care medicine, research and development lead in critical care at University Hospital of Wales, and an editor of BMJ OnExamination.

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