People Are Keeping Their Vaccines Secret

COVID-19 vaccinations have become a public spectacle, but they touch intensely private questions.

a mouth taped over by vaccination bandaids
Getty / Adam Maida / The Atlantic

In the past three months, Americans have become collectively obsessed with shots of shots. Photos featuring the humble deltoid—that meaty muscle that swaddles the upper arm, newly famous as the injection site for all three currently cleared COVID-19 vaccines—have been flooding Twitter, Facebook, Instagram, and even Tinder. After a year of misery and chaos, they’re digital proof of the relief and elation that comes with boosted immunity; they’re a rallying cry for others, including those who might be wary, to join in. Individual vaccinations, normally an intimate affair, have become a public spectacle.

Yet for every immunization that sparks public joy, there’s perhaps another that blips silently by, shaded with guilt, frustration, or fear. Many of the recipients of these early jabs have chosen to hide them from even close friends and family—some of the people who stand to benefit the most from the protection that immunization affords.

I spoke with more than a dozen of these covert vaccinees last week; all asked to remain anonymous. (The Atlantic agreed to these requests because they involved personal health information.) The reasons behind the vaccinees’ reticence ran the gamut: Some worried that they would be accused of line hopping; others were wary of exposing the criteria that had qualified them. A weatherman in Florida wanted to avoid being prematurely called back to the office, because he’d miss out on quality time with his family. But they were united by what we might call shot self-consciousness—the worry about how their shots will be perceived by others.

Everyone I spoke with said they were grateful to get their shots when they did. They were glad to have the protection, and happy to help quash a pandemic that just hit its one-year anniversary. This week, the CDC officially granted a new suite of enviable privileges to vaccinees, allowing them to mix with one another indoors, without masks; previous guidelines had cleared them to skip postexposure quarantines.

This problem may be fleeting. In the United States, at least, the pace of vaccination has picked up, and some countries, including China, are pushing for mandatory disclosure of immunization status from travelers. But as long as vaccine demand continues to outstrip supply, the inoculated might hesitate to reveal their status and risk their eligibility being debated among those still waiting in the queue. The vaccination rollout has forced people to consider where they fall in each state’s prioritization scheme—a strange sort of government-sanctioned meritocracy—and to square that identity with their public image. The fear that those two metrics don’t match up is enough to drive many people into hiding, and many are unsure of when, or how, they’ll decide to emerge.

During the weeks following the first vaccine authorization, when nearly all of the shots were given to health workers and nursing-home residents, eligibility was, for better or worse, simple to profile. But since then, states have splintered over whom to prioritize next. Some, such as Montana, have explicitly called communities of color to the fore; others, such as California, have focused on reaching essential workers. Although America’s oldest residents are now eligible for their shots, age floors differ across county lines; states also disagree on which preexisting medical conditions are most urgent to address. People who are green-lit for a jab in one place might be booted out of line in another.

The mixed messaging has made official priorities difficult to discern. When a friend in Montana was told that she was eligible for a vaccine, “I thought it was a glitch at first,” she told me. “I still feel I can’t trust anyone to tell me that [it’s] my turn.”

A lot of the conditions that now qualify people aren’t easily identifiable. Scrubs or white coats no longer demarcate eligible professions in photos; many of the newest shot recipients are young. When eligibility becomes a patchwork, people have an easier time tugging at the seams: Every week, more stories surface of people who have been accused of stealing or sequestering vaccines, or faking their eligibility to filch a dose. “People are asking suspiciously, ‘Well, how did that person get it?’” says Nita Farahany, a bioethicist at Duke University. As others anxiously await their turn, the inoculated have felt pressured to share not just whether they were immunized, but why.

Cynthia Cochran Leyva, a 64-year-old attorney in Columbia, Missouri, did announce on Facebook that she had received her first shot at the end of January. She was surprised and saddened, she told me, when a longtime friend questioned her eligibility.

After a series of online exchanges, Leyva said, “I realized, Oh my God, she thinks I jumped the line.” At the time, Leyva’s daughter, who lives in Arizona, was very close to giving birth to her second son. Her friend seemed to imply that Leyva had manipulated her way into the vaccine line to expedite meeting her grandchild. In reality, Leyva had qualified for the inoculation because of her type 2 diabetes, which has been linked to a higher risk of developing severe COVID-19. Her friend, she told me, hadn’t been aware of her condition.

“It really took me aback,” Leyva said. She had expected only support—with perhaps a touch of good-natured jealousy—when she posted her photo. “I just thought of it as an exciting thing in my life, after a year of hard things,” she told me. Shaken by the tussle with her friend, Leyva kept the news of her second dose to herself.

There’s a special kind of survivor’s guilt that comes with lucking into a vaccine—getting a dose that would have been thrown away without a willing and available arm. One such arm belongs to a writer I spoke with in Wisconsin, who was offered an extra dose from a workplace health center after nearly all of her colleagues had gotten their shot. She jumped at the opportunity, knowing that the dose would otherwise go to waste. “I didn’t take a vaccine from someone else who needed it more,” she told me. “But I did accept a vaccine before others who needed it more had the chance.”

Disclosures aren’t just about bragging rights, or sexing up a Tinder profile. Personal narratives of individual vaccinations can help sway the hesitant and uncertain, especially in communities of color that have been repeatedly disenfranchised, ignored, and abused by the medical system. “Some of us felt a calling in this moment,” Utibe Essien, a physician and health-equity researcher at the University of Pittsburgh, told me. “We knew how important it was to get it out there, that these vaccines are safe and effective.” Even the weeks-late announcement of President Donald Trump’s January vaccination might persuade some reluctant white Republicans, a group in which vaccine distrust is particularly high, to sign up for their shots.

But for some people, disclosing their vaccination status means openly acknowledging the health condition that qualified them in the first place. Several of the conditions that check an eligibility box carry immense social baggage. A New Jersey scientist told me she was eager to extol the virtues of vaccination, but embarrassed to admit that she got the shot because of her high BMI. Leyva, the Missouri lawyer, said she’s hesitated to discuss her diagnosis of diabetes, a condition that often invites judgment about the lifestyle choices of those it afflicts.

I spoke with an attorney in New York whose parents have gotten their shots. He, too, will soon be fully vaccinated, and be able to visit them with substantially less risk. But almost no one in his life knows that he has received the jab. He qualified because he has HIV—a condition that he’s concealed from most of the people in his life, including his mother and father. “As a member of the gay community, I think there’s already enough stigma associated with HIV,” he said. “I don’t feel like cluing people in to the fact that I deal with that.” He’ll tell his parents that he’s been vaccinated, he said, when more people in his age group have gotten their jabs.

Ruth Faden, a bioethicist at Johns Hopkins University, told me that some of the calls for vaccine justifications trouble her. National prioritization plans have set up a strange and uneven hierarchy of protection; the people immunized first have been alternately hailed as heroes and pitied as society’s most fragile. To be vaccinated mid-rollout is to be saddled with a public identifier, and an invitation for the world to vet it. It’s a harrowing form of eligibility warfare. Faden, who herself has a disability that sometimes makes walking difficult, notes that not all medical conditions are readily visible. She told me that she was once berated after parking in a handicapped space, by a woman who accused her of using someone else’s plates. Faden gently corrected her: “I told her I had a problem that you just can’t see all the time.”

None of the experts I spoke with thought that people should be duty-bound to share their immunization status. “I don’t think there’s any moral obligation for that,” Carleigh Krubiner, a policy fellow at the Center for Global Development, told me.

But more questions about immunization status are headed our way. Employers, airlines, even entire countries have already begun to explore the notion of tracking people’s shots; eventually, these check-ins could balloon into “vaccine passports” that would green-light certain people to reenter workplaces or board airplanes. The general idea isn’t unprecedented; schools, for instance, have long requested the vaccine records of their students. But because vaccination rates continue to lag in vulnerable communities, any system of perks available only to the vaccinated will inevitably worsen the socioeconomic, racial, and ethnic inequities laid bare by the pandemic, says Grace Lee, a pediatrician and vaccine expert at Stanford University. “Access and acceptability have to be solved first,” Lee told me.

Vaccine scrutiny will eventually ebb, Faden predicted. “We’re in a transient period,” she said. “There will be less angsting over who’s eligible as supply increases.” Perhaps by then the true purpose of the rollout will be a little clearer: Although we’ve treated them like personal luxuries such as concert tickets or limited-edition sneakers, each shot that makes it into an arm benefits everyone else who’s still in line.

As winter melts into spring, once-shy vaccinees might start to reveal themselves. Several people told me that they would make a quiet announcement as soon as their age group or profession has been called to the queue. There’s no playbook for retroactively divulging the timing of a shot. “How do we come out and say, ‘Oh, we got vaccinated in January’? That’s awkward,” a writer in Colorado, who was able to nab a spare vaccine through her mother’s retirement community, told me.

Still, nearly everyone I spoke with said they would eventually share the good news. At some point along the march to a protected majority, they will unveil themselves as vaccinated—not as outliers, but as one of hundreds of millions.