Black plastic spatulas, anti-vaccine fears, and the illusion of control

How I care for vaccine-hesitant patients

Last fall, all my friends were talking about plastic.

Specifically black plastic. Specifically the black plastic spatula that I’d been using for years to scramble eggs and flip pancakes. I have no idea where I got it; maybe at Target, 15 years ago, when I started medical school and furnished my first grown-up apartment. It’s served me well.

Until now. Last fall, my black plastic spatula was on the outs. My group chats were blowing up with discussion about how it was bad for you. Exactly why and how much, nobody seemed to know.

“Did you see the article in the Atlantic?”

“Here’s a link to the metal spatula I use instead.”

Then, later this past spring, the New York Times made a video about how all of us apparently have a spoon’s worth of microplastics in our brains. That is genuinely freaky. The discussion started up again: Should we be getting metal lunch boxes for our kids? Water bottles made of glass? (Great plan; send a four-year-old to preschool with a glass bottle.)

After all the texting about plastic slowed down, my family did make some changes. We bought a cutting board made of bamboo — I think — and I vowed to stop microwaving plastic take-out boxes. (To my husband’s horror, I mostly don’t heat up leftovers at all. I’m a monster who usually eats sad, lukewarm food at my desk while I type. I know, I know.)

The freakout about plastic seems to make intuitive sense. All that plastic can’t be good for us, right? Still, I hadn’t actually read the Atlantic article, let alone done a critical appraisal of the original scientific paper it’s about. All my friends who had been texting me about the spatulas were smart and educated, and the Atlantic is a reputable outlet, so I just kind of trusted the idea of it all.

The vibes— plastic seems probably not great—were coherent with my worldview and politics.

But the truth is, I don’t have a great way of evaluating whether or not our new bamboo cutting board would make a meaningful impact on my family’s health. It just felt good.

It felt like something I could control, all with the swipe of a (plastic!) credit card at the kitchen supply store.

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Why am I telling you all this? Not to advocate for plastic!

(I finally read the Atlantic article, and yeah, those black plastic spatulas do seem shady. But then I found this Slate article, which claims they’re not actually that bad? More shady, I might argue, are the landfills full of single-use plastic, which those of us in the U.S. so casually buy and discard on a daily basis.)

I’m telling you this story because it helps me understand why so many Americans are afraid of vaccines.

I’ve been watching the Make America Healthy Again discourse at an arm’s length over the last few months, each update and announcement a fresh insult to the work I do as a primary care physician. I haven’t written much about it because I simply can’t keep up. Every day, Robert F. Kennedy, Jr. and his team of quacks find new and innovative ways to attack science and the truth.

In particular, the MAHA crew’s war on vaccines seems to be a metaphor for their shock-and-awe approach to dismantling our public health infrastructure. Vaccines are a particular sticking point for the Trump Administration. Most recently, the Department of Health and Human Services announced that Covid vaccines would no longer be formally recommended for children and pregnant people, a move that will put these vulnerable populations even more at risk of illness and death.

As I read the news each day, I struggle to understand what is going on. Does RFK, Jr. truly believe, in his heart of hearts, that this will make people healthier? Or is it a move to stir up the Trump voting base? Both are equally depressing.

My guess is the latter; remember the good old days when Donald himself bragged about operation warp speed, the government-industry partnership to get a Covid vaccine quickly to market? The Trump crew was pro-vaccine back then! But riling people up about their fear of vaccines —and, I’d argue, a fear of health care, certain forms of technology, and institutions in general—is a convenient way to mobilize voters.

I do know that this fear of vaccines isn’t new. Long before anyone used the acronym MAHA — shout out to my health care peeps who can’t help but think about microangiopathic hemolytic anemia, or is it just me?—people have always been freaked out by vaccines.

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For my entire career as a primary care doctor, I’ve cared for patients who don’t want to get vaccinated.

It predates MAHA and RFK, Jr. It predates the vaccine conspiracies of the pandemic, which, researchers have found, can be traced back to a handful of influential anti-vaccine figures. Even in the good old Obama days, I saw patients who were “vaccine hesitant.” That’s the preferred term that doctors use; “anti-vaxxer” is seen as pejorative.

I wasn’t really aware that vaccine hesitancy existed until I went to medical school. I was naive. Growing up, everyone I knew went to the doctor regularly and got all the recommended vaccines. We needed vaccines to go to school; we’d get our flu shots in the fall. It was just what you did. No big deal.

When I first started seeing patients, I started to realize that many people didn’t accept this as readily as my family did.

I first learned about vaccine hesitancy as a Christian, rural, and mostly white phenomenon. I did a clinical rotation in central Pennsylvania, and there I did meet people who were deeply skeptical of health care in general—and vaccines in particular. Many of them were religious, but not all.

Then I started working as a general primary care doctor for both adults and kids in Philadelphia. And I learned that a lot of different types of people were nervous about vaccines—for a lot of different reasons. People of all races, religions, and backgrounds hated shots. Over time, I started to see common threads in why.

Most frequently, here in Philly, I’d hear from families that wanted their kids to get routine childhood vaccines, but wanted to skip their flu shot each fall.

“The flu shot makes me sick, Doc,” they’d say.

The flu shot anxiety seems to be a distinct phenomenon from concern around childhood vaccines like measles and chickenpox. There’s a widespread (incorrect) belief that it actually gives you the flu. That belief is hard to shake, no matter how earnestly I try to explain how antibodies work and that they might have had a different, non-flu virus around the time they get the shot.

Then there are families that reject the routine “required” vaccines of childhood. The people I’ve cared for in that category give many reasons why. Here are a few I’ve heard over the years:

• “We don’t really know what’s in them.”

• “It’s against our religion.”

• “They aren’t natural.”

• “I’d rather leave it in God’s hands.”

• “I’ve done a lot of my own research on vaccines, and we don’t really know if they’re safe.”

Some pediatric practices refuse to see patients who aren’t vaccinated; our practice allows them, which feels like the right thing to do. I’d rather help kids from anti-vaccine families get some medical care, even if vaccines are rejected.

And families often feel persecuted or discriminated against for their anti-vaccine beliefs, which I’ve noticed makes them dig in their heels. I try hard not to play into that dynamic. I just quietly remind families that they’re welcome and that we all want the best for their kids.

Instead, I try to share personal stories rather than data or statistics, which can be hard to process.

“My kid gets his flu shot every year,” I tell people. “He does great! He loves getting his sticker after he’s done. It helps protect him from getting really sick.”

Another line I use a lot with patients I know and feel comfortable with? “If you were my sister, I’d be texting you every day, telling you to go get your flu shot!”

A little humor lightens the mood. Sometimes it seems to convince people I know what I’m talking about. Sometimes it doesn’t.

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What is it about vaccines that scares people so much?

I think an injection represents something visceral about medicine. Once you get a vaccine, you can’t get rid of it, like a pill you can just decide to stop taking. It’s seen as compulsory, a medical decision that isn’t entirely in your control.

And in medicine, we have a cognitive bias about action. When we talk about the core ethical principles of modern medicine—autonomy, beneficence, non-maleficence—we often talk about them in relation to actions being taken on the body, proactive treatments and procedures. We talk about a patient’s right to refuse those interventions.

We don’t talk much about our right to refuse inaction, what rights we might have if our neighbors don’t get vaccinated, what harms might befall us.

But of course, those harms are real.

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What does this have to do with the black plastic spatulas? I think the plastic panic I experienced last fall has more in common with vaccine hesitancy than I might like to admit.

Because we’re all seeking a sense of control over our lives—over our bodies—when so much feels uncontrollable.

In my left-wing circles, we freak out about those spatulas. I’m not saying that’s wrong; it may very well be warranted to worry about microplastics in our placentas.

Buying a new spatula or water bottle feels like something we can fix, something we can do. The other things that keep me up at night—the threat of disease, the threat of bad luck, the threat of impending fascism, the threat of climate change—are hard to fix. It’s hard to protect our kids from these powerful, complex forces.

So of course we reach for a way to solve it. With the $29.99 purchase of a bamboo cutting board.

For many of my patients, forgoing a vaccine feels like an assertion of control, too. Trust in physicians is at an all-time low, and perhaps with good reason. Doctors send them surprise medical bills; care is disjointed and superficial; everything feels tragically corporate.

So instead of turning to doctors, people turn to their social networks. My social networks tell me to throw out all my plastic. For many of my patients, their networks tell them: “Vaccines are harmful. Forgo them at all costs.”

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During the pandemic, vaccine anxiety took on a whole new dimension.

“Wasn’t it developed too fast?” many of my patients asked. “How do we know if it’s safe?”

I empathize; I really do. I was pregnant when the Covid vaccine was finally released, and I was nervous about getting it. (So nervous that I even wrote an essay about it for the New York Times!) But within a few weeks of the vaccine coming out, I got the shot, and went on to have a healthy, Covid-free pregnancy.

We’ve had a Covid vaccine for almost five years now, and still, the wariness remains. After that brief period when proof of vaccination was required to get into restaurants and businesses, the momentum has lagged. The majority of my patients have not kept up with routine Covid vaccination; it’s seen as “optional” and not necessary to stay healthy.

The armchair anthropologist in me is mind-boggled by the speed of the scientific process that brought the Covid vaccine to market, then devastated by the pathetic public health response, five years later.

Science is worthless without public trust, it turns out.

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These perceptions can and do change over time. The HPV vaccine was FDA-approved in 2006, and in my days as a student and early trainee, people were nervous about it. There was a widespread narrative that, because it prevented sexually-transmitted cervical and anal cancer, getting the shot might give kids “permission” to have sex. (It’s about as wackadoodle as it sounds; we know that improved access to sex education and sexual health resources does not encourage early sex.)

Twenty years later, that narrative is mostly gone — at least in the community where I practice. HPV vaccines are seen as part of the “regular” childhood vaccines that kids are required to get before they start school; it isn’t any different from the meningitis or polio shots.

There are still some families that are wary of vaccines in general, but the HPV shot doesn’t have much of a special significance compared to the others.

And that feels like a huge success story. A success story, attributed at least in part, to ordinary primary care doctors like me, talking to family after family; telling them, “This is a vaccine that prevents cancer;” putting in the hard and unglamorous work of earning their trust.

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I share these experiences not to justify or condone vaccine hesitancy. I am not a relativist about this. My son is a few weeks away from getting his second measles vaccine. This means he is especially vulnerable to the measles outbreaks going on now, in the year 2025, even when a safe and effective prevention has existed for years.

I take this personally. Forgoing vaccines can kill children. It can kill pregnant people. It can kill the elderly. It could hurt my own child. RFK, Jr. and his cohort are directly sowing the seeds of this violence.

But as a clinician, I’ve learned a thing or two about human psychology. I think of a bumper sticker I often walk past in my very blue Philadelphia neighborhood: “Proud to be everything a liberal hates.” I don’t want my patients — even the vaccine-hesitant ones—to feel that kind of antagonism towards me. (Or towards anyone, frankly.)

When my patients feel belittled and underestimated, they refuse to budge. So it’s worth my time, as a primary care doctor, to extend some empathy to my patients’ concerns about vaccines.

I’m angry at and utterly unsympathetic to the leaders who have created this mess. They know better, know that this is a cheap and dirty way to drum up their political base.

My patients are different. I owe them my care. I owe them my curiosity. And I owe them the understanding that we’re all just to keep our families safe while the world burns around us.