The COVID Questions Tribalism Keeps Us from Discussing
I. Emergency Logic and Its Aftermath
In early 2021, COVID-19 vaccines were a medical intervention. By late 2021, they had become a loyalty test.
This transformation didn't happen all at once, and understanding its stages matters for understanding what went wrong—and what repair might look like.
The first stage was genuine emergency. Institutions faced impossible decisions with inadequate information, under time pressure, with lives on the line daily. The initial push for rapid, universal vaccination wasn't primarily tribal signaling—it was crisis logic, operating with the tools available. Fear was rational. Urgency was justified. Uncertainty was real but felt unaffordable.
The second stage was calcification. Positions taken under emergency conditions became identity-constitutive. Institutions that had recommended universal vaccination couldn't easily walk back to nuanced, subgroup-specific guidance without appearing to admit error. Critics who had questioned early mandates became invested in comprehensive skepticism. What began as emergency triage hardened into tribal loyalty as positions taken in uncertainty became identities defended in perpetuity.
By the time the acute emergency had passed—by the time Omicron had washed through a largely immunized population and case fatality rates had dropped—the tribal lines were fixed. Your position on vaccines told observers how you probably voted, what media you consumed, which experts you trusted. The vaccine itself, a genuinely remarkable scientific achievement, became subordinate to what it signified.
This distinction between emergency logic and tribal sorting matters for how blame is distributed and how repair might occur. If the failure was primarily tribal, the solution is depolarization. If the failure was emergency logic that never demobilized—crisis communication that couldn't transition to nuanced guidance—the solution is building institutional processes for exiting crisis mode. Public health, notably, lacks such processes.
Both failures occurred. They interacted. But they aren't identical, and conflating them obscures the path forward.
II. What the Science Shows—and What Couldn't Get Out
The research record on mRNA COVID vaccines, now five years deep, tells a story more nuanced than either tribe acknowledges.
What's well-established:
The vaccines provided substantial protection against severe disease and death, particularly during the Delta wave when they were most needed. They represented a genuine technological breakthrough—the first successful deployment of mRNA vaccine technology at scale, with implications extending far beyond COVID. They are safe for the vast majority of recipients. And they carry rare but real risks, most notably myocarditis in young males.
What was studied but poorly translated:
Much of what critics later claimed was "suppressed" was actually being tracked, discussed, and investigated—but inside expert systems that had no mechanism for communicating calibrated uncertainty to the public.
Myocarditis signals appeared in VAERS data and were discussed in ACIP meetings. Menstrual changes were reported and eventually studied. The differential risk-benefit ratio for young males with prior infection was recognized in technical discussions. The challenge wasn't that institutions didn't know these things. It was that what they knew couldn't exit the expert system in a form that acknowledged legitimate individual variation.
The institutional voice had only two settings: reassurance and alarm. Calibrated concern—"this is a real but rare risk that may affect your personal decision-making"—was not in the repertoire. Uncertainty was permitted inside; only confidence was permitted outside.
What remains genuinely uncertain:
Vaccine-associated myocarditis, while usually clinically mild, leaves persistent cardiac scarring (late gadolinium enhancement on MRI) in a majority of studied cases. The long-term significance of this scarring—whether it predisposes to arrhythmia, cardiomyopathy, or nothing at all—remains unknown. The studies that would answer this question require long-term follow-up that hasn't yet occurred.
We lack comprehensive data on cumulative effects across five or more doses. The cohort of people who've received that many doses now exists, but systematic cardiac surveillance of this population hasn't been published.
The risk-benefit calculation for specific subgroups—particularly young, healthy males with prior COVID infection and multiple prior vaccine doses—may be closer than population-level messaging ever acknowledged. This isn't an argument against vaccination; it's an argument for honesty about heterogeneity.
III. The Myocarditis Question
No issue better illustrates the communication failure than myocarditis.
The narrative I want to avoid is too simple: denial, followed by grudging acknowledgment, followed by vindication. The actual history was messier and more instructive.
Early signals appeared in adverse event reporting systems—systems designed to be sensitive, meaning they capture many events that aren't actually caused by the intervention being monitored. Distinguishing signal from noise in VAERS data is genuinely difficult. Clinician reports accumulated, but myocarditis has many causes, and establishing causation required time and careful analysis.
Regulatory agencies investigated while publicly downplaying—not necessarily from malice, but because the cost-benefit calculation during a deadly pandemic seemed to favor continued vaccination, and because expressing uncertainty would be weaponized by actors whose opposition wasn't rooted in good-faith risk assessment.
When official acknowledgment came, it arrived with the framing "rare and mild"—accurate in a statistical sense, but inadequate for young men trying to make personal decisions, and potentially misleading given emerging evidence of persistent cardiac changes even in clinically mild cases.
The failure was not that regulators ignored myocarditis. It was that signal detection occurred under conditions where:
- False positives carried reputational cost and could reduce uptake
- False negatives carried human cost and could harm individuals
- Political actors waited to weaponize either type of error
- The base rate of the outcome was genuinely low, making detection hard
- The communication architecture couldn't express graduated concern
Institutions weren't uniquely villainous; they were structurally incapable of communicating calibrated uncertainty in a polarized information environment. This doesn't excuse the messaging failures—people were harmed by inadequate informed consent—but it explains why those failures were overdetermined rather than conspiratorial.
The Stanford study published in December 2025 offers a useful reference point—not as vindication, but as illustration. Researchers identified a specific inflammatory mechanism (the CXCL10/IFN-gamma pathway) that appears to drive vaccine-associated myocarditis, and demonstrated in cell and animal models that this pathway could potentially be mitigated.
The study has important limitations: it's a mechanistic hypothesis supported by preclinical work, not yet replicated, not yet extended to humans, not yet incorporated into clinical practice. It represents one research group's findings, awaiting the validation that comes from replication and extension.
But what the study represents matters as much as what it found. It demonstrates that asking "why does this happen and how do we prevent it?" was always a scientifically appropriate question—not a heretical one. The inquiry the Stanford team pursued should have been publicly legible all along. That it felt transgressive to even acknowledge the phenomenon says more about the discourse environment than about the science.
IV. The Questions We Couldn't Ask—And Why
When vaccines became tribal signifiers, certain questions became difficult to ask publicly. But the nature of that difficulty varied, and the distinctions matter.
Questions studied but poorly communicated:
Does prior COVID infection change the risk-benefit calculation for vaccination?
This was studied extensively. The answer—yes, hybrid immunity is robust, and the marginal benefit of vaccination decreases with prior infection—existed in the literature but couldn't propagate into public guidance without undermining the universal vaccination message.
What's the myocarditis risk for young males specifically?
This was tracked and quantified. The numbers existed. But expressing them in ways that might lead young men to hesitate was treated as irresponsible, even as those same young men were being asked to accept a non-zero risk for modest personal benefit and uncertain transmission reduction.
Questions studied but with inconvenient answers:
Why are so many women reporting menstrual changes?
This was eventually studied, and the answer—yes, there are real but temporary changes—was confirmed. But the initial response to widespread reports was dismissal, and the lag between patient experience and institutional acknowledgment damaged trust in ways that persist.
Do the vaccines prevent transmission well enough to justify mandates for protecting others?
This was studied, and the answer evolved in uncomfortable directions. Early data suggested meaningful transmission reduction; later data showed this effect waned quickly, particularly against newer variants. By the time the evidence was clear, the policy had calcified.
Questions inadequately studied:
What are the cumulative cardiac effects of multiple doses?
The infrastructure to answer this—prospective cardiac imaging studies following multi-dose recipients—largely doesn't exist. This isn't suppression; it's a gap in the research agenda that should have been filled.
What would personalized risk-benefit assessment look like, and why aren't we doing it?
This question threatens existing public health infrastructure, which is built for population-level interventions, not individualized guidance. It remains largely unaddressed.
Questions actively discouraged:
If I'm a 22-year-old male who already had COVID twice and received three vaccine doses, what's the marginal benefit of dose four?
Asking this question publicly—in many contexts—coded you as vaccine-hesitant, even though it's precisely the kind of question informed consent requires. The answer might well be "the benefit is small but the risk is also small, and here's how to think about it." But the question itself was treated as suspect.
Distinguishing these categories matters. The solutions are different: better science communication, more honest public guidance, expanded research agendas, or cultural change in how questions are received. Conflating them—treating everything as "suppression"—feeds conspiracy framing while obscuring the specific institutional failures that actually occurred.
V. The Compliance Architecture and Its Constraints
Public health messaging defaulted to a compliance model rather than an informed consent model. The implicit message wasn't "here's what we know and don't know, here are the tradeoffs, here's our recommendation and why." It was "get the shot."
Understanding why requires examining the structural constraints that made this outcome nearly inevitable—not to excuse it, but to understand what would need to change.
Liability and accountability:
Nuanced guidance creates accountability exposure. "We recommended it for everyone" is legally cleaner than "we said it depended on individual factors you should discuss with your doctor." When outcomes are uncertain, institutional self-protection favors simplicity.
Political pressure:
Elected officials needed clear metrics to demonstrate pandemic response. "X% vaccinated" is measurable and attributable; "population made informed contextual decisions" is neither. Political incentives pushed toward universal targets rather than stratified guidance.
Media dynamics:
Uncertainty, communicated honestly, becomes "experts don't know" or "experts divided" in media translation—frames that undermine uptake and create exploitable controversy. Confidence, even overconfidence, plays better in headlines. Institutions learned that expressing uncertainty was punished more than expressing false certainty.
Trust fragility:
Institutions correctly perceived that acknowledging uncertainty would be weaponized by bad-faith actors. They incorrectly concluded that suppressing uncertainty would prevent weaponization. In fact, the suppression itself became evidence for conspiracy theories, and the inevitable corrections—when guidance changed—became further evidence of untrustworthiness.
Professional incentives:
Public health careers are built on intervention success metrics. "We achieved 70% uptake" advances careers; "we honestly communicated that some subgroups might reasonably decline" does not. The incentive structure rewarded compliance maximization rather than informed consent.
Fragmented authority:
No single institution controlled the message. CDC, FDA, state health departments, hospital systems, and individual physicians all communicated, sometimes inconsistently. Coordination pressure pushed toward lowest-common-denominator messaging—simple directives rather than nuanced guidance.
These constraints don't excuse the outcome. People were harmed by inadequate informed consent. Trust was damaged in ways that will affect future public health efforts. But institutional actors weren't simply arrogant or dishonest—they were caught in a system where honesty about uncertainty was punished by media, exploited by political actors, and potentially deadly if it reduced uptake during a crisis.
The tragedy is that dishonesty about uncertainty also proved costly—to trust, to future compliance, to the institutions themselves, and to individuals who made decisions without adequate information. The system's attempt to protect itself undermined the very credibility it was trying to preserve.
VI. The Topology of Distrust
When institutions communicated poorly, trust eroded. But that erosion didn't flow uniformly toward conspiracy. It pooled in multiple basins, each with different characteristics and different implications for repair.
Conspiracy adoption:
Some people adopted comprehensive counter-narratives—the vaccines were deliberately harmful, the virus was engineered, the death counts were fabricated. This population is small but vocal, and it now has institutional infrastructure (alternative media, aligned politicians, social networks) that didn't exist at scale before 2020. They may be largely unreachable by traditional public health messaging.
Selective compliance:
A larger group complied with initial vaccination but stopped trusting ongoing guidance. They got the first two shots; they skipped the boosters. They didn't join the anti-vaccine tribe, but they no longer believe institutional recommendations reflect their personal risk-benefit calculation. This population might re-engage if messaging became more honest and personalized.
Performative agreement:
Some people learned to say the right things publicly while making private decisions differently. They expressed support for vaccines in social settings where skepticism carried costs, while quietly declining boosters or opting out of vaccination for their children. This gap between public performance and private behavior reveals the coercive texture of the discourse environment.
Silent disengagement:
Many people simply stopped listening. Not oppositional, not conspiratorial—just exhausted and disconnected. They don't follow CDC guidance because they don't follow CDC anything. They're not against public health; they've just tuned out. This population is large and invisible in most analyses of vaccine attitudes.
Exhausted ambivalence:
Perhaps the largest group: people who still loosely trust institutions, still more or less follow guidance, but have lost confidence in institutional honesty. They got vaccinated but felt manipulated. They'll probably comply in the next pandemic, but with less trust and more resentment. Their relationship to public health authority has been damaged in ways that don't show up in compliance statistics.
Understanding these distinct populations matters because their recovery pathways differ. The conspiracy-captured may require generational change. The selectively compliant might respond to more honest messaging. The performatively agreeing reveal where social pressure substituted for genuine persuasion. The silently disengaged need entirely different outreach. The exhaustedly ambivalent need institutional acknowledgment that their trust was handled carelessly.
The next pandemic will be shaped by which of these basins is largest—and we don't actually know the answer.
VII. The Field Between the Camps
There's a space that neither tribe acknowledges—a field beyond the binary of full-throated vaccine advocacy and comprehensive vaccine skepticism.
In this space, you can hold that:
- mRNA vaccines were a scientific triumph that saved millions of lives
- The risk-benefit calculation was strongly favorable for most people, especially the elderly and immunocompromised
- Mandates involved genuine ethical tensions, with legitimate arguments on multiple sides
- Some safety concerns were dismissed as misinformation before being validated
- The risk-benefit ratio for young, healthy males with prior infection was always closer than messaging suggested
- Institutions would have maintained more trust through transparency about uncertainty
- Much of the "anti-vaccine" movement was genuinely misinformed or conspiratorial
- Some vaccine skepticism was a rational response to institutional failures
This isn't "bothsidesism"—a term that has become a cattle prod used by both sides to force fence-sitters into their camp. Bothsidesism, properly understood, means creating false equivalence: treating a fringe position as equally credible as scientific consensus, or balancing expert analysis with uninformed opinion as if they deserved equal weight.
What I'm describing is different. It's acknowledgment that even the credible side of a debate can have blind spots, failures, and legitimate critics—and that acknowledging those failures isn't equivalent to endorsing the other tribe's comprehensive counter-narrative.
One asymmetry should be explicit: institutional authority carries a higher burden of honesty than individual skepticism carries a burden of coherence. Institutions have power, resources, expertise, and obligation. Individuals have limited information, varying capacity, and legitimate self-interest. The CDC failing to communicate honestly is a different kind of failure than a worried parent misinterpreting a study. Both might be wrong, but they aren't equally culpable.
Holding institutions to higher standards isn't "anti-science." It's the foundation of accountable expertise. Science earns trust through transparency and self-correction, not through demanding belief.
VIII. What We Should Be Asking Now
Five years into the mRNA vaccine era, with billions of doses administered and multiple variant waves survived, we have enough data to ask harder questions. These questions remain largely unaddressed—not because they're scientifically illegitimate, but because answering them would require confronting uncomfortable institutional realities.
About personalized medicine:
Why are vaccine recommendations still essentially one-size-fits-all? We have the technology for individualized risk assessment—we can measure antibody levels, sequence viral variants, stratify by age and sex and medical history. Personalized medicine is the stated future of healthcare. Why does it stop at the vaccine clinic door?
The honest answer involves infrastructure: public health systems are built for population-level interventions, not individualized guidance. Personalization requires different logistics, different communication, different accountability structures. It would also require admitting that one-size-fits-all was always a simplification—defensible under emergency conditions, but a choice nonetheless.
About cumulative exposure:
What are the long-term cardiac outcomes for people who've received five or more mRNA vaccine doses? This cohort now numbers in the millions. Serial cardiac imaging studies could answer whether cumulative exposure matters. They largely haven't been done—or if done, haven't been published. Is this because the answer is reassuring and uninteresting, or because the studies don't exist? We should know.
About institutional learning:
What would public health agencies do differently in the next pandemic? Has there been honest internal reckoning with communication failures, or merely defensive entrenchment? The CDC underwent reorganization in 2022 with acknowledgment of failures—but what specifically changed? What mechanisms now exist to communicate uncertainty? To transition out of emergency messaging? To stratify guidance by subpopulation?
The absence of visible, credible institutional self-examination makes trust recovery harder. "We learned from our mistakes" means nothing without specificity about what the mistakes were and what changed.
About rebuilding trust:
How do institutions restore credibility with people who aren't conspiracy theorists but simply stopped believing official guidance? This population—selectively compliant, silently disengaged, exhaustedly ambivalent—isn't anti-science. They're disappointed. They expected honesty and felt they received propaganda. Reaching them requires acknowledging that their disappointment was warranted, not treating them as a messaging problem to be solved.
About the discourse itself:
Can we create space for legitimate scientific debate about vaccines without that debate being weaponized by either tribe? Can scientists investigate adverse effects without being coded as "anti-vaccine"? Can public health officials acknowledge uncertainty without being accused of "undermining confidence"?
The current discourse environment punishes exactly the kind of honest inquiry that science requires and that informed consent demands. Changing this isn't a technical problem—it's a cultural and political one.
Why these questions remain unanswered:
These aren't questions institutions are eager to engage, because the answers imply redistributing authority. Personalized risk assessment moves decision-making from central recommendations to individual negotiation. Cumulative exposure studies might complicate booster campaigns. Institutional self-examination creates accountability. Rebuilding trust requires admitting it was lost.
Each question threatens existing power arrangements. That's not conspiracy—it's institutional self-interest, the same force that shapes every large organization. But naming it explains why the questions persist despite being obviously important.
IX. Beyond "Choosing Neither"
You can reject conspiracy theories and reject institutional dishonesty. You can be grateful for the vaccines and critical of how they were communicated. You can trust science as a method and distrust specific scientific institutions' communication. You can acknowledge uncertainty without surrendering to paranoia. You can refuse both tribes.
But this refusal, however intellectually honest, is not a destination. It's a clearing.
Humans don't operate well without trust networks. Cognition is distributed; no one can evaluate everything from first principles. We need institutions we can trust—not blindly, but provisionally, with verification mechanisms that don't require each individual to become an expert in everything.
The challenge, then, is not simply how to stand alone in the field between hostile camps. It's how to build non-tribal institutions capable of tolerating uncertainty without collapsing into chaos or coercion.
What would such institutions look like?
They would model uncertainty rather than suppress it—communicating what's known, what's unknown, and what's contested, in forms laypeople can actually use.
They would have accountability mechanisms that reward honesty, not just outcomes—where admitting "we were wrong" or "we don't know" isn't career-ending.
They would build communication architectures that permit graduated confidence—not just "safe" and "dangerous," but the full spectrum between.
They would cultivate epistemic diversity within expert systems—legitimate internal debate that's visible enough to demonstrate that science is a process, not a pronouncement.
They would create feedback loops that don't require crises to activate—ways for patient experience, practitioner observation, and emerging data to update guidance without institutional defensiveness.
Building these institutions is harder than critique. It requires not just identifying what went wrong, but proposing what would go right—and navigating the political resistance that will come from those whose authority would be redistributed.
This essay hasn't done that work. It has cleared ground, identified failures, named the forces that produced them. The constructive project remains.
But the ground-clearing matters, because we cannot build trustworthy institutions while pretending the current ones didn't fail. We cannot restore trust without acknowledging why it was lost. And we cannot escape the tribal binary without first demonstrating that escape is possible—that the field exists, that it can be occupied with integrity, and that the questions asked there are not betrayals but necessities.
Coda
I am vaccinated. I have received multiple boosters. I am glad the vaccines exist and believe they saved millions of lives, including possibly my own.
I also believe the institutional communication around vaccines was often dishonest, that legitimate questions were stigmatized, that the risk-benefit calculation for some subgroups was closer than messaging acknowledged, and that trust was damaged in ways that will cost lives in future health emergencies.
These positions are not contradictory. The tribes just insist they should be.
The questions this essay raises—about cumulative effects, personalized risk, institutional accountability, the structure of public health communication—are not attacks on science. They are what science looks like when it's working. They are what informed consent requires. They are what trust, once lost, demands before it can be restored.
If we cannot ask them without being sorted into enemy camps, then the camps have won, and the field between them has been salted and abandoned.
It doesn't have to be that way. But changing it requires people willing to stand in the open, ask uncomfortable questions, and refuse the loyalty test—even when both tribes are watching.
The author believes vaccines work, institutions failed, both tribes oversimplify, and the silence in the space between them is where the hardest questions live. Readers seeking validation for either tribal position will be disappointed. Readers seeking certainty will find none offered. What's offered instead is an invitation: to the field, where the questions are.