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> based on highly biased information that they have obtained from others around them. There is little "cost-benefit" analysis being done when you aren't actually comparing the real costs and benefits, but rather an extremely skewed interpretation you hear from the bubble you're in.

You're talking about the quality of the cost-benefit analysis, which I alluded to in my charitably-phrased parenthetical about rigor. That doesn't mean it isn't a cost-benefit analysis, and doesn't make it the same thing as religious adherence to pro- or anti-vaxxing. While some portion of the population engages in this approach, my point is that it's a lot fewer than most people think. That doesn't mean I think the cost-benefit analysis is high-quality, but that modeling these people as dogmatically irrational instead of very bad at being rational is misleading.

In stark contrast to Covid, the nature of smallpox outbreaks makes it so that even an extremely dumb person nominally engaging in cost-benefit analysis would have little trouble making basic inferences about the outcomes faced by people they knew who contracted it vs people they knew who didn't. I got vaccinated because I estimated that my low risk of a bad time after contracting Covid was higher than my low risk of a reaction to the vaccine. If for some reason, I didn't have access to the vaccine, it very likely would not have materially changed my young, healthy, no-comorbidity life.

There's another trivial rebuttal of your hypothesis, outlined in a sibling comment:

> You see the rational behavior play out when you look at vaccinations by age. 98% of people over 65 in the US have had one dose and 86% have had two. Because that's where the risk gets higher. Elderly people are not vastly better educated, smarter, less susceptible to propaganda, or lean toward political ideologies that are more inclined to take it, or have significantly easier access to it.

In your model of most people as not considering the cost-benefit tradeoff of vaccines, how do you explain the significant age disparity?

> The first vaccine hesitancy campaign literally was against the smallpox vaccine in Stockholm

This was _literally the first vaccine for a contagious illness_. You'd have to be irrational _not_ to have some degree of skepticism about being infected with a contagious disease, especially in an era with a population accustomed to a state with infinitely lower capacity and infinitely lower reach into everyday life. A quarter of a millennium later, in a society where the state licenses and ensures our safety in a trillion different publicly-known ways, the reactions of 1750s Swedes could not be less applicable.

Again, the pivotal difference relative to my framing is the approach to vaccines as an all-or-nothing tenet of religious faith, to be rejected with prejudice or embraced with devotion. This is obviously a fairly popular (implicit) perspective on public health, which makes it easy to lose sight that most people do not think like this, even the dumb ones.

> I don't see how you could say that there would be no hesitancy to it.

Kindly don't put words in my mouth. I said that Covid hesitancy is a different enough context that it's not usefully-applicable to a hypothetical future smallpox outbreak.