Ask an Expert: Why Am I Still Experiencing 'Moral Fatigue,' Even After Vaccination?

Jaime Zuckerman, PsyD, is a Philadelphia-based licensed clinical psychologist in private practice who treats mood disorders, anxiety, adjustment to medical illness, and relationship difficulties. Dr. Zuckerman breaks down the concept of moral fatigue and how it's manifesting during the pandemic. 

Never did the decision of going to the grocery store hold so much weight until 2020. For over a year most have weighed dozens of moral questions about masking, vaccines, and social distancing before making decisions from going to the market to visiting an elderly loved one.

The spotlight on the moral implications of every action makes it so mundane decisions now demand critical thinking—forcing you to weigh the what-ifs of every scenario. It can be exhausting.

This is known as moral fatigue.

The availability of COVID-19 vaccines has slightly diluted its effect. But the rise of the Delta variant, reports of breakthrough infections, and the difficulties in differentiating between vaccinated and unvaccinated people still leave us vulnerable to this type of post-vaccine fatigue.

Dr. Zuckerman spoke to Verywell on the science behind moral fatigue and the best ways to cope with it.

Verywell Health: How has moral fatigue affected us generally throughout the pandemic?   

Dr. Zuckerman: The concept of moral fatigue as it pertains to the pandemic is largely a collective experience. Prior to the pandemic, most of our daily behaviors and routines were on automatic pilot. We put forth very little cognitive and emotional effort into these day-to-day actions.

Prior to the pandemic, thoughts like, “Should I still wear a mask to the bank even if I’m vaccinated against a lethal virus because I don’t know if I can still get it or transmit it to someone else?” were never considered. Now, however, these decisions are part of our everyday thought processes, and it’s exhausting.

We not only need to keep ourselves safe, but we need to consider the safety of family, colleagues, friends, acquaintances, and even total strangers in almost every single decision we make.

This is something that we, being part of a largely individualistic society, are simply just not used to. It involves a significant shift in mindset, one that has been thrown upon us without warning. And while on the surface it seems obvious we would, of course, do whatever we can to protect others, this intention often gets lost in translation.

Given the implications and frequency of these unavoidable moral decisions, it takes a toll on us emotionally, cognitively, physically, and behaviorally. Constant consideration of the potential consequences your behavior can have on others is overwhelming and anxiety-provoking because it forces people off of automatic pilot.

Verywell Health:  Why are people experiencing so much stress, even after vaccination, when deciding what they should and shouldn't do?

Dr. Zuckerman: All of the “what-if’s,” inconsistencies, and uncertainties surrounding the vaccine will undoubtedly impact our post-vaccine decision-making.

For example, people may have questions such as, “Can I still contract COVID even if I’m vaccinated? If so, can I still transmit it to others? If I do contract COVID post-vaccine, but don’t have any symptoms, how will I even know I have it?”

These questions could impair our everyday decision-making capabilities. With these decisions now becoming a chronic occurrence, there is an increased risk for mental health difficulties as well as reckless decision-making. 

When presented with two conflicting beliefs or values, people are very good at justifying, rationalizing, and ignoring information that contradicts our understanding of something. Why? Because it makes us uncomfortable.

In an effort to minimize this discomfort, we often engage in unhealthy behaviors that temporarily allow us to avoid feeling bad. This is known as cognitive dissonance.

When applied to post-vaccine behaviors, this can look like: “My symptoms are probably just allergies. I already had my vaccine. I’m totally fine to go to work without getting a test.”

Verywell Health: In that case, how should people proceed with caution when vaccinated, when they know that they’re still not certain of the potential consequences of their decisions?

Dr. Zuckerman: People have been isolated, uncomfortable, agitated, and lonely for over a year, and many are eager to return to “normal.” I believe how people choose to move forward will be very personal and depends on numerous factors.

For example, those who had COVID and became long-haulers, lost someone to COVID, have compromised immune systems, or know friends and family who contracted COVID may engage in more cautionary decision making.

They may be more mindful of the potential impact their behaviors have on others because they personally experienced and had to navigate through COVID’s emotional and physical toll.

Because of this, they are able to demonstrate empathy towards those in similar scenarios which will likely affect their choices.

Generally speaking, people who are vaccinated should proceed with caution (i.e., following the Centers for Disease Control and Prevention (CDC) guidelines) and, for now, ease themselves back into social situations that are lower risk like outdoor events/activities. Because we need to consider the safety of others, ask those around you what they are most comfortable with so you can make the safest decision in a given situation.

Verywell Health: Do you think fears regarding vaccine efficacy against rising variants are affecting this phenomenon?

Dr. Zuckerman: I do believe that fears of vaccine efficacy against new variants are impacting people’s decisions and behaviors.

I think it makes those who are concerned about the vaccine’s efficacy remain cautious, hypervigilant, and hyper-aware of their behaviors—including how it impacts others.

Those who are vaccinated and believe it is quite effective in its ability to fight off new strains may engage in less cautious social behaviors because they feel the vaccine offers a layer of social protection.

Verywell Health: Do you think this will go away when more of the population is vaccinated and we reach herd immunity?

Dr. Zuckerman: I think that once we reach herd immunity, and more of the population has been vaccinated, moral fatigue is likely to decrease as it relates to the pandemic. Again, this will be person-specific, but generally speaking, I think we will see a decrease.

This has been a collective trauma. Everyone has somehow been impacted by COVID, although the degree may vary. Over time,  as we get further away from the events of the last year, it is likely that our pre-pandemic ways of thinking will resurface and our emotions will become less heightened.

Verywell Health: How does one cope with this in the meantime?

Dr. Zuckerman: We need to manage our expectations and reframe our goals. To have the expectation that one needs to “overcome” a collective trauma of this magnitude is not a rational or healthy goal. The pandemic changed how we see ourselves and how we relate to others.

Instead of fighting against what is a very appropriate emotional response to an abnormal situation, we need to learn to live with the fatigue. Going forward, it will be important to keep the following in mind:

• There is often not a 100% correct response to many of these moral issues. Reminding yourself of this can be helpful in getting you unstuck from your thoughts. Try to identify the things you can control in your life rather than focusing on the things you can’t.
• Maintain as much of a routine as possible to provide structure to your day-to-day life. We are creatures of habit, and our brains like to be able to predict what comes next. It helps to reduce the anxiety associated with uncertainty.
• Go at your own pace. We are out of practice at being social. We haven’t seen people’s full faces in over a year. Be patient with yourself as you re-enter society now that you’re vaccinated. You don’t need to jump back in with both feet. For now, just stick your big toe in. 

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.