Thursday, January 20, 2022

Of vaccines and mandates

 That there are numerous divisions on how to handle the pandemic has been obvious for a while. The most well-known is the division between pro-vaccine and anti-vaxxers, but a secondary one that may be even larger is the schism between those who support vaccine mandates and those who don’t. I’m unabashedly pro-mandate and I don’t believe that vaccine mandates are unconstitutional or an improper infringement on personal liberties. I’ll tell you why.

First, as I’ve pointed out many times, the Supreme Court upheld state vaccination mandates way back in 1905 in Jacobson v. Massachusetts, a case that everyone probably recognizes by now. The rub here is that the Court recognized the power of states to enforce mandatory vaccinations, but not the federal government.

Photo by Jeremy Bezanger on Unsplash

Now let me stipulate that I think the government should work within the law to accomplish the goal of near-universal vaccinations against COVID-19. I favor mandates at the state level, but I think the current Supreme Court is correct that the federal government doesn’t have that power apart from federal employees and contractors.

With a great many state governors and legislatures not only refusing to mandate vaccinations but actively blocking pandemic mitigations, there is a case to be made that Congress should consider extending more public health power to the federal government, especially since some states have walked back public health powers to the point that it may be very difficult for future governments to fight the next pandemic.

Whatever your opinion on federal health authority, I think we can agree that such legislation isn’t going to happen anytime soon. Any discussion of extending federal public health authority is a discussion about how we should handle future pandemics. The ship has already sailed on this one.

And the ship of pandemic recovery has definitely sailed slowly. Once a leader in vaccinations, a recent Morning Consult poll found that the US has one of the highest rates of vaccine skepticism and one of the lowest rates of vaccination against COVID of any country surveyed with one exception. Only Russia fared worse on both questions, which may make the issue even more depressing.

So where do we go from here? It should be obvious that vaccines are still the way out of this pandemic. At least, they are the best way out without incurring hundreds of thousands of additional deaths and long-term health problems.

However, there are several large misconceptions that are working to undermine the vaccination push and prolonging the pandemic. One is that current COVID vaccines are ineffective against Omicron. In reality, a booster dose of the current vaccines is estimated to be 75 percent effective against infection and 88 percent effective against severe disease. A three-fourths chance of not even getting sick is nothing to sneeze at (pun intended).

As a real-world example, my vaccinated teenagers both got COVID last week. My wife (who had Delta over the summer) and I had both had our booster shots and neither of us got sick at all. Thankfully, the basic vaccinations along with their youthful age prevented my kids from having serious cases of the disease, but they still missed a week of school. My wife and I both had to isolate as well, which added to the inconvenience. (I was on a trip when they were diagnosed and had just tested negative, but I isolated when I returned home.)

A second big misconception is that COVID Omicron is mild. There is evidence that it is less severe than the Alpha and Delta variants, but “milder” is not the same as being “mild” followed by a period and the end of the sentence. The recent surge in COVID hospitalizations is proof of that.

Despite more breakthrough infections, the second year of the pandemic remains a pandemic of the unvaccinated. Everywhere you look, the probability (if not always the raw numbers) of serious illness and death is much higher among the unvaccinated than among the vaccinated. Even studies that push back on claims of protection against infection acknowledge that current vaccines are effective at preventing severe cases of COVID.

So, if vaccines remain effective, why are mandates necessary? The answer there is the same as for the past year. For one thing, it is primarily the unvaccinated who are responsible for clogging hospitals and ICUs, and when this happens it threatens the lives and health of people who were vaccinated. If you’re in a car wreck or have cancer then the availability of care is important to you, regardless of whether you are vaccinated or not. These days, the available beds may be filled with COVID patients.

A second reason is that we have already seen two major variants emerge that changed the pandemic playing field. Looking to the math and probabilities again, the basic science is that the more times a virus replicates itself, the greater the probability of mutations. The more mutations that emerge, the greater the chances will be of a new dominant strain that can evade vaccines and therapies and cause the pandemic to linger on. To avoid this possibility, the best strategy is to vaccinate the entire world to establish herd immunity and give the virus fewer places to spread.

At this point, it’s apparent that natural immunity isn’t going to do the job. We’ve already seen that people can be infected more than once with COVID-19 and that is going to continue. The same variants that make vaccine boosters necessary also undermine antibodies produced by natural infections.

There are a couple of other common arguments against vaccine mandates as well. Many people have claimed that because the COVID vaccines require boosters and are not 100 percent effective, they are suspect compared to other vaccines. This argument ignores the fact that both COVID-19 and the COVID vaccines are relatively new. When we developed other vaccines, against polio, for example, we had the benefit of studying the disease for thousands of years before we developed the vaccine. Even then, it took about 20 years to develop an effective vaccine. At this point, we’ve had about 70 years to perfect the polio vaccine so it shouldn’t be surprising that it is highly effective.

As I’ve pointed out, current COVID vaccines are very effective, but they have the disadvantage of having been designed to combat a virus that has already undergone two significant mutations. There is a second generation of COVID vaccines that will more specifically target the newer variants and hopefully provide longer-lasting antibody protection as well. Both Pfizer and Moderna have new vaccines in the works that target Omicron. Pfizer’s shot is supposed to be ready by March.

As with COVID, other easily, preventable, and nearly-eradicated diseases can come back when vaccinations wane. Measles was declared eliminated in the US in 2000, but there have been American outbreaks in recent years as anti-vax outlooks took hold and people decided not to vaccinate their kids. Vaccines don’t work if people don’t get them and a resurgence of the disease can threaten even those who did get vaccinated.

If vaccine policy is to get us to herd immunity, then vaccinations have to be near-universal. A lot of people miss this point when child vaccinations are considered. Yes, it’s true that young people don’t typically get serious cases of COVID (although that isn’t to say that they never do), but it is true that children can spread the disease. Schoolchildren can be vectors of disease transmission that spread COVID around their communities. This is an important reason why children should be vaccinated, especially if other mitigation strategies are not in place in schools.

This is not unprecedented. Influenza is another disease that is primarily dangerous for seniors and people with pre-existing health problems, but we still encourage kids to get vaccinated even though (a) the flu vaccine is only about 40-60 percent effective and (b) young people rarely have serious cases of the flu. We vaccinate kids to keep them from spreading the flu around the community or from taking the flu virus home to their vulnerable grandparents, aunts, and uncles. The flu vaccine isn’t mandatory in most places, but then again the flu isn’t as deadly as COVID either.

But are the COVID vaccines safe for children? There have been claims of everything from myocarditis to infertility after COVID vaccinations, but the vaccines are safe for kids. During trials of Pfizer, the only vaccine currently approved for kids, for kids aged 5-11, “no serious adverse events related to vaccination” were reported. The rare incidences of myocarditis were both mild and temporary and occurred at a lower rate than heart problems (including myocarditis) in unvaccinated children who contract COVID-19. The claims that COVID vaccines can cause infertility or miscarriages are a complete fantasy. Compare that to the early polio vaccine which used a live virus and actually caused hundreds of kids to contract polio, yet was still widely adopted.

I can’t say that there is any perfect analogy to a previous vaccine or pandemic because what we are facing is a situation that the world has never faced before. We have pandemics, but it has been more than 100 years since we have had one that rivaled COVID-19 for its unique combination of deadliness and infectiousness. There was no vaccine for the flu until 20 years after the Spanish flu pandemic, so in 1918, there was little choice but to let the virus run its course. Today, we have better options.

Donald Trump was right on at least one thing. Considering the rapid onset of the Coronavirus pandemic from a totally unknown pathogen, the development of safe, effective vaccines in such a short time is a miracle of modern medical technology. Like American soldiers in the midst of a smallpox epidemic in the Revolutionary War, we should be clamoring for an inoculation that will protect our lives and health as well as those of our loved ones and help us return to normal.

Favoring vaccine mandates didn’t use to be a controversial position, even among Republicans. It was only the politics of COVID that suddenly made many on the right suddenly decide that not getting jabbed was a fundamental human right. If you don’t believe me, just look at how many red states have broad vaccine mandates for diseases from polio to chickenpox to tetanus to HPV.

The problem is the fake news and conspiracy theories that, as the old adage goes, travel around the world faster than the truth can get its boots on. A corollary to that adage is Brandolini’s Law, which holds that the amount of energy required to refute such bovine excrement is an order of magnitude larger than the amount required to produce it. These days there is lots of fecal matter being spewed and thanks to the internet, it travels farther and faster than ever before.

I’m generally not a proponent of government mandates, but when a highly infectious and virulent disease is on the loose and misinformation is being propagated to undermine the voluntary adoption of vaccines, mandates become necessary. This isn’t a liberal or big government proposition, rather it is one that is founded upon one of the most roles of government, that of safeguarding public health.

From the Racket

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