Mandatory COVID Vaccinations

Today we're going to wade into the uncomfortable land of mandatory vaccinations for COVID. You're already seeing these spring up in hospital systems, federal work forces, and universities.There's a lot to understand with these and I only offer my own perspective while hopefully acknowledging accurately my own biases to help you better understand the topic. We will review some science, the underlying political tension, and my conclusions.

For the foundations of knowledge that you should have I'd recommend you read/listen to the following episodes:

• Moving from pandemic to epidemic
• Is myocarditis in COVID a really big problem?
• Understanding PCR
• Vitamin D and it's role in COVID
• The ethics of a vaccine passport
• Independence Day from COVID - June 1, 2021.
• Why we shouldn't ignore natural immunity
• Don't sweat the variants and explanations of how the immune system works.

COVID is Real and Vaccines Work

We need to start our discussion with some facts. SARS-CoV-2 is a virus that causes COVID-19. It is a potentially deadly disease that preferentially causes mortality in the elderly and frail. Young adults are relatively spared from the worst effects although on very rare occasions they can get seriously ill from COVID. For most though, COVID is somewhere along the spectrum of asymptomatic to mild/moderate disease rarely requiring hospitalization. Fortunately, children are almost entirely spared from the worst parts of the disease and rarely get very sick.

Likewise, the mRNA vaccines are extremely effective at preventing people from getting severe disease requiring hospitalizations and death. That's why you see a disconnect now in many countries where even though people may get infected, they don't get severely ill.

We've Figured out a Little with Treatment

We've figured out a few treatments that work like avoiding ventilators, prone positioning, early dexamethasone for hospitalized patients. Monoclonal antibodies seem to help. Most other treatments are anecdotal or unproven at this time.

We Still Don't Know a lot

Just as we have learned a lot about COVID, there is still a lot we do not understand. We don't know how to limit its spread outside of massively restrictive policies like those seen in communist China and the island nations of New Zealand and Australia. Rolling house arrest lockdowns and almost total bans on travel have been the only government policies which have mitigated the spread of the virus. Mask mandates, economic lockdowns, and travel restrictions have shown zero correlation with the spread of the virus. There are also a lot of confounding factors making it almost impossible to prove any specific measure works or doesn't work as we've seen the virus indiscriminately affect every state and country on a timeline of its own.

Tension Between Freedom or Bodily Autonomy and the Protection of Others

The current debate with the mandatory use of vaccinations centers on the tension between our freedom to do as we wish with our bodies (refuse medical care, exercise or don't exercise, etc.) and the concern that if we carry an infectious agent we could unintentionally harm others by getting them infected. This is where the debate really stands and I believe it is necessary to look at the real risk, the locations for the risk, and the costs. We can't make decisions on our policy without taking those factors into account.

As I stated before in episode 127, there is no reason why any adult in the US should be at risk for COVID because they have now had months to get a vaccine if they do not already have natural immunity from an infection (est. ~30% of Americans). Therefore, it would be unreasonable to require people to go to extreme measures in order to protect those who chose not to protect themselves. If the vaccine were not very effective, then we might have a different argument but when one is vaccinated, they are almost assuredly safe from serious illness. If someone is still concerned, they always have the option of avoiding social contact  but others should not have to bow to their risk assessments.

This would be more difficult if children were highly vulnerable because they are not yet allowed to get the vaccine. But despite the higher infection rates because of the newer variants, they still show no higher signs of significant disease than April of 2020. Again, the threat to children is almost negligible so those who find that level of risk too high can certainly find alternatives to getting by in life to avoid that small risk until a vaccine is out.

Where is it OK to Mandate Vaccines?

I definitely believe because COVID is mostly harmless to those vaccinated or who have natural immunity there is no reason to have any sort of mandatory vaccinations for most people. This means also that 'nudging' is not ok whereby the government restricts people and their ability to travel, earn a living, or leave their home. This soft house arrest or removing a means for supporting yourself financially is repugnant and should not be tolerated.

That said, I do believe it is reasonable for some places to have mandatory vaccinations (or more accurately, immunity). Although it is unreasonable for those rare people who are immunocompromised to restrict the lives or most or to inject medications in their bodies against their will, it is probably reasonable for people who are most at risk to be able to safely get care when they are sick. These are places which can't be avoided by the sick and an extra level of safety is probably a reasonable expectation.