“Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron's cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience.” - C.S. Lewis
Our society's headlong rush toward mandatory vaccinations is alarming. I say that as someone who is fully vaccinated, who thinks that vaccines are excellent at preventing severe disease, and who thinks that vaccination is a very prudent choice for most adults.
We are seeing increasing contempt and anger directed at a small minority in our society, those who cannot or will not vaccinate. Those emotions are being fueled by fear and shamelessly stoked by politicians, media, and TV doctors for their own ends. The frustration of 18 months of pandemic - and endless ineffective strategies to stop it - has left people eager for both scapegoats and quick solutions. How many times in human history has this happened - where angry, frustrated people blame their problems on a minority which appears to be different? The usual justifications are already widespread. "It's their own fault - they could choose differently." "We need to keep ourselves safe." "If they would just act like us, they wouldn't have a problem."
Some questions and thoughts on mandatory vaccination, in no particular order. This will likely be very long, so you are much better off skipping this and having a beer instead.
1. Where is the science, and where is the risk analysis?
Ontario's Covid Science table wrote last month that, while limiting high-risk activities to the vaccinated only could theoretically reduce risk, "there is currently no direct scientific evidence of the impact of COVID-19 vaccine certificates on vaccine coverage or SARS-CoV-2 transmission."
It seems that the purpose of limiting trains, planes, and games to the vaccinated is to keep people safe, presumably by reducing or preventing transmission of the virus. Ontario's Dr. Moore said that he would consider lifting capacity limits - currently at 1000 people - for large venues that require vaccination. Is a crowd of 20,000 vaccinated people at less risk of transmission than a crowd with 750 vaccinated and 250 unvaccinated? The good doctor did not show his math, almost certainly because he did not do any such math.
The various Covid vaccines were not intended to prevent transmission - this was not even tested in their trials. Prior to Delta, it seemed they were actually reducing transmission fairly well. Delta has changed that - the vaccines may reduce transmission, but the reality is that vaccinated people can spread Delta easily (see article in comments below.) Taking an individual or group from super-contagious to only highly-contagious is not exactly "keeping us safe."
Even if the vaccines do reduce transmission of Delta, it is likely that the overall risk reduction from mandatory vaccines would be extremely small, given the already-high rate of vaccination. Imagine if a vaccine mandate changed the composition of a room or train or church from 75% vaccinated to 90% vaccinated (keep in mind that those under 12 can't be vaccinated, and there are also people who can't be vaccinated for medical reasons.) That means that 15 out of 100 people went from super-contagious to only highly-contagious. If that change makes you feel safe, your safety sensor is broken.
The science does not establish that vaccine mandates lead to any significant risk reduction for anyone but the person vaccinated. There will be many more studies on this - but in the meantime, we can look at massive case increases in heavily-vaccinated Israel, Iceland, and UK to see that widespread vaccination does not necessarily curb transmission. To make matters worse, there are now findings that the vaccines' limited ability to reduce transmission actually declines rather quickly, and someone who was vaccinated in January may have very little protection at all by now.
I listened to CBC interview a Globe and Mail health columnist this afternoon on the subject of vaccine mandates. He explained that there are two objectives: first, to reward those who are vaccinated; and second, to serve as a "stick" to get others to vaccinate. Interestingly, safety didn't even come up.
Are vaccine mandates really about safety and preventing transmission? If so, let's see the science, and the risk analysis. Or are they becoming, like masks, more of a moral test?
2. What if they actually make things worse?
What if mandates not only divide our society, but are actually counter-productive? A recent UK study found that domestic vaccine passports could increase vaccine hesitancy and decrease uptake, especially among certain demographic groups. In particular, younger people, Black people, and non-English ethnicities were less inclined to vaccinate if passports were introduced.
There is the further issue of stigma. With the blame and scorn being directed at the unvaccinated, they may be less willing to seek testing or treatment when ill, a problem seen in previous situations where a particular group was shamed for public health reasons.
3. Can individuals choose?
It's fascinating, in our "my body, my choice" society, where bodily autonomy is fiercely protected, that pressuring or coercing people to undergo a medical procedure is seen as progressive and desirable.
One way that this is justified is by creating a false image of those who do not get vaccinated. They are scorned as "anti-vaxxers," even if they have supported every routine vaccination up until now. They are obnoxious, selfish people who care only about their own rights. They are misinformed and get all their knowledge from incorrect social media posts.
Once these people are vilified and typecast, it is much easier to deny them personal choice. And yet there are many reasons why individuals don't get vaccinated. There are people who are extremely careful about what they put into their bodies and who use natural treatments instead of pharmaceutical ones. There are people who have had a terrible experience with government or medicine in another country - or even in this one. There are people who have significant medical conditions that make vaccination impossible. There are people who have carefully weighed the risk of vaccines vs. the risk of Covid and decided the benefit-harm analysis does not favour vaccinating. There are people who think it is unethical to give vaccines to those at very low risk of Covid (eg. healthy children) when high-risk people in other countries are dying without the vaccine.
These people may be right, and they may be wrong, but I'm not sure it matters. As a society, we have long given people the right to be wrong when it comes to their personal health choices. You can gorge on Big Macs or liverwurst, you can drink too much Coke Zero, you can engage in extreme sports, you can smoke tobacco or pot. Society may not always approve - but there is implicit recognition that you have freedom to make those choices. And yes, our health care system spends considerable resources treating people who are damaged by their choices.
4. Do mandates protect the privileged and hurt the marginalized?
New York City is aggressively imposing vaccine requirements for restaurants, gyms, and museums. 70% of Blacks in NYC are unvaccinated, as are 50% of Latinos. Think about it for a minute. Who will be admitted into public spaces, and who will be turned away?
It's well known in Canada too that certain demographics are more vaccine hesitant. These include people of lower income, racialized people, and recent immigrants. This is not because they are foolish, or anti-vaxxers, or getting bad information from Facebook. Various demographic groups have very good reasons to distrust government and medicine. Shaming or coercing them will make it worse, not better.
The problem is that pandemic policy has been primarily promoted and promulgated by the privileged. Well-paid politicians, professors, and public health officials can work from home, have paid sick days, and have no reason to distrust government or medicine. And yet it's the most vulnerable in our society that have taken it on the chin over and over again - low-paid essential workers, groups with much higher rates of Covid infection and severe consequences, and those more likely to have experienced job disruption or loss as a result of lockdowns. And now the privileged will take another swing, this time with mandatory vaccination, and the vulnerable will take another hit. But it's for their own good, bless their essential-working hearts.
5. Where is the discussion about public health ethics?
Vaccination is a significant personal choice. For a lot of people, it's not an easy choice. It may require balancing competing health concerns, family situation, employment considerations, and more. I am deeply uncomfortable with "hey, we'll give you a free ice cream cone if you vaccinate!" Is that how we help people make a careful and accurate personal risk assessment? Or promise them a lottery ticket?
On the flip side, what are the ethics behind the "stick"? If you really want to go to a concert, or sports event, you'll need to make the right personal choice on vaccination. What if that pressure causes someone to be vaccinated who really shouldn't be? Who is responsible?
What are the ethics behind pressuring kids to be vaccinated so they can "get back to normal" (even though they can't?) To setting up vaccine clinics in schools where kids can get vaccinated without parental consent? To avoiding a public risk-benefit discussion with respect to the risks of vaccines, vs. the risk of Covid, in children?
I've found it remarkable, and disappointing, that there has been very little public discussion of the ethics of all this. In fact, it seems that the accepted approach is now "the end justifies the means." High rates of vaccination are good, right? As such, let's do what it takes to get there. Well, that might be deserving of further discussion, because there are a lot of worthy goals that could be achieved by unethical means if that's the road we want to travel.
If you think that the end of public safety justifies the means, give some thought to all the constraints we put on the police. They can't search houses without a warrant; they have to respect your Charter rights when they investigate or arrest you. Imagine all the assaults and murders that could be prevented if we did away with these obstacles. Obviously you care more about your rights than about people's lives. You selfish, rights-obsessed jerk.
6. But are rights even part of the discussion?
No, it's not all about rights. But, in a society that values the Charter and human rights protection, it has been astounding how quickly these are tossed aside. When the Ontario NDP leader stated, quite correctly, that she does not take Charter rights lightly, and that there should be alternatives to mandatory vaccination, she was forced to quickly repent and proclaim that she made a mistake by thinking that mandatory vaccines should "take a back seat to Charter rights." This from the NDP!
We are increasingly hearing that there will be NO EXEMPTIONS to mandatory vaccination. That's despite the fact that the Charter (which applies to government) provides protection for things like beliefs, conscience, and even mobility, and that human rights codes (which also apply to businesses and organizations) protect disability and religion. Governments and organizations which announce that they will not allow exemptions, even on these protected grounds, are essentially announcing that they simply don't think the law applies, or that "safety" trumps law. It doesn't.
This is where it will get interesting, of course, because civil liberties associations and some unions are stepping forward and saying that they will contest mandatory vaccination policies. And there is a lot to contest.
It's very interesting that the "no exemptions" crowd is now also saying that rapid tests are not sufficient (as UWO announced tonight.) If this is really about safety, rapid testing has a lot of promise. What better way to prevent transmission than to test for infection, instead of relying upon vaccines which do not prevent infection? Removing testing as an option suggests that this is not really about safety, but about compelling a particular behaviour - and publicly signaling a form of morality and virtue.
7. Is our messaging all mixed up?
We waited a long time for vaccines. They were going to be a game changer. We just had to hold on to restrictions long enough to get lots of people vaccinated.
Ontario and Canada have some of the highest vaccination levels in the world. Restrictions are not gone, and in fact Ontario's Dr. Moore estimates it could be another 6-8 months... and if you believe that, I've got some swampland you really need to buy.
Is it any wonder that some people are not enthused about the game-changing nature of vaccines?
In fact, vaccines ARE a game-changer, but we keep talking about the wrong game. They are incredibly effective at preventing severe disease. Despite this, they've been over-sold. They've been promoted as preventing infection when they simply don't. And the consequences are serious - because it appears that the vaccines aren't doing what was promised.
The messaging should be focused on the actual strengths of the vaccines - getting vaccinated won't prevent you from getting infected, or from infecting someone else, but they will greatly reduce your chances of getting seriously ill. And why are we reluctant to use this messaging? Because it severely undermines the case for vaccine mandates.
8. No more false equivalencies.
No, vaccine mandates are not like seatbelt laws, unless the law requires that you permanently implant a seatbelt in your body. No, they're not like anti-smoking laws either, unless there's a new vaccine I haven't heard of yet which prevents smoking-related illness. And no, they're not like the required childhood vaccinations either, unless you have been showing that yellow vaccine record to get into restaurants and Blue Jays games. To be honest, I haven't been and I don't know where mine is.
9. Might there be unintended consequences?
Well, if a deeply divided society, medically-based segregation, increased vaccine hesitancy, and stigmatization of vulnerable groups are not enough for you....
I think there are significant implications for workplaces and businesses. Hospitals that are already short-staffed have promised to terminate non-compliant staff... and replace them with whom? And it is highly likely that such employers will also be on the hook for very large amounts of severance pay. Are health care employers going to be paying out hundreds of thousands, or even millions, of dollars in order to fire staff they desperately need? And next we'll need further restrictions because our health care facilities are overwhelmed due to lack of staff. If Alice accidentally fell into our world, she'd be desperate for a return to Wonderland to find some logic and reason.
And what happens to people who are unable or unwilling to get vaccinated? Are they to be permanently unemployed? Lose their homes? What is the impact of this on them? Their families? Our society?
10. There is no #10. This is way too long already.
If you read between the lines, you might get the feeling that I think vaccine mandates will do terrible harm and very little good. You would be correct.
I expect we will continue to see evidence that the vaccinated can readily spread the virus. We will likely see evidence that vaccination immunity wanes quickly, more quickly than natural immunity. And I expect that none of this will make the smallest difference when it comes to vaccination mandates, for three reasons.
First, politicians have seen the polls. After a Year of Fear, people are afraid, and looking for someone to blame, punish, and ostracize. There is no shortage of unprincipled leaders eager to capitalize on this fear and anger.
Second, vaccine mandates may have relatively little basis in science or risk management, but they have a lot to do with perceived morality. If your school, business, church, or organization is truly caring and progressive, it will rush to enact as strict a policy as possible. If that risks breaking the law, or harming the disabled or vulnerable... well, it's all for the greater good, right? When life gives you lemons, sometimes you have to break a few eggs to make lemonade, or something like that?
Third, it's starting to feel like the only tool we have. Remember surface disinfecting and how it prevented approximately zero cases of transmission? Remember how distancing and masking would stop transmission? Remember how we just needed sick days and it would all be better? Or just a few more weeks of lockdown? Or just wait 'til we have high vaccination levels? The ugly reality is that it doesn't seem like any of these things have been very effective. So we cling to vaccine mandates as the next magic bullet.
The Ontario government has, to its credit, resisted the pressure to create a provincial vaccine certificate. At the same time, however, it's kicked out an MPP who chose not to be vaccinated. Did this reduce the risk to anyone? Sure. It reduced the political risk to the governing party. And the political risk to resisting a vaccine certificate program is too great, so expect that sooner than later. When that happens, hopefully there is an opportunity for Ontario to be different in a good way - and to create a program that actually respects rights and exceptions and recognizes that people who choose not to vaccinate do so for diverse and complex reasons - and have equal human worth to the vaccinated.
On to today's stats, in case you're still awake after all of this. Ontario hospitalizations dropped slightly, by 12 to 283. This appears to be a blip in an otherwise fast-rising trend line, but it's still good news. ICU numbers are up by 5 to 161, while ventilator numbers climbed by 7 to 92.
And, while I no longer report on daily case numbers, I'll note that while they continue to increase, the rate of increase has actually slowed a bit.
That's all. Bring on the robber barons. Please!"