A Strange & Unexpected Effect of COVID Vaccine-Hesitancy

Yet another milestone has been made in the US’s efforts to take control of the COVID-19 epidemic in the US. The supply of vaccines is now exceeding the demand. Now, there are undoubtedly some locations in the US where there is still a bit more demand than supply; but there are lots of places where there is supply and not nearly enough demand. This would sound good except for a couple of facts. The demand isn’t lacking because there are not sufficient numbers of unvaccinated citizens in many of those under-demand areas, rather it means there is a phenomena of self-induced under-demand which is referred to as “Vaccine Hesitancy”. This does not mean that there is only one contributing factor to Vaccine Hesitancy, but the end result is the same. Vaccine Hesitancy presents an obstacle to achieving or reaching the goal of “herd-immunity” for the nation.

Now, everyone has been hearing about the reasons for achieving herd-immunity for over a year now. But in any national effort related to a public policy there are going to be some who will object or refuse to support or comply with it. This is not unique to the COVID-19 vaccine. There are and have been people who oppose vaccination efforts and policies for previous vaccines. Some have religious objections, some are suspicious of the government or businesses promoting the vaccines, and there are plenty of conspiracy theories that are promoted for various reasons like generating revenue for the theories advocates. All these factors are at play with the COVID-19. But there is a new or certainly much less common factor with the COVID vaccines: political alignment. There is a significant portion of the Republican party’s constituency what is refusing to get vaccinated. Some of these Republicans are going to also overlap with the religious sub-group, some with those suspicious of the government or big Pharma, and some are entangled with various conspiracy theories. However, most appear to be refusing or rejecting for a political, ideological, or emotional reason.

Taken in total these different population segments appear to represent about 30% of the US population, where 5% are in a “Not Sure” segment and may or may not change their current decision of not acting to get vaccinated. If we hope that most of the “Not Sure” / undecided comes around, we have 25% of the US population at risk of being in the “No” column. This part of the Vaccine Hesitancy group are not really hesitant they are rejecting and refusing to overtly support the public policy and the herd-immunity goal. This doesn’t mean that there is no way to reach herd-immunity but rather that the process whereby it is achieved is different with different consequences and implications. It is these consequences and implications which are interesting to consider and assess. Consider for instance that herd-immunity is not a new concept, it is not dependent upon a vaccination approach as a public policy, and it can be achieved without our even knowing that there is a way to get to herd-immunity with less harm to ourselves and our society. Herd-immunity has been achieved many times in the past, but at great loss to various populations.

Now don’t look at COVID-19 through the lens of what the healthcare and government experts and leaders are advocating. Instead, look at what it means to the different groups if herd-immunity is not achieved. Are the outcomes to each group the same? Suppose you were a critical thinker and objective analyst that set aside the moral and humanitarian consequences, what happens to different groups? After you have estimated and assessed the results for each population sub-group would then there are differential implications not just to those groups but even to what decisions you might want to present as options.

If 25% of the population is rejecting vaccination and half of them are Republican men and their families then that 12.5% of the US’s 330+M citizens; that is 41.25M people. If half of them eventually become infected with COVID because herd-immunity is not achieved, the virus continues to spread to the uninfected, and they hold to their partisan position of refusing to vaccinate for political reasons that is 20.7M infected people. With a mortality rate of 1.0% we will have 207K more US deaths.

That 207K US deaths is just from the Republican aligned part of the US population. The religious sub-group that isn’t overlapping with them will have additional deaths, so will the anti-vaccine sub-group, and the conspiracy theorists. This is just a little objective critical thinking leaving out any consideration of the morality or humane aspect of these results. These 207K deaths also do not account for those who will suffer other consequences from their infection but not die from COVID.

But this is also just the start. There are implications beyond just 207K deaths. Each death will have consequences. There are implication upon implication that will flow forward from these 207K lost citizens.

Absent the emotional, moral, and humanitarian considerations, it would seem this is not a prudent decision because of one’s political views, ideology, or party. That Republican leaders (not all) are contributors to the Vaccine Hesitancy phenomena would seem to be self-defeating and doesn’t show much competency in forward looking leadership.

Adding consideration of the moral facet of how the US deals with the virus, factoring in humanitarian aspects of these consequences, and remembering our societal value of human life; there has undoubtedly been a huge misstep by the Republican party concerning it’s reaction and in-actions regarding supporting the COVID-19 Vaccination effort and goals. They may not be able to prevent the nation from achieving herd-immunity, but at what cost?

This brief assessment doesn’t even begin to look at all the other implications and consequences, which ought to give everyone involved vaccinated, unvaccinated, or undecided/unsure a reason to pause and ask: “What else happens that has import to me, my family, my community, my state, my country, and yes even your party."

There Are Two Choices in Politics: Both Are Bad

If you haven’t noticed, in politics there is a common view that one side has the ‘right’ answer on an issue and the other has the ‘wrong’ answer. [An aside: I would hope that the use of ‘right’ and ‘wrong’ provided a self-evident meaning of these terms in the non-political sense. If you aligned either or both terms to a political entity, then the rationale for this aside is hopefully helpful.] This is seen daily in news coverage of our elected officials at the federal, state, and local levels. The partisan alignment of “truth, justice and the American way” that turns every issue, question, or policy into an “Either-Or” confrontation is particularly visible when the media provides politicians or their spokespersons with any bandwidth on a topic. But forget about the “Either-Or” of the topic on display, what is the reason, logic, or intelligence of the “Either-Or” perspective? That politicians use this strategy so predictably is, in and of itself, an almost self-evident proof that it is an ill-informed and inappropriate way to understand or deal with the issues.

Besides the inane strategy of force-fitting any and every issue into a choice between “this” side or “that” side, there is just no logical basis for why that concept would be valid in the real world on most issues. As often as we happen upon the “Either-Or” phenomena, how often is there an issue which is so simple and basic that it has only one of two choices? Take an issue where there is even some moderate degree of complexity and ask yourself: “Is it is reasonable to conclude that the laws of physics, principles of economics, or an area of scientific knowledge which would suggest that the issue divides into only one of two sides/cases?”

If you believe most of reality works on an “Either-Or” basis, then tossing a coin would be a good way to model most of the questions, issues, and policies that you have to make your decisions on. Consider applying that model to your life. If it does not work there, why would it work for larger issues and circumstances in your community, society, or government? Is buying a car something you could easily do by flipping a coin? Yes, you can do it that way, but do you actually? How about buying a house or renting an apartment? Surely when you go to the grocery store you can use a coin-toss to buy or not buy items. Unless you are planning to have something specific for a meal and require specific ingredients. Maybe deciding to have a baby is simple enough to use a coin to decide. Now I am not trying to claim that there are ‘no’ decisions, choices, or situations where a coin-toss would not work perfectly well. Who goes first in a two-person game for instance, or who’s going to pay for lunch (unless there are other factors that are relevant even to paying for lunch). There are some conditions and situations where a coin-toss (“Either-Or”) is fine, but there are many more where it just isn’t rational.

Reality requires dealing with more complexity than the simple-mined “either-or” tunnel-vision politicians force upon themselves and others with ideological blinders. On almost every issue, perhaps actually on every issue; it would be more intelligent for politicians to think in terms of the answers to an issue as being presented by a die. The die might be four, six, eight, …, or perhaps to keep the concept within a politician’s ken no more than a dodecahedron (that is a 12-sided die, for politicians). The purpose of this die-based conceptual approach is to encourage politicians, their political parties, and their advisers who may themselves struggle to see outside their own self-imposed blinders to try and see the world as requiring one to think about what the actual problem is rather than trying to fit it into a pre-ordained box.

The “Either-Or” problem is about how does one solve the propensity for people, especially politicians, to put every question into a forced “Either-Or” choice?  Applying this bifurcation rule is a foolish way to try and solve problems. Making everything an “Either-Or” question will rarely deliver a sound, reasoned and informed solution. Believing that you can force reality into an “Either-Or” choice in order to satisfy a “them vs us” political box is a pretty good definition of a “fool’s errand” or idiocy; and is thus quite reasonably to be expected of politicians. Solving the “Either-Or” problem has readily available strategies, and lots of practical methods and techniques.

The solution would be to do what any semi-competent STEM-educated individual would advise. Use STEM-based problem-solving. This begins with understanding the problem without bias, identifying/defining what your objectives and goals are (and not pre-constrained by an ideological bias), and then look for and at all the solutions and approaches that you are capable of thinking up, and then assess which solution options are best able to satisfy the objectives you have. Once you have at least one option to solve the problem, and for which you can see a path that can be implemented to achieve those goals, then you can determine what would make your choose among alternative solutions to guide your selection (hopefully while still avoiding a pre-set because of an ideological preference).

This will be a herculean challenge for any politician, since it requires that you remove the blinders, open your eyes to all the ways in which an issue can be solved, and then perhaps most importantly assess the benefits and costs without regard for whether they conform to and confirm your ideological principles. When ideological principles contradict smart and intelligent solutions, it would be best to follow the advice of John Maynard Keynes. Or, if you have heard this phrase recently: “Let the science guide us” then you can hopefully prevent the pre-conceived answer, solution, or policy from degrading or preventing get to the benefits you were seeking.

What validates the need to avoid or solve the “Either-Or” problem? Just think of some of the issues that occupy our nation regularly or constantly. Who, beside a politician, actually thinks that any of the following issues, problems or topics can be answered or solved with an “Either-Or” answer/solution?

•   ·       Lowering taxation policies are better for an economy. Or its counterpart: Raising taxation policies are worse for an economy.
•   ·         Gun-violence or Gun-control laws are a violation of the 2^nd Amendment.
•   ·         The government (federal or state) cannot require the public to get vaccinated.
•   ·         Climate Change is real and humans contribute to it. Or, its counter-claim: Climate Change is not impacted by human activities.
•   ·         Abortion policy: It is either total legal or totally illegal. Or an obscuring issue: No federal tax dollars can go to any activity with any connection to an abortion related event.
•   ·         Tariffs: Either the other party pays the costs, or you do.
•   ·         Other issues: Perhaps your favorite issue meets the “Either-Or” category.

Now as nice as clear, simple and opinion-confirming “Either-Or” answers are to a problem there is no requirement that a problem has a clear, simple or opinion-confirming answer and especially not an “Either-Or” one. Certainly, there is no Law of Physics that requires this, and our experiences from the STEM world is that even what seems simple can become quite complex and not so “Either-Or”-based as thought.

The reason that it is important to question “Either-Or” answers, solutions or decisions is that it is in those questions that we can learn something that might be critical to what matters. After all, just because you have an answer, solution or have made a decision that is no guarantee that the answer is right, or that the solution will accomplish your objective, or that the decision will serve your interests.

We can see this aspect of human self-awareness (on those rare occasions when humans show self-awareness) just by how they make statements regarding an answer, solution, or decision. How often have you heard something akin to the following:

·         Given the information available, this is the best answer we can get.

·         We do not know how else to solve this problem.

·         We do not have time to find another solution.

·         Based on what we know today, this seems to be the right decision.

I am sure that you could generate your own ‘qualifying’ statements about facts you have heard that are more semi-facts than absolute “this and only this” facts; or answers that you are not so sure of, a solution that has other paths that might work as well (or even better), and decisions that you had to make but not between what was ‘right’ or ‘wrong’ but where it was just necessary to make a decision (like in voting in an election).

At this point, lets drop back to one of the oft heard “Either-Or” issues fought over between our politicians and political parties: Taxation policy.

Is the economy better with lower taxes or higher taxes? Simple question, right? Then there must be a simple ‘right’ answer and therefore a simple ‘wrong’ answer. This has been a long-standing “Either-Or” issue. Some assert or shout that “Taxes are too high.” And there are others claiming and haranguing that “The wealthy need to pay more taxes.” [Note: “more taxes” can mean higher in a number of different ways but the net meaning is a greater amount than is currently incurred by this sub-group of the population.] One can get a sense of the “Either-Or” positions from these opposing views. There would apparently be some point between them that would satisfy both sides if there is an “Either-Or” solution. Except, we have never found it. Taxes have been higher, they have been lower, and they have varied in a multitude of ways across a variety of dimensions. Yet, none of the political parties and certainly not both have found a means to find the proverbial “Either-Or” sweet spot. The easiest answer is of an Occam’s razor type and would be: “There isn’t one.” For those who of are not familiar with Occam’s razor it asserts basically that the ‘simplest answer is often the right one’. What makes it relevant here is that contains an implicit warning about “Either-Or” answers; it contains the salient term “often”.

To ascertain the ‘right’ answer to the taxation issue one must understand the problem. Taxation policy is a solution to societal problems that are deemed in need of solutions: How should the costs of societal needs be accounted for and distributed? There is no answer to this problem unless you answer or define what the ‘societal problems’ are. There are some societal needs that even politicians and parties both agree upon. There needs to be some governmental entities and activities that must exist and perform their functions. The US Constitution itself provides simple proof is this requirement. But even the Constitution does not answer the questions about what all those societal needs are.

If what is required of a government is not self-evident. If the government and its responsibilities are not fixed and unchanging. If the circumstances under which the government must operate are not constant. Then the ‘right’ taxation policy(ies) surely must adapt to needs of reality; just as history has demonstrated over and over, despite the ideological positions of politicians, political parties and even economists some of whom cannot seem to adapt to failures in their preferred economic theories, models and principles.

Perhaps relying upon “Either-Or” answers is not something that an informed, rational, and democratic nation should aspire to be. “Either-Or” may be all that politicians or political parties are able to do; but like any other problem they can be solved. Politicians can be replaced with someone who is less bound to an ideological “Theory of Everything” that fails most if not all tests. Political parties can be forced to evolve by the proper exercise of Darwinian selection. And the public could benefit from having issues of the day presented and explained in terms of the reasoning and decisions that are being made rather than in “Either-Or” ideological themes of what ‘is hoped to be true’ rather than ‘what is true.’

BEWARE of the Other Implications of COVID-19 Vaccines

 

There are plenty of facts and non-facts spreading around about COVID-19 and its vaccines. There are also plenty of conspiracy theories used to support arguments against getting the vaccine, and then there is the politics which never adds any intelligence, value, or benefit to an issue. So, it should be of no surprise that no one thinks about what the consequences of various decisions, actions, and beliefs will be. I may be being a tad hard on the healthcare professionals in so far as they are being inundated with the reality of COVID and confronting the immediate crises, the changing conditions, and try and anticipate what needs to be done next. So, that they may not be looking at or thinking about some tangential aspects of the situation might be expected.

But not everyone involved is a healthcare professional. Not everyone is wholly occupied in carrying out COVID related tasks critical to handling or managing issues related to its transmission, or in executing the vaccination programs. There are some people who are engaged in conceiving how to get the public to want to or agree to getting vaccinated. Then there are the politicians. Some politicians spend some time doing the “get vaccinated” promotions. Some politicians try and walk the line between being an advocate versus an opponent. And some politicians are aligning with a denial mentality of the dangers, risks, and consequences of any effort which does not serve their political interests. So, you want to be wary of a healthcare decision based upon a political mind-set.

As easy as the obvious questions are:

•     Get vaccinated or not?
•     Wear a mast or not?
•     Wash your hands or not?
•      Socially distance or not?

There are some facets to the COVID-19 pandemic which are worthy of some contemplation from a broader and more nuanced consideration of implications and consequences that the virus will or might produce.  There are some facets that are self-identifying. Take the segment of the Republican party that is effectively an anti-vaccination sub-culture or the white evangelical groups that reject COVID vaccinations (Note: there is a likely high correlation within these two groups.) Let’s call this group: Republican Evangelical Deniers of Science (REDS). Are there any implications to the REDS anti-vaccination stance decision to that constituency? Are the consequences to the REDS population different than the consequences to other population segments?

Assessing what consequences there may be depends upon what we know about the REDS target-group that is also different from the rest of the population. Are the REDS a younger, average, or older age group? If REDS are an older group than there is an implication that goes with the age factor. If they get infected with the COVID virus they are more likely to experience more severe outcomes including the one that they hope leads to a journey upwards rather than downwards. So, one implication should be quite simple, it’s just numeric. I suppose the here-after may be worth the risk, but then that’s guaranteed to happen eventually; and it comes at the cost of diminishing what can be done in the here-and-now. It’s giving away something for nothing. That is not to say that there are not some positives, just not for you. Most people probably can’t figure out the positives but if you know someone who has any experience in doing business cases, they can probably provide some insights.

What about the non-dying implications? Well, because COVID is a test, a test from God as the creator of all things, there are consequences to the decisions that everyone makes on this test just like on every other one. Some people don’t die but they also don’t exactly recover. If you decided to not get vaccinated, it’s like a long-lasting reminder that you may have failed the test. But that is just for starters. You also may get to the opportunity to pay more for your medical expenses. You may not be able to do some of the things that you use to do just a little while ago. These implications are more of the personal/individual ones. But remember we are discussing a sub-group of the population. This means that there are implications that come from the aggregation of the individual consequences.

That aggregation can come in many flavors or layers. There is the family group(s), the community group(s) both religious and civic, the political group(s) local, state, national, and party; and of course, there is the American group (all of us in total). With each decision by every individual the small consequences combine along one or more of these layers. When some of the consequences become large enough in aggregate, they produce their own consequences. This is where things get interesting and important[TB1] . This is where tipping point events can happen without anyone see them coming or ever tracing back their source back to small decisions made by many individuals. It’s why the mountain range that once was is now a beach of fine sand.

Now the REDS are just one of the aggregations and even they come in multiple layers; but there are others who can contribute to their own tipping points or merge together where there is a commonality of consequences. The mountain does not just fall to the rain, but the wind can bring it down also.

What might be some of the consequences from these small individual decisions? Look for aggregation points.

COVID has a mortality rate and that rate differs along several factors. That means that it aggregates along those factors differently. If the REDS as a group also coincide with one or more of those factors than the potential for disproportionate outcomes emerge, and even tipping points can occur. As a population REDS are older on average than the rest of the nation. These two factors: age and political-religious sect alignment have potential to create differential outcomes if the decision to get vaccinated or to not get vaccinated produces a differential COVID death rate for those vaccinated or not. The same aggregation has implications which can extend to the non-fatal consequences that derive from being in groups that get vaccinated or not.

All this would seem to be an: “Oh well, that may all be true but it only affects those who die or are impaired, and don’t impact the majority of the group who don’t.” Unless the implications have implications. If your political-religious sect aligned group loses more than other groups, then the aggregate political influence is diminished. If the diminution is just large enough you get a tipping point.

Not all the consequences are by default negative, there can also be beneficial consequences. These consequences may not be to the particular sub-group that experiences the negative outcomes but to other sub-groups or to the larger population. The increased deaths among the older population that COVID has produced and will continue to produce will result in consequences that are positive in their impacts. For example, if the average lifespan is the US is temporarily reduced and concentrated at the higher age ranges then costs associated with that age group is reduced. It is not a benefit that the population would approve of given the cost in lives and human impacts, but it occurs irrespective of what would be desired.

What other aggregation points may be relevant to understand? How about:

• ·        Insurance: Life and medical insurance businesses will be impacted. Whether the net from a business perspective will be a business loss or profit will have to be determined by how each different company and their respective customers aggregate under each company.
• ·         Politics has already been impacted from how the nation has responded to the crisis, how it has disrupted virtually every aspect of life and the nation. The change in the composition of constituencies and their changes in political views and issues will carry into the future. Tipping points.
• ·         Education has changed and there could be consequences which persist and more changes that will come about. Again, different groups may experience the consequences of those changes depending upon different factors that aggregate differently in their outcomes.
• ·         Religion could be an interesting arena which is impacted by aggregation consequences. Part of this could be a simple result of a connecting factor that links people and their religion to the decisions that they make related to that religion just through having closer association because of local community. You physically aggregate with your aggregate group locally. If your faith community promotes getting vaccinated and another faith community promotes not getting vaccinated, then there can be different outcomes. At some point some savvy economist, social researcher, insurance actuary, or government statistician will determine that some religious alignments resulted in better outcomes and other produced worse results.
• ·         As a last thought, there are future implications that will come the decisions people make. The difficulty here is that they include situations and events that are like the current COVID-19 event. No one will know that they are coming, even if there are a few individuals who study and work to be prepared for the unexpected. We were very fortunate that there was a level of STEM-based knowledge, expertise and capabilities that were able to respond quickly and effectively to the COVID virus. This is not guaranteed to always be the case. The choices that sub-groups make create opportunities for future implications. The emergent variations in the COVID-19 virus are examples of future implications. Choices related to getting vaccinated or not can result in implications which are just another opportunity for different population sub-groups to experience different outcomes.

At this point you might be asking, so what is the point?

Well, one point is that the very popular issues about the COVID virus are simple-minded, short-sighted, and are mis-appropriated to the wrong context. COVID-19 is a national healthcare issue and not a political one. This requires that choices be made. Not just choices by individuals, but choices by the society. In the US this means that our elected officials and governmental entities have to determine what the “necessary and proper” public policies are, and deal with any obstacles that inhibit or prevent those policies from being delivered. This creates disagreements over the ‘my right’ versus ‘social obligation’ because America always has to deal with dissent. This is where the implications come in. The choices that people make have implications beyond their individual self. If the risk to the society is high enough our society, government and Constitution allows for the individual’s right to be subservient to the public’s right. Fortunately, COVID-19 is not so deadly that even politicians can determine that there is a societal imperative for public policies that give little to no leeway to individual decisions. However, COVID-19 is not so benign as to make individual choices inconsequential.

This renders the decisions about America’s public policies related to COVID-19 a quagmire of choices. In these circumstances the question moves more to one of “Who and based on what criteria are the policies to be decided?” In these situations, the answer should actually be what we constantly hear from political leaders, but which doesn’t seem to actually be the case. The “we are following the science” sounds fine but I don’t think “following the science” would tell us to go left, go right and keep going forward all at the same time.

This is why leaders need to look at the implications of the decisions beyond the immediate. When “the science” tells you something and you do not do it then what do you think is going to result? If you are good with that outcome, then you can defend it; but if you didn’t “know” that was going to happen “and implication” then did you “listen to the science”?

You are making your “personal choice” which makes you feel that you are accountable for what happens to you. But others are making they choices also. When your choice or their choice has implications beyond just you then you forgot about your ‘responsibility’ that is required for you to even have a “personal choice”. It’s the implications, not the choice.

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 [TB1]