Is It Right or Wrong? Societal Choices: #1 Vaccines

 

We all live in some societal construct that we influence and that influences us. In many cases people don’t think about how the rules and norms of their social environment(s) are accepted as ‘just the way things are’ rather than question if the rules or the norms are sufficiently beneficial to their society’s interests. More often than not, our individual behaviors and choices do not have significant, or notable, impacts upon the society. Generally, what clothing styles, fashions, or brands that people choose are of little societal concern or import, except perhaps in terms of their unnoticed implications like economic factors (capitalism, consumerism, profits, …). But “more often than not” is a conditional that has an implicit “sometimes it is” counterpart. Does your personal choice about what sports team you support really matter all that much, compared to your personal choice about what, if any, political party/ideology you align with or what religious belief-system you follow?

I am not implying there are no consequences to who you choose as your favorite sports team, but the effect on your society overall is not likely to have a substantive relevance. Conversely, the political entity or religious group that you choose to identify with, follow, or promote is fundamentally part of the societal context that affects many aspects of how that society operates both in terms of beneficial and malfunctioning ways. America is just as much a product of the societal views that permeate our population as other nations’ societal factors and choices influence theirs. This leads to a ‘frame of reference’ problem in determining what is good or bad, right or wrong, acceptable or unacceptable, and prudent or unwise; if we look at the choice from a different perspective.

America’s dilemma, dichotomy, and differences of opinions regarding COVID vaccines is an example of where a society’s members’ choices have consequences far beyond the individual. The choices of individuals have implications to the health of their own families, not just from transmission but in other areas that effect their lives. On the public-health front, an infected individual can spread COVID to their neighbors, communities, co-workers, fellow commuters, other customers of businesses they visit, and healthcare workers with whom they interact. Transmissions in these areas can lead to illnesses, hospitalizations, and deaths beyond the individual or their family. But the ripples in a society don’t stop there. There are economic ripples. We have all seen the disruptions to businesses and public entities which resulted from the COVID pandemic. To curtail infections businesses were forced to alter their operations or even close. Employees lost incomes and in some cases jobs. Hospitals were forced to focus on COVID patients to an extent that prevented patients with other illnesses to postpone their treatments, some at a risk to their lives.

In another area, the individuals’ choice regarding vaccination has a political dimension to it. There is a clear and definitive difference between an individual’s choice to vaccinate or not according to their political alignment. For Republicans, approximately 60% are vaccinated, while for Democrats 86% are vaccinated. This notable difference has predictable consequences to each of these self-selected demographic groups. Those consequences play out as each COVID variant’s infection wave washes across the nation. The unvaccinated showing up as the majority of the infected who are hospitalized, and as the dominant portion of patients dying from COVID and has been reported on regularly. This is where the unasked question(s) become relevant. Is it wrong to look at COVID in contexts which set aside the traditional medical perspective expected in America? Note: I am less sure how prevalent this view is elsewhere in the world.

If you are unsure or unclear about what the traditional medical perspective is, I must admit that I also struggle to define it even as I suggest that most Americans share a generally common sense of it. This leads to the following fleeting attempt to define this medical perspective view. So, here is my rather futile and limited definition of America’s traditional medical perspective.

In the US, we believe, we expect that we are entitled to the ‘best’ medical care available. Well, within your affordability class. The general principle is that the healthcare system provides good, competent, and appropriate care to the public. This principle is of course constrained by many factors, not the least of which is affordability and availability. Under this perspective, the goal is to keep you alive, to enable you to return to work or your home, and to keep you healthy enough to be less of a burden on society. This perspective operates within a healthcare industry that is a complex and amorphous conglomerate formed from public, private, and other social entity-types. Our healthcare view is that the healthcare industry and the nation (that includes the public) will work diligently to protect the individuals in need of healthcare and the nation from the ravages of threats to our individual and collective health.

Given that healthcare perspective, we expect the nation to work to protect everyone’s health. It is that perspective and that goal which I am suggesting that we set aside and not apply to what is or isn’t the right, proper, or appropriate way in which the nation should respond to the COVID pandemic issues. This will be a hard perspective to set aside because some will see it as a violation of their professional code/ethics (like healthcare workers). Some will see this as a violation of their religious beliefs. Others may consider it a violation of their oath of office to serve the nation’s interests (I will note here that I don’t have much faith or confidence in politicians actually caring about what the ethical or moral principles are that they apply to their actions or decisions). But despite the difficulties that some may face, we can at least try to examine questions and options that are not considered because the traditional medical perspective preemptively dismisses the questions from even being conceived of, let alone considered as better policies and strategies than the ones that are naively seen as adhering to the mythical belief that America’s aspirational healthcare perspective would advocate.

Let’s try the COVID vaccine issue. If we ignored the ‘goal’ of preventing people from dying unnecessarily from a COVID infection, or even from being hospitalized unnecessarily, would it be right or wrong to make decisions and policies about COVID infections or about being vaccinated versus unvaccinated? Other ways to ask this question are:

A.      Do I have a right to be protected from you?

B.      Can a business treat vaccinated individuals differently than unvaccinated?

C.      Are public policies (even mandates) appropriate for reasons besides people dying or requiring hospitalization? [Remember, we don’t care if you die or not.]

D.      What factors might be ok to use in deciding if a given state or community can be treated differently than others because of the consequences obtained?

These are just a few of the ways that one could look at the issue of being vaccinated or being unvaccinated.

The first two questions actually have been addressed before but are still fought over and of course have their own degrees of complexity. You do have a right to be protected from me and vice versa. Not even the most conservative Supreme Court Justice would argue that an individual (or individuals) who have a highly contagious disease with a high mortality rate warrants a society or ‘the government’ from imposing restricts, requirements, and mandates. With COVID the issue is thus what is a ‘mortality’ rate which is unacceptable? Remember, it’s not a question of the healthcare goal we aspire to. We have set that aside. There is a point where your or my risk threat if infected is unacceptable to others, and it’s their right to not die that is relevant. Your or my death is not relevant, since we have the disease, and it is too late to act to prevent our being infected.

Can businesses treat their vaccinated customers or workers or unvaccinated customer or workers differently? Yes, they can. Can the government impose requirements on public entities? Yes, it can. Like question A, the rationale and criteria for both would be seen differently depending upon the severity of the risks and the consequences. For example, differential treatments must directly relate to the biology of the disease not to an unrelated factor which could be used to some nefarious intent. This of course makes it not just possible but likely that there will be different sides taken on any given policy or requirement. Of course, if the mortality rate of the disease was anywhere over 33%, such opposition would quickly die out.

Regarding Question C, the answer here ought to be rather obvious but let’s suppose there are some who do not see it. The risk to the nation’s economy and thus to all aspects of society would not just warrant governmental actions including vaccine mandates but would be required under the Constitution. An existential threat to the public and thus the nation would fall within the responsibilities of all governmental entities. Even the Supreme Court, assuming any are still alive under such conditions, would be hard pressed to find any precedent which contravened such actions by our elected executives. This principle has even been demonstrated under the COVID pandemic by both Republican and Democratic Presidents, governors, mayors, and federal and state agencies. And these actions were for a disease which has only killed less than 1 million Americans. Now, remember we are putting aside any consideration of wanting to protect people’s lives as it colors our decisions. The problem here is that the deaths and illnesses are the threats to the proper functioning of the society, economy and nation.

Question D is a very different question. It opens the door to a much broader range of factors and considerations that could be made. Is it acceptable to establish or allow policies which advantage one group over another or even at the expense of another? Is it right or proper to designate some workers as essential and not provide any proactive considerations for protecting their health? Can we require someone to work and not require those whom they work with to be vaccinated? This situation can devolve into some very convoluted considerations. If someone decides not to be vaccinated and they are an ‘essential’ worker would that not imply it is ok to expose them to others whether those others are vaccinated or not. How about the governors of individual states that set public policies which prohibit restrictions on unvaccinated individuals in areas like schools, public events, even businesses? If those policies resulted in more hospitalizations and deaths in some communities than others, or in one politically aligned segment of the population than another would that be acceptable? What if the group of individuals who are negatively affected by those policies are members of the governor’s own political party? Yes, the governor would have to be pretty stupid in this latter case; but then we are talking about politicians. How do we properly consider whether the equivalent results benefit or disadvantage such groups depending upon a factor like whether the governor’s politics / party aligns with the affected group(s) or not? This same issue can be turned around by asking: Is it acceptable for a President allow a governor’s policies to stand if the consequences are less detrimental to his supporters than to those of the other party? Consider, if the other party is losing voters at 10, 15, or 20 times the rate that your party is then there is a predictable benefit in letting the policies remain unchanged or unchallenged.

The disputes and contention over vaccination policies and mandates and even that of masks can appear to be quite different questions if you look at the questions through different lens. The assessment of the impact on what is or is not a good public policy may depend upon how competently the issue is examined. It’s easy to take a political stance, or some ideological perspective; but the more appropriate way to assess policies and requirements may be to recognize that the most visible dimension of the issue isn’t the most important. Keeping people alive, healthy, and safe from a disease may be obvious as a desired goal; but perhaps understanding the consequences beyond the obvious are even more substantive and important than the attention-getting gesture used to distract your attention.

Vaccinations are important because they create different outcomes. How you use that information and what strategies you select to take advantage of that knowledge to achieve can be the most important aspect of what you do. To make the right selection thus implicitly involves asking whether the policy that the aspirational goal produces the best outcomes given the reality of the problem that is actually operating on the ground the battle is being fought upon. If you can set policies which serve both the aspirational goal and simultaneously achieve what is better for the nation overall, it may be the case that you have to find the solution paths that thread both needles.