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.