About That Mandate…

In an op-ed in the Wall Street Journal physician Joseph A. Ladapo makes some remarks about President Biden’s vaccine mandate, some of which strike me as sensible and some of which risk his being shunned in the contemporary form that the “shunning” of the Amish community takes at Facebook, Google, et al. for spreading disinformation. Here’s what strike me as interesting and pretty good sense:

The common argument for vaccine mandates is: You have no right to infect me. But cases are partly driven by asymptomatic and presymptomatic spread—people who are unaware that they even are infected. It isn’t practical to punish adults who have no symptoms. This is why other diseases that can be spread by people without symptoms—such as influenza, genital herpes and hepatitis C—are met with policies like voluntary vaccination drives, screening protocols for sexually transmitted diseases, and clean needle exchange programs for intravenous drug users. Doctors and public health officials used to understand that stopping spread is usually not practical.

Here’s another problem: The vaccines reduce but don’t prevent transmission. Protection from infection appears to wane over time, more noticeably after three to four months, based on a large study of more than 300,000 people in the United Kingdom. As clinical studies from the U.S., Israel, and Qatar show—and many Americans can now personally attest—there is substantial evidence that people who are vaccinated can both contract and contribute to the spread of Covid-19.

qualified by this:

The data still show that people who are vaccinated against Covid-19 are less likely to become infected than people who aren’t vaccinated. People who have recovered from Covid-19 appear to have the most protection of all.

Taken together that’s why I believe that COVID-19 is here to stay and we have reached the point in which we are learning to live with the risks it presents. And this strikes me as making a good point:

But these realities aren’t informing vaccine policy. When New York Gov. Kathy Hochul discussed expanding vaccine mandates to state-regulated facilities, she said: “We have to let people know when they walk into our facilities that the people that are taking care of them” are “safe themselves and will not spread this.” In fact, the data say they can and will spread it.

while this echoes a point I’ve made around here:

The response from many vaccine advocates has been to promote boosters, and the momentum behind third shots is outpacing the limited data available. The reality is that a more practical approach to managing Covid requires a diverse set of strategies, including using outpatient therapies.

Yep, medicine is hard and complicated. One size does not fit all. That’s why physicians exist and their jobs haven’t been automated away. This is the part that I think risks getting him “shunned”:

Other medications like hydroxychloroquine and ivermectin, on which health officials seem determined to close the book, are, in reality, unsettled. Controlled clinical trials have yielded conflicting results, but many physicians with substantial experience treating patients with Covid-19—including members of the Early COVID Care Experts group—have reported low rates of hospitalization and death when using these therapies. Some of these patient cohorts are large and have been published in peer-reviewed journals, such as one study of 717 outpatients published in Travel Medicine and Infectious Disease.

That leaves us with his conclusion which strikes me as combative but not entirely without reason:

Vaccine mandates can’t end the spread of the virus as effectiveness declines and new variants emerge. So how can they be a sensible policy? Is it sensible to consign tens of millions of people to an indeterminate number of boosters and the threat of job loss if it isn’t clear more doses will stop the spread, either?

He neglects to make a point I have made repeatedly here and cannot be answered on an a priori basis but only based on a more empirical approach. Which strategy will actually result in fewer cases of COVID-19 here? A third booster inoculation here for people who’ve already received inoculations, contracted the disease and recovered, or both? Or ensuring that people in Mexico, Guatemala, Honduras, Haiti, etc. and the Afghan refugees who are coming here inter alia are inoculated against the disease? I also wonder if we have enough information at this point about the experience with the mRNA vaccines to know whether an inoculation once a year, multiple times per year, or once a month has adverse effects.

I don’t believe that making that decision based on purely political considerations serves us well.