There is quite a difference of opinion on the vaccine mandate which President Biden announced yesterday. At The New Republic, for example, Tim Noah is enthusiastic:
President Biden is imposing the most comprehensive Covid vaccine mandates thus far, requiring federal employees and most private sector workers to get vaccinated.
The new mandates to combat the delta variant, which is starting to slacken economic growth and perhaps even the ferociously tight labor market, arrive after months of dithering within the Biden administration over how aggressively to police workplaces about Covid-19.
[…]
I’ve been very hard on Biden’s reluctance to impose health protections against Covid-19 in the workplace. He waited way too long. But he seems now to be making good on his promises. With new Covid cases approaching January’s levels, Thursday’s moves are better late than never.
and the editors of the New York Times are supportive:
Faced with this avoidable catastrophe, President Biden is right to order tighter vaccine rules, which he did for roughly two-thirds of the nation’s work force on Thursday. “We’ve been patient,†Mr. Biden told vaccine holdouts. “But our patience is wearing thin. And your refusal has cost all of us.â€
The president moved to require all executive branch employees, federal contractors and millions of health care workers to be vaccinated. Workers at private businesses with 100 or more employees will have to either get vaccinated or take a weekly Covid test. Any business covered by the order must offer its employees paid time off to get their shots or recover from any side effects.
As incursions on bodily autonomy go, this is pretty mild stuff. No one, the Times columnist David Brooks wrote in May, is being asked to storm the beaches of Iwo Jima.
but a group of Republican governors are challenging the diktat in court:
A number of republican governors, who have long fought mask mandates and other safety regulations intended to stop the spread of the deadly virus, immediately argued that this rule change infringed on their personal freedom and was unconstitutional. The change was an attack on private businesses and states rights, they claimed.
“Biden’s vaccine mandate is an assault on private businesses,†tweeted Texas Governor Greg Abbott. “I issued an Executive Order protecting Texans’ right to choose whether they get the COVID vaccine & added it to the special session agenda. Texas is already working to halt this power grab.†Last week Abbott enacted legislation that would prevent the majority of women in Texas from choosing whether or not to receive an abortion, even in cases of rape and incest.
Texas Attorney General Ken Paxton also questioned Biden’s ability to issue the mandates. “I don’t believe he has the authority to just dictate again from the presidency that every worker in America that works for a large company or a small company has to get a vaccine,†he said on a radio program hosted by former President Donald Trump advisor Steve Bannon. “That is outside the role of the president to dictate.â€
Governor Kristi Noem of South Dakota wrote on Twitter that she would see Biden “in court,†and Governor Henry McMaster of South Carolina said in a statement that “Biden and the radical Democrats (have) thumbed their noses at the Constitution.†Governor Mark Gordon of Wyoming also said he was preparing his state’s attorney general to take action.
while in an op-ed in the New York Times Robbie Soaves, editor of the libertarian site, Reason.com warns:
The president’s plan is certainly well intentioned. The vaccines are the only tried-and-true strategy for defeating Covid; government officials should both encourage vaccination and make it easier to get vaccinated. Health officials must continue selling people on the vaccines by emphasizing the considerable upside: Vaccination decreases transmission of the virus and turns hospitalization and death into very unlikely outcomes. It provides such robust protection that 99 percent of coronavirus fatalities in the United States now occur in the unvaccinated population. Vaccination works, and it’s the right option for a vast majority of Americans.
But forcing vaccines on a minority contingent of unwilling people is a huge error that risks shredding the social fabric of a country already being pulled apart by political tribalism.
The president should not — and most likely does not — have the power to unilaterally compel millions of private-sector workers to get vaccinated or risk losing their jobs: Mr. Biden is presiding over a vast expansion of federal authority, one that Democrats will certainly come to regret the next time a Republican takes power. Moreover, the mechanism of enforcement — a presidential decree smuggled into law by the Department of Labor and its Occupational Safety and Health Administration — is fundamentally undemocratic. Congress is supposed to make new laws, not an unaccountable bureaucratic agency.
For my part while I have no problem with vaccine mandates in the abstract, think that at this point there is ample evidence for at least the short term safety and effectiveness of the vaccines, and believe that more state and local governments should be mandating vaccinations, I’m a ways and means kind of guy and doubt that the federal government has this power. Before you point out the venerable court cases asserting that government does, indeed, have that power, find one that ruled that the federal government has that power. If it does have the power, it can only be wielded by act of Congress, and the president does not have the authority to make such mandates on his own and the Congress does not have the authority to delegate that power to the president or an executive branch agency. I also suspect this is another of the myriad well-intentioned decrees which there is no actual intention of enforcing which I think weakens the rule of law in general.
It does raise an interesting question, however. At this point I know of no state which has an unconditional COVID-19 vaccine mandates or even a universal mandate conditioned on the absence of religious objections. Illinois doesn’t have one. Why not? I think it’s because the governors fear political repercussions.
There is one thing that President Biden has not done, is certainly within the federal government’s authority, and in which I think that President Trump was remiss in the early days of the pandemic: curbing and controlling travel between the states. My explanation for this, is that fear of political blowback overrules all other considerations.
Considering that covid has the mortality of a very bad flu (less than 2% overall), but orders of magnitude less than the Spanish Flu, and virtually no threat to the young, the hysteria surrounding it is ridiculous, to the point of indicating a pervasive panic and a complete collapse of reason among our leaders, both Democrat and Republican. Australia today is an East German police state. The Canadian-American border is closed from both sides. The British government is in a hysterical (not funny) breakdown. There is not a single sane, rational government int the West.
The totally unhinged leadership of the West bodes ill, and more stunning disasters are coming.
“My explanation for this, is that fear of political blowback overrules all other considerations.”
Or shut down the southern border. And note that Congress has exempted itself. And note that a study has just come out concluding that the risk of heart inflammation from vaccine issues in teen boys is a multiple of their risk of hospitalization.
No science. Its all political.
Is that recent? I have a colleague who has crossed the border in each direction within the last two weeks. He and I spent the week in Cincinnati with a client two weeks ago.
An example of the sort of thing that complicates the issue.
Unless there’s a reliable nationwide database and biometric id to prove vaccination (which would take political will, an appropriration, and act of Congress) it seems to me that one of the consequences of vaccine mandates and punishments will be widespread fraud.
The Canadian-American border had big changes for the Canadian side in August.
tl;dr Non-Canadians (i.e. Americans) can go into Canada if they present proof of full vaccination(one has to input it through an app) and a -ve COVID test. Non-vaccinated Canadians with a -ve COVID test can return but they must quarantine for 7 days at government approved hotel at their own expense.
The US government didn’t change the rules on their side of the border. Only Americans can return with a -ve COVID test.
What’s struck me was how much more competent Canada is in implementing the rules. Canadian border agents actually look at test papers and the data one inputs into the app; the Canadian government sends an email detailing traveler obligations and resources vis-a-vis COVID while in Canada. US border agents don’t even look at the -ve test results and the government doesn’t do any follow up….
Back to vaccine mandates…
Here is the abstract from the NEJM article which says the opposite of what you think. If you are thinking of another article please cite. I occasionally miss one. Please read the actual numbers. I would be willing to bet you never read the original article and not even the abstract, that you are just believing someone else. The word “most†at the beginning could be misleading. You actually have to read the entire sentence and the following ones.
In case you have trouble with this since it doesnt seem like you have much experience with science or medical journals, it says that with the vaccine you see myocarditis in 2.7 out of 100,000 cases. With Covid you see myocarditis 11 out of 100,000 cases. 11>2.7.
“In the vaccination analysis, the vaccinated and control groups each included a mean of 884,828 persons. Vaccination was most strongly associated with an elevated risk of myocarditis (risk ratio, 3.24; 95% confidence interval [CI], 1.55 to 12.44; risk difference, 2.7 events per 100,000 persons; 95% CI, 1.0 to 4.6), lymphadenopathy (risk ratio, 2.43; 95% CI, 2.05 to 2.78; risk difference, 78.4 events per 100,000 persons; 95% CI, 64.1 to 89.3), appendicitis (risk ratio, 1.40; 95% CI, 1.02 to 2.01; risk difference, 5.0 events per 100,000 persons; 95% CI, 0.3 to 9.9), and herpes zoster infection (risk ratio, 1.43; 95% CI, 1.20 to 1.73; risk difference, 15.8 events per 100,000 persons; 95% CI, 8.2 to 24.2). SARS-CoV-2 infection was associated with a substantially increased risk of myocarditis (risk ratio, 18.28; 95% CI, 3.95 to 25.12; risk difference, 11.0 events per 100,000 persons; 95% CI, 5.6 to 15.8) and of additional serious adverse events, including pericarditis, arrhythmia, deep-vein thrombosis, pulmonary embolism, myocardial infarction, intracranial hemorrhage, and thrombocytopenia.â€
Link to the NEJM article which is not behind a paywall. Note that there are a couple of other problems seen at a higher rate with vaccine but they didnt find very many. Then look at the lengthy risk of problems associated with Covid.
“An example of the sort of thing that complicates the issue.”
Unless there is another study which Drew can provide, this is more likely an issue of disinformation.
Steve
As t the mandate itself, he should have mandated it for federal employees earlier. The other part of the mandate will just make people dig in harder. Should have just offered tax cuts to companies that meet vaccinations goals.
Steve
My brother in law has to go to Canada for his work. CO has it right.
https://www.medrxiv.org/content/10.1101/2021.08.30.21262866v1.full.pdf
But you miss the whole point. We are making up policy on the fly, in a giant and still inconclusive human study. And we choose the data and sources that all lead the way the politicians and certain public health officials want the policy to go. This is politics and expediency, not science.
There are plenty of advocates for vaccination of every Tom, Dick and Harry because of a PR campaign. There are no advocates for the others. A perfect example is Ivermectin. I have no idea if it is efficacious or not. I do know there are 58 studies reporting some or significant benefit. I know there are clinicians who believe it to be helpful. But in the PR campaign its “horse dewormer.†A rigorous evaluation should be undertaken, and for all therapeutics. That’s not the case. Its vaccination morning, noon and night. That’s not science; it’s biased expediency.
Our county is offering a $200.00 bonus to employees who show proof of vaccination, sidestepping the issue of civil liberties.
I think honey would draw a lot of flies.
Illinois implemented a similar mandate for certain sectors to vaccinate their employees or implementing testing a few weeks ago, and the deadlines have already had to be moved back twice at the request of healthcare facilities and schools because they weren’t ready to implement it. I suspect its the testing alternative that is the issue, as well as implementing vaccine exemptions. State employees have been ordered to get vaccinated without the testing alternative and AFSCME has been pushing back.
Other issues I’ve heard are that people are having trouble documenting that they have had both shots of an mRNA vaccine. Illinois has the second greatest disparity btw/ people identified as receiving one dose and two doses.
I did miss that one. So after a quick reading it has some obvious problems but it does make me rethink things a bit. On the problem side it is not peer reviewed so I am not sure if I missed some things. I have some qualms about pulling directly off of VAERS. A friend of a friend managed to have posted on VAERS that the vaccine turned him into a monster. I would prefer a large multi institutional study. Prospective is better but more expensive. Finally (there are others but lets limit this) they look only at 120 days of Covid while the myocarditis occurs in the first week after the injection. The study was done at a time when some kids were not going back to in person school yet.
So my take home would be that if you think covid is going away, or you can be sure your child will not get covid AND your child has no other health issues you can think about not getting vaccinated IF your primary concern is hospitalization. If your concern is about death or the long term effects of covid, if your child has any illnesses, if you think covid will become endemic and be around more than one more year then vaccination is still the better option. Even if hospitalization is your primary concern vaccination is probably better if Covid persists for more than another year.
This assumes that hospitalization rates both for myocarditis and Covid stay the same. My sense from talking with our cardiologists is that we have been overly careful with admitting these kids and it may go down but it is so rare who knows.
So first let me congratulate you on being that rare conservative who now seems to understand that we need to look beyond just death rates. Hospitalizations matter. As to your claims above of course we are doing this on the fly. It is a new virus. We could just wait until we definitely had almost 100% positive answers and then treat, but then tons more people die. The irony of you pushing for Ivermectin with no good studies while not wanting vaccines when there is tons of evidence and so far it has been good is just weird. So I wish you would get the idea out of your head that this is some giant conspiracy. Remember that data and experience comes in from the rest of the world. This is not a conspiracy to hurt Trump, make the government bigger, hurt conservatives or whatever the latest crazy ideas you guys espouse.
“There are no advocates for the others. ”
Such as? Look, CO made a good case for pushing harder on MABs since they actually work pretty well. However, I do have a strong bias about pushing them hard since I am in the middle of struggles trying to find nurses. The last thing I, or my hospitals, need is to pull away more to go run some MAB clinics when vaccinations are much, much faster and cheaper and wont take away those staff.
Ivermectin? Sigh. I think that I have read most of those studies. The parallels with HCQ are pretty noteworthy. The early studies showing it had positive effects were almost all small, didn’t have controls, overweighted with younger pts and women and were not published in peer reviewed journals. Some were retracted after getting closer scrutiny. More recent studies have been larger, have controls and to be honest done in countries where I trust the results more. They arent showing those positive effects seen in earlier studies. They mostly show no effect, though to be fair some of those had some study methods issues and still not as large as I would like.
There are some larger, well designed studies still under way so I think we should wait for those before we decide anything about Ivermectin, but I am expecting either no positive effect or a small one. We tried it at our hospitals and didnt see a notable effect but didnt stick with it very long. I think people were pretty skeptical after HCQ which we used a lot, again with no effect we could find.
I hope we never have another pandemic that is so politicized but that is probably too much to ask. We have also wasted thousands of hours and lives trying to find a previously existing drug that would work well against a new virus.
Steve
documenting?
They gave me a card, it’s in my wallet.
@Grey, sounds like some people are having trouble documenting the second dose, as opposed to two first doses. I don’t know if that’s a problem that would be solved with the original card(s) (which the person may not have kept) or with the on-line system the state set up. I don’t know if the problems originate from traveling to multiple places / states to get vaccinated.
I’m not much of one to advocate or even defend fad treatments on the order of either HCQ or Ivermectin. I do remain puzzled about the South Korean physicians’ confidence in their “cocktail” in the early days of the pandemic which included HCQ. Anecdotal? Post hoc propter hoc? I have no idea.
PD:
I was referring to a broad mandate covering all sectors rather than just the health care sector. Quite a number of states have those including some Red States which sort of goes against the narrative.
25% of health care workers are not vaccinated it is reported.
What to make of that?
My biggest concern is not the idea of a mandate per se, but how this is going to be attempted. It would be one thing if Congress passed a law, or directly empowered the Executive branch to do some kind of mandate, but it’s quite another when the Biden administration digs up an obscure option from the federal code and then unilaterally deputizes businesses to enforce it at size and scope that’s never been done before. I’m not a lawyer, but unless the rule is very carefully crafted, I think the courts will greet it skeptically.
I think the messaging has been dumb as well. The messaging boils down to we’re tired of your shit, so we’re gonna force you one way or another. I think Matt Yglesias is correct that the better messaging would be to promote this as a mandatory testing regime with the option to opt-out if one is vaccinated. I think that would also align better with the OSHA gimmick they’re using to implement this, though the lack of direct legitimacy and the Congressional inaction are still major problems.
@Dave, I was mainly pointing out that states can do this, but there have been logistical issues at least in Illinois. Also, I’ll point out that according to covidestim, 45 states have already peaked ( R < 1 ). Iowa is exactly at 1, and a few other states look close. Ohio is the outlier right now R = 1.45.
@steve, a local judge ordered my wife’s hospital to administer ivermectin to a man in the ICU on a ventilator, but after the hospital challenged it, revoked the order.
I think the initial order was entered because his wife said he had a thirty percent chance of living, and should be given the chance to try it after other therapeutics had failed. She said they were familiar with the product because they’ve used it with dogs they breed.
The hospital responded that his condition had stabilized, that they’ve discovered a cyst on his liver and are afraid of organ failure. They said he no longer had active infection (he tested positive in late July), which seemed to be more important than discussed in the coverage — if Ivermectin is an anti-viral, then it has to be given pretty early, like within the first week from symptom onset. If I understand that correctly, its use as last chance for the dying isn’t justified.
That’s my point. Consider this scenario:
– one or more states challenge the diktat in court
– a court somewhere issues a stay
– there are appeals
That could go on for weeks, months, or years. I do not care for trying to sidestep the rule of law but I also do not care for wheel-spinning.
The resolution is for Congress to pass a law. Or for President Biden to use powers clearly within his authority rather than looking for obscure loopholes.
PD- Of all the studies suggesting some positive effect it seems to happen if given early. If its true method of action is inhibiting viral replication that makes sense I think. That far along I would not expect an effect. Even its advocates push for it to be given early.
“then unilaterally deputizes businesses to enforce ”
Thats why I like the tax incentive idea, though on second thought you have all of those states that passed laws so businesses cannot require vaccinations. I wonder if you could just pass a law requiring vaccination then letting people sue those who dont get vaccinated with minimal claims of at least $10,000? Would that only be legal in Texas?
Steve
On myocarditis — Ontario released data that made the Canadian news a couple of weeks ago.
https://www.publichealthontario.ca/-/media/documents/ncov/epi/covid-19-myocarditis-pericarditis-vaccines-epi.pdf?sc_lang=en
The finding is for 18-24 males, the rate of myocarditis for Moderna was 263.2 per million, which is 1 for every 3802 patients. Pfizer was significantly better (through elevated) at 37.4 per million, which is 1 for every 26737 patients.
The rate for all ages and genders roughly matches the NEJM study listed above.
To put it in perspective, Ontario continues to recommend vaccines, even for this age group.
But I think its common sense that any physician that looks at the data would advise young males away from the Moderna vaccine towards Pfizer or J&J. Or tell women under 60 to use Moderna or Pfizer over J&J to avoid blood clots.
Which actually gets at two of the problems we have.
1) The US is woefully short on data about vaccine effectiveness and adverse effects — we are dependent on other countries to generate the data.
2) The US is in urgent need of more types of vaccines. The FDA has only approved 3, and really the US is only using 2 (and both of the same technology). What we are seeing is each type of vaccine is overall effective and safe, but has elevated risks for specific demographics. The government should have enough vaccine choice for those demographics if it is going to mandate them.
Here’s another pointer to why these two points matter — the UK published data that the viral vector vaccines (AstraZeneca + J&J) effectiveness decay slower then mRNA vaccines (Pfizer + Moderna) and extrapolates the viral vector vaccines are more effective once past 6+ months. Is that why the UK has managed to keep their hospitalization / death numbers much lower then even highly vaccinated US states?
The worrying thing is the FDA/White House/CDC seems oblivious to these two issues and could be making sub-optimal decisions because of it.
Here’s my take on the vaccine mandate.
On the legal question; my take is it is a closely balanced matter. Jonathan Adler’s take at Reason and Matt Yglecias pithy tweet was persuasive to me; that OHSA has the authority to issue regulations regarding COVID, which incidentally take vaccination into account; but a general vaccination mandate is beyond the law. A hot take would be this mandate is like Trump’s travel ban; it can be legal depending on what exceptions are granted, process of getting exceptions, how it adapts if situation changes, etc.
It is the philosophical / moral / precedential implications that argue away from a mandate. There are 4 levels of coercion that are being employed.
First level, positive incentives (money, social approbation)
Second level, take away non-essential activities (concerts, restaurants)
Third level, take away employment opportunities in some fields (military, medical fields, elder care)
Fourth level, take away all employment opportunities
At the first 3 levels, its acceptable because the choice while unpleasant, one can survive with refusing. At the last level, its getting close to that survival line. An analogy is conditioning access to public transit or grocery stores to having a vaccine (which most would find to be intolerable coercion) — conditioning employment is like that except the need is less immediate. On the other hand, the data from other polities show mandates are more effective then incentives, so its a complex debate.
On the political side, I think this is a masterstroke. Biden has neatly framed the unvaccinated as his political opponents (nevermind the demographic data shows it is much more ambigous), got Republican governors vowing to oppose the mandate (and take the blame for any vaccination apprehension). I am reminded that Biden advised Obama to not go forward with the Bin Laden raid because Obama couldn’t blame anyone else if it went wrong. I could see how that thinking drove Biden’s speech and how he framed his actions.
“got Republican governors vowing to oppose the mandate (and take the blame for any vaccination apprehension). ”
It doesnt work that way. Those governors will be seen as heroic for standing up against Biden and the libs. It just wont matter if a lot of people die. Its all tribal now.
Steve