Vaccines and Mandates

Therefore, knowing the fear of the Lord, we persuade others. 2 Corinthians 5:11

I’ve been waffling on today’s blog entry. I usually stick to addiction/recovery topics and rarely wade into politics or current events. As I was pondering today’s passage however, I just kept coming back to the pandemic, vaccines, and mandates. In today’s passage, Paul said that if we know a truth – in Paul’s case, knowing and fearing God – we must share that truth with others. As a physician, I’ve got certain beliefs pertaining to the Covid-19 vaccine, and I feel that I’d be abandoning my responsibility if I didn’t address it.

First, I must be clear that I’m not equating my beliefs on today’s topic with the gospel of Christ. I’ve got good Christian friends with whom I disagree greatly on this topic and so far, we’ve remained friends. As a physician though, I do have certain beliefs in science and medicine that are pertinent to the discussion. So, here goes.

I’ve been all over the map on this topic myself. When Covid-19 first began changing my life, I didn’t want to believe it was real. That desire taints a lot of my interpretation of what is true and what isn’t. It’s always challenging to try and look objectively at the facts, while avoiding my own bias, desires, and politics. There are a lot of crazy theories out there that aren’t driven by fact, but by preference. I don’t want this to be true, so I’ll find some conspiracy that supports my view. If you’re in that camp, nothing I say will change your mind and I don’t have the ability here to address all the bizarre theories I’ve heard.

In short though, Covid-19 is real. It isn’t just a cold. It’s far more lethal than influenza (about 20-30 times more). When it first began to march across the globe and our country, we realized the only way out lay in herd immunity. That comes one of two ways. First, it spreads naturally, killing about 2-3% of those it infects, or we get a vaccine. I didn’t believe a vaccine was likely for a long time, so I was pretty sure that we’d just see several million U.S. deaths within a few years. Then, medical science offered us a vaccine.

It is of course, impossible to know all the side effects that we might later discover with a new vaccine. This is the same with any medicine, though we’ve not yet had as much time with Covid-19 vaccines. From what we know now however, the risk of significant complications from the vaccine is profoundly lower than the risk of significant complications from getting a Covid-19 infection. This vaccine, so far, is remarkably safe and effective. In short, the quickest way out of this pandemic is to get everyone vaccinated. Unless of course, you simply don’t believe in vaccines at all, which I’m not even going to address here.

We get vaccinated for two reasons. First, we do it for our own health. The Covid-19 vaccine reduces our likelihood of becoming infected and if we do get infected, it seems to significantly reduce the severity of the illness. Many will feel they don’t need it, which, I believe, should be their choice. The second reason we get vaccinated though, is for the health of everyone else. Some infections that were once commonplace (polio) are now an obscure part of our history because everyone (or most everyone) got vaccinated. There are breakthrough cases of Covid-19 after vaccination (as there are with influenza), but the vaccine offers protection and decreased severity of illness for us and those around us. We may never eradicate Covid-19 completely, but if everyone got vaccinated, the destructiveness of this pandemic would largely be mitigated in a very short amount of time.

So, if you dislike Covid-19 restrictions, closed businesses, and masking (which I do), then you, above all, should get the vaccine. It’s the quickest, safest, healthiest route out of this mess. If you refuse to get vaccinated, then you are part of the machine that keeps the pandemic going. Unfortunately, if enough people refuse to get vaccinated, then this may just continue indefinitely.

This is why so many institutions are considering or implementing mandates. Mandates are nothing new of course. I’ve been told for years by my employer that I must be vaccinated against influenza. I believe in the statistical, epidemiological advantage of the influenza vaccine, so that’s not been a big issue for me. I feel the same way about the Covid-19 vaccine.

Still, I don’t like the idea of forcing a treatment down anyone’s throat, particularly on such a divisive issue. In medicine, there are four main principles that guide our decisions: Autonomy (respecting the rights of patients), Nonmaleficence (do no harm to patients), Beneficence (provide a benefit for patients), and Justice (being fair with all patients). Mandates do sacrifice autonomy, which offends my sensibilities and seems to abandon patients’ rights to make their own decisions. In any bioethics debate though, there is always a clash of the four principles. Conflict arises anytime all four principles cannot be equally maintained. In this case, these vaccine-mandating organizations would say that the values of beneficence and nonmaleficence trump the value of autonomy. There’s precedence for this of course. We require multiple vaccines for both education and employment (overriding autonomy) in order to provide maximum beneficence for all.

Still, I don’t want to see mandates due to the divisiveness of the Covid-19 vaccine. I do though, also want to see people do the right thing. For me, the right thing absolutely means getting the vaccine, not just for my own good, but for the good of everyone around me. I don’t want anyone telling you what you must do. If I can though, I’m going to try to convince you to choose to do the right thing voluntarily. If we’re tired of Covid-19, we should all be vaccinated as soon as possible. There are times to fight for our right to go our way and then there are times when we should surrender our way to do what’s right for the good of everyone.