Vaccine mandates, personal freedom and public health

A disclosure right up front, namely that I’m a member of the UCT Covid -19 Vaccine Mandate Panel, which is currently seeking comment on the draft vaccine mandate policy that we have drafted. (And, it’s no doubt also relevant that I’m a member of UCT’s Council, which will have to approve the final conditions of any mandate the panel proposes.)

With that said, some personal reflections follow, starting with the fact that it’s undeniably the case that a vaccine mandate is more difficult to justify under Omicron than it was during earlier manifestations of Covid-19. Nevertheless, implementing a vaccine mandate is still the right thing to do, even though the nature of such a mandate might need revision (and, you can offer your feedback via the link above if you have any ideas in this regard).

It’s still the right thing to do because as I argued in a previous post, “the minimal risk of (typically, trivial) adverse effects is a small cost to pay for the benefits of vaccination”. And yes, it’s of course true that those benefits are far less apparent under Omicron, they still exist, and the risks entailed by vaccination continue to be trivial.

But more importantly: it would be a mistake to craft policy in response to the current situation with regard to Covid-19, rather than in response to the broader context. Covid-19 is not “like the flu”, at least not yet.

It’s a systemic disease, which has the potential to result in negative outcomes on physiological functions that ordinary influenza does not. Yes, maybe that is no longer true for Omicron and whatever mutation/variant comes next, but we don’t know — and given that there’s good reason to believe that vaccines are somewhat protective, and somewhat effective in reducing transmission — while carrying negligible risk — they seem like an obviously good idea.

Does the general point (that they carry minimal risk, while also — for Omicron — convey less benefit than we might hope for) still support vaccine mandates? Yes, it does.

While I understand the reasons why support for mandates is less enthusiastic at present than e.g. under Delta, it remains the case that hospitalization and death are reduced for those that are vaccinated versus those who are not.

And, for all that people are talking about Omicron as being mild, it would be foolish to dismiss the possibility of long-term negative effects for a systemic disease, even if those who contract it are asymptomatic, or barely notice that they have it. You probably know people, as I do, that are still suffering from “brain fog” or mysterious fatigue, months after theoretical recovery from Covid-19.

Furthermore, we don’t know if we have reached a point of endemicity with regard to Covid yet (which might allow for embracing more risk), and we have no way of knowing whether or not the current vaccines help to protect you from possible future variants.

But we do know that — for nearly everyone — vaccines probably offer a benefit, even if slight, and that they carry negligible risk. Whether a vaccine mandate is still advisable, given this uncertain cost/benefit analysis, is obviously going to be determined by subjective preferences.

The Democratic Alliance (the DA, the South African political party who are the official opposition) oppose mandatory vaccination on grounds including violations of personal freedom, a lack of government capacity to enforce a mandate, and also because a “mandatory vaccine policy ignores evidence of some degree of natural protection through prior infection”.

While this post won’t segue into a detailed criticism of the arguments presented by the DA (the link above has a further link to their full policy statement), it is odd for me to read “the State lacks the capacity to implement and enforce” vaccine mandates in a piece that argues that “natural protection through prior infection” should be recognised.

Not because we don’t yet have robust data on how long natural protection lasts, nor because we actually already have data that natural protection plus vaccination offers even better protection, but simply because we have no way — in an institutional setting like a university, at least — of implementing and enforcing a policy that recognises “natural protection through prior infection”.

It’s simply not a workable policy suggestion, in light of the fact that we see dozens, if not hundreds, of fake medical certificates every year, presented as mitigation for missed assignments. There’s no capacity to monitor and ensure that medical certificates describe a real condition; that they are issued by the person whose letterhead you’re looking at, nor that they aren’t simply opportunistic.

And, that’s fine for the occasional missed test. But it’s hardly the sort of policy I’d want to rely on when thinking about how to regulate the movement of students and staff who might be carrying a systemic disease into an environment which might contain vulnerable individuals.

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Jacques Rousseau lectures critical thinking & ethics (University of Cape Town), and co-authored “Critical Thinking, Science and Pseudoscience” (Springer 2016).

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Jacques Rousseau lectures critical thinking & ethics (University of Cape Town), and co-authored “Critical Thinking, Science and Pseudoscience” (Springer 2016).

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