On vaccine mandates

One of my spare-time fascinations is what happens when two deeply held values conflict on some given issue. Examples:

  • Many liberals are cynical about large corporations having a lot of power, and also think it’s important to prevent harmful opinions from getting a platform. So how do they feel about large corporate social media platforms regulating what gets said on them?
  • Many American conservatives feel strongly about the right to own firearms, and also think it’s important to be tough on criminals. So how do they feel about bureaucracy imposed on firearm sales to prevent felons from obtaining them?
  • Many feminists believe that women should have autonomy to choose their careers, and also oppose practices that perpetuate norms they consider to be degrading to women. So how do they feel about sex work?

The last example was a really fascinating question in the 1970s and 1980s, when it divided feminists of the day. In practice, most other conflicts don’t end up in such interesting and challenging discussions, and instead resolve quickly into whatever is convenient for immediate partisan objectives.

Vaccine mandates seem to be a bit of both. Many authorities seem reluctant to impose them, walking a tightrope between civil liberties and population health needs. Most other commentators seem very adamant that either they or their absence is a dire threat to civil society.

Photo by Mat Napo on Unsplash

If you have any sympathy for the notion of bodily autonomy, the idea of requiring anyone — let alone most people — to have a foreign substance injected into their body should make you at least uncomfortable. Like all principles, in practice we impinge on it routinely in small ways, e.g. dress codes. But as far as things you can do to your body go, “injecting a foreign substance” scores pretty highly on the invasiveness scale. On balance, it might still grudgingly be a good idea, but such a violation of “my body, my choice” should feel at least a little squeamish.

If you have any instinct that likes protecting people from illness or death, the idea of a requirement whose net effect is to protect people from illness or death should be at least tempting. In practice, we don’t impose good Samaritan obligations everywhere, but we do sometimes restrict freedoms in an effort to improve public safety, e.g., driver licensing. Vaccinations have the unusual property that they supercharge in efficacy at a population level — the benefit of widespread vaccination is much greater than the sum of individual vaccinations. On balance, maybe that’s not quite enough, but this kind of collective payoff to saving lives should feel at least attractive.

When two rights conflict, a couple of strategies normally follow. The first is to establish some sort of “hierarchy” among rights. Not dying seems pretty important, surely that should take precedence over everything? This normally falls down pretty quickly. Few principles hold up when taken ad absurdum, and counterexamples are easy to find. Every year, more than 30,000 people die in traffic accidents in the United States, and more than 300 die in New Zealand. We probably wouldn’t want to get rid of all vehicles — ambulances and freight trucks are really helpful — but the death-minimising level of traffic is probably much, much, much lower than where we are now.

The second is to try to propose some workaround so that it wouldn’t really violate the principle. Sure, we wouldn’t physically corner people and force needles into their arms. But if you choose not to take a vaccine, and you’re shut out of travel, jobs and/or markets, that’s just a choice that you’re making about your body, right?

I find this thinking hard to square with how I, and most people I hear this from, generally think about coercion and discrimination. Shutting anyone out of the economy doesn’t make for a choice in any meaningful sense. If someone gets sacked from some warehouse job because they joined an environmental movement, would I be comfortable explaining that away as a “choice”? If a prospective mother faces a choice from her employer — don’t do it, or be replaced — is that a “choice”? If supermarkets turn away everyone who’s unemployed, or wearing some sort of slogan? (From what I understand, these would all be illegal in New Zealand; the second would be illegal in America.) Perhaps this is the sort of decision matrix we want to force on people when it comes to vaccines, but the idea that it’s a choice in any meaningful sense seems hard to maintain.

In the spirit of full disclosure: Personally, I would rather be assured that everyone in every gathering I go to is vaccinated (or has good medical excuse). I’d prefer that my employer, gym and supermarket somehow verify that everyone else in the building has reduced their risk of contracting and transmitting SARS-CoV-2, and I’d be sorely tempted to switch affiliations over it if that’s what it took.

But even that contravenes my instincts on coercion and discrimination. I imagine if lots of customers decided they were going to boycott the local greengrocer until they stopped serving people with dreadlocks, or people with tattoos. Even without the government or large corporations, the community is still imposing its preferences on other people. Maybe it’ll make the average local happier, but I couldn’t deny that it’s (indirect) “coercion” without trivialising the concept.

I spent about a decade on the competitive university debating circuit. In a game, or in a doomthread, this exercise of “weighing” or “defining” rights is fun and interesting. When genuinely trying to parse through an issue, I’ve started to find it rather uninsightful.

In a fictional Community, someone has discovered a pill that can prevent most strife caused by emotional disorders. If everyone took it, of course not all violence would vanish, but a lot of it would, as people’s tempers almost never flare up. In fact, not just emotional disorders — this pill helps with emotional well-being all around. All the grief that people experience when relationships break up — gone. That spiral of demotivation when life really isn’t going well — gone. The non-clinical anger management issues that sometimes lead to assaults — no more. The one side effect is that, in suppressing the harms of extreme emotions, it also suppresses emotions in general.

(Tangent: It’s very important here to point out that, while there’s a link, most people with emotional disorders don’t commit crimes. This is a complicated and well-studied area, and not one I have an expertise in, so while I referenced violence to make it a little more concrete, I haven’t premised this thought experiment on “crime”. I don’t have specific sources in mind, so I’m not going to pretend that I do. Whatever your intuition is here, hopefully you at least agree that, if we could magic away all emotional disorders, it’d be nice to do, just as it’d be nice to magic away cancer, or COVID-19.)

This is, in part, the dystopia presented in The Giver (shout-out to my year 8 teacher, who apparently managed to leave a lasting impression on me), in which everyone starts taking an emotion-suppressing pill at around the onset of puberty. There are (at least) two important differences between this dystopia and the COVID-19 vaccine.

  1. The COVID-19 vaccine doesn’t have common side effects lasting longer than a few days. (There are some extremely rare ones, but nothing akin to “suppresses emotions in the entire population”.)
  2. The COVID-19 vaccine has lots of scientists who have spent all the time they can muster researching what it does, how it works and quantifying its efficacy, resulting in an impressive library of scientific evidence for such a short time. (I haven’t told you anything about scientific evidence for the anti-emotions pill.)

(1) is sort of the premise for the dystopian Community in The Giver, so of course it tips the cost-benefit analysis by a lot. But I think this thought experiment still works if we make the pill even more magical, and imagine that warm fuzzy emotions like love still happen, just without the dark sides. At least, that utopia still makes me instinctively squirm.

(2) is what I really want to hit at. How, as a society, do we tell the difference between a preventative medicine that the government dubiously wants everyone to take, and one that will actually be as magical as is claimed?

The obvious first place to look is the actual difference — the legions of scientists willing to back the COVID-19 vaccine. As far as evidence and facts go, this is a huge indicator. So a good place to start would be, “you’re not allowed to compel unless lots of immunologists and epidemiologists and infectious disease specialists think it’s a good idea”.

But when it comes to compelling entire populations, or other major policy decisions, any implementation based on what to believe is actually a decision about who to believe. And what system do we use to accredit scientists? As a society, how do we extract the findings from a very, very large group of trained people, whose search for knowledge is never quite “finished”, and who (like all groups of people) often have disagreements among themselves?

(Often these disagreements are blue-skies stuff, but sometimes they’re extremely relevant.)

A tempting method would be something like, “if >90% of all scientists believe something, then it’s The Truth for policy purposes”. Setting aside what you do when <90% of scientists agree, the implementation gets real complicated real fast. Do we weight votes according to proximity of expertise to the topic in question? What paper trail do we require to verify the count? Scientific gatekeeping is pretty informal (sure, maybe you need a PhD, but you can get that at lots of places with varying reputations); would this entail formalising it? Maybe we could design a mechanism for all of this. But the deeper I get, the more it dawns on me that this is essentially using democratic voting procedures to adjudicate scientific truth — and that makes the scientifically minded part of me shiver.

The legal profession deals with this by establishing a strict hierarchy of Very Esteemed Individuals, each tier able to overrule the ones below it. Once the highest tier (often called the Supreme Court) makes its pronouncement, that becomes The Truth for legal purposes, whether the lower tiers like it or not, and whether it’s right or not.

The scientific profession kind of has a hierarchy. Very Esteemed Professors who have gone through the grind of gaining thirty years’ experience have more weight than graduate students who are learning the ropes. But it’s definitely not a strict hierarchy with a national apex, and given the importance of free inquiry to advancing knowledge, it’d be quite the anathema to science if it were.

In practice, the government employs some Very Esteemed Individuals to be scientific advisors, and places a lot of weight on their advice. But by design, these individuals don’t purport to be the final word on science. And (I assume) in part to prevent this power from getting to them, they’re accountable to laypeople who make the final decisions, also known as politicians, who are free to canvass other esteemed advice. Conversely, there’s a strong norm that politicians shouldn’t generally make decisions that aren’t recommended by their expert advisors.

This works for a lot of purposes. Basically, a bunch of government-employed experts do the grunt work and have to explain themselves to laypeople, so for something to happen, it has to sound reasonable to both.

But remember where I started with bodily autonomy, and how high injections sit on the invasiveness scale. No matter how desirable you think it is, mass-injecting an entire population is a really big decision, and the consequences of getting it wrong aren’t just medical mishap, but go to the heart of government power. It’s hopefully not too hard to imagine how this sort of power could be abused. And remember, the government employs these scientific experts — they’re not formally shielded from political pressure in the way that judges are. And if they were, I don’t think the scientific method would sleep well giving anyone that sort of power.

One way to protect against the Community’s pill is to set a very strong norm that we can’t force people to take a medicine. This includes constructively forcing them to do it, by making it hard for refusers to access things like supermarkets, housing and employment.

Instead, if it’s really important, we do lots of other things. We have scientist after scientist go on telly to say how very important it is for everyone to get the vaccine. We have opposition politicians back them up, even as they criticise the government for messing up the rollout. We have local providers demand the ability to manage the vaccine rollout in their own communities. We pretty much beg people to take it. In ads. At family dinner tables. On marae. Doctors and nurses everywhere have the same conversations, over and over again, but each with patients who personally trust them. We run a televised 1980s-style “vaxathon”. We get world-famous singers to chip in. We even cooperate with the gangs. The gangs!

Basically, we handicap ourselves by taking the most efficient mechanism — the law — off the table, and instead make ourselves go through the least efficient way imaginable. We get everyone to individually consent to it. We do this because it can’t possibly work without the voluntary efforts of thousands if not millions of people — too many for a dodgy government conspiracy to be viable.

If we really feel like we can’t live without a mandate, we tip-toe into it extremely nervously. We poke into it sector by sector, starting with those we think we might mostly get away with. We have our Top Esteemed Individual call it an “extraordinary decision” for “extraordinary times”. We have employers beg for guidance, we have airlines, law firms and consultancies take the step themselves, while the government drags its feet on it. We have political leaders basically really not want to do it, and all but beg their constituents not to make them have to.

If I had reservations about the vaccine, and I was watching this large-scale community-wide everywhere-you-look effort, I can’t imagine my gut reaction would be to feel reassured. It would probably feel uncanny to see nearly everyone fall in line, parroting the same lines for the same reasons.

On one hand, that probably is a warning sign. On the other hand, mass medication is occasionally the answer, and we need a system that allows us to do it, but that protects society from wayward governments forcing it because they feel like it. This ritual of everyone getting behind the same message like sheep, of everyone decorating their Facebook profile pics with the same frame, of deputising citizens to “convince” their friends and family — this is our substitute for a bodily autonomy-infringing mandate. Needing far too many people to fall in line is the system we put up with to avoid having an actual government be tempted by actual overreach.

Will it be enough? Who knows. Will we end up with a mandate anyway? Maybe. Hopefully we won’t need it. But an absolute prerequisite for such an invasive mandate is that we have to have tried everything we can to avoid the question. And if we end up going with it, it should be because we very grudgingly resigned to it, because it’s a trade-off we’d rather never have made at all.

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