COVID-19: Let's Talk Mandates (For Healthcare Workers and, Frankly, Anyone Going Out In Public)
Updated: Sep 27, 2021
Vaccine mandates are the latest discussion to dominate the news cycle. Local to me, the Buffalo Bills and Sabres both announced that starting next month, proof of full vaccination will be required to attend games. I recently saw Phoebe Bridgers at an outdoor concert (terrific show) and she required proof of vaccination to attend. These are good measures to ensure fan safety and prevent COVID-19 spread.
I see a lot of people making malicious comparisons to Nazi Germany and Tsarist Russia, referencing the showing of papers. Some are even comparing it to segregation. Tell me you misunderstood (or are misappropriating) history without telling me you misunderstood history.
Vaccine mandates are nothing new. By now most of you have seen the meme (which is true) that George Washington required his troops to get inoculated against smallpox. So as far back as the 18th century, "Necessity not only authorizes but seems to require the measure, for should the disorder infect the Army . . . we should have more to dread from it, than from the Sword of the Enemy." In modern times, we have had vaccine mandates for jobs and school attendance for years. Why do we have these? It's because we have learned that mass vaccination against these preventable diseases keeps people safe and out of the hospital (and alive). Do we still need these mandates? Well, when vaccinations against measles and pertussis drop, we see outbreaks. Some children are okay, while others get incredibly sick (sound familiar?).
COVID-19 is now the latest of these mandatory vaccinations, and boy, are these vaccines needed. The deadliest pandemic of our lifetimes rages on in its fourth wave (fifth by some counts, with 4.55 million people dead worldwide), and it's arguably even worse in some ways now. The death toll has slowed, but is ramping up again. Worse, where last year we did our part to avoid strain on the healthcare system by staying home and wearing masks, that is not happening this year. Healthcare institutions all over the United States are overwhelmed. Idaho is discussing a statewide Do-Not-Resuscitate (not generally implemented, but on the table) and doctors everywhere are having to search multiple states for ICU beds or any kind of hospital care for their patients. COVID-19 is still wreaking havoc because not enough folks are vaccinated (in the United States and in the world).
Of course, many people are objecting to the mandates, which is why I am writing this. I commented on the Buffalo Bills' status praising the move (before we go further, yes, I do think that the players should also be mandated to get vaccinated before they play). The responses to my comment were exactly why I write these posts, and proof that I and my fellow scientific communicators are not able to reach enough people. Every myth about vaccines got thrown at me in the replies, and trying to address each myth was like plugging holes in a bursting dam.
These vaccines are no longer experimental. It's been over a year since the final trials for Pfizer, Moderna, and Johnson & Johnson commenced, and we have administered over 6 billion doses, fully vaccinating 2.5 billion people (>2 weeks out from final dose) with close active monitoring of side effects and adverse events (and no, I'm not talking about VAERS, a useful but often misused system). We have been able to identify incredibly rare but significant side effects associated with the vaccines, and we have been able to disprove other claimed, but not attributable, side effects. Despite our best efforts, some of these myths still persist.
The most frustrating question, because I have answered it so many times, is "Why are you worried if the vaccine works? Why do I need to get vaccinated if I don't want to?"
People like to say "my body, my choice" here, too, and I have already discussed why that is egregiously wrong and a dangerous misapplication of the slogan. No one has ever stated that any vaccine is 100% effective. They do prevent spread and actual infection to an extent, but they have never been an individual-only preventative mechanism (and to think so is an example of "perfect being the enemy of good"). Vaccines are a tool of public health and they rely on as many people getting vaccinated as possible to clamp down on spread. That is why so many have been mandated for so long.
(Also, a few lone wolf physicians and other individuals have gone viral with videos of themselves talking to groups and trying to spread myths. One of those myths is that vaccines are incapable of eradicating disease, which is straight-up not true. That said, eradicating COVID-19 will be significantly more difficult than eradicating smallpox, but frankly, "living with the virus" is not working out well for us at this point; we must at least get closer to eradication than we are now).
The next myth is that "Vaccinated people can still spread it, so why bother?" This is also not so simple. You cannot spread a virus you do not catch, so if we clamp down on spread and infection, that effect spirals and the virus is controlled.
Disinformation-spreaders love to cite the myth that vaccination breeds worse variants. This is incorrect for multiple reasons.
We examined samples from since the beginning of the pandemic. The alpha, beta, gamma, and delta variants (and others) were all present BEFORE vaccines were rolled out in their respective parts of the world. So they could not have been bred by vaccines!
People like to compare viruses to bacteria in terms of developing resistance, but they are different organisms. Bacteria get exposed to antibiotics almost exclusively after infection. Vaccines are meant to be given BEFORE infection, meant to prevent viral replication and longer infection - which is EXACTLY what the COVID-19 vaccines do.
Vaccines also train your body to form responses (immune memory) against multiple parts of viral proteins, so viruses need significantly more mutations to really evade or resist your own immune system.
Yes, the delta variant can still infect you and viral loads may be high (in some cases just as high - at first - as if you were not yet vaccinated), BUT the viral loads do not stay that high for nearly as long. Viral loads drop much faster, which means the individual's ability to spread is cut off that much more quickly. The latest data shows that without the vaccine, you are 8x more likely to get infected and 25x more likely to get hospitalized. In a pandemic that has stolen parents from children, children from parents, friends and family from each other...vaccination is a better way to go.
There are also papers coming out whose research shows that vaccinations DECREASE mutations of SARS-CoV-2. They're still preprints, but if after vetting and peer review they hold up, it would be further proof that these myths are just that - myths.
And finally, the next biggest myth is concerns about fertility. I have written about this multiple times - there is NO EVIDENCE that vaccines affect fertility at all (a myth based on biologically-implausible rumor). We have studied this heavily for the past year, and there is no increase in adverse events with pregnancy or fertility. So many people have gotten the vaccine before and during pregnancy and have gone on to have healthy babies. The most that happens pre-pregnancy is that periods may pause for 1-3 cycles, but they always come back. Moreover, no parts of the vaccine get into the fetus - only the antibodies that protect against the virus! You know what is more likely to cause infertility? Infection with COVID-19.
HEALTHCARE EMPLOYMENT AND VACCINE MANDATES
At my place of work and at hospitals and healthcare offices and institutions across the country, vaccine mandates are a point of conflict. September 27th is a big day where I live as those mandates are coming into effect. Some healthcare workers are resistant to this and feel that they're being threatened for non-compliance. Among the most vocal are nurses, but this also includes respiratory therapists, medical assistants, environmental staff, doctors, and others.
Let's take nurses. I don't speak on behalf of them, but I am grateful to count many nurses as friends.
This is a profession that has unfortunately had to become used to being crapped on (literally and figuratively), for years. Nurses have long been subject to difficult work conditions (too many patients at once with not enough time to do all the care and other tasks required). Over the years more and more care has come under their purview, resulting in an overworked and underpaid workforce. Not to mention the misogyny constantly directed at them (most often female nurses getting unwanted male attention, though male nurses certainly are not always protected from discrimination and stereotypes, either). You've seen my posts for Nurses' Week - nurses are often a patient's lifeline, and I as a doctor rely on them to advocate for patients so that I do my job well. They don't get nearly enough tangible thanks for this (see the negotiations and plans for strike that are currently being discussed in area health systems, which is not even related to vaccination).
So it's not unreasonable that any mandate on nursing, especially when employment is contingent, is met with resistance. Nurses have little reason to trust such moves by administrators or the government. And again, this is not solely nurses, either - every worker in healthcare is and has been overworked and underpaid (not to mention weighed down by loans and other obligations) for some time now, and the media have been pretty capricious in their portrayal of our professions. Healthcare workers do not like to feel like their choice is being removed (no one does).
It's here that I re-emphasize that vaccination against COVID-19 is NOT an individual choice. Public health relies on all of us protecting each other. I have written previously about how infection-mediated immunity (people like to call it "natural immunity" but as vaccines merely educate your immune system, that is also still natural) is not as reliable or as effective as vaccine-mediated immunity (we have both laboratory/immunology-based studies and real-world application studies). I agree that healthcare workers, especially nurses, deserve so much better than what they are subject to, but this vaccine mandate is a necessity to protect our patients. I know we worked through a whole year without a vaccine, but now it is here and it IS safe and effective for us and our patients.
All of that said, those outside of healthcare must do their part as well. The healthcare workers may be employer-/government-mandated to get the vaccine, but there is, as I mentioned in a previous post, a moral mandate here for everyone. The healthcare system cannot take much more at its current capacity. I understand a healthy distrust of government, and honestly that is a good idea these days. However, vaccines are our only way out of this pandemic, and they only work if everyone gets vaccinated (see my previous posts about why home remedies and things like HCQ and ivermectin are not viable treatment options, and the monoclonal antibodies are nice for treatment, but are expensive and do not prevent spread, and they have a narrow window of opportunity). Now, with boosters approved for those >65, 18-64 with underlying medical conditions, and 18-64 with increased occupational/institutional exposure, now is the time to take steps to protect one another. PLEASE get vaccinated to protect yourselves and your community.
Pics below thanks to The Unbiased Science Podcast and Dr. Risa Hoshino.