Pandemic Update 7:  Why do we need mandates?

On December 14, 2021, the United States surpassed 800,000 COVID-19 deaths since the pandemic began.  On July 30, there were about 612,000 deaths.  That means that since the time that all adults could have been vaccinated in the U.S. there have been close to 200,000 more deaths.  Almost all of the deaths since July have been adults and 90% were in the unvaccinated population.  Conservatively, 80% or about 150,000 deaths, were avoidable.  And yet people still refuse to get vaccinated.

I will not review all of the excuses that people give for not getting vaccinated.  It doesn’t matter.  Clearly the benefit of vaccination outweighs any of the risks that people voice concerns about.  And because vaccination primarily prevents the spread of infection to others, vulnerable populations have been put at risk by the unvaccinated.  This has resulted in many of the deaths from breakthrough infections in vaccinated people.

Because of the continuing pandemic, some say the vaccine doesn’t work.  You can hear this statement almost every night on Fox News.  It is a false statement.  The chart from the CDC above is just one of many reports that demonstrates the benefit of vaccination (and boosters).

On November 8, 2021, the Texas Department of State Health Services published a report of COVID-19 Cases and Deaths by Vaccination Status. This report showed that 85% of hospitalizations and 85% of deaths from COVID-19 in Texas since January 1, 2021 have been in the unvaccinated population.  Other Key Findings from the report:

1. From September 4 through October 1, 2021:
   • Unvaccinated people were 13 times more likely to become infected with COVID-19 than fully vaccinated people. 
   • Unvaccinated people were 20 times more likely to experience COVID-19-associated death than fully vaccinated people. 
2. Vaccination had a strong protective effect on infections and deaths among people of all ages. The protective impact on infections was consistent across adult age groups and even greater in people ages 12 to 17 years. The protective impact on COVID-19 deaths, which was high for all age groups, varied more widely. In the September time frame, unvaccinated people in their 40s were 55 times more likely to die from COVID-19 compared with fully vaccinated people of the same age. Unvaccinated people aged 75 years and older were 12 times more likely to die than their vaccinated counterparts. 
3. Overall, regardless of vaccination status, people in Texas were four to five times more likely to become infected with COVID-19 or suffer a COVID-19-associated death while the Delta variant was prevalent in Texas (August 2021) compared with a period before the Delta variant became prevalent (April 2021). 

https://dshs.texas.gov/immunize/covid19/data/Cases-and-Deaths-by-Vaccination-Status-11082021.pdfhttps://dshs.texas.gov/immunize/covid19/data/Cases-and-Deaths-by-Vaccination-Status-11082021.pdf

People have argued that vaccination is causing the new variants that are taking over the pandemic.  There is no evidence that any mutations have been selected through vaccination.   New variants have emerged in populations that were not vaccinated (including the delta variant), or where vaccination rates were low (omicron variant). The fact is that the unvaccinated population is mostly responsible for the development of new variants.  Viruses mutate during replication, and viruses have the chance to replicate much more often in the unvaccinated population.  First, viruses have more vulnerable new hosts in the unvaccinated population.  Then viruses can replicate many more times in an unvaccinated person.  Even with the delta variant, where viral loads are similar between vaccinated and unvaccinated populations, the period of infection (and replication) is reduced from 7-10 days in an unvaccinated person to about 3 days in a vaccinated person.  Take Governor Abbott and his breakthrough infection as an example.  He had mild symptoms and tested negative after 3 days. A negative test generally signals you are no longer contagious.  An unvaccinated person provides the virus with millions more chances to mutate. 

Clearly, vaccination is the key to reducing illness and death from COVID-19 and ending the pandemic.  So why do we need mandates?

Misinformation and false information are prevalent on the internet and in other media.  It is produced by conservative politicians who are promoting extremist views to drive political contributions and public support for their re-election to office, and by a handful of malfeasant physicians and scientists.  Social media allows this misinformation and false information to be multiplied like the virus itself.  It seems that mandates and calls for mandates only feed these false narratives.

But even without false narratives magnified by the internet, mandates are generally required to achieve significant compliance with public health guidelines.  I would challenge any parent who is not a pediatrician to name the immunizations required for their child to start kindergarten.  Mandated vaccines are listed for the parent by the school district, and the parent can check the list of mandates against their child’s vaccine record.  Very often, parents have to go to the pediatrician and get vaccinations updated right before school starts.  Without the mandate, they would not know what vaccines their child should have.  

The other reason for mandates is that even if people have the information they need about vaccination, getting vaccinated requires a commitment to action.  After overcoming misinformation and false information, as well as valid concerns about adverse events, without mandates many people would still not get vaccinated.  While the vaccine is free, there is the cost of time (like taking off work), plus transportation issues, vaccine availability, and just plain laziness that get in the way.  Maybe fear of needles?

So, mandates are necessary to provide people with information that they need about vaccination and to ensure that they make the commitment to get vaccinated.  In a public health emergency, it is a necessary tool.  For politicians, judges, and others with secondary motives to oppose a COVID-19 vaccine mandate is to deny about a hundred years of public health experience with vaccine mandates. 

Yes, you have the right to refuse vaccination.  But you do not have the right to remain unvaccinated and expose others to the risk of infection in public settings.  This includes any job where there is interaction with the public, workplaces where individuals are in close contact, public transportation, public events, and public places where people may be exposed like restaurants, bars,  gyms – and yes, even going to church.  To see a listing of high-risk activities, see Pandemic Update 6 (https://waterloo-austin.com/2021/08/12/pandemic-update-6-its-time-for-accountability/).

It is past time to enforce mandates for COVID-19 vaccination.  If you are not vaccinated, do the right thing and get vaccinated.  If you are vaccinated and frustrated that this pandemic is continuing, call on your elected officials to stop opposing vaccine mandates and start enforcing them.