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On September 9, 2021, Joe Biden announced that the federal government will enforce sweeping COVID vaccine requirements on approximately 100 million Americans. This is complete turnaround from December 2020 when he stated that COVID vaccination would not be mandatory.
Back in July 25, 2021, I warned that brute forcing COVID vaccinations will not work. I iterated that while I took both doses of the Pfizer vaccine, it was 100% my choice. The best way to convince people to get any of the COVID vaccines is respecting their autonomy and opinions. A study from MIT revealed that "anti-mask" and vaccine hesitant individuals are not scientifically illiterate. They take the time to gather and analyze data to draw conclusions. The absolute worst thing you can do is to treat them as if they are complete idiots.
Beneficence - Providing the patient with the best possible care to promote the patient's welfare.
Nonmaleficence - The "Do no harm" principle.
Autonomy - The patient has the power to make rational and moral decisions, and should be allowed exercise his/her self-determination.
Justice - Fairness, i.e. no discrimination based on race, gender, sexual orientation, etc.
If you guessed that Biden's mandate violates the principle of autonomy, then you'd be correct. As I stated earlier, individuals skeptical of the COVID vaccines do take the time to do their own research. If they have found the data over the efficacy rate to be inconclusive and decide not to take the vaccines, then they effectively have made a rational decision. Telling them "Shut up and take the vaccine or we'll force you" disrespects their autonomy and will achieve the opposite of the intended effect.
Elizabeth Dorrance Hall, Ph.D. in Psychology Today describes the phenomenon as "our brain’s response to a threat to our freedom. Threats to freedom include any time someone suggests or makes you do something. Health communication experts note that reactance sometimes happens in response to health campaigns that tell people to quit smoking. Rather than reducing smoking behavior, these ads sometimes cause people to want to smoke more".
For many Americans, they see the mandate as a threat to their freedoms because it robs them of their autonomy. They see the mandate as the government saying, "You're too stupid to make your own decisions, so we're going to make them for you".
On top of that, autonomy contains multiple sub-principles, including informed consent, truth-telling, and confidentiality. The sub-principle that is being violated in this case is truth-telling. The vaccine mandate, itself, does not violate this principle, but rather the combination of the mandate and the government's mixed messaging prior to it.
According to Varkey (2020), "truth-telling is a vital component in a physician-patient relationship; without this component, the physician loses the trust of the patient. An autonomous patient has not only the right to know (disclosure) of his/her diagnosis and prognosis, but also has the option to forgo this disclosure". On top of that, the patient has the right to know the pros and cons of all possible treatments and non-treatment. While the government is not a physician, this principle still applies as this is a public health matter.
How has the government violated this specific sub-principle of autonomy? Here's Dr. Zubin Damania, MD., aka. ZDoggMD's explanation on how the government has frequently flip-flopped on the pros and cons of the COVID vaccines, giving Americans the impression that the vaccines don't work.
"They said, 'Guess what? If you're vaccinated, take your masks off. Live your life. Beautiful messaging... *Spongebob voice* '12 seconds later...', 'Nope! Just kidding! Psyche! There's a thing called Delta and you know what? Better mask up!' which sends this message: the vaccines don't work". (@2:10)
"So you're going to treat people like children. People who have been naturally infected who understands science, people who already feel outraged that you're violating their perceived rights of freedom and who've been the victims of misinformation and poor communication and mixed messaging. And you're saying, 'Do this and guess what you'll get in return? Jack! Nothing! Nothing! You'll get nothing in return!'" (@6:30)
When you keep sending mixed messages, it exacerbates the psychological reactance. People won't listen if you are not consistent and the Biden administration is facing the consequences of that.
Now contrast that with how Dr. Damania has handled emails and calls from people who are skeptical of the vaccines (@7:50). He treated them with respect and because he took the time to give them as much information as possible, he did a far better job than the Biden administration at persuading people to get the COVID vaccines. In other words, Dr. Damania respects people's autonomy.
Oh, and it doesn't help when the Biden administration is only requiring certain unvaccinated people to get the vaccines.
At first glance, it looks like it is reminiscent of Winter 2020 with the high amount of cases. However, if you look at the daily deaths, it's a whole different story. What's more important is the case fatality rate. You can calculate this by dividing the number of deaths over the number of cases and multiply by a large number (usually 100,000).
When you look at the daily cases, the summer spike is more similar to Winter 2020's than Summer 2020's. In contrast, the daily deaths summer spike more closely resembles Summer 2020's than Winter 2020's. Even without doing specific calculations, just looking at these two graphs reveals that the case fatality rate is lower this summer than during Winter 2020.
This is good news because not only are fewer people dying per 100,000 cases, but it also means more people are surviving from COVID infection, meaning more people who are naturally immune. A study by Gazit et al. (2021) discovered that naturally immune individuals have a lower risk of breakthrough infection and symptomatic infection than individuals who received two doses of the COVID vaccines. Even when accounting for waning immunity among both the naturally infected and vaccinated, "SARS-CoV-2 naïve vaccinees had a 5.96-fold (95% CI, 4.85 to 7.33) increased risk for breakthrough infection and a 7.13-fold (95% CI, 5.51 to 9.21) increased risk for symptomatic disease".
Another reason for the lower case fatality rate is that the high-risk demographics like the elderly or immuno-compromised have already gotten vaccinated or infected and recovered. As a result, the majority of the Delta cases are coming from low-risk demographics who recover and become naturally immune.
Did it require a government mandate? Did it require lockdowns? No, so what's the point of Biden's mandate when the Delta variant is already on its way down?
A few videos from Dr. Damania on the Delta variant and why it is not so bad.
As you can see, Biden's vaccine mandate is a fool's errand for a variety of reasons. It violates the core principle of autonomy which will only exacerbate psychological reactance among the individuals who are vaccine hesitant. The mandate was doomed to begin with because the government sent mixed messages far too often that Americans became suspicious of the government's intentions. Lastly, the case fatality rate throughout this summer is lower than that from last winter and last summer, meaning more people survive infection and become naturally immune which is a better line of defense than the vaccines.
If I were Biden, I would pull back the mandate and be less coercive. Instead, I would give strong recommendations among the unvaccinated individuals to consult their physicians because more likely, they will listen to their doctors than someone all the way in D.C. On top of that, I would place funding towards alternative COVID treatment research in case there are still many people who do not want to take the COVID vaccines. Doing so would fulfill the core principle of beneficence (i.e. providing the best possible care) as I want as many unvaccinated people to recover as possible for natural immunity.