2. That same source lays out why worrying about this risk is not rational (in this case)
3. No-one is seriously calling for forced vaccination for corona
4. (my opinion) by over-emphasizing the "personal choice" angle we are letting anti-vaxxination pseudo science and conspiracy beliefs spread without being challenged. Some things are more wrong than others and the science for the harm of vaccines has oveerwhelmingly failed to arrive. So using the term "without anti-vaccination beliefs" is fair in this case, since I will argue the only reason why you'd reject a vaccine that is recommended by a physician is an irrational belief not grounded in evidence
> No-one is seriously calling for forced vaccination for corona
There will be de facto mandatory vaccination, to a degree. This is a Canadian news source but read about the companies involved with creating this program (by the way—-it’s not Ticketmaster). It is definitely coming to America and already underway.
No coronavirus vaccine, no entry? Experts say it’s possible in pandemic’s next stage
In Europe, mandatory vaccinations do exist in some countries, for both children and adults. Also, in Croatia (which is part of the European Union), if you refuse to have your child vaccinated, it is legally considered to be child abuse. In Croatia, they have school doctors that literally come to the schools with nurses that not only ensure the health of all of the kids, but also have them vaccinated there. Homeschooling is also illegal in Croatia.
>>The New York State Bar Association (NYSBA) is recommending that the state consider mandating a COVID-19 vaccine once a scientific consensus emerges that it is safe, effective and necessary.
It is also not definitive that the 532 cases of Guillan-Barré were actually caused by the vaccine. In any large scale vaccination effort people die/get sick just because that is what happens in any large population.
> No-one is seriously calling for forced vaccination for corona
Define forced. I'm not in favor of pinning people down and forcibly injecting them with something, but I am all for some kind of vaccination "passport", where if you don't have proof of vaccination you stop enjoying the benefits of society. No public schools or services, right for businesses to refuse service, etc. Or at the very least, a heavy tax fine or something a long those lines.
If people choose to not get a vaccine, that's fine. But its time we align incentives to eliminate these externalities being born from societal free-loaders who believe in quack-science.
In response to 3, many rational people are. And I agree with them. We have mandatory vaccinations for MMR and for dTAP. Have you ever heard of anyone catching diphtheria? A reasonable risk profile puts COVID-19 at higher risk than whooping cough, as the chances of getting it are so much higher, even if the fatality rate is lower.
"Mandatory" vaccination for children in the USA usually aren't: all states allow exemption for true medical reason, and [edit: --some--] almost all allow exemption on religious grounds. Sixteen allow exemption for parental objection.
> We have mandatory vaccinations for MMR and for dTAP. Have you ever heard of anyone catching diphtheria?
Not specifically, but DTaP vaccinates against pertussis which has seen epidemic-level outbreaks in the past decade in multiple states.
I'd expect any SARS-CoV-2 vaccinations to be targeted at adults for the foreseeable future, but who knows.
> I did find a a source of 532 developing Guillan-Barré
You should have mentioned that the 532 cases of Guillan-Barré were found within the 48 million people receiving the swine flu vaccine.
Accordig to Wikipedia, the incidence of Guillam-Barré is about 2 per 100,000 people per year.
Statistically speaking, your example suggests that taking the swine flu vaccine is linked with a lower incidence of Guillam-Barre syndrome, nearly lowering it to about 60% of the baseline.
If we're allowed to play fast and loose with back-of-the-napkin statistics, your example contradicts your original claims, and indeed makes a strong case in favour of vaccination.
Physicians recommend many drugs that end up proving to have dangerous side effects. The anti-inflamatory Vioxx is just one that comes to mind without doing any research.
That's like saying that there have been unsafe cars in history without understand which cars and why and why they're unsafe.
There's a lot of unsafe stuff, but this example is so absurdly generalized that it seems either malicious or just so ignorant that it's not even a worthy position to take.
I've had lots of vaccines in my life, the thing is, all those were for diseases that had a high risk of crippling or killing me.
Why would I want a vaccine that is actually less effective than my chances of surviving?
If I get the vaccine, there's a 95% chance it'll work, if I get covid, there's a 97% chance i'll live.
All I know is, if you told someone they had a 97% chance of winning at a casino, they'd be down there in a flash.
Why would I choose to have some barely tested vaccine with not fully studied long term side effects made by companies who have extremely poor track records with medication in general?
Pfizer is bascially responsible for the oxycontin epidemic. Their reps bribe doctors into pushing their drugs.
Moderna's some secretive biotech company that just appeared out of nowhere with this whole covid thing.
What reason do I have to trust any of these companies over the 97% survival rate I can expect from getting covid?
It's the other way around - for any given chance of you getting COVID, there's a (to use your number) 3% mortality rate - if you take the vaccine - that outcome changes because you now have much smaller risk of infection, to 0.15% chance.
Your choice is between 3% and 0.15% - not 95% and 97%.
I don't think this individualistic way of looking at things is sound, though. First 3% mortality sounds way high - even given health system collapse (basically turning every ventilator survivor into a dead patient).
And on the other hand, mostly the old and those with pre-conditions will die - we alltake the vaccine to protect everyone. That way we might avoid a population wide 0.5% (or thereabouts) mortality rate.
That would still 1 in 200 - most people would likely know a handful of people dying from the disease if there's no mitigation.
> Your choice is between 3% and 0.15% - not 95% and 97%.
I would put it differently: if we become covid carriers, we become spreaders. Those 3% are, thus, applied to a large population comprised of everyone we interact ina daily basis.
Thus even if at most the likelihood that we die of covid is only 3% tops, the likelihood that at least one person that catches covid from us does is proportional to the number of people we infect.
With a 3% fatality rate, the likelihood that at least one person we infect will die can reach 80% if we spread it to over 50 people.
If we infect someone over 60, the likelihood that they will die from covid grows from that 3% to about 20%.
So unless you are infected while living in a bubble, the real risk is far higher.
I live in a US state with essentially no lock down measures in place. Companies around me are going out of business by the dozen. These companies are not going out of business due to any government mandate they are going out of business because of economic uncertainty and people not spending as they dont want to go to places and potentially get sick. I used to spend ~$500 a month on eating out, I spend almost zero now as I dont want to take the risk. This has nothing to do with government choices and fully to do with mine. Now multiply this by tens of thousands of other people making the same choice and you will understand why an effective widely used vaccine is important for an economic recovery. Until the virus is under control I and many others will severely curtail our spending and there will be only a limited economic recovery.
In addition I dont go out as I have elderly relatives who I dont want to sicken, they dont expect it, its my choice. So blaming others for being selfish is really missing the point and is an illustration of not really understanding the current economic situation.
Your point is perfectly true, but there is also one more thing to consider. It is possible for the health care system to get overworked like they did in NYC and North Italy. There are signs it could happens in other places in the US now like Wisconsin.
At that point everything else suddenly becomes critical, because there is no ICU left.
Also, at least in CA, doctors/hospitals/dentists etc are only doing what is critical right now to avoid the whole hospital going into lockdown. That has large consequences for health outcomes and for the economy of those practises.
To add some data to that: there is a correlation between disease spread and GDP reduction, and it's the one that consistent with your anecdote: The economic impact is greater where the disease is left unchecked :
(unfortunately, the graph doesn't include countries like china, vietnam, and many other asian countries, because that would make the trend even clearer.)
average of 17 pedestrians are killed by cars in the US every day (data from 2018). Over 1,000 people per day are dying from covid in the US. So your odds of dying crossing the road on any given day are actually far, far less than your odds of dying from covid...
I think it's easy to look at a mortality rate of half a percent, and think "no big deal" - but it really is. One in every 200 people dying would mean most of us have a close connection to a couple of victims.
And there's already more dead from covid-19 in the US than casualties during the Vietnam War. Granted, more elderly people than young, but it's still a bit difficult to accept that it's insignificant.
Add to this what could happen with an exponential surge, with icus being over-run - and a) you'd end up being more likely to die from other causes, like a traffic accident - and b) many of the current covid-19 survivors would end up as casualties.
You sound like a child. No one is panicking, the problem is it's killing people and hospitalizing even more people to the point of overrunning hospitals.
Very very few hospitals have actually been overrun. Many were and still are empty (or flooding in with people who couldn't get treatment for other things during the lockdowns). The cases in NYC, Michigan and Kirkland (Seattle) were all due to orders that packed elderly care facilities with sick. Governors Whitmer and Cuomo made huge mistakes with their orders and neither is owing up to it.
The problem is that with the infection spreading exponentially you might have hospitals half empty one day and at 200% a week later.
Here in Czech Republic it looks like we managed to avoid running out of capacity during the ongoing second wave, but just. The measures taken included canceling any elective and non-life-threatening surgeries, drafting medical school students, many foreign doctors that came to help and moving covid patients in critical state from overloaded hospitals hospitals.
We even built two full field hospitals which we will thankfully not need as it looks like. BTW, building one of them took about a week - which you migh not have, once you hit exponential growth. Not to mention having spare medical personnel to run it.
> Why would I want a vaccine that is actually less effective than my chances of surviving?
Well, the vaccine hopefully doesn't kill you if it's ineffective, so the numbers aren't exactly comparable.
The reasoning in this comment is wild. Let's take it back to the math a moment:
Let's take your 3% chance of death (actually the population survival rate is significantly higher IIRC, but OTOH there's long haul COVID to consider too). If the vaccine is 95% effective, all else being equal you have a 3% chance of death without the vaccine, and a 0.15% chance of death with the vaccine. So the question becomes: is there a greater than 2.85% chance of the vaccine killing you or doing you crippling injury? If not, you're probably better off taking the vaccine.
Numbers depend on the age. Bulk of deaths are concentrated in older populations. CDC recently updated estimated infection fatality rates for COVID. Here are the updated survival rates by age group:
The CDC updated their pandemic planning scenarios[0] based on earlier studies in Europe plus some educated guesswork using data collected from the US through August 8. The numbers which you represent as the CDC’s sole official estimate of true IFR are only one of three possible sets of parameters that they provide for scenario modelling. Furthermore, the footnote on these estimates states “The estimates for persons ≥70 years old presented here do not include persons ≥80 years old”, since the underlying study they base the model on assumed that CFR = IFR for people ≥80 years old. Why they label this 70+ instead of 70–79 is beyond me, and I have no idea how sound the methodology is that they used to derive these estimates.
I would also mention that there are studies in peer review on patient populations in the United States which suggest IFRs closer to CDC planning scenario 4/5 than 3—for example, this one from Connecticut[1]:
We all hope for the best—that the lower bounds are true—but I think we should also be prepared for the reality that the upper bounds might be the correct ones, and act conservatively.
Also, you know, all IFR estimates assume that patients will actually be able to access care. Without hospitals, IFR approaches IHR, and the hospitalisation rates from the Connecticut study are grim: 0.8%, 2.68%, 3.09%, 12.43%, and 79.89%.
" if you told someone they had a 97% chance of winning at a casino, they'd be down there in a flash"
this is a bad analogy, what if you also told them that if they lost they were taken out back and shot? I bet a lot fewer people would show up. In this particular case, winning just means not dying, if I could increase my odds of not dying I would probably do so.
Also there is no proof that getting covid grants lifetime immunity, so lets assume immunity lasts a year, every year you now have a 3% chance of dying from covid using your numbers. 3% is not that low, there is a ~3% chance of rolling double sixes with 2 dice, and that happens all the time.
Your IJME link does not support in any way your assertion about the "danger" of the HPV vaccine. From the link, 30,000 were vaccinated. Three girls died for reasons that are never stated. The article provides that "there is no conclusive evidence of a causal link between the vaccine and the deaths."
I take the general gist of some of your points, but it might be worth reframing some of your logic. To take just one point, let's go to the casino: you have a 97% chance of winning...pretty great! The downside is that if you lose, we take you out back and shoot you. Do you still want to go?
Looking at your individual risk profile is a good way to decide who ought to get vaccinated first its a poor way to decide who gets vaccinated at all. There are some parties including those who are too young to vaccinate or who have poor immune systems whom are only protected by the surrounding population not passing around virii like baseball cards.
Having a large enough host population to sustain an outbreak means those vulnerable parties are fucked and the rest of the population even those for whom the vaccine is 90% effective are at still at some risk. Worse the selection pressure among millions of vectors to develop a strain that can infect the previously safe population is high and the possibility is real.
This is to say that the proper assessment of safety is the likely net effect on the entire population of an increasingly large portion of society not vaccinating.
Existing precedent would seem to suggest that its impossible to force you to vaccinate but possible to prevent you from participating in society if you do not. For example the state can put you in jail for not putting your kid in school but not let you do so unless you vaccinate your kid.
I would not be terribly surprised if people, especially vulnerable people argued that a work allowing anti vaxxers to work alongside them violated their right to a safe workplace.
Imagine one lawsuit from someones family that lost a baby or a family member resulting in an 7-8 figure settlement. There wont have to be a law. The lawsuits will be from anti vaxxers alleging that this violates their rights and will take place over the following 2 years after every major workplace in America adopts such rules giving American workers the choice between employment and remaining an antivaxxer.
I'm not anti-vax by any means, but I would rather have 3 months of outcomes from widespread deployment prior to being vaccinated or having my low-risk family members be vaccinated.
That this vaccine is mRNA-based makes it likely safer than some other lightly-tested vaccines, but if you're young, healthy, and at low-risk of serious COVID infection, I'm not sure it's wise to be among the first in line for this vaccine.
Yes, of course it is, provided that the vaccine that I take would otherwise go un-given in that 3 month period. That seems unlikely to me as we are likely to be vaccinating as many people as we can manufacture doses during that period and the difference is "which" rather than "how many".
I leave my house about once a week, wearing a mask, to spend 20 minutes grocery shopping. My risk of contracting, contracting and dying from, or contracting and spreading the disease is extremely low and quite possibly lower than leaving that dose for someone else who is leaving their house and being around people more than 4 hours in those 3 months. Bonus is that someone at higher risk gets "my" dose and I get 3 additional months of population-wide study of safety, side-effects, and efficacy.
You're fine then, because the young, healthy and low-risk won't be able to access any vaccine for months after higher-risk people. It's probably closer to a year before the really low-risk people get any.
A little, but when you are talking about my baby that is going to the part with older kids. A lot of kids do look at my baby first learning to crawl and run up to get a close look.
Agreed. I think vaccines are generally a good idea, but that there are risks involved in beta testing them.
Also, there are some interesting treatments targeting the ACE2 receptors that SARS-CoV-2 binds to which looks like they are reducing mortality rates, and perhaps long-term scarring in the lungs. Among these are Vitamin-D (which people are probably nutritionally-deficient anyways), and human recombinant soluable ACE2 (basically, injecting a form of ACE2 into the body so that the virus binds to that, instead of to cells with a lot of ACE2 receptors, thus short-circuiting the replication pathway). I would be interested to see if nutritionally-sufficient vitamin-d is better at preventing severe cases of covid-19 than masking or social distancing.
My own opinion is that it is foolish to pin all the hopes on a single strategy (prevention, via vaccination), which is not guaranteed to work or guaranteed to be safe. To add forced vaccination is folly. I think it is better to see a depth of prevention and treatment options (including vaccination).
The study described findings of antibody-dependent enhancement with the original SARS. I am no expert, but my understanding is that when test subjects were given the vaccine, and then later 'challenged' by the SARS virus, they developed a pathological response. In other words, taking the vaccine had a potential to make their response to SARS and potentially other coronaviruses worse.
The study I linked therefore recommended caution in giving the vaccine to humans.
Obviously this is something that vaccine researchers are aware of (see https://www.nature.com/articles/s41564-020-00789-5), but I think it's something that is perfectly rational to be concerned about given the time and money pressures available with SARS-CoV-2 vaccination.
There won’t be enough vaccines to go around, so no one will be forced to take anything for at least a year. By then we might be at 60-70% of the population vaccinated, at which point the R0 of the virus would be much lower.
Don’t worry about it for now, the rest of us will take the risk so you don’t have to.
I feel like we are about to enter the variation on the prisoner's dilemma where we all get a massive benefit if at least 70% of us get the vaccine, but getting the vaccine has a cost (please roll a D20 to select your random side effect) so everyone has an incentive to be one of the shirkers.
I foresee things getting ugly as we collectively all get together to shame, bully and trick the shirkers into compliance.
The immunocompromised and the economy get a benefit if we get to 70% vaccinated; I get a benefit for myself just by getting the vaccine.
I’ll allow that there is seemingly a significant portion of the population who believes they don’t personally benefit from a vaccine, but your comment said -everyone- is incentivized to shirk: that’s just not true.
That is fair. But I think that the fraction of people who individually benefit from getting the vaccine is less than the 70% who need to get it, do there's going to be a gap that will need to be filled with lies, bullying and shaming.
Of course this depends on the unknown factor of how bad the side effects are, if they are nonexistent then it's a different story, but if they are on average as bad as a flu shot then it becomes tricky.
I suppose I'm really thinking in the context of countries like Australia which have essentially eradicated the virus. My risk of getting the virus right now is practically zero, so my only incentive to get vaccinated is that we can eventually reopen our borders once enough people are vaccinated. And personally I'm in no hurry to get flooded by foreign tourists anyway.
This is not how the Prisoner's dilemma works since not getting the vaccine is not a purely dominant strategy. You are neglecting to adjust the vaccination scenario payout to account for the fact that you personally are much less likely to get Covid-19 if exposed to someone infected. This benefit largely exceeds any cost of receiving the vaccine based on current data.
This is not a prisoner's dilemma. The expected payoff if you get vaccinated is still far higher than the cost, whatever the rest of the population does, so you can ignore the cost in your calculation. It's like if the situation for the prisoner was that if you stay silent you go free, but if you both stay silent you both go free and the rest of your gang gets a reduced sentence too. Why would you ever defect?
The alternative is a high chance of becoming ill with COVID, which according to the data available so far is much riskier than the vaccine (1-2% hospitalization risk even for healthy young adults, evidence of long term issues at least in some people).
Unless of course your alternative plan is full isolation for years, in which case not taking the vaccine is the correct choice, but such isolation is only reasonable if you don't care about going outside anyway at all.
There looks like treatments developing that can reduce the mortality or severity of COVID after contracting it, including possibly reducing long-term scarring from it. These treatments are coming out of better modeling and understanding on how COVID spreads in the body and kills people.
It isn't so binary or black and white -- vaccinate or risk dying. We're starting to get other options.
I’m not scared of a vaccine. I am not sure what words I used to give you that impression.
I do see a lot of people fixating on vaccines as if it will make everything better. Vaccines will help, but better if there are other treatments as well. I think that if mortality rates and long-term scarring decreases, then people won’t feel like their survival depends upon other people’s cooperation.
Presumably because any side-effects of new COVID treatments would only affected those who get a serious form of COVID while any side-effects of a vaccine would be applied to the entire population.
Some of those options, like monoclonal antibodies, are extremely expensive and hard to produce and distribute at scale, plus they only work early in the course of the disease. I'm not aware of any small-molecule drugs that have hopes of great efficacy on the horizon. You're not going to pump out 150K/day doses of MABs.
It really is vaccinate or risk dying. The other options are too expensive, too timing-dependent or too ineffective.
Vaccines are the only way we can end the pandemic though. However great a treatment is, it won't stop anyone catching it or spreading it. If we're to be able to go back to anything resembling normal, we need to stop widespread transmission in the population, and the only way to do that without these restrictions is for an effective sterilising vaccine.
The strong asymptomatic spread of this virus, however, makes these decisions more complicated and less individualistic than “what happens to me if I catch it”.
There's a recent quasi-exprimental study on that, showing that vitamin-d is likely one of the central factors in better outcomes for severe cases of covid-19:
According to this study, vitamin-d gives better outcome than the other treatments, including hospitalization:
"Regarding care dedicated to COVID-19, only the proportion of patients who received a bolus of vitamin D3 during or just before COVID-19 differed between deceased participants and survivors, with a higher prevalence in survivors (respectively 92.2 % versus 66.7 %, P = 0.023). In contrast, there was no between-group difference in the proportion of patients treated with corticosteroids, hydroxychloroquine or dedicated antibiotics, or hospitalized for COVID-19."
And this has to do with Vitamin-D's role with the ACE2 receptor. SARS-CoV-2 has a binding affinity to ACE2, aggressively invading cells with proportionally higher ACE2 receptors (including the lungs).
In fact, someone had tried injecting hrsACE2 into someone as a treatment -- that is, letting the virus bind to hrsACE2 instead of the ACE2 receptors in the cells.
A treatment with hrsACE2 isn't generally-available, and needs a lot more study. The logsitics in producing them at scale would need to be solved, if this is a viable treatment. But this looks promising to me.