HOW TO SAVE LIVES

Vaccine mandates are controversial. They’re also an effective way to save lives.

By David Leonhardt and Ian Prasad Philbrick | The New York Times
July 23, 2021

How to save lives
Vaccine mandates are controversial. They’re also effective.

• Before Houston Methodist became one of the first hospital systems in the U.S. to mandate Covid-19 vaccines, about 85 percent of its employees were vaccinated. After the mandate, the share rose to about 98 percent, with the remaining 2 percent receiving exemptions for medical or religious reasons, Bloomberg’s Carey Goldberg reported. Only about 0.6 percent of employees quit or were fired.


• Schools — including Indiana University and many private colleges — that require students and workers to get vaccinated have reported extremely high uptake.


• A recent Kaiser Family Foundation survey of Americans who had been opposed to getting vaccinated and later changed their minds found that mandates — or restrictions on the unvaccinated — were one common reason. One 51-year-old man told Kaiser that he began to feel as if he had “limited options without it.”


• The French government will soon require that people show proof of vaccination or a recent negative test to eat at a restaurant, attend a movie or participate in many other activities. After President Emmanuel Macron announced the policy last week, the number of vaccine appointments surged. Italy announced a similar policy yesterday, The Times’s Marc Santora explains.

It’s true that these mandates often generate intense criticism. In France, more than 100,000 people marched to protest Macron’s policy. In the U.S., critics sued, unsuccessfully so far, to stop Indiana University’s mandate. Some Republican politicians have also tried to stop mandates, including Gov. Ron DeSantis of Florida and Gov. Mike DeWine of Ohio.

The mandates are also not 100 percent effective. Some people will receive exemptions, as was the case at Houston Methodist. A small number may forge vaccine records. And some vaccinated people will still contract mild versions of Covid, through so-called breakthrough infections.

But even with the opposition and the exceptions, mandates can play a major role in reducing the spread of Covid and saving lives. That’s especially true now that the Delta variant is fueling a rise in cases. “The takeaway message remains, if you’re vaccinated, you are protected,” Dr. Céline Gounder, an infectious disease specialist, told our colleague Apoorva Mandavilli. “You are not going to end up with severe disease, hospitalization or death.”

A ‘staggering’ success

Covid is a new disease, and the debates over Covid policy can seem new, as well. But they’re often not wholly new. They instead echo longstanding debates. Vaccine mandates fall into this category.

Throughout history, societies have struggled with when and how to require vaccines. Opponents of mandates have argued that individuals should be allowed to make their own health decisions — and bear the consequences: What, they ask, is more personal than deciding whether to inject a medicine into one’s body? Supporters of mandates have replied that society has a duty to protect its citizens, including those who cannot be inoculated (like young children and some immunocompromised people, in the case of Covid) and are therefore put at risk by people who voluntarily refuse vaccines.

For these reasons, vaccine mandates cause intense disputes. But when supporters win the argument, public health has often benefited. Guy Nicolette, an administrator at the University of California, Berkeley, pointed out to The Washington Post that colleges have long required other vaccines, like the one for measles. “It’s staggering how well a mandate works on a college campus,” he said.

Dr. Aaron Carroll, Indiana University’s chief health officer, has noted that the country’s victories over many diseases — including smallpox, polio, mumps, rubella and diphtheria — have depended on vaccine mandates by states or local governments. “That’s how the country achieves real herd immunity,” Carroll wrote in The Times. (In the U.S., a national mandate may be unconstitutional.)

When states and school districts have opted not to require vaccines, a disease can often spread needlessly, Carroll explained. That has been the case with human papillomavirus, a sexually transmitted disease known as HPV that can cause cancer. It’s also been the case with influenza, which kills about 35,000 Americans in a typical flu season.

Covid now seems certain to join influenza and HPV as diseases that American society chooses to accept. But it is a choice. Companies, schools and communities that decide to enact vaccine mandates will almost certainly save American lives by doing so.

Mark Barnes, a former health official in New York City, told Bloomberg that he expected the number of these mandates to grow in coming months. “We’re going to see more vaccine mandates by large organizations of all kinds,” he predicted.

Link to original article:

https://www.nytimes.com/live/2021/07/23/world/covid-variant-vaccine-updates#vaccine-mandates-are-controversial-theyre-also-effective

Why you can't compare Covid-19 vaccines: What a vaccine's "efficacy rate" actually means

Nicely and clearly explained: why all the vaccines will work...if people will just take them!

https://www.vox.com/

Reasons To Be Optimistic About The Vaccine

We explain why the vaccine news is better than you may think.

by David Leonhardt
January 18, 2021 for New York Times

‘We’re underselling the vaccine’
Early in the pandemic, many health experts — in the U.S. and around the world — decided that the public could not be trusted to hear the truth about masks. Instead, the experts spread a misleading message, discouraging the use of masks.

Their motivation was mostly good. It sprung from a concern that people would rush to buy high-grade medical masks, leaving too few for doctors and nurses. The experts were also unsure how much ordinary masks would help.

But the message was still a mistake.

It confused people. (If masks weren’t effective, why did doctors and nurses need them?) It delayed the widespread use of masks (even though there was good reason to believe they could help). And it damaged the credibility of public health experts.

“When people feel as though they may not be getting the full truth from the authorities, snake-oil sellers and price gougers have an easier time,” the sociologist Zeynep Tufekci wrote early last year.

Now a version of the mask story is repeating itself — this time involving the vaccines. Once again, the experts don’t seem to trust the public to hear the full truth.

This issue is important and complex enough that I’m going to make today’s newsletter a bit longer than usual. If you still have questions, don’t hesitate to email me at themorning@nytimes.com.

‘Ridiculously encouraging’ 

Right now, public discussion of the vaccines is full of warnings about their limitations: They’re not 100 percent effective. Even vaccinated people may be able to spread the virus. And people shouldn’t change their behavior once they get their shots.

These warnings have a basis in truth, just as it’s true that masks are imperfect. But the sum total of the warnings is misleading, as I heard from multiple doctors and epidemiologists last week.

“It’s driving me a little bit crazy,” Dr. Ashish Jha, dean of the Brown School of Public Health, told me.

“We’re underselling the vaccine,” Dr. Aaron Richterman, an infectious-disease specialist at the University of Pennsylvania, said.

“It’s going to save your life — that’s where the emphasis has to be right now,” Dr. Peter Hotez of the Baylor College of Medicine said.

The Moderna and Pfizer vaccines are “essentially 100 percent effective against serious disease,” Dr. Paul Offit, the director of the Vaccine Education Center at Children’s Hospital of Philadelphia, said. “It’s ridiculously encouraging.”

The details

Here’s my best attempt at summarizing what we know:

*The Moderna and Pfizer vaccines — the only two approved in the U.S. — are among the best vaccines ever created, with effectiveness rates of about 95 percent after two doses. That’s on par with the vaccines for chickenpox and measles. And a vaccine doesn’t even need to be so effective to reduce cases sharply and crush a pandemic.

*If anything, the 95 percent number understates the effectiveness, because it counts anyone who came down with a mild case of Covid-19 as a failure. But turning Covid into a typical flu — as the vaccines evidently did for most of the remaining 5 percent — is actually a success. Of the 32,000 people who received the Moderna or Pfizer vaccine in a research trial, do you want to guess how many contracted a severe Covid case? One.

*Although no rigorous study has yet analyzed whether vaccinated people can spread the virus, it would be surprising if they did. “If there is an example of a vaccine in widespread clinical use that has this selective effect — prevents disease but not infection — I can’t think of one!” Dr. Paul Sax of Harvard has written in The New England Journal of Medicine. (And, no, exclamation points are not common in medical journals.) On Twitter, Dr. Monica Gandhi of the University of California, San Francisco, argued: “Please be assured that YOU ARE SAFE after vaccine from what matters — disease and spreading.”

*The risks for vaccinated people are still not zero, because almost nothing in the real world is zero risk. A tiny percentage of people may have allergic reactions. And I’ll be eager to see what the studies on post-vaccination spread eventually show. But the evidence so far suggests that the vaccines are akin to a cure.

Offit told me we should be greeting them with the same enthusiasm that greeted the polio vaccine: “It should be this rallying cry.”

The costs of negativity

Why are many experts conveying a more negative message?

Again, their motivations are mostly good. As academic researchers, they are instinctively cautious, prone to emphasizing any uncertainty. Many may also be nervous that vaccinated people will stop wearing masks and social distancing, which in turn could cause unvaccinated people to stop as well. If that happens, deaths would soar even higher.

But the best way to persuade people to behave safely usually involves telling them the truth. “Not being completely open because you want to achieve some sort of behavioral public health goal — people will see through that eventually,” Richterman said. The current approach also feeds anti-vaccine skepticism and conspiracy theories.

After asking Richterman and others what a better public message might sound like, I was left thinking about something like this:

We should immediately be more aggressive about mask-wearing and social distancing because of the new virus variants. We should vaccinate people as rapidly as possible — which will require approving other Covid vaccines when the data justifies it.

People who have received both of their vaccine shots, and have waited until they take effect, will be able to do things that unvaccinated people cannot — like having meals together and hugging their grandchildren. But until the pandemic is defeated, all Americans should wear masks in public, help unvaccinated people stay safe and contribute to a shared national project of saving every possible life.

Link to original article:
https://www.nytimes.com/2021/01/18/briefing/donald-trump-pardon-phil-spector-coronavirus-deaths.html