The post-Covid-19 world is a surrealistic nightmare. Companies have been arbitrarily closed with no evidence that these shutdowns will save lives. Tens of millions of Americans have become unemployed as a result of these stalemates. There are already requirements for a compulsory Covid-19 vaccination before a vaccine is available. "Make vaccines free, avoid religious or personal objections, and create negative incentives for those who oppose vaccines that have been shown to be safe and effective." This is an empty statement as every vaccine available is neither 100 percent safe nor 100 percent effective. Based on the first study of the Russian vaccine in a very limited number of patients, it is not even clear that the vaccine will be safer than the disease itself.
Justification for mandatory vaccines
When a vaccine is 100 percent effective, there is no justification for compulsory vaccination. Anyone who wants to be protected can take the vaccine voluntarily. It would not be possible for someone who refuses the vaccine to harm someone who takes the vaccine voluntarily. Any request for a mandatory vaccine is an explicit admission that the vaccine is not 100 percent effective.
If a vaccine were 0 percent effective, there would be no justification for someone taking the vaccine. There needs to be an intermediate percentage of effectiveness that maximizes the benefits of mandatory vaccination. As the vaccine becomes more effective, fewer people may benefit from mandatory vaccination. If the vaccine becomes less effective, a lower percentage of people who could potentially benefit from mandatory vaccination will actually benefit from it.
For compulsory vaccination to be useful, the vaccine must be effective in some people who would not take it voluntarily (conscripts), that the vaccine be ineffective in some patients who would take it voluntarily (beneficiaries), and that the conscripts interact with beneficiaries that these interactions lead to additional infections despite other preventive agents, and that the additional infections lead to serious illness or death. That's a lot of ifs. There is no way of knowing what that optimal effectiveness would look like. There is no way of knowing how many forced vaccinations it will take to prevent infection or serious illness or death (number of people being treated). Since the number of people to be treated may not be known prior to vaccination, compulsory vaccination may not be ethical, even based on appropriate calculations.
An ideal vaccine induces an immune response that neutralizes a pathogen. The immune response can be antibody or T cell activity. Claims that a Covid-19 vaccine will prevent infection are not exactly correct. Immune responses are not like missile defense systems that destroy the missile before it reaches the body. A better analogy for an ideal vaccine would be to create an immune response that prevents invading pathogens from breaking through a wall using siege ladders or battering rams. The immune defense can only work if it is triggered by the presence of the invading pathogen. An ideal vaccine can neutralize the pathogen before it invades tissue cells, replicates in the tissue cells, enters the blood, invades distant organs, and causes clinical disease or death. The process of neutralizing the virus is not instant. So while the battle between immune defense and invading pathogen is taking place, the host is technically infected and can theoretically transfer the pathogen to others. The best we can hope for is to prevent clinical disease and minimize the amount of time the host can pass the pathogen on to others.
Studies of the Russian vaccine have not measured its effectiveness in preventing clinical diseases. The measure of "effectiveness" used was evidence of the antibody response to the vaccine antigen. However, there is no guarantee that the presence of an antibody will prevent infection, clinical disease, or death. There is no evidence that serious illness or death from Covid-19 is due to the lack of an antibody. Studies of the immune response in patients with Covid-19 show that patients with severe illness have higher antibody levels than patients with mild illness. There are concerns that the cytokine storm, which is due to an overly strong immune response rather than an underactive immune response, could be a major killer of Covid-19. The cytokine storm is a possible side effect of a vaccine. As always, the devil is in the details.
Vaccination advocates always mandate that the vaccine is safe. What is safe No vaccine can possibly be 100 percent safe. The elephant in the room is always: How big is the risk? The Lancet study on the Russian vaccine examined 76 subjects. There were 38 in the vaccine group and 38 in the control group. A study of this size would probably not show a 1/50 vaccine death rate. Fever occurred in 100 percent of a subgroup (20 subjects) and 31/38 subjects who received the active ingredient Gam = COVID-Vac. The ages in the study ranged from 18 to 60 years. The mean age of the subgroups was 25–32 years. Given the young age of the participants and the high percentage of asymptomatic Covid-19 cases in young patients, it is not clear that the vaccine was even safer than infection with the virus.
Alternative virus protocol HERE
A few decades ago, the Centers for Disease Control and Prevention decided to eradicate tuberculosis in the United States. The plan was to test everyone with PPD and treat all positive PPD patients with a drug called INH. This plan had to be stopped after fifty patients died of liver failure due to INH toxicity. Liver toxicity was overlooked in small clinical trials but discovered through the much larger public health program. Neither the CDC nor the Food and Drug Administration can know that a treatment or a vaccine is safe. The more people are vaccinated, the more side effects are discovered. This is a major ethical issue for compulsory vaccination. If everyone needs to be vaccinated, there is no control group to compare safety and effectiveness.
Proponents of compulsory Covid-19 vaccination assure the public that the vaccine is safe. Why did the government have to exempt vaccine manufacturers from liability for their vaccine prior to manufacturing? This is a clear case where one should ignore what the government is saying and watch what the government is doing. The government clearly knows something that is not being made available to the public. This is the opposite of transparency, but anyone who refuses to be vaccinated is classified as stupid, uniformed, or insufficiently concerned about their elderly neighbors.
Catastrophic tail risks
Some risks are not known in advance. Some risks will not manifest themselves until years later. Imagine a hypothetical situation where a vaccine causes sterility ten years later. There is no way to anticipate this risk. Imagine that all of humanity is vaccinated with this vaccine. Humanity would be wiped out when the last person dies. No matter how small the risk of an existential threat, why should humanity take this chance against something as common as severe flu? Instead of treating antivaxxers as a threat to civilization, we should be grateful that some people always volunteer to control our medical experiments by refusing treatment.
Markets offer the best solutions to complex problems
How effective will the vaccine be? How safe will the vaccine be? We don't even have an American vaccine to assess, but the authorities are calling for a mandatory American vaccination. Even when vaccination options are available, we have limited information about their effectiveness and safety. There are no objective answers about effectiveness and safety. So how can objectively correct decisions be made to balance risks and benefits? Markets offer the best solutions to these subjective questions. Just as markets determine value through the process of pricing, the only way to determine the balance between the risks and benefits of a vaccine can only be how many people willingly take the vaccine.
Vaccines are a wonderful insurance against the risk of infectious diseases. We are fortunate to have vaccines as options. However, compulsory vaccination can never be justified. Clearly, if a vaccine were 100 percent effective and 100 percent safe, no coercion would be required. People would volunteer to line up to take the vaccine. Real vaccines are never 100 percent effective or 100 percent safe. Judgments about risk and benefit can only be made by people who are exposed to the risk. People who refuse vaccines are neither stupid nor misinformed, nor do they have reckless disregard for their neighbors. Vaccine advocates who are disappointed with the number of people willing to accept the vaccine should stop blaming those who reject and reevaluate their poor persuasiveness. Vaccine skeptics are required as controls for ongoing evaluation of effectiveness and safety. Vaccine skeptics are necessary to hedge against catastrophic mistakes by experts.
Gilbert Berdine, MD
Gilbert Berdine is Associate Professor of Medicine at Texas Tech University's Health Sciences Center and a member of the Free Market Institute at Texas Tech University.