A Rational Perspective – Onne Vegter unpacks the case FOR mandatory vaccines
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A Rational Perspective – Onne Vegter unpacks the case FOR mandatory vaccines

Onne Vegter’s brother, journalist Ivo, is better known when it comes to writing and, indeed, unpacking facts as they relate to the pandemic. As you’ll read below, however, both are competent wordsmiths and capable of interpreting complex issues in a way that we can all understand. Onne, an entrepreneur whose formal education is in biological science, takes the unusual approach of offering both sides of the Mandatory Vaccine issue. Here’s his case for the prosecution. – Alec Hogg

Onne Vegter

By Onne Vegter*

Mandatory vaccination against Covid-19 has become a highly emotive and divisive issue. Throughout 2021, as the Covid-19 pandemic raged on despite the biggest mass vaccination campaign in history, the world became divided into two distinct camps – the vaccinated, and the unvaccinated. A certain portion of the world’s population remains unvaccinated due to lack of access to vaccines. But a surprisingly large number of people have remained unvaccinated by choice.

To combat vaccine hesitancy, mandatory vaccination has been proposed and implemented globally to various degrees. Some countries have gone with the carrot approach, promising greater freedoms to vaccinated citizens. Getting jabbed would ostensibly allow you to travel, enter public venues, attend sports events or use public transport. You won’t be forced, but refusing the jab would greatly curtail your freedom to participate in society. Others, like Austria, have gone with a more authoritarian “stick” approach. From February 2022 it is compulsory for everyone to get a Covid-19 vaccine. The unvaccinated would be locked down, to keep them from infecting others. Depending on your country of residence, refusing vaccination might see you fined, banned from venues and public transport, or even arrested and interned in some kind of containment camp.

Historical precedent

Vaccine mandates are nothing new. There is historical precedent for mandatory vaccination. In several countries, many childhood vaccines are compulsory. Smallpox vaccines were compulsory in the UK until 1947, after which educating people became the preferred way to persuade citizens to get vaccinated. Yellow fever vaccines are compulsory in order to travel to or from the tropics, where yellow fever is endemic.

The overriding justification for vaccine mandates is the idea that compulsory mass vaccination is for the common good, as it contributes to herd immunity. A sufficiently immunised population is better able to conquer an infectious disease than a population with low levels of vaccination. If mass vaccination with a safe and proven vaccine is able to end a pandemic and save lives, it is perfectly reasonable to support the idea of mandatory vaccination to achieve this goal, as long as valid exemptions are permitted.

In the case of Covid-19, the justification for mandatory vaccination centres around the idea that the Covid-19 vaccines are our only way out of this pandemic. We need to achieve sufficiently high levels of vaccination to reach population immunity. Mandates are premised on the belief that the unvaccinated present a risk to the vaccinated, and that insufficient levels of vaccination will prolong the pandemic by keeping herd immunity out of reach, resulting in new waves of infection which will once again put pressure on the healthcare system and on the economy.

Importantly, these arguments only make sense if the vaccine is able to prevent infection and transmission to a significant degree. If vaccinated people are less likely to require hospital care, and also less likely to get infected and transmit the virus, it is easy to conclude that vaccinated people are safer to be around than unvaccinated people. This is the crux of the case for mandatory vaccination.

When is mandatory vaccination appropriate? 

Mandatory vaccination is a reasonable policy for the common good if the following requirements are met: 

  1. The vaccines are properly trialled and tested, and fully approved by regulatory bodies.
  2. The vaccines are effective at preventing infection and transmission by inducing substantial sterilising immunity.
  3. The vaccines are overwhelmingly safe and present negligible risk of harm to the person receiving the jab.
  4. No other reasonable alternatives exist to prevent or treat the disease. 
  5. The risk or disease being immunised against is sufficiently serious that failure to achieve herd immunity through mass vaccination will result in significant loss of life at an unacceptable scale.

As an example, annual vaccines against common strains of influenza are available but have never been mandated except in certain public health settings, because they do not meet all of the above criteria (point #5 in particular).

As it stands, many governments, public health agencies and large corporations around the world have come out in favour of mandatory vaccination, and feel that the above five criteria have adequately been met by the available Covid-19 vaccines. While mandatory vaccines might impose on the idea of bodily autonomy and a person’s right to choose what medical procedures they submit to, the public health benefit or “greater good” argument outweighs the rights of the individual.

What about exemptions?

One question that remains is on what basis exemptions should be permitted. 

Medical exemptions are necessary in some cases. There are people for whom vaccination is medically contra-indicated and might present a grave risk. Those individuals should be able to get a medical exemption letter from their doctor, and be free to participate in society without restrictions. 

Should natural immunity count the same as vaccine immunity?

Another exemption category might involve people who have recovered from Covid-19 and have natural immunity. An August 2021 study from Israel found that “natural immunity confers longer lasting and stronger protection” than vaccine induced immunity. The study found that the rate of breakthrough infections among fully vaccinated people was about 13 times higher than the rate of reinfections among unvaccinated people who had previously recovered from a Covid-19 infection. 

I should point out that this conclusion was later contradicted by a CDC study which found the exact opposite, claiming that vaccine induced immunity offers better protection than natural immunity. By some convoluted adjustment and statistical gymnastics, the authors concluded that the odds of getting reinfected after previously recovering from Covid-19 was about five times higher than the odds of testing positive after being fully vaccinated. From the raw data they presented, however, I was unable to understand how they arrived at this conclusion. Looking at 94,264 hospital patients who had Covid-like symptoms and were tested twice for Covid-19, they found 1,020 hospitalisations among previously infected and unvaccinated persons, and 6,328 hospitalisations among fully vaccinated and previously uninfected patients. Among these, only 89 of the 1,020 previously infected patients tested positive (confirmed reinfections), while 324 of the fully vaccinated 6,328 tested positive (confirmed breakthrough cases). At first glance, this appears to confirm the findings of the Israeli study, which found significantly more cases of breakthrough infections among the fully vaccinated, than reinfections among the recovered. The authors mention that the adjusted odds ratio took into account several circumstantial factors that might influence the odds of testing positive, but they fail to clarify how they calculated their adjusted odds ratio to arrive at their conclusion.

Another study among employees of the Cleveland Clinic Health System found that individuals who have recovered from Covid-19 are unlikely to benefit much from vaccination: “Not one of the 1359 previously infected subjects who remained unvaccinated had a SARS-CoV-2 infection over the duration of the study.” This means, for recovered people who are forced to get vaccinated, that they have to accept the risks of vaccination (however small) without any meaningful benefit. It is reasonable to argue that if a policy of mandatory vaccination is followed,  recovered people should therefore be exempt from the mandate, if natural immunity following recovery is indeed equal to or better than vaccine-induced immunity. 

Resistance to mandates

Resistance to Covid-19 vaccine mandates is widespread, and growing. And the opposition is not limited to anti-vaxxers. Many medical professionals and fully vaccinated people are equally outspoken against these mandates. The question is, why is there such resistance to mandatory vaccination in the case of Covid-19? Do the Covid-19 vaccines in fact meet the requirements outlined above? Is the case for mandatory vaccination clear cut? We will explore this question in the second essay of this series, The Case Against Mandatory Covid-19 Vaccination.

  • Onne Vegter is a writer, educator and entrepreneur with a degree in biological science. Follow him on Quora or Twitter @OnneVegter

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