Some people’s arrogance regarding what their fellow citizens ought to do regarding the COVID-19 vaccine is both infuriating and astounding. Here is a prime example from today:
What’s cool about the DeWine lottery idea relative to a more sensible “pay people to get vaccinated” program is that it specifically addresses the incentive to the crucial target population of people who are bad at assessing risks.
— Matthew Yglesias (@mattyglesias) May 25, 2021
As Matty sat home able to earn a living on Skype and typing his thoughts for money, millions of working-class Americans went to work—to make stuff, deliver stuff, and provide all the services Matty needed to stay safely ensconced in his home. However, in his elite opinion, the rest of you rubes don’t assess your risk very well, and a lottery will play to your base instincts for gambling and other vices. So, in Matty’s opinion, Governor DeWine of Ohio has a great plan to make sure you get the jab.
Those who were essential workers, and their families or close contacts, were most likely to be exposed or become ill with COVID-19. And while there is a significant consensus among treating physicians that people over the age of 65 and others with preexisting conditions should be vaccinated to prevent severe illness and death, there is a legitimate debate about whether that applies to younger and recovered patients.
Studies of immunity in patients who have recovered from COVID-19 demonstrating an adequate immune response with very few confirmed reinfections in the millions of patients infected globally fuel the debate. This immunity was established in the largest sample to date in Israel, a country with a robust vaccination program and a nationalized health system allowing for an extensive complete population study:
The overall estimated efficacy of vaccination was 92·8% for documented infection, 94.2% for hospitalization, 94.4% for severe illness and 93.7% for death.
Similarly, the overall estimated level of protection among individuals with prior SARS-CoV-2 infection was 94.% for documented infection, 94.1% for hospitalization and 96·4% for severe illness.
Since only one death occurred in the recovered cohort, protection against death following prior infection was not estimated.
According to the CDC, a conservative estimate is that approximately 142 million Americans have had COVID-19 or been exposed and remained asymptomatic. The CDC’s current estimate of disease burden is that for every case identified through testing, there were 4.3 people infected or exposed. Additionally, a more recent study showed that recovered patients had significantly higher incidences and severity of side effects from the COVID-19 vaccine.
So, maybe Matty and Governor DeWine should slow their roll. In the United States, there might be millions of people who will get no additional benefit from the vaccine due to natural immunity. Why would we waste these precious doses for no reason when at-risk older people globally can’t get them? Especially when there is a test to detect T cell immunity available under a EUA from the FDA. Why would the FDA approve a test if it conferred no valuable information? It is a policy question that a moral society would ask. Several leading health policy experts and clinicians are.
Dr. Jay Bhattacharya said that getting vaccines into people in high-risk groups globally should be the priority. Hooman Noorchashm M.D., Ph.D., and Dr. Peter McCullough have asserted that vaccinating those who recovered from COVID-19 is unprecedented in public policy.
I want to reiterate as we have before, the most unprecedented thing that we’re doing in this vaccine campaign is that we’re deploying it indiscriminately into folks who have been recently or previously infected. And I think that we shouldn’t underestimate what the effect of a vaccine-driven immune response is on the tissues in individuals who have been previously infected, that literally, the antigenic footprint of the virus persists in the tissues of the previously infected.
After explaining that recovered and suspected recovered patients were excluded from clinical trials along with pregnant women and women of childbearing age who could not guarantee contraception, McCullough said:
“I am not a public health official, I’m a doctor. I don’t think like public health officials. It appears to be out of an air of, we’ve had a year of this difficult time in America of trying to make a new product through American innovation available to everybody.
And there was an idea of we’ll make it available and then we’ll try to weigh benefit and risk later on under the investigational use EUA period. As a doctor, I can tell you I am not recommending pregnant women get the vaccine.
I am not recommending actually any of the excluded groups from the trials get the vaccine. We have no information on safety and we have no information on efficacy. It violates a simple medical practice principle. We don’t use things where we don’t have a signal of benefit or acceptable safety. We don’t do it.”
Further, the Washington State Department of Health warned about a potential risk for myocarditis and pericarditis post-vaccination. Myocarditis is an inflammation of the heart tissue usually caused by a virus. Pericarditis is inflammation of the thin tissue that covers the heart. These cases are under investigation to see if they are connected to the COVID-19 vaccine and are correctly reported as a potential concern. Notices like this have emerged previously and will continue.
These warnings and reports are not unexpected or surprising with a vaccination that has not undergone a complete safety evaluation. No clinical trial for efficacy can capture the full range of side effects seen in the general population. Our healthcare bureaucracy decided the emergency use authorization for the COVID-19 vaccination was required to address the threat of COVID-19. Most certainly for the high-risk populations, this was in all likelihood the correct assessment.
However, the level of coercion and the failure of frontline doctors to engage patients in a risk assessment based on their unique medical history is extraordinary and beyond concerning. The CDC has always said its recommendations, made at the population level, are subject to the judgment of the physician for a specific patient. The COVID-19 vaccine should be no different. And elites like Matty should worry a whole lot less about the best way to incentivize people who could well be saying, “I have already had COVID-19 and don’t need the vaccine right now, according to my doctor.” They may be making an appropriate risk assessment after all.