It’s Way too Early to Discuss a Vaccine Mandate

by James A. Bacon

Four days ago State Health Commissioner Dr. Norman Oliver said he planned to mandate a COVID-19 immunization once it’s safely released to the public. Yesterday Governor Ralph Northam said he’s not planning a mandate, despite what his top health official said.

When asked why the the Governor wasn’t embracing the stance of his top health official, Northam spokesperson Alena Yarmosky said in a statement, “We are focused on accessibility, affordability, and fair distribution of a vaccine—not on a mandate.”

“When a vaccine becomes available, we’re confident that Virginians will seek it out. That’s why we don’t have plans for a mandate,” Yarmosky continued in a separate email, reports WAVY TV.

I’m no expert on the subject of vaccines, to be sure, but it strikes me as way too premature to begin discussing a mandate. Many potential vaccine candidates are being tested, we don’t which one (or ones) will be approved, and we know nothing about the efficacy, side effects and trade-offs of each.

The FDA has issued guidelines saying that the efficacy rates for the COVID-19 vaccine should be at least 50%. Anthony Fauci, director of the National Institute of Allergy and Infectious Disease, has said he would “settle for a vaccine between 70% and 75% effective. Moncef Slaoui, former head of the vaccine program for GalxoSmithKline, has said, “I wouldn’t be surprised it it’s in the  90% [range].” The most effective vaccine ever, for measles, is about 97% to 98% effective. Flu vaccines range between 40% and 60% effective.

The logic for mandating a 50%-effective vaccine is not nearly as compelling as mandating a 98%-effective vaccine. Think of the public messaging problem: We’re going to compel you to get this vaccine even though there’s only a 50% chance it will help you. You’ll never know for sure if you’re protected, so you shouldn’t stop self-isolating and wearing a mask. The only thing you can know for certain is that, if you do get the virus, it didn’t work.

Meanwhile, vaccine experts are warning of potential side effects. Side effects identified in clinical trials of different vaccines include fatigue, fever, headache, muscle pain, and chills. Almost all are relatively mild and certainly preferable to contracting the disease. But they are a factor to consider.

Another concern is that embracing the first vaccine out of the gate might make it impossible to find enough subjects to test other vaccines that would have higher efficacy rates or fewer side effects.

Yet another factor to take into account is development of COVID-19 treatments that can significantly reduce the length of hospitalization and risk of death. According to Statista, there were 544 drugs and vaccines in development for the virus, as of Aug. 20, 2020. Most were in the preclinical phase, but 27 were in Phase 1 clinical, 53 in Phase II, 20 in Phase III, and one in the pre-registration phase. If the fatality rate of the virus falls to nearly zero, that would undermine the case for a mandate.

Given the fluidity of scientific developments, talk of a vaccine mandate would seem wildly premature. We don’t know (1) how effective the first vaccine across the regulatory finish line will be, (2) what side effects it will have, (3) the efficacy of other vaccine candidates following close behind in the development pipeline, (4) whether the COVID-19 epidemic is still raging or coming under control, or (5) what therapies may be available for those who catch the virus.

WRIC TV quoted Oliver four days ago as saying: “It is killing people now, we don’t have a treatment for it and if we develop a vaccine that can prevent it from spreading in the community we will save hundreds and hundreds of lives. “He added: “We would not launch a campaign around mass vaccination with anything that hasn’t proven to be safe.”

A recent NPR/PBS NewHouse/Marist poll found that 35% of U.S. adults would not choose to be vaccinated if a coronavirus vaccine were made available. Del. Dave LaRock,R-Loudoun, has filed a bill to prevent the state from forcing vaccines on individuals whose health or religion prevents them from being vaccinated. However, Oliver said public health takes precedent over choice.

Oliver’s office later clarified that he was sharing his personal opinion as a physician, not commissioner of health.

Cautious as always, Northam seems to be in no hurry to commit himself either for or against a mandate. Yarmonsky, his spokesperson. mentioned “accessibility, affordability, and fair distribution of a vaccine,” which, translated, means the Governor wants to ensure that all segments of the population have access to the vaccine when it comes. That’s a legitimate concern, of course, but it begs the larger questions about choosing between competing vaccine candidates and alternatives.

I’m not impressed by the way anyone in the Northam administration has framed the vaccine-mandate issue. But we can take some comfort in the fact that the Governor is keeping his options open.