Omicron struck down vaccine mandates; Not the Supreme Court

What many commenters don't see

Many are upset that the Supreme Court blocked OSHA’s ability to compel employers to enforce a vaccine mandate for sars-cov-2. But Omicron struck down the vaccine mandate, not the court.

In the wake of Omicron, it is clear, that vaccine’s effectiveness against symptomatic disease (not death) has plummeted. This means with repeated exposure to the virus (which is inevitable over time), and vaccine efficacy this low (and dwindling over time), infection is guaranteed. Thus vaccination, while it may retain a reduction in the risk of death if you get sick (and still worth doing for adults!), will do almost nothing to slow onward transmission.

Immediately, I and others pointed out that this had implications for mandates. The legitimacy of vaccine mandates is that there is a broader benefit to society, warranting the loss of individual bodily autonomy. The moment vaccine effectiveness (for symptomatic disease) plunges like this, that case has vanished. This is what Dr. Jamrozik, an ID ethicist says:

Infectious Disease Ethics @ID_ethics

The ethical case for vaccine mandates requires that vaccines significantly reduce transmission & harm to others Preventing harm to others is the only potential justification for coercive policies This is a basic principle of liberal democracy and public health ethics

Vinay Prasad, MD MPH 🎙️📷 @VPrasadMDMPH

A pre-requisite to vax mandates is vax substantially lower risk of spread; that pre-requisite is no longer true with dwindling vax & booster efficacy w omicron; Thus they r a personal health decision like smoking, alcohol & diet & grounds for mandate gone https://t.co/hw2VIMnPSt

Now, many proponents have moved the goal posts. They lament that the Supreme Court’s decision means many lives will be lost. Presumably those lives will be lost because of the loss of individual health due to a person who would have been compelled to be vax’d choosing not to be* because loss of broader health due to slowed pandemic spread is no longer compelling. *I will come back to this

Yet, think about what it means if this were precedent. If OSHA could mandate that you do something to improve your individual health (far outside the scope of your employment) with no implications for others’ health. Presumably this logic could be extended to diet, exercise, blood pressure medication adherence, alcohol use or consumption. OSHA can mandate your employer police that you eat Kale, work out, take your HCTZ, and don’t drink too much!

Proponents respond that this slippery slope is not possible. COVID19 is unique in its’ ability to inundate health care systems, which worsens outcomes for others. Yet, by this logic when hospitals start to reach capacity (in the winters perhaps), the government can mandate workers cease activities that could lead to hospitalization. No skiing or snowboarding during weeks of high volumes. No consuming alcohol either— we can’t overburden the hospital with extra cases of Holiday heart or alcoholic hepatitis. All contact sports/ risky activities will be halted.

*Side note: I wanted to return to the idea of vaccine mandates. I have heard folks say that mandates work because in the X weeks after a mandate, X million more people got vaccinated. But that isn’t right. The equation is complicated

First consider, that with or without mandates, some people will be vaccinated eventually anyway. Look at the curve of vaccination over time. Do you see the moment they put in the mandate? Yup, me neither. The biggest upswing was in the beginning during the supply limited phase, and then there has been slow steady growth recently. But of course, this is coarse data— not a formal analysis— so allow me to articulate the real equation.

The benefit vs harm of vaccine mandates is the following equation

Benefits:

The fraction of people who would otherwise not have been vaccinated now getting the shot * their net health benefit

+

People accelerating their time to shot * the benefit of that acceleration

-

Harms: (

People who are lost from the work force * the devastation of their unemployment and social isolation on their health

+

People who are privately angered by the intrusion into bodily autonomy * their shift in political choices in the years that follow * the difference that shift makes in terms of policies that improve health (better childhood nutrition/ medicine/ etc) aka loss of future political power from party that forced mandates * good that party would do

+

Extra adverse events (e.g. myocarditis in young men) that could have been averted had we delayed the mandate & learned from emerging safety data to revise policies (e.g. as Germany suspended Moderna in Men <40) * change in health as a result

Or in shorter form:

VACCINE MANDATE NET EFFECT = [(People who got vax - people who otherwise eventually would)* health gain from vax + (people who got vax earlier * health gain from early admin)] -

[(Displaced individuals * health decrement) + (anger * political consequence decrement) + averse events that would have been mitigated with more time (e.g. if we later suspend Moderna or spread doses). * harm to people]