Comment by fwlr | Hacker News Reader

Comment by fwlr | Hacker News Reader

While I don’t at all doubt the public health advantages of the Covid vaccine, I do have one reservation about the whole thing that I feel was never properly addressed: when I was growing up, I was taught the reason we make vaccines mandatory is because they confer herd immunity; that is, if 90% of people cannot catch or spread the disease because they are vaccinated, the other 10% are conferred protection as well because there aren’t enough remaining vectors for a disease to spread (any potential chain of infections peters out quickly rather than continuing). This reasoning made a lot of sense to me and I accepted mandatory vaccinations on that basis. I do feel that a kind of “bait and switch” happened where the Covid vaccine was initially presented as mandatory for the same reason, but then “prevents infection” was replaced with “significantly lowers the harm from infection”, and thus the new motivation for making it mandatory was “it stops the public health system from collapsing by dramatically lessening the cost and impact of each infection”. While that is a very good thing, it is still the case that we lost the original ‘herd immunity’ justification for mandatory vaccination, but never re-litigated the mandatory aspect of it on this new basis.

I’m unsure that “keeping the public health system afloat” actually justifies mandating medical decisions for individuals. I urge you before responding to note that I am unsure - it might have justified mandatory treatment, I was quite open to believing it did, but it remains an uncomfortable fact for me that we went ahead and kept it mandatory without anyone making those arguments.

(Posting this because that’s what this study shows: a small effect on preventing infection and a very large effect on reducing the severity of infection)

People find this difficult to grasp, because of black and white thinking.

COVID vaccines significantly reduce how many people who get exposed to COVID actually get sick. They also reduce just how sick people get. Both of those reduce how COVID spreads, how much it impacts people's lives and how much it impacts society by people being sick.

But some people just have that black and white thinking where if the vaccine doesn't make you completely immune, it "doesn't work and it's all fake". If you get sick with COVID while vaccinated, you can't compare with alternate world where you weren't vaccinated and see whether it would kill you instead.

>COVID vaccines significantly reduce how many people who get exposed to COVID actually get sick.

The linked article says that Covid boosters, at least, are 26% effective. Personally, I don't call that a significantly effective treatment.

From the study:

> Booster effectiveness relative to primary series was 26·2% (95% CI 23·6–28·6) against infection and 75·1% (40·2–89·6) against severe, critical, or fatal COVID-19, during 1-year follow-up after the booster.

And then you write:

> Personally, I don't call that a significantly effective treatment.

I don’t think you’ve thought this through very well.

I'll quote OP again:

>>COVID vaccines significantly reduce how many people who get exposed to COVID actually get sick.

The boosters are 26% effective at preventing infection.

Sure, they do something if you are particularly at risk of having a bad time with Covid, but that low effectiveness at preventing infection means there isn't much argument that they did much to slow the spread of Covid.

I think a 75% reduction if getting a serious or lethal case of COVID is totally worth it, although, like the flu vaccine, it might make more sense for the over 65 crowd than the under 30 crowd.

>totally worth it

Exactly. That was sort of the point of my original comment, although unfortunately I think I only confused things by mentioning herd immunity.

Another way of making my point might be to say, there’s a “personal standard” (is it worth it for me to take it?) and a “mandatory standard” (is it worth abrogating individual self-determination to make everyone take it?). Influenza clears the “personal” standard for many, but it appears that it does not clear the “mandatory” standard in most jurisdictions, as it has not been made mandatory in most places. On the other hand, smallpox (~7,000 infections per million people before, 0 per million after) and measles (~3,000 per million before, ~1 per million after) are examples where the standard for “mandatory” is cleared with flying colors. My point is not to debate whether the covid vaccine clears the mandatory standard or not - my point is only that we didn’t have that debate.

Even without a 100% immunity granted, it still gives a herd immunity effect, the disease is far less effective spreading, either for not be able to infect as much people, or people not being severely impacted and being less contagious and for less time.

And lowering odds of getting severe adverse effects in the case of infection is a net plus for you.

Regarding the health system, you are not immune to everything. A saturated health system may not be available for you if you i.e. have an accident.

Even not caring about COVID that it spread more may affect you. You are part of a system.

>the disease is far less effective spreading, either for not be able to infect as much people, or people not being severely impacted and being less contagious and for less time.

This idea doesn't mix well with Covid's very high rate of asymptomatic cases (which may be even higher among the vaccinated).

>A saturated health system may not be available for you if you i.e. have an accident.

At least where I live (Wales, UK), asking citizens to avoid healthcare for several years to "Save the NHS" has resulted in an ongoing health crisis of unprecedented proportions.

>>the disease is far less effective spreading, either for not be able to infect as much people, or people not being severely impacted and being less contagious and for less time.

>This idea doesn't mix well with Covid's very high rate of asymptomatic cases (which may be even higher among the vaccinated).

Indeed. Isn't it counterproductive (and also contrary to the history of public health remedies) for a "vaccine" to only reduce symptoms but not reduce infectivity? Doesn't that cause people to go to work and school when they might not have otherwise?

>At least where I live (Wales, UK), asking citizens to avoid healthcare for several years to "Save the NHS" has resulted in an ongoing health crisis of unprecedented proportions.

"Save the NHS" has a long history pre-COVID19, too. <https://twitter.com/KulganofCrydee/status/833654730849136641>

>Doesn't that cause people to go to work and school when they might not have otherwise?

Hence the absurd situation where you "need" to get vaccinated to be a good person, but you also need to keep testing, in case you leave the house while infected.

My understanding is that herd immunity can be seen differently for different things. As such, it gets really tricky really quickly, as some folks will be talking about the kind of immunity you can have for things like Measles, while others will be talking about Flu and such.

That is to say, a whole shit ton of talking past each other.

My own view is that looking at population level metrics usually means that you can't really view the individual level metrics at the same time. Way too easy to see confounding increases in personal risks from some protection that oddly leads to more damage at the population level.

At least in Germany the discussion about mandatority took too long.

And it was plenty discussed at that time.

But the Querdenker issue was too strong in comparison to a lot of other eu countries

Reply on news.ycombinator.com