by: Blake Murdoch
It’s summer 2020. My friend is arguing with me about COVID deaths, saying how they are similar to the flu. I point out that even if this were true (it wasn’t and isn’t), it would only be because we have implemented widespread shutdowns, social distancing and other public health measures that have dramatically altered society and drastically limited viral spread. He doesn’t seem to register this, despite my repeated appeals. Fast forward to March 2021, and our provincial government here in Alberta announces that it did not record a single confirmed case of influenza during the flu season, from over one and a half million swabs.
For some reason, many of us are susceptible to irrational thinking about public health, and are easily misled. People seem to better understand what does and doesn’t make sense in a personal context. For example, if you wore a helmet while biking, then fell and hit your head but were uninjured, you would say the helmet did its job. You wouldn’t say that helmets are unnecessary because you didn’t get hurt. Yet, the latter statement encapsulates many common misunderstandings of recent public health measures.
When these measures work, they immediately become both widely misunderstood and also weaponized by purveyors of misinformation. Others have already pointed this out, of course. I’m bringing it up because it is about to happen again, in an entirely foreseeable way, with mandatory proof of vaccination and domestic vaccine passports.
These mandates will work. They are not a panacea and do not remove the need for other public health measures to combat highly infectious variants like Delta, but they will make workplaces and venues safer, significantly reduce the number of people who get seriously ill and help increase vaccination rates. Fewer unvaccinated people will be hospitalized and die than would have otherwise, because they will be excluded from certain high-risk activities (to the extent they don’t replace them with equally high-risk illegal activities, that is), and because there will be fewer of them. Vaccinated people will also benefit, of course. But their health benefits will be smaller than those of the unvaccinated because they already have protection, and because their lifestyle-driven exposure risk may increase, such as in cases where individuals attend stadium events or return to the workplace after working from home. Plus, more will join the ranks of the fully vaccinated.
Then, as a result of some basic math, over time a significantly higher percentage of total hospitalizations than before will be vaccinated people. Right now, with the Alberta health system collapsing under the weight of the unvaccinated sick, this seems unlikely. But it will happen. This will lead pundits to wrongly argue that vaccine mandates are not working. It will also be used to argue the vaccines aren’t effective. From the logical outcomes of an effective public health intervention, many will draw completely incorrect conclusions. They will argue, yet again, that the helmet didn’t help and wasn’t needed. And for some, it will be convincing.
Without understanding the differences in demographics and behaviour-driven infection risk between the vaccinated and the unvaccinated, it is difficult to appropriately weigh and properly communicate what relative hospital rates mean. Some level of waning vaccine immunity will play a role in rising relative rates of infection among the vaccinated, but this needs to be placed in context as only one of many variables at play. In Israel, rising proportions of the vaccinated in hospitals led to outcry about waning immunity. But because the higher risk elderly population there is so much more highly vaccinated than the lower risk young population, a phenomenon called a Simpson’s Paradox made the overall statistics misleading about vaccination effectiveness. Clearly, media outlets will continue to play an important role in first understanding, then properly framing and presenting the latest science.
In 2019, the World Health Organization listed vaccine hesitancy as a top 10 threat to global health. In the depths of this pandemic and “infodemic,” as we see swarms of Canadians protesting at hospitals and even harassing patients in dire need of care, we are still coming to terms with just how powerful a destructive force misinformation can be. The next push will continue attempting to delegitimize vaccines as well as proof of vaccination systems. Consider yourself forewarned.
Blake Murdoch, a senior research associate with the Health Law Institute at the University of Alberta, notes that he has a concurrent position as privacy officer of immunization software company CANImmunize. His views are solely his own and do not represent the position of the company.