Back in January, the Biden Administration released the first parts of its plan to “beat” Covid-19. What, exactly does “beat” mean? While this sounds like the beginning of a graduate seminar discussion, as our own Dr. Aaron Carroll discusses in the New York Times piece linked above: we should have a more concrete answer to this question.
I agree. Why is this relevant to a blog on Covid-19 Ethics, Law, and Policy? First, it’s increasingly becoming clear that we’re not going to vaccinate ourselves all the way out of the pandemic. Second, how we answer this question will have real consequences for how we structure our local and national responses to new Covid-19 cases when they arise.
For example, Australia, New Zealand, and a number of other countries are pursuing a “Zero-Covid” strategy. But America’s political and community intolerance for strict disease control measures seem to indicate that “beating” Covid-19 will have to mean something other than aligning our response toward elimination or eradication of the virus.
I’m reminded of a stanza from T.S. Eliot’s poem, The Hollow Men:
Between the idea
And the reality
Between the motion
And the act
Falls the Shadow
Dr. Carroll puts it this way:
As we continue to improve, it would be useful to have guidance on how we might ease the policies that have kept us protected.
Too many people, though, are unwilling to talk about any lowering of our guard — even in the future — because some danger still exists. They want to know that no one is dying of Covid-19 in their community anymore, or they want to know that there are no cases in the area and that there is no chance of their being exposed.
I understand the sentiment, as we have been overwhelmed with messaging about how dangerous Covid-19 is. But the sentiment is not realistic, nor is it reasonable. Such extreme vigilance can also backfire: Each day we wait, more people become impatient and abandon their posts.
Normal has never meant “perfectly safe.” A safer world will likely still have Covid-19 in it….
We can’t be afraid to set benchmarks on our way there for the gradual relaxation of guidelines. Announcing goals and expectations will give Americans something to shoot for and a reason to hold fast for now.
Dr. Carroll raises several potential benchmarks for us to pursue (like a rate similar to our flu season daily death rate), and concludes that “The important thing for people to do is to strike a balance between the ideal and the doable.”
However, 0ne question Dr. Carroll’s column does not answer is who, exactly, are the “we” and the “people” to make these determinations?
I believe the Biden Administration should convene a new White House Task Force that includes voices from across the public and political spectrum, as well as broad representation from public health and healthcare (e.g., Federal and local agency representatives, health system representatives, as well as social scientists, health communication experts, community-engaged scholars, ethicists, and, yes, lawyers) to develop a new national roadmap. While we may never come to a total agreement on where, exactly, the balance lies, we would be well served to consider development of a national policy grounded in an approach such as the Accountability for Reasonableness framework of Norman Daniels and James Sabin. In this framework, originally developed to ensure transparency by government agencies asked to set health priorities with finite resources, priority setting by public bodies is assessed based on the government’s ability to have its process meet the following four conditions:
- Publicity – The extent to which decisions taken over the allocation of health care resources are made accessible to the public.
- Relevance – The extent to which decisions are influenced by evidence that fair-minded people would consider relevant.
- Appeals – The existence of mechanisms for the challenge and review of decisions and for resolving disputes.
- Enforcement – The existence of effective mechanisms for ensuring that the other three conditions are implemented.
Vaccinations are Plateauing – Don’t Blame It On “Resistance”
An important piece by Dr. Stefanie Friedhoff this week in STAT News discussing her research on why vaccine uptake has slowed. It’s not “vaccine hesitancy” — a phrase she believes should be retired, as hesitancy is not fixed, and the more it’s repeated, the more it becomes a self-fulfilling prophecy. According to Dr. Friedhoff, her research finds that people need more information on where and how to get the vaccine:
What we have learned so far from this survey, fielded by HIT Strategies in communities of color in five U.S. cities, is telling: Even though a majority of Black and Latino Americans want to get vaccinated — 72% in this survey — a surprising 63% said they didn’t have enough information about where to get the shot. In addition, more than 20% said they had regularly been treated with disrespect when getting health care in the past, and 20% said they have had trouble finding health care when needed.
Despite these systemic barriers, only 3% of the total sample said that nothing at all would move them to get the Covid-19 vaccine.
Everyone else, even those who said “no” to getting a vaccine now, listed reasons that would motivate them to get a shot, such as “seeing a person I trust get the vaccine” or having “a vaccination site close to my home.”
In fact, “having more information” is the single most important concern expressed by those unsure about the Covid-19 vaccine, according to almost every poll that asks this question.
It’s worth repeating from last week’s blog post (and sharing widely): the IRS now has a page with information and filing forms small and medium sized employers (and the self-employed) can submit to claim tax credits for providing paid leave to employees who take time off related to COVID-19 vaccinations.
In Other News…
- The American College Health Association has issued a statement in support of all colleges and universities requiring on-campus students be vaccinated against Covid-19 for the fall.
- This New England Journal of Medicine piece looks at the legal and ethical arguments supporting vaccination and decarceration to protect those in our jails and prisons from Covid-19
- Cook County’s Covid-19-related backlog has resulted in 100s remaining in jail waiting for hearings for more than a year during the pandemic
- The Ohio Supreme Court awarded a prisoner $1000 in a case against the state prisons for their failure to provide him information about Covid-19 rates within the state’s criminal justice system.
- A concerning JAMA study examining the rates of opioid overdose deaths in Cook County, Illinois rose during the lockdown and have continued to stay above pre-2020 pandemic levels.
- State legislatures continue to take actions to prohibit Covid-19 vaccination requirements.