Happy spring! Finally. For much of the country, this was a very rough winter. And I’m not just talking about the weather. As many reputable experts predicted as far back as a year ago, this past winter was the worst of the pandemic. And the cold days and long nights made it seem even more depressing. A combination of good luck, delayed arrival of more infectious variants, and widespread (but inconsistent) public health measures provided a somewhat surprising, but welcome, decline in COVID cases from the peak in January.
But where do we go from here? As a country, as a community, as a profession? Clearly the answer is vaccination, as imperfect as that may be. And by the time this issue hits your desks I’m anticipating that over half the country will have gotten at least one vaccination. We’ve already seen very notable drops in mortality, having first protected the elderly and infirm with vaccine. I’m hoping that our overall numbers will drop as well, since it’s become pretty apparent that long-term sequalae of COVID are not infrequent, even for the young and healthy.
If vaccination is the path to ‘normalcy’, then how do we get everyone vaccinated? We’re finally at the point where there is more than enough vaccine in the United States, but there are still sizable populations who don’t want to get the shot. In March, almost half of our active military troops declined the vaccine. There’s an active antivaxxer movement that found new life in refuting the science of COVID vaccines, and a variety of demographic groups that, for a variety of reasons, are digging their heels in. So far, with exceptions, there’s no requirement to get a vaccine. But should there be? And if so, for whom?
It seems clear to me that, rightly or wrongly, in the United States we won’t be able to mandate the vaccine. But, as with the flu shot, are some groups/work categories so critical that they must receive it? There’s a precedent for this, with the mandate that health-care workers of all stripes be vaccinated for flu, measles, etc. Can we—should we—do that for the COVID vaccine as a condition for them to keep their jobs? How about flight attendants? Restaurant workers? Things get complicated then. Legally, employers do have the right to require vaccinations as a condition of employment, but as I know first-hand from managing my practice, it can entail some unpleasant conversations.
I believe that with a combination of education, encouragement, incentives and coercion, we’ll get the vaccinated percentage of our population quite high. Will it be high enough, though? And what do we do with the unvaccinated? I would like to say leave them be. Those who wish to protect themselves, can. Those who don’t can take their chances. But should they be spared from the consequences of their decision, such as being fired from their jobs, being denied boarding on airplanes, or being turned away from concerts? Should we as a society subsidize their health-care costs if they fall ill?
As gratifyingly Old Testament as my response sounds, there are those pesky public-health considerations. The more COVID is still circulating, the greater the likelihood that variants will arise and the greater the risk that even the vaccinated will no longer be protected. For those espousing an individual’s right to not be vaccinated, that decision has implications for all of society. In a planet as overpopulated and connected as ours, John Donne’s famous quote, “No man is an island,” is truer now than when he wrote it 400 years ago.
Dr. Blecher is an attending surgeon at Wills Eye Hospital.