Friday, June 18, 2021

Make COVID-19 Vaccination Mandatory at Universities?

By Kai Chan [Improved 2021.6.19]

With COVID vaccine policy, Canadian governments and universities risk sleeping at the wheel, unfairly endangering vulnerable individuals in the name of a wrong-headed protection of personal freedoms. Governing effectively might—but doesn't necessarily—mean mandating vaccination.

As we contemplate finally returning to in-person instruction, now is the time to make this right.

Governments have been reticent to mandate vaccinations. For example, B.C.'s Return-to-Campus Primer states that “The COVID-19 vaccine will not be mandatory.” A recent editorial in the Globe and Mail argues forcefully against this policy, pointing out that "there is no constitutional right to put other people’s health at risk."
British Columbia's "Return-to-Campus
Primer"
: "The COVID-19 vaccine will
not be mandatory"


As a university professor, I've seen these dramas play out first hand. I've had students contract long-COVID, and almost fail out of my course. One student was in tears for an hour as we tried to work out a plan to complete the course.

And that was not a case contracted in class. I teach a course where students are expected to attend class and to participate (last year was on Zoom). Their grades depend on it. Sure, most students will probably get vaccinated, but some will choose not to. Imagine three hypothetical students.

A is unable to get the vaccine, perhaps due to severe allergies to vaccine components or—worse—due to an autoimmune disease that also puts them at additional risk should they contract COVID. They are extremely careful about their own exposure and are deathly afraid to go to any indoor place where some people are unvaccinated (and not nearly as careful as they are).

B is able to get the vaccine, but lives with immunocompromised individuals (perhaps like A), who are understandably hyper-vigilant about any source of exposure to COVID. B understands that the vaccine provides a strong degree of protection against them getting severely sick with COVID, but they worry about the unquantified risk that they might pass COVID from classmates to others, perhaps even without getting symptoms.

British Columbia's Guidelines document
doesn't even mention "vaccine".

C
is a healthy young adult. They're not afraid of COVID, and they won't get the vaccine. Perhaps they think (contrary to abundant and diverse forms of evidence) that COVID is just a conspiracy. Perhaps they have been told that they need to trust in God's will to protect them, rather than vaccines. Because they are not afraid, they're not at all careful about limiting their own exposure.

Is it fair that C should be able to subject A and B (and their families and friends) to the risk of COVID-19 in the classroom?

I don't think so. And at first, I couldn't see how anyone could argue otherwise. (This was a classic case of cultural cognition, by which my views were inordinately shaped by those I was reading and hearing.) But there are worthy counter-arguments. 

The first is that it is unfair for a government to force an individual to do something that entails side-effects and risks. Vaccination does have risks. Some of the rare side-effects don't emerge until after a large-scale roll-out, like the current concerns about rare heart inflammation associated with Pfizer in young people (fortunately most have recovered quickly, with no apparent deaths). So, on fairness, the arguments for mandatory vs. voluntary vaccination seems to depend on cultural context and political leaning.

Second, there is very little vaccine hesitancy here, and early polls suggested that most people didn't favour mandatory vaccination (only 39% of Canadians did in late 2020; although with vaccine-hesitancy shrinking, views about mandatory vaccination may also be changing). In this context, it's important to consider (a) effective alternatives to mandatory policies; (b) back-fire effects, where anti-vax folks might double-down on their position and cheat (e.g., Savulescu 2020); and (c) blowback in the form of widespread resentment of mandating authorities (e.g., Meier et al. 2019). Risks of back-fire and blow-back are substantial in some contexts (although fortunately, vaccine polarization in Canada is not like the US). 

So let's consider some alternatives to mandatory vaccination. One possibility is that individuals could be left to enforce a social contract by pressuring each other to get vaccinated (e.g., Korn et al. 2020). This might sound attractive. But this means governments leaving the burden of persuasion on the vulnerable and the proactive. To me, that sounds like governments reneging on their responsibility to govern.

A second possibility is incentives, offering rewards for vaccination. There's a question of fairness here, though, with any incentive program that only targets new vaccination once most of the population is vaccinated. Why should the hold-outs get rewarded? This also risks encouraging people to wait until rewards are offered. If instead everyone gets a reward, it's costly. And by rewarding people for basic pro-social actions, we may undermine altruistic and civic motivations.

A third possibility is to shift the default (a form of 'nudge'). Make it expected (not mandatory) for students to be vaccinated. Those who can't be vaccinated safely can supply a doctor's note, etc. Those who don't wish to be vaccinated can show up to provide their reasons for health officials. The decision can be automatic (e.g., without judgement about legitimacy). As long as we shift the burden of effort to those seeking not to be vaccinated, we reflect public priorities for herd immunity in the choice structure that individuals face.

If people requesting exemption have to show up to a vaccine clinic, this solution might be even more elegant. Resistant folks would be surrounded by folks getting vaccinated, and they could change their mind at the last moment to receive a vaccine instead.

For public policy, the choice isn't simply between mandatory vs. purely voluntary. There are other smart alternatives that might be both fair and effective (particularly switching the default).

This is a message for every province, and for every university where provincial governments continue to sleep at the wheel.

Don't mistake a purely voluntary approach for a good solution. It's just the easy one, not the right one.

If you found value in or agree with this post, please share it widely. KC

This post has been modified substantially since first publication, to better reflect a range of views and alternatives, thanks to an exchange with a colleague.

Friday, June 11, 2021

Let’s Talk about Complex Chronic Illness and Academia

By Kai Chan

Yesterday, a subset of my lab group (<10 people) had a gathering on the beach for the first time since COVID began. I wasn’t among them.


The normal way to interpret this is to assume that I don’t care that much about them, that I don’t really enjoy being around them.


Nothing could be further from the truth. I love these people. They’re brilliant, generous, creative, inspiring people that I’ve gone out of my way to surround myself with. I cherish the time I get to spend with them.


So, why did I miss the gathering? Because my wife had a really bad week.


Sounds lame, doesn’t it? The words wither in my mouth as I spoke them, by way of a quick explanation for my absence.


This blog post is the longer explanation, the one I realized I had to give. It explains a whole bunch of events I’ve skipped, tasks I have begged off, deadlines I’ve missed.


Let’s try that sentence again: (because) the woman I love and the mother of my children is suffering. Chronically, and last week was especially bad. For years I made it worse by pushing her when she had nothing more to give. No more.


The suffering is hard to understand from the outside. And for those who suffer, the feeling of shame that folks just don’t get it—even close friends and family—just adds to the misery.

chaya.goldberger, Flickr


The family of conditions are called “complex chronic syndromes”. They include myeloencephalitis/chronic fatigue syndrome, multiple chemical sensitivities (MCS), fibromyalgia (sometimes called chronic pain syndrome). With permission, I’ll share that in my wife’s case it’s quite likely fibromyalgia, perhaps with systemic mold toxicity, explained partly by uncommon genetic predispositions. That’s the medical speak, the jargon.


On a human level, this manifests in an unceasing world of fog, incapacity, and hurt. It’s a body reliving past traumas—physical and otherwise—in an endless self-reinforcing cycle. It’s somewhat like having a flu and never shaking it. You still feel off, listless, achy, painfully tired, and out-of-it mentally. People think the pain is the worst of it, but that’s not my wife’s experience. The mental fog is the worst, and the anxious buzz. The pain seems most troublesome because of how it undermines sleep, which seems absolutely crucial for coping and any chance of recovery.


It’s so bad that many chronic sufferers can’t do most of what they used to do. My wife can’t work any longer. She can barely get up to function for appointments that start at 11:30am. One appointment is about all that she can manage in a day, they tax her so much. It’s hard to imagine recovering at that rate, given how many appointments seem necessary when so many things are off.


The biggest blow is almost certainly to one’s sense of self as a capable person. It’s one thing to be sick for a while, and get better. It’s another thing entirely to be so sick that you can’t do most anything, with no clear route to recovery. She will get better—I believe it firmly. But in the meantime, her incapacity gets in her head, dangerously.


And that kind of danger I can’t take lightly.


So life just isn’t the same—for me, either. I always shared child-rearing duties quite equally, and took pleasure in that. But whereas school drop-offs used to be shared, now that plus breakfasts are all mine. Ditto for cooking dinner (after my wife does dinner prep while I work), and bed-time routines—every night. I have 9-5pm on workdays for work; outside that, I’m primary parent >95% of the time.


Travelling used to be a big part of my job, but those days are long gone. When I travelled, I would work like a demon, cranking out 15+ hour days even while also juggling security checks, customs lines, and the rest. That was the only way I could keep up. I haven’t had a ten-plus-hour work day since March 5 2020, when I spent a solid seven hours on a whole-brain task and also cleared out hundreds of emails, including some complex ones. It’s crazy that I miss it.


I don’t need a pity party. My wife is the one who's suffering. (She just wants doctors to stop saying or suggesting that it's all in her head.) I have a few colleagues who are single-parenting, and what I’m going through is not close to that. My wife still does a lot, and she is there to balance out my heavy-handedness and all my other parenting foibles. Plus she’s there for me when I need her.


from Flickr

I used to think that meant that I could travel, and she’d rally. And she did. Before I understood her condition—before either of us did—I thought this was OK. I’d have a work trip on the horizon. As my departure approached, she would grow increasingly anxious about coping without me. Inevitably, she would lash out, and I’d get defensive at the perceived guilt trip. We’d argue for days. When I would return, she’d be sapped, but she would have made it.


“What doesn’t kill you makes you stronger,” they say. I don’t think they suffered from a complex chronic illness.


These trials certainly didn’t seem to be making my wife stronger. The knowledge that she had made it through before was no comfort next time around. If anything, the anxiety was worse.


I’m done making it all worse. I don’t want to see how far she can be pushed. I want to make space for her to get better.


This post deepens my understanding of achieving balance in academia, which I reflected on in the following three posts from 2015:

Creative Commons Licence
CHANS Lab Views by Kai Chan's lab is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Based on a work at https://chanslabviews.blogspot.com.

Wednesday, May 19, 2021

It’s a bird, it’s a plane -- it’s a bat!


By Julia Craig, Masters student

View over Lost Lagoon, Stanley Park


Not every master’s thesis makes you feel like a comic book hero. Yet as I strap on my helmet and vest and emerge from my basement apartment, I feel like Batman suiting up and zooming out of the bat cave. Admittedly, there are some differences. Unlike Bruce Wayne, I lack a tragic back story. Oh, and I have to get by on a graduate student’s budget, rather than a billionaire’s. Ultimately however, we share the key qualities that make a comic book hero: we both have cool gadgets, a sweet ride, and a self-mandated mission to protect the citizens bats of Gotham City Vancouver. 

My stealthy mode of transportation is an eco-friendly batmobike. It features several high-tech gadgets including an ultrasonic acoustic detector and microphone on a pole (a lot cooler than it looks) and several low-tech solutions like audio dampening devices (which others might call “pieces of cardboard that block noise from my brakes”). The appearance is as striking as the batmobile--but for entirely different reasons. I often get odd looks from passersby. Maybe they’re also expecting a tinfoil helmet? But here function is more important than form: the batmobike lets me eavesdrop on bats.


Diagram of the Batmobike, drawn by Julia Craig


Like all biology students, I yearn to peek into the lives of animals. In this case, bats. I can’t actually translate bat conversations (yet), but I can tell which bats are present.

There are actually bats in Vancouver— as many as 8 different species, according to a preliminary study. Year after year, they return from a winter-long hibernation to their favourite summer roosts around the city; in tree hollows, abandoned buildings, attics and bat boxes. 

In fact, they’ve been here for generations. Much like humans, bats have long enjoyed living in river valleys, wetlands, and deltas, where there’s fresh water and warm nights. They become so attached to their summer residences that they have found ways to remain even as cities were built up around them. Indeed, they don’t have many other options in BC as much of their ideal habitat is regularly logged or developed for agriculture and industry. This loss of habitat is a primary threat for the many bats at risk in BC.

Protecting these species involves learning how to coexist with them—even in cities. First, we need to know what animals like about our cities to begin with. 

Although bats share our city and live amongst us, we know surprising little about them. Birds advertise themselves in plain sight. Bats, on the other hand, hide during the day. And when they emerge at night, they call at a frequency that people can’t hear. How they use the city is a mystery—for now.

Bats can be distinguished from birds at twilight by their agile and unpredictable flight patterns


Cue the batmobike. Using an ultrasonic detector and riding around the city at night, I hope to catch glimpse into where bats are. From other studies that monitored bat activity, I have some idea of where bats may like to hang out. For example, they often prefer one-stop destinations like ponds where they can easily grab dinner and a drink.

Vancouver, however, is one of the greenest cities in the world, with parks of all sizes, surrounded by a bay and a river, with greenways and trails that run through or by them all. Will bats use these varied landscape features for foraging or as connections to other parts of the city? Or will they stay only in the most “natural” areas? Are there differences between bat species: do they form cliques, with all the artsy little browns hanging out by the river or sporty California myotis foraging by the beach?

These kinds of studies (called “mobile transects”) are often done with cars, but I have chosen to use a bike as it is better suited to the city. With a bike, I can transverse the city on its many greenways, roll through parks on gravel paths, and ride through forests on dirt trails, or by ponds on golf courses. In theory, I will get a pretty complete picture of where bats are in the city. Perhaps batmobikes will become more common practice in the future, with enough velophile grad students!

Stay tuned to discover with me the secret lives of bats! 




Creative Commons Licence

Thursday, January 28, 2021

Should I stay, or should I go? Mental health, retention, and crossroads (Part 1 of 2)

By Jo Fitzgibbons, PhD Student

I almost quit my PhD last week.

It’s probably the thousandth time I’ve considered leaving my PhD. I’ve been insecure in the decision to pursue doctoral studies since even before applying. Frankly, I will think about it a thousand more times before I finish - or don’t. And although most people don’t talk openly about this inner conflict until they actually pull the plug, I know from conversations with my peers that I am not the only one toiling about this decision, right now. 

How did I get to this point, I wonder? I have enjoyed many privileges in life that have allowed me to succeed academically, and have been incredibly fortunate to have supportive supervisors and professors over the years who pushed me to be the best scholar I can be. In many ways, an academic career seems like a natural fit - it’s something I’m good at and have been well-supported to do. But academic achievement isn’t a measure of wellbeing, and like many graduate students, I struggle with chronic mental health problems. 

I was already burnt out by the time I started my Master’s, and again, still, when I started my PhD. I’ve become physically ill from stress. Most of the time, I feel that I am driving on flat tires: I doubt that my research makes a difference, yet, the world chugs on around me, seemingly getting progressively more dismal, hateful, and barren with every moment that I spend working toward my degree. Personal family challenges have me constantly looking over my shoulder at the East Coast, wondering if I am in the right place, and if it is time to go home. Now, in 2021, we have been dealing with COVID-19 related lockdowns and social restrictions for nearly a full year. Grad school is already a solitary endeavor, but the pandemic has made it feel brutally lonely. 

Image source: Melinda Aley, “grad school memes with relatable themes” Facebook group

On the other hand, the limited experiences I have had in practice have felt gratifying. I’m a license-eligible urban planner, and I’ve done internships with governments and worked as a project manager in nonprofits. In these roles, my deliverables (and the uplifting fanfare over their completion) were only ever, at most, about six months out from the current date (instead of… how many years, again?). I could see the impact of my work on real people in real communities, even if the magnitude of it was smaller than the global sustainability issues I explore in my research. Being paid a professional wage for my labour also, obviously, sounds more appealing than watching 60% of my academic “income” get whittled away on the cost of housing and food alone (that's even after splitting the cost of living with another person, and with more generous funding than many students get). And every year that I spend on my PhD is a year that I am not building the essential applied experience needed to get professional accreditation in my field. 

In other words, I feel like there are lots of “push” factors nudging me to leave, and a few “pull” factors urging me to stay. It’s hard to self-help myself out of this rut because sometimes it feels like nobody understands, even though I know, statistically, that most grad students have gone through this. That’s because all the well-intentioned op-eds, self-help apps or online self-guided mental health tools address only one problem at a time, or only talk about factors from one part of my life (school). Sure, impostor syndrome is something that I and many grad students experience, but it is not the only thing keeping me up at night. My life is an ecosystem, full of moving parts and interconnected pieces. Salmon and I have that in common - there is no “smoking gun” causing us to decline, but rather, it is a matter of cumulative impacts from several stressors. 

My situation is not unique - many students struggle with this, and it has been written about on the CHANS Lab Blog before, in 2015. We have learned a few things about graduate mental health and its relationship to retention since then, and with Bell Let’s Talk Day upon us, it felt appropriate to re-ignite the conversation. Let’s Talk Day takes place on January 28th each year, and is the company’s charitable effort to reduce stigma and normalize conversations about mental health. (Note: I share a healthy cynicism with others about this campaign - see here and here - but ultimately still value the space it provides to speak openly about mental health.)

The journal “Nature” published results of an international multi-language survey in 2019 about mental health and life satisfaction of graduate students. While 38% of students indicated that they were “very satisfied” with their decision to pursue a PhD, the (rounded) remaining 63%, a majority of respondents, sat somewhere between “somewhat satisfied” and “very dissatisfied”. 

Furthermore, 36% of respondents indicated that they had “sought help for anxiety and depression caused by their PhD studies”. The study does not report on how many respondents dealt with these issues, but did not "seek help". The findings echo similar research conducted by the World Health Organization examining clinical signs of mental disorder among students. Concerningly, only 26% of the students that sought help “said they got real assistance at their institutions”. Worse still is that many students (18%) do not feel supported when they do seek help, and 10% indicated that no help was available for them at their institution.

The magnitude of these responses indicates that this is not an individual problem - it’s a pervasive, systemic one. A large majority (76%) of survey respondents indicated that they work more than 41 hours per week, and most attribute this to the culture of their university. Combine these excessive working hours with “publish or perish” pressure, rampant impostor syndrome, a lack of suitable mental health supports, an oversaturated job market where a doctoral degree may even reduce your earnings, and people constantly asking you when you’re going to join the “real world”... are we really surprised that so many PhD students do not see their program through to completion?

Image source: www.phdcomics.com

Last week, it all came to a head for me. I sat staring at my puffy red face on Zoom, occasionally muting myself to blow my nose, and trying to explain through a tight throat and a broken voice to my supervisor, Kai, why I could not do this anymore. And Kai, bless him, spent our whole monthly meeting trying to understand, telling me he believed in me, offering help, and nudging me to see the forest for the trees. He was kind, and his arguments were reasonable: planning practice offers more instant gratification and feedback for my efforts, but as a scientist, I could achieve a wider sphere of influence, make more of a difference on the issues that really matter to me outside of the planning profession. It’s not that I don’t care about making a difference, I had to explain, but those are tall ambitions for someone with flat tires. There are days when I can hardly even drag myself out of bed, much less think about changing the world. 

This was not his first rodeo, obviously: he has talked students down from the ledge before. I had a chance to hear from one of those students during our departmental coffee social, and have known a few other people in my life who made the difficult decision to leave their PhD. The truth is that most of these people (the ones I know, anyway) have felt satisfied with their decision whether they stayed, or whether they left… after it’s over, of course, and it’s all hindsight, it is easier to be happy with what you’ve done. In the words of the late, great Douglas Adams in “The Long Dark Tea-Time of the Soul” (the title of which is a remarkably good description of how I’m feeling right now): “I may not have gone where I intended to go, but I think I have ended up where I needed to be.” 

For today, at least, I have backed down from the proverbial ledge. It can feel taboo to talk about “dropping out”, but in stigmatizing this conversation, we’re leaving students stranded and confused, worsening stress, and squeezing them out. Your mental health should not be the price you pay for a PhD. So, let’s talk.

In Part 2 of this blog post, we’ll hear from some of those people about how they made it through (or didn’t) and what life has been like on the “other side”. In the meantime, let’s acknowledge the truth about systemic mental health problems in academia, and support each other openly, and navigate the weeds together instead of alone.