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:

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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.