Autonomy and Vaccine Mandates

Some Sunday afternoon musings on the "Common Good" from an "Anti-Liberal"

Introduction

By now, everyone has heard about the vaccine mandates in the US and beyond. The rhetoric surrounding them has largely been disturbing, but there is a concern I have seen pop up which I think is legitimate and worthy of engagement: is taking the vaccine critical to maintaining the common good? Put more simply, where is the line between "personal liberty" and public responsibility?

This question was posed to me recently:

If you've read this blog for much time, you are aware of my various arguments against Autonomy/Liberty/Freedom as a meaningful guiding virtue in politics. Here:

Autonomy demands atomization because any bond that is not chosen represents a limitation on one's free actions. I have been forced into accepting some situation. We see variants of this belief in calls for family abolition and "collectivizing" the youth: "They don't belong to anyone!!!" Furthermore, in the same way that one doesn't choose what family one is born into or what race one is, these things cannot have meaning if autonomy is our most core value. And if they cannot have meaning, we cannot identify with them, since (as Charles Taylor explains) how we identify/what we identify with, reflects the values we hold and what we perceive is meaningful. Any bonds that are not chosen must be dissolved. To identify with them is to appeal to some value outside of autonomy that must (at least in some case) overrule autonomy. And this cannot stand.

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If we believe that autonomy is the core good in the world, then it is the final justification. It is the final arbiter of right/wrong. Something is good if it allows for individuals to express their autonomy, and bad if it does not. "Personal relationships", so far as they exist in a world that worships autonomy, only persist so long as the people in them want them to. In other words, at the bedrock of every personal relationship, every supposedly "non-commodified" connection, is utility. Everything is governed by the logic of the market and its central tenet: "value". There can be no "unconditional love". Everything is conditional, and it's conditioned on value.

...

Autonomy demands atomization, which forces everything (including your very identity) to be governed by market logic. It is as hypercapitalistic as it comes.

Or here:

The autonomy they demand impoverishes our social lives, by privileging thrownness:

People "become" an individual in the eyes of another when they meaningfully interact with them and care about them.

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The networks we operate in have simultaneously become broader and shallower, and I believe this is deeply detrimental to our lives (and I think the data on friendships, suicides, and mental health all support that claim).

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Autonomy directly opposes embeddedness. It demands shallow relationships:

We are all embedded within networks we had no choice in. We didn't choose where we were born or who our biological parents are, etc. We never consented to these characteristics that were thrust upon us. We didn't even consent to being thrown into the world in the first place!

And so, it is reasonable that when our society's core value runs up so strongly against the nature of our existence, our society rebels against "nature" itself.

As we engage in a society that opposes embeddedness, it should come as no surprise that empathy falls as well. As people have fewer and fewer deep relationships, it becomes harder and harder to conceive of others as full Persons.

That our impoverished social lives lead to impoverished inner lives:

If you only engage with people on a shallow level, what is the point of cultivating those inner depths that make life so rich and meaningful? There is nothing left but the surface: signaling and pleasure become the highest goods.

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The endpoint of Autonomy is, ironically, the abolition of our inner depths. In some ways, perhaps, an abolition of the Self. In its place, we witness the emergence of a terrible new order: collectivism without community, alienation without actualization.

Our society becomes little more than a shallow sea of nodes: each one thinking the same thoughts, desiring the same things, and consuming the same products. The freest man in the world is the NPC.

And our impoverished inner lives end up "justifying" the most horrendous commodification of all: the commodification of our very Selves:

Commodification of the body is so heinous because it demands an individual detach "themselves" from a part of themselves. It is a psychological amputation, a mutilation of your full being. It renders us mere ghosts in a machine. You and I are embodied. We are not machines. We are not spirits temporarily trapped in a decaying piece of meat-clay.

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This profound disenchantment of the world is "justified" by calling others moralizers or maintaining recourse to "it doesn't hurt anyone." Pay no attention to the fact that these individuals in their disenchanted worlds tend to be far less happy than those who accept and embrace the deeply spiritual aspects of our existence and do not deny them for fear they will lay down some obligation.

Of course, I've also noted that railing against autonomy should not be caricatured as endorsing a position of unlimited "authoritarianism":

Certainly I do not wish to say the State can do whatever it wants. This is not an argument of "the Private sector is barely consensual so who cares, let the State run amok!" The State HAS limits.

So where does this leave us? Certainly the question Khan posed me is a fair one:

How does someone who is so openly and strongly opposed to autonomy as a guiding virtue within politics going to determine his stance when it comes to vaccine mandates?

Certainly if there is no value of autonomy to pose a counter-weight against "public health," I must support mandates, no?

Well, not quite.

A Quick Review: Public vs Private spheres

Politics is fundamentally a Public activity, as is Public Health (obviously). What is a Public activity, and how does this differ from a Private one? Well, we need to properly understand these two spheres:

While the public sphere is the "open" realm of shared norms, politics, employment, etc, the private sphere is the intimate realm of the domestic and the Home. These spheres are defined by both an orientation towards the broader society as well as by geographic differences (aka they're in different places).

Here we have a substantive and meaningful notion of Private: there are zones, physical regions or particular relationships and/or institutions, that cannot be invaded because they are social Goods.

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The Private sphere of intimate life and domesticity is "closed" to a significant extent. We intuitively understand this: having sex in public is typically frowned upon (you have brought a Private activity into the Public sphere). On the other hand, the Public sphere of politics, commerce, and social situations is "open" in a meaningful way: we all participate in a set of social norms that are, at the very least, intersubjective and sit outside of the desires of any one individual.

Any institution operating in the Public Sphere, whether that is the State, a corporation, or a charity, is subject to the social norms and rules. It is governed by society as a whole. On the other hand, the Private Sphere is the sphere of individual subjectivity and this is an important Good that must be protected. If an individual wants you off of their personal property, a simple "I don't like you, get out" is sufficient. People need a Zone to express themselves without judgment or ridicule, as subjectivity is an important Good that must be respected. On the other hand, if a business wants you off of its property, it must appeal to some greater moral purpose than just "we don't like you." Even if it is "your" business, you are operating in the Public sphere. You have relinquished your right to govern based on personal sentiment once you enter the marketplace. That doesn't mean the customer always wins. It just means you must abide by a morality more substantive than your personal subjective desires.

The Big Q: Are Mandates Justified

So now I must ask, what is the basis for a mandate for Public Health? Obviously, contagiousness. It is why defenders of the mandate reject the comparisons of the virus to obesity: obesity is not contagious. Presumably if you gained a pound every time you walked by a fat person we'd be having a very different set of conversations now (or we'd live in a parody of Wall-E).

So if contagion is the basis, the mandated solution would need to prevent that contagion. Simple enough. Which leads us to a relatively simple test for if vaccines can be mandated:

If an already vaccinated person will see a significant drop in their chance of negative consequences if others are vaccinated, a vaccine mandate is reasonably justified.

Whoa, wait a second: already vaccinated? what counts as "significant"? Do the sniffles count as "negative consequences" or do we mean pneumonia, hospitalization, and death?

The first question is meaningfully different from the latter two, so let's address it first.

The "Already Vaccinated" Dilemma

Anyone can decide to get vaccinated if they so wish. Data so far suggests that the vaccines are highly effective at preventing deaths and other morbidities. While polling is always suspect, it appears reasonable to say that data and experience shows at least 50% of the US voluntarily chose (or would have voluntarily chosen) to get the vaccine.

So what is the point of mandating if the vaccine is effective and the people who want the vaccine have already taken the vaccine? Well the point would be that so long as the other 50% of society is not vaccinated, this significantly increases the risk of negative consequences for the already-vaccinated. If my outcomes are meaningfully impacted by your decisions, this represents the potential for a justified mandate. I see two potential ways that a mandate may lead to a significant reduction in risk: transmission and variants. But before we discuss this, let's address the latter pair of questions.

"Stop being so damn vague!"

Ultimately, what counts as "significant" is going to have to be decided by society, but I think we can say that there is a sizeable difference between a 1% reduction in likelihood of death vs. a 90% reduction. The FDA issued a 50% effectiveness threshold for a COVID vaccine, so that's a decent place to start.

In terms of negative consequences, I'm going to stick with hospitalizations + deaths, simply because they're measurable. Yes, Long Covid might be a serious issue, but the data surrounding it is...murky to put it lightly. So, even though I hate doing this, I'm sticking with the factors that are most visible.

So now we have our standard:

If the increase from 50% vaccinated -> 100% vaccinated leads to a 50+% decline in chance of hospitalization and/or death, there is a case to be made for a vaccine mandate.

The Transmission Question

Vaccines do appear to reduce infectivity. In other words, the data suggests that a vaccinated individual is less likely to spread the virus than someone who is not vaccinated. To put a number on it, the data appears to suggest a vaccinated individual is only ~0.2x as likely to transmit the virus to another individual as an unvaccinated person. However, this estimate comes with a fair deal of uncertainty, as it could reduce infectivity by as much as 90+% or as little as 35%.

We run into a problem though: COVID appears to be endemic. In other words, you are likely to be infected with it at some point. There is no escaping that COVID is here to stay. Even 100% vaccine coverage likely wouldn't change this, unless we began to approach 99%+ effectiveness. Over a long enough timeframe, the effectiveness of preventing serious negative consequences will trend towards the effectiveness of the vaccine in a single person. Any additive effects will reduce to zero.

But, the mandate supporter says, that isn't how life works. We should be focusing on shorter time-frames. Assuming lower infectivity, the virus should spread much slower throughout the population, reaching dead-ends and fizzling out at times.

Now, I have neither the time nor energy to do a sophisticated statistical analysis of the chances of transmission. I understand the math might not work out (I literally did this on the back of an envelope relatively quickly), and NO ONE IN ANY GOVERNMENT SHOULD BE MAKING DECISIONS BASED OFF BACK-OF-THE-ENVELOPE CALCULATIONS FROM A PSEUDONYMOUS SUBSTACK AUTHOR. But since I want to lay something out:

Assumptions Part 1:

Let's assume we have an infected individual A. We have a vaccinated individual B. 

We assume vaccines reduce infectivity by 80% and we assume vaccines are 80% effective at preventing infection. 

We also assume that unvaccinated individuals transmit the virus 75% of the time (and so vaccinated individuals transmit it 15% of the time - an 80% reduction). 

The above assumptions appear to align with the data we have and look reasonable.
Scenarios Part 1:

In scenario 1, individual A is unvaccinated: 15% chance individual B becomes infected (1-80% vaccine protection * 75% chance of spread). There is a 0.0375% chance of negative consequences (0.25% chance of negative consequences * 15% chance of getting infected).

In scenario 2, individual A is vaccinated. There is a 0.0075% chance of negative consequences (4% chance of getting infected).
Assumptions Part 2:

Assume we have, on average, 20 daily contacts. 

Also assume there is, at any point in time, a 10% active infection rate. So, 2 people are infected.
Scenarios Part 2:

In scenario 1, 50% of the population is vaccinated = 2 infected people are vaccinated, 2 are not (just assume a uniform population for the ease of this calculation). The chance of getting infected in any given day is as follows:

1-[(0.85*0.96)] = 18.4%

In scenario 2, 100% of the population is vaccinated. The chance of getting infected in any given day is as follows:

1-(0.96^2) = 7.8%

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Over the course of a year, the chances of getting infected are as follows:

Scenario 1 (50% vaccinated): 1-(81.6%^365) = ~100%

Scenario 2 (100% vaccinated): 1-(92.2%^365) = ~100%

While increasing the vaccination rate to 100% might reduce the possibility of getting infected on any given day, even over a time frame as short as a year, your chance of infected goes to 100% no matter what.

You have to bring the infection prevalence rate down to 0.1% for the mandate to stand a fighting chance. Here (based on my quick calculations), an increase in vaccine coverage from 50% -> 100% leads to a nearly, but not quite, 50% reduction in your annual chances of contracting Covid. 0.1% of the US is ~300k people. There is anywhere from 5-8x as many infections in the US as cases. Which means that ~37.5-60k cases over 7 days can be interpreted as having ~0.1% infection prevalence. Looking at 7-day averages, the United States hasn't reached this low level of infection prevalence since March 2020. While we got close earlier this summer (bottomed out at around ~11k cases/day, after substantial vaccinations, we never got to that low level. The prevalence of Covid infection has been roughly between 0.1-3.0% since the vaccination drive started.

A more sophisticated model will give you better results (and my calculations can surely be incorrect, or my assumptions absurd), but I don't see good evidence for a vaccine mandate in terms of reducing transmission.

The Variants Question

Let's address something here:

Anyone who claims with any degree of certainty that the vaccines will decelerate or accelerate viral mutation to such an extent that it could lead to a substantial decline in transmission is kidding themselves. The data isn't good enough, there is no telling whether selection pressures will lead to greater transmissibility but less morbidity + mortality. Maybe 100% vaccinations means mutation completely stops. Maybe it means the virus turns into Super-SARS and we all die horrible deaths. Who knows! I don't consider this a sufficiently good reason to mandate vaccines. Especially when combined with the following point...

The Prudence Question: Adverse Effects and Cost-Benefit

There have been no long-term studies on the Covid vaccine because it's been in existence for a year and a half. Unless we have a time-traveler handy, that isn't going to change. Uncertainty about the future is profound. We already know that within certain demographics, there is a greater risk of negative consequences from the vaccine than from Covid itself. That alone disqualifies mandating the vaccine for those demographics. But even if we constrain the mandate to 21+, the question of adverse effects should make us more wary about mandates rather than less. Finally, questions of institutional trust and social order must come into the question, as even if the response to the Covid crisis is indeed legitimate, it is setting up structures that can very easily be wielded by bad actors in the future, putting us at risk of genuine tyranny.

Conclusion

Ultimately, I do not believe an increase from 50%->100% vaccine coverage in the population is going to reduce transmission to a sufficient extent to justify mandating the vaccine. Cost-benefit analysis means mandates for anyone under 21 (maybe 25?) are unjustified already, but for adults the mandates still don't appear justified based on reasonable assumptions and standards. As more data is generated in the coming years, as the vaccines are improved and refined, and as therapeutics are improved, this might change. Hopefully Covid ends up being something like an endemic bad flu, and our therapeutics and vaccines get safer and more effective to the point it stops being a worry at all.


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