So yesterday, my town abruptly closed the high school and canceled all high school sports, but they failed to communicate why.
Why so hush hush? Because there's been an outbreak among high school students, and they want to continue to suck Mass Department of Elementary and Secondary Education's (DESE's) crusty old dick and open full-time in-person learning by April 5, which might be a little harder to pull off if parents are informed of an outbreak among their children's classmates.
Get this: We've still heard nothing about the outbreak through official district or committee channels. My wife found out via a parent group on Facebook, and I got an email from the Little League today, alerting us that tomorrow's practice is canceled out of an abundance of caution because of the outbreak among the town's high school students. Of course, the Little League doesn't have a vested interest in bending over for DESE, but do you know what they do have a vested interest in? The health and safety of the town's children who participate in their program. Sure would be neat to have a school committee that felt the same way.
Maybe the committee put something on their Twitter or something, but the cunts blocked me forever ago for pointing out that they perpetuate systemic racism and that the superintendent is a white supremacist. No discussion at all, just a block. (Note: To be faaaaaaaaaaiiiiiiiir, this was pre summer 2020; doubt that's changed anything for them, though.)
So it appears that the immature, head-in-the-sand way they handle important issues persists. They'd rather take the batteries out of the alarm than deal with the actual fire.
Nothing to see here, parents. Please send your lab rats children back to us full time so that we don't look bad to our superiors. Jesus fuck!
At least our kids participate with us in school committee meetings so that they know institutionally/systemically who/what they're dealing with. My daughter has even taken to emailing the superintendent herself, lately, so that's good. I have a feeling that her voice will be harder to ignore than mine.
Posting with some friends the other day, to be faaaaaaaaaaaaaaiiiiiiiiiiiiir, sounds like to me, McMurray, that you need to run for Chair of the Grange, err school committee. Give yer balls a tug.
A very interesting dissection of the ethical considerations involved in the decision to halt use of the A-Z vaccine because of the possible link to a very rare side effect (from the NYT).
Europe’s Vaccine Ethics Call: Do No Harm and Let More Die?
European health agencies this week faced, with millions of lives in the balance, a staggeringly high-stakes incarnation of what ethicists call the trolley problem.
Imagine standing at a railway switch. If you do nothing, a trolley barreling down the track will hit three people in its path. If you pull the lever, the trolley will divert to an alternate track with one person. Which option is morally preferable: deliberately killing one person or passively allowing three to die?
In Europe’s version, German regulators identified seven cases of a rare cerebral blood clot, three of them fatal, out of 1.6 million who had received the AstraZeneca vaccine. Regulators had no proof they were linked, only a statistical anomaly. Still, continuing vaccinations might make them responsible for putting a handful of people in harm’s way — like pulling the lever on the trolley tracks.
Instead, the German authorities withdrew approval for the vaccine starting Monday. Neighboring countries followed, waiting for the European Union drug regulator to deem the vaccine safe, which it did on Thursday.
It might seem like a strange choice. With a third viral wave claiming thousands of lives per day in Europe, even a brief pause seemed all but certain to imperil many more lives than the unproven, very rare side effect.
Still, medical ethics can be tricky. Experts tend to view Europe’s decision as either an understandable, if risky, cost-benefit calculation or, as the Oxford University ethicist Jeff McMahan put it, “a disastrous mistake.”
Dr. McMahan, who studies life-or-death dilemmas, said that the extra Covid deaths likely to occur would “be by omission, or by not doing anything, rather than by causing. But you have to ask, does that make any difference in this context?”
But Ruth Faden, a Johns Hopkins University bioethicist and vaccine policy expert, called the pause “an extremely tough call.”
“If the only thing that mattered was deploying the vaccine in such a way as to reduce severe disease and death as quickly as possible, then you just go ahead,” Dr. Faden said. But it isn’t. While countries that continued vaccinations “probably made the right call,” she said, Germany and others faced real considerations around public trust and ethical duty.
And this will not be the last time in the pandemic, the experts said, that leaders will be forced to weigh a possibly flawed treatment against the heavy costs of caution.
Pulling Up the Ladder
Germany’s health ministry said in a statement, “The state provides the vaccine and therefore has special duties of care,” such as monitoring for risks and responding if certain conditions are tripped. Even, the statement acknowledged, if the decision cost more lives than it saved.
“This idea of the precautionary principle plays a big role in E.U. policy,” said Govind Persad, a University of Denver bioethicist. That principle calls for pausing any policy that might bring unforeseen harms in order to study those harms before proceeding. Imposing blind risk, however small, on unknowing citizens would be wrong.
But Dr. Persad said that he had “never really been able to make sense of how you would apply that principle in a pandemic.”
For one, even if vaccinations did carry some risk or uncertainty, the risk and uncertainty introduced by withholding them, therefore allowing cases to spread, was surely higher. It was not as if infections paused for bureaucratic process.
For another, vaccinations are voluntary.
“This is not a case where you’re imposing risk on unconsenting people,” Dr. Persad said, and therefore violating the precautionary principle. “You’re allowing people to consensually protect themselves from a big risk by taking a very small one.”
Imagine, he said, “You have somebody who’s stuck on a subway track, and there’s a service ladder that they want to use to climb out.”
Europe’s approach, he said, was akin to pulling up the ladder, telling the stuck person that they couldn’t use it until it had been safety-tested for the general public.
“It’s true that a ton of British people use ladders like this and they’re fine,” he said, referencing the widespread use of the AstraZeneca vaccine in Britain. “But we can’t let you hurt yourself.”
In those situations, he said, it is usually considered more ethical to give people all the information so that they can make an informed choice on how best to protect themselves.
Such concessions are already common in medicine, many with exponentially greater risks and lower chances of success than the vaccine: elective surgeries, vaccine trials, experimental cancer treatments.
There are exceptions, like when companies recall a hazardous product rather than simply slap on a warning label. But limiting peoples’ access to cabbage during an E. coli outbreak doesn’t harm them; withholding a lifesaving vaccine does.
Do No Harm
“In Germany, there’s a very great reluctance to countenance imposing affirmative harm on people in trade-off situations,” Dr. Persad said. “It’s a very strong emphasis on not causing harm, even if you allow much more harm through inaction.”
This unusually high aversion to anything that might be seen as the government violating individual autonomy or dignity are, like so much in Germany, a reaction against the country’s Nazi past.
With Germany’s position as first among equals in the European Union, and a broader wariness against appearing permissive on vaccine safety, others quickly followed, including France, Italy and Spain.
Still, the thinking behind Europe’s decision also reflects something universal: the Hippocratic oath, “First, do no harm.”
Even so much as administering doses with an unproven potential to harm patients at about the same odds as being struck by lightning could be considered impermissible under that oath.
“But when the alternative to doing a small amount of harm is allowing a vast amount of harm, then the ‘do no harm’ slogan is a poor guide to policy,” said Dr. McMahan, the Oxford ethicist.
And while “first, do no harm” can feel like an iron law of medical ethics, it is in fact primarily a professional code of conduct. For centuries, it has reflected an inborn human bias that sees affirmatively causing harm as categorically different than passively allowing it.
“That doing/allowing asymmetry is of course not just in the medical codes but in the law,” Dr. McMahan said. Especially liability law.
The statement from Germany’s health ministry acknowledged as much, writing that, if it allowed vaccinations “to continue without properly informing the population and those receiving the vaccine, there could also be legal consequences.”
But in a country with 74,000 deaths and counting, Dr. McMahan said, for a public health agency to weigh its own liability against the survival of hundreds or thousands more “would be truly terrible.”
Reassurance vs. Doubt
Much as policymakers might like to make a purely medical decision, Dr. Faden said, the vaccine bioethicist, they also have to think about guarding public confidence.
Vaccine skepticism was already high in Europe, especiallytoward the AstraZeneca shot, on which Europe has built its plans. The proportion of people willing to get the shot has, in some polls, dropped significantly below the 70 percent needed to achieve herd immunity.
“High-profile, vivid events that are really scary have a way of controlling the public imagination,” Dr. Faden said.
Pausing, she added, can be a way of “reassuring the public that you as a public health authority, or as a government, take super seriously any signal that comes up like this.”
The hope is that this builds trust in the health authorities, demonstrating that they put caution and safety ahead of rushing shots into arms. Even if people remain unsure about the vaccines themselves, perhaps high trust in the vaccinators could overcome this.
But on ethical grounds, Dr. Persad said, “It seems like a troubling line, to say that one person’s access to treatment should be dependent on how that might affect the comfort or psychology of a third party.”
It is also a gamble. The delay imposed by European governments risks a deepening of public doubts about the vaccine. And now officials must demonstrate they take these three fatal clots seriously, which means calling more attention to them.
“This is a safe and effective vaccine,” Emer Cooke, executive director of the European Union’s drug regulator, said on Thursday, urging countries reinstate its use. Still, she urged that governments “raise awareness of these possible risks.”
“Drawing attention to these possible rare conditions,” she said, “will help to spot and mitigate any possible side effects.”
Asked whether Americans might ever face such a dilemma, Dr. Persad countered that they already did. Though trials may show the one-shot Johnson & Johnson with a lower efficacy rate than two-shot variants, health officials hailed its simpler distribution as a breakthrough in the push for herd immunity. Americans have largely gone along.
“We don’t always see it,” Dr. Persad said of these ethical trade-offs, “but it actually comes up all the time.”
my small self... like a book amongst the many on a shelf
A very interesting dissection of the ethical considerations involved in the decision to halt use of the A-Z vaccine because of the possible link to a very rare side effect (from the NYT).
Europe’s Vaccine Ethics Call: Do No Harm and Let More Die?
European health agencies this week faced, with millions of lives in the balance, a staggeringly high-stakes incarnation of what ethicists call the trolley problem.
Imagine standing at a railway switch. If you do nothing, a trolley barreling down the track will hit three people in its path. If you pull the lever, the trolley will divert to an alternate track with one person. Which option is morally preferable: deliberately killing one person or passively allowing three to die?
In Europe’s version, German regulators identified seven cases of a rare cerebral blood clot, three of them fatal, out of 1.6 million who had received the AstraZeneca vaccine. Regulators had no proof they were linked, only a statistical anomaly. Still, continuing vaccinations might make them responsible for putting a handful of people in harm’s way — like pulling the lever on the trolley tracks.
Instead, the German authorities withdrew approval for the vaccine starting Monday. Neighboring countries followed, waiting for the European Union drug regulator to deem the vaccine safe, which it did on Thursday.
It might seem like a strange choice. With a third viral wave claiming thousands of lives per day in Europe, even a brief pause seemed all but certain to imperil many more lives than the unproven, very rare side effect.
Still, medical ethics can be tricky. Experts tend to view Europe’s decision as either an understandable, if risky, cost-benefit calculation or, as the Oxford University ethicist Jeff McMahan put it, “a disastrous mistake.”
Dr. McMahan, who studies life-or-death dilemmas, said that the extra Covid deaths likely to occur would “be by omission, or by not doing anything, rather than by causing. But you have to ask, does that make any difference in this context?”
But Ruth Faden, a Johns Hopkins University bioethicist and vaccine policy expert, called the pause “an extremely tough call.”
“If the only thing that mattered was deploying the vaccine in such a way as to reduce severe disease and death as quickly as possible, then you just go ahead,” Dr. Faden said. But it isn’t. While countries that continued vaccinations “probably made the right call,” she said, Germany and others faced real considerations around public trust and ethical duty.
And this will not be the last time in the pandemic, the experts said, that leaders will be forced to weigh a possibly flawed treatment against the heavy costs of caution.
Pulling Up the Ladder
Germany’s health ministry said in a statement, “The state provides the vaccine and therefore has special duties of care,” such as monitoring for risks and responding if certain conditions are tripped. Even, the statement acknowledged, if the decision cost more lives than it saved.
“This idea of the precautionary principle plays a big role in E.U. policy,” said Govind Persad, a University of Denver bioethicist. That principle calls for pausing any policy that might bring unforeseen harms in order to study those harms before proceeding. Imposing blind risk, however small, on unknowing citizens would be wrong.
But Dr. Persad said that he had “never really been able to make sense of how you would apply that principle in a pandemic.”
For one, even if vaccinations did carry some risk or uncertainty, the risk and uncertainty introduced by withholding them, therefore allowing cases to spread, was surely higher. It was not as if infections paused for bureaucratic process.
For another, vaccinations are voluntary.
“This is not a case where you’re imposing risk on unconsenting people,” Dr. Persad said, and therefore violating the precautionary principle. “You’re allowing people to consensually protect themselves from a big risk by taking a very small one.”
Imagine, he said, “You have somebody who’s stuck on a subway track, and there’s a service ladder that they want to use to climb out.”
Europe’s approach, he said, was akin to pulling up the ladder, telling the stuck person that they couldn’t use it until it had been safety-tested for the general public.
“It’s true that a ton of British people use ladders like this and they’re fine,” he said, referencing the widespread use of the AstraZeneca vaccine in Britain. “But we can’t let you hurt yourself.”
In those situations, he said, it is usually considered more ethical to give people all the information so that they can make an informed choice on how best to protect themselves.
Such concessions are already common in medicine, many with exponentially greater risks and lower chances of success than the vaccine: elective surgeries, vaccine trials, experimental cancer treatments.
There are exceptions, like when companies recall a hazardous product rather than simply slap on a warning label. But limiting peoples’ access to cabbage during an E. coli outbreak doesn’t harm them; withholding a lifesaving vaccine does.
Do No Harm
“In Germany, there’s a very great reluctance to countenance imposing affirmative harm on people in trade-off situations,” Dr. Persad said. “It’s a very strong emphasis on not causing harm, even if you allow much more harm through inaction.”
This unusually high aversion to anything that might be seen as the government violating individual autonomy or dignity are, like so much in Germany, a reaction against the country’s Nazi past.
With Germany’s position as first among equals in the European Union, and a broader wariness against appearing permissive on vaccine safety, others quickly followed, including France, Italy and Spain.
Still, the thinking behind Europe’s decision also reflects something universal: the Hippocratic oath, “First, do no harm.”
Even so much as administering doses with an unproven potential to harm patients at about the same odds as being struck by lightning could be considered impermissible under that oath.
“But when the alternative to doing a small amount of harm is allowing a vast amount of harm, then the ‘do no harm’ slogan is a poor guide to policy,” said Dr. McMahan, the Oxford ethicist.
And while “first, do no harm” can feel like an iron law of medical ethics, it is in fact primarily a professional code of conduct. For centuries, it has reflected an inborn human bias that sees affirmatively causing harm as categorically different than passively allowing it.
“That doing/allowing asymmetry is of course not just in the medical codes but in the law,” Dr. McMahan said. Especially liability law.
The statement from Germany’s health ministry acknowledged as much, writing that, if it allowed vaccinations “to continue without properly informing the population and those receiving the vaccine, there could also be legal consequences.”
But in a country with 74,000 deaths and counting, Dr. McMahan said, for a public health agency to weigh its own liability against the survival of hundreds or thousands more “would be truly terrible.”
Reassurance vs. Doubt
Much as policymakers might like to make a purely medical decision, Dr. Faden said, the vaccine bioethicist, they also have to think about guarding public confidence.
Vaccine skepticism was already high in Europe, especiallytoward the AstraZeneca shot, on which Europe has built its plans. The proportion of people willing to get the shot has, in some polls, dropped significantly below the 70 percent needed to achieve herd immunity.
“High-profile, vivid events that are really scary have a way of controlling the public imagination,” Dr. Faden said.
Pausing, she added, can be a way of “reassuring the public that you as a public health authority, or as a government, take super seriously any signal that comes up like this.”
The hope is that this builds trust in the health authorities, demonstrating that they put caution and safety ahead of rushing shots into arms. Even if people remain unsure about the vaccines themselves, perhaps high trust in the vaccinators could overcome this.
But on ethical grounds, Dr. Persad said, “It seems like a troubling line, to say that one person’s access to treatment should be dependent on how that might affect the comfort or psychology of a third party.”
It is also a gamble. The delay imposed by European governments risks a deepening of public doubts about the vaccine. And now officials must demonstrate they take these three fatal clots seriously, which means calling more attention to them.
“This is a safe and effective vaccine,” Emer Cooke, executive director of the European Union’s drug regulator, said on Thursday, urging countries reinstate its use. Still, she urged that governments “raise awareness of these possible risks.”
“Drawing attention to these possible rare conditions,” she said, “will help to spot and mitigate any possible side effects.”
Asked whether Americans might ever face such a dilemma, Dr. Persad countered that they already did. Though trials may show the one-shot Johnson & Johnson with a lower efficacy rate than two-shot variants, health officials hailed its simpler distribution as a breakthrough in the push for herd immunity. Americans have largely gone along.
“We don’t always see it,” Dr. Persad said of these ethical trade-offs, “but it actually comes up all the time.”
OR, Can you foresee an ethical dilemma wherein children, who have low risk of severe COVID-19 complications are put at greater risk by taking a vaccine? It seems we would risk their health to achieve herd immunity and protect the vulnerable; whereas the vulnerable would not place themselves at risk to protect children.
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A very interesting dissection of the ethical considerations involved in the decision to halt use of the A-Z vaccine because of the possible link to a very rare side effect (from the NYT).
Europe’s Vaccine Ethics Call: Do No Harm and Let More Die?
European health agencies this week faced, with millions of lives in the balance, a staggeringly high-stakes incarnation of what ethicists call the trolley problem.
Imagine standing at a railway switch. If you do nothing, a trolley barreling down the track will hit three people in its path. If you pull the lever, the trolley will divert to an alternate track with one person. Which option is morally preferable: deliberately killing one person or passively allowing three to die?
In Europe’s version, German regulators identified seven cases of a rare cerebral blood clot, three of them fatal, out of 1.6 million who had received the AstraZeneca vaccine. Regulators had no proof they were linked, only a statistical anomaly. Still, continuing vaccinations might make them responsible for putting a handful of people in harm’s way — like pulling the lever on the trolley tracks.
Instead, the German authorities withdrew approval for the vaccine starting Monday. Neighboring countries followed, waiting for the European Union drug regulator to deem the vaccine safe, which it did on Thursday.
It might seem like a strange choice. With a third viral wave claiming thousands of lives per day in Europe, even a brief pause seemed all but certain to imperil many more lives than the unproven, very rare side effect.
Still, medical ethics can be tricky. Experts tend to view Europe’s decision as either an understandable, if risky, cost-benefit calculation or, as the Oxford University ethicist Jeff McMahan put it, “a disastrous mistake.”
Dr. McMahan, who studies life-or-death dilemmas, said that the extra Covid deaths likely to occur would “be by omission, or by not doing anything, rather than by causing. But you have to ask, does that make any difference in this context?”
But Ruth Faden, a Johns Hopkins University bioethicist and vaccine policy expert, called the pause “an extremely tough call.”
“If the only thing that mattered was deploying the vaccine in such a way as to reduce severe disease and death as quickly as possible, then you just go ahead,” Dr. Faden said. But it isn’t. While countries that continued vaccinations “probably made the right call,” she said, Germany and others faced real considerations around public trust and ethical duty.
And this will not be the last time in the pandemic, the experts said, that leaders will be forced to weigh a possibly flawed treatment against the heavy costs of caution.
Pulling Up the Ladder
Germany’s health ministry said in a statement, “The state provides the vaccine and therefore has special duties of care,” such as monitoring for risks and responding if certain conditions are tripped. Even, the statement acknowledged, if the decision cost more lives than it saved.
“This idea of the precautionary principle plays a big role in E.U. policy,” said Govind Persad, a University of Denver bioethicist. That principle calls for pausing any policy that might bring unforeseen harms in order to study those harms before proceeding. Imposing blind risk, however small, on unknowing citizens would be wrong.
But Dr. Persad said that he had “never really been able to make sense of how you would apply that principle in a pandemic.”
For one, even if vaccinations did carry some risk or uncertainty, the risk and uncertainty introduced by withholding them, therefore allowing cases to spread, was surely higher. It was not as if infections paused for bureaucratic process.
For another, vaccinations are voluntary.
“This is not a case where you’re imposing risk on unconsenting people,” Dr. Persad said, and therefore violating the precautionary principle. “You’re allowing people to consensually protect themselves from a big risk by taking a very small one.”
Imagine, he said, “You have somebody who’s stuck on a subway track, and there’s a service ladder that they want to use to climb out.”
Europe’s approach, he said, was akin to pulling up the ladder, telling the stuck person that they couldn’t use it until it had been safety-tested for the general public.
“It’s true that a ton of British people use ladders like this and they’re fine,” he said, referencing the widespread use of the AstraZeneca vaccine in Britain. “But we can’t let you hurt yourself.”
In those situations, he said, it is usually considered more ethical to give people all the information so that they can make an informed choice on how best to protect themselves.
Such concessions are already common in medicine, many with exponentially greater risks and lower chances of success than the vaccine: elective surgeries, vaccine trials, experimental cancer treatments.
There are exceptions, like when companies recall a hazardous product rather than simply slap on a warning label. But limiting peoples’ access to cabbage during an E. coli outbreak doesn’t harm them; withholding a lifesaving vaccine does.
Do No Harm
“In Germany, there’s a very great reluctance to countenance imposing affirmative harm on people in trade-off situations,” Dr. Persad said. “It’s a very strong emphasis on not causing harm, even if you allow much more harm through inaction.”
This unusually high aversion to anything that might be seen as the government violating individual autonomy or dignity are, like so much in Germany, a reaction against the country’s Nazi past.
With Germany’s position as first among equals in the European Union, and a broader wariness against appearing permissive on vaccine safety, others quickly followed, including France, Italy and Spain.
Still, the thinking behind Europe’s decision also reflects something universal: the Hippocratic oath, “First, do no harm.”
Even so much as administering doses with an unproven potential to harm patients at about the same odds as being struck by lightning could be considered impermissible under that oath.
“But when the alternative to doing a small amount of harm is allowing a vast amount of harm, then the ‘do no harm’ slogan is a poor guide to policy,” said Dr. McMahan, the Oxford ethicist.
And while “first, do no harm” can feel like an iron law of medical ethics, it is in fact primarily a professional code of conduct. For centuries, it has reflected an inborn human bias that sees affirmatively causing harm as categorically different than passively allowing it.
“That doing/allowing asymmetry is of course not just in the medical codes but in the law,” Dr. McMahan said. Especially liability law.
The statement from Germany’s health ministry acknowledged as much, writing that, if it allowed vaccinations “to continue without properly informing the population and those receiving the vaccine, there could also be legal consequences.”
But in a country with 74,000 deaths and counting, Dr. McMahan said, for a public health agency to weigh its own liability against the survival of hundreds or thousands more “would be truly terrible.”
Reassurance vs. Doubt
Much as policymakers might like to make a purely medical decision, Dr. Faden said, the vaccine bioethicist, they also have to think about guarding public confidence.
Vaccine skepticism was already high in Europe, especiallytoward the AstraZeneca shot, on which Europe has built its plans. The proportion of people willing to get the shot has, in some polls, dropped significantly below the 70 percent needed to achieve herd immunity.
“High-profile, vivid events that are really scary have a way of controlling the public imagination,” Dr. Faden said.
Pausing, she added, can be a way of “reassuring the public that you as a public health authority, or as a government, take super seriously any signal that comes up like this.”
The hope is that this builds trust in the health authorities, demonstrating that they put caution and safety ahead of rushing shots into arms. Even if people remain unsure about the vaccines themselves, perhaps high trust in the vaccinators could overcome this.
But on ethical grounds, Dr. Persad said, “It seems like a troubling line, to say that one person’s access to treatment should be dependent on how that might affect the comfort or psychology of a third party.”
It is also a gamble. The delay imposed by European governments risks a deepening of public doubts about the vaccine. And now officials must demonstrate they take these three fatal clots seriously, which means calling more attention to them.
“This is a safe and effective vaccine,” Emer Cooke, executive director of the European Union’s drug regulator, said on Thursday, urging countries reinstate its use. Still, she urged that governments “raise awareness of these possible risks.”
“Drawing attention to these possible rare conditions,” she said, “will help to spot and mitigate any possible side effects.”
Asked whether Americans might ever face such a dilemma, Dr. Persad countered that they already did. Though trials may show the one-shot Johnson & Johnson with a lower efficacy rate than two-shot variants, health officials hailed its simpler distribution as a breakthrough in the push for herd immunity. Americans have largely gone along.
“We don’t always see it,” Dr. Persad said of these ethical trade-offs, “but it actually comes up all the time.”
OR, Can you foresee an ethical dilemma wherein children, who have low risk of severe COVID-19 complications are put at greater risk by taking a vaccine? It seems we would risk their health to achieve herd immunity and protect the vulnerable; whereas the vulnerable would not place themselves at risk to protect children.
Children are at risk from long Covid effects, based on what we are learning, right? I want my kid to get the vax....my wife does not. Fun discussions.
OR, Can you foresee an ethical dilemma wherein children, who have low risk of severe COVID-19 complications are put at greater risk by taking a vaccine? It seems we would risk their health to achieve herd immunity and protect the vulnerable; whereas the vulnerable would not place themselves at risk to protect children.
Yes, it's possible that the situation will arise that there could be higher risk of direct consequences to a child from vaccination than from getting the disease. It's unlikely, given what we know about the current vaccines, but it's possible and that's why the studies are now being done on children. It's a very similar calculus with all vaccines.
Vaccinating Children against Covid-19 — The Lessons of Measles
List of authors.
Perri Klass, M.D.,
and Adam J. Ratner, M.D., M.P.H.
Imagine a highly contagious virus circulating in the community. Many infected children have fever and some general misery but recover without incident. Rarely, devastating complications occur, leading to hospitalization, severe illness, and occasional deaths. Susceptible adults fare worse, with higher rates of poor outcomes. Would you want your child vaccinated against this disease?
You guessed we were talking about measles, right?
As the first SARS-CoV-2 vaccines are rolled out to the highest-risk groups, the current stage of the Covid-19 pandemic is pregnant with possibility. Even as cases multiply and new restrictions loom, we gaze longingly toward the next few months, hoping vaccines will deliver us. Vaccination could liberate us to return to school or work, celebrate holidays, eat in restaurants, travel, run marathons, and [fill in your own deprivations]. Early announcements of vaccine efficacy send stocks soaring, and suddenly everyone knows about phase 3 trials and cold-chain logistics. We look to vaccines to give us back our world.
Children back in classrooms, on soccer fields, and at birthday parties are essential elements of that normal world — and we need children to help us get there. Since nearly a quarter of the U.S. population is under 18 years old — and the percentage is significantly higher in many other countries — effective herd immunity will require pediatric vaccination. Vaccinating children is likely to have benefits both direct (protecting children against rare severe pediatric cases of Covid-19 and postinfectious conditions such as multisystem inflammatory syndrome in children [MIS-C]) and indirect (protecting others by reducing spread).1 Those “indirect” benefits also reduce the family toll of parental illness, failing economies, and chronic stress.
So we need to think creatively and empathically about what motivates parents to accept vaccination for their offspring. How do the conversation and the stakes change when children are not themselves at highest risk? What do we owe children and their families for helping to protect the rest of us?
Robust safety data, including pediatric-focused studies and postlicensure monitoring for potential rare outcomes such as vaccine-associated MIS-C, are a bare minimum, as is ensuring just and equitable access to vaccination. Societal decision making that prioritizes children’s needs, including keeping schools open and safe, would be another step in the right direction. Flexible sick-leave policies, widespread access to testing, and financial support for parents, teachers, and other caregivers would help protect families in this stressful time. We must minimize children’s risk, maximize their chances of returning to school, and mitigate the pandemic’s effects on their families.
Measles and measles vaccination campaigns may offer relevant insights about parents’ decisions regarding vaccinating children they don’t believe are at serious risk; about trust, access, and equity; about using education campaigns and vaccination mandates to advance public health goals; and about how targeted disinformation about a safe and effective vaccine can endanger public health.
Measles is so highly infectious that it was once nearly universal in childhood. The Centers for Disease Control and Prevention (CDC) estimates that before a vaccine was available, the U.S. measles burden was several million cases a year, with 400 to 500 deaths, 48,000 hospitalizations, and 1000 cases of encephalitis. A measles vaccine developed by John Enders and colleagues was licensed in 1963. Because measles has no nonhuman reservoir, it seemed a feasible target for eradication, and in 1966 U.S. Surgeon General William Huffman Stewart called for eliminating measles in the United States by 1967 as a step toward global eradication. A CDC publication, Measles Eradication 1967, suggested that a public health victory of historic proportions was at hand: “Never before has the eradication of an important communicable disease been readily within reach.” President Lyndon Johnson publicly supported the campaign, as did medical and school health organizations, and Ann Landers columns and Peanuts cartoons urged the public to vaccinate.
Parents had volunteered their children as “polio pioneers” in 1950s vaccine trials, and the result — that the Salk vaccine was safe and effective — was celebrated as a national victory over a dread disease. But most children survived measles without serious sequelae. So the National Association for Retarded Children emphasized rare, severe complications with their 1966–1967 poster child, Kim Fisher, a 10-year-old who had developed measles encephalitis at 2 and been left “mentally retarded, hard of hearing, unable to walk, talk, or hold up her head.” It wasn’t only parents who needed convincing; a 1965 editorial in JAMA worried that many physicians didn’t take the disease seriously.2
The campaign reduced the incidence of measles but did not eradicate it. With the vaccine more readily available to children cared for by physicians in private practice, measles became disproportionately a disease of Black and Hispanic children. CDC officials blamed insufficient federal funding under President Richard Nixon, and there was growing support for stronger laws requiring immunization for school entry.3
The measles–mumps–rubella (MMR) vaccine was licensed in 1971, replacing monovalent vaccines for the three diseases. Mumps and rubella posed the same challenge of convincing parents (and some physicians) to vaccinate children against diseases that didn’t pose deadly dangers to most children. One of us vividly remembers the “rubella umbrella” campaign of the late 1960s and early 1970s, which advertised directly to children using television “commercials” formulated by Dr. Vincent Guinée of the New York City Health Department. It encouraged children to get protected so they wouldn’t spread the virus to pregnant women who were vulnerable to rubella’s serious teratogenic effects; the message to children was so effective that more than 17,000 parents called, and the approach was extrapolated for use in other public health campaigns.4
Using MMR, and buoyed by the success of school vaccination mandates in controlling measles outbreaks, in 1978 the CDC set a goal of eliminating measles in the United States by 1982. Again, the campaign reduced cases dramatically but didn’t meet the target date. Outbreaks among vaccinated children led to a recommendation for an MMR booster, and by 2000, endemic measles had been eliminated in the United States. Yet that victory has not held; the famous 2014–2015 Disneyland outbreak was followed by others, including a series of 2019 outbreaks involving more than 1000 cases in 28 states.
Since a now-discredited and retracted article suggesting a link between MMR vaccine and autism was published in the Lancet in 1998, media attention and parental anxiety have been deliberately exacerbated by antivaccine activists and organizations, despite extensive research that has failed to find any verifiable link to neurodevelopmental disorders. Many recent outbreaks have involved children left unvaccinated by parents who had been targeted with propaganda, including antivaccine messages developed to target specific ethnic communities. This disinformation entails both lies about dangers and impurities of the vaccine and false reassurance about the benign nature of measles. The downstream effects are global, with plateauing vaccination rates and rising measles mortality after decades of progress. Ongoing measles transmission in regions with fragile immunization systems can seed outbreaks elsewhere, including in countries like the United States, with pockets of undervaccination despite high overall vaccination rates.
Today, many Americans express mistrust regarding the safety of Covid-19 vaccines. This attitude is unsurprising in an environment where mask wearing is politicized and loud voices on social media express doubt about the severity — or even existence — of SARS-CoV-2. But the measles vaccine story reminds us that we have an obligation to provide equitable access and clear information; that coordinated, federally supported efforts are essential; and that doubt, distrust, and disinformation can undermine safe, effective vaccines and worthy public health initiatives. Planning for the implementation of SARS-CoV-2 vaccination requires not only working out details of distribution, priority, and cold chains, but also strategies for reaching people who are distrustful, hesitant, dubious, or frankly opposed.5
Protecting children against SARS-CoV-2 infection is both an ethical obligation and a practical necessity. We need data from pediatric trials to reassure parents about the safety and wisdom of this approach. We must prepare for disinformation campaigns that prey on parental fears and target communities made vulnerable through histories of medical neglect, health disparities, and racism. Trusted messengers may help deliver truth and reassurance. And we need to consider lessons from recent measles epidemics — not only about the power of legislative mandates, but also about their potential for sowing distrust if delivered without careful, sensitive, accurate public health messaging. Dare we imagine a campaign that would actually thank children and parents for helping to protect others, as the rubella campaign did, perhaps suggesting that they proudly display their SARS Stars or Corona Diplomas?
my small self... like a book amongst the many on a shelf
Is it an ethical obligation for children to take the risk for the direct benefits from rare disease and indirect economic benefits? Couldn't the elderly bear the risk instead?
Is it an ethical obligation for children to take the risk for the direct benefits from rare disease and indirect economic benefits? Couldn't the elderly bear the risk instead?
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
So yesterday, my town abruptly closed the high school and canceled all high school sports, but they failed to communicate why.
Why so hush hush? Because there's been an outbreak among high school students, and they want to continue to suck Mass Department of Elementary and Secondary Education's (DESE's) crusty old dick and open full-time in-person learning by April 5, which might be a little harder to pull off if parents are informed of an outbreak among their children's classmates.
Get this: We've still heard nothing about the outbreak through official district or committee channels. My wife found out via a parent group on Facebook, and I got an email from the Little League today, alerting us that tomorrow's practice is canceled out of an abundance of caution because of the outbreak among the town's high school students. Of course, the Little League doesn't have a vested interest in bending over for DESE, but do you know what they do have a vested interest in? The health and safety of the town's children who participate in their program. Sure would be neat to have a school committee that felt the same way.
Maybe the committee put something on their Twitter or something, but the cunts blocked me forever ago for pointing out that they perpetuate systemic racism and that the superintendent is a white supremacist. No discussion at all, just a block. (Note: To be faaaaaaaaaaiiiiiiiir, this was pre summer 2020; doubt that's changed anything for them, though.)
So it appears that the immature, head-in-the-sand way they handle important issues persists. They'd rather take the batteries out of the alarm than deal with the actual fire.
Nothing to see here, parents. Please send your lab rats children back to us full time so that we don't look bad to our superiors. Jesus fuck!
At least our kids participate with us in school committee meetings so that they know institutionally/systemically who/what they're dealing with. My daughter has even taken to emailing the superintendent herself, lately, so that's good. I have a feeling that her voice will be harder to ignore than mine.
Posting with some friends the other day, to be faaaaaaaaaaaaaaiiiiiiiiiiiiir, sounds like to me, McMurray, that you need to run for Chair of the Grange, err school committee. Give yer balls a tug.
Clearly, we have a difference of opinion about how to effect change. You believe it’s possible within; I believe it’s ONLY possible with pressure from without.
Update: The superintendent finally communicated about the Covid-19 outbreak at the high school to the town’s parents and students—more than 24 hours after shutting down the high school and extracurriculars/athletics.
And get this: It’s the largest outbreak the town has experienced for the entire duration of the pandemic!
That sounds like something you should inform affected parties about immediately, does it not?
BTW: My wife informed me that it’s illegal for the superintendent to block me on Twitter. I don’t really give a shit. But this could get fun!
^ good point, D. I'm guessing it will have some and that it's greater than covids' risks. I suppose this lack of data is making FMe's discussion hard!
I'm not sure why you would assume that vaccination will provide greater risk to children that getting covid.
We are still waiting for data but it is extremely unlikely that vaccination for children would be approved it it led to greater risk than the risk associated with covid infection. That's just not how vaccine approval works.
For context, data that I was able to pull from UpToDate shows the effect of covid on children in the US - I couldn't find relevant data from Canada, due to our lower population and lower case counts. Although kids are more likely to have mild or asymptomatic cases, the idea that kids very rarely get sick is incorrect:
Despite the trend of increasing hospitalization, a minority of children with COVID-19 require hospitalization [21]. Among >69,700 laboratory-confirmed cases of COVID-19 in children <20 years reported to the CDC by May 30, 2020, the hospitalization rate ranged from 2.5 to 4.1 percent. Among children who were hospitalized with COVID-19 from 14 states by late July 2020, approximately 33 percent required intensive care and 6 percent required invasive mechanical ventilation [39].
In CDC surveillance of COVID-19 in the United States, underlying conditions are associated with higher rates of hospitalization (15 to 22 versus 2 to 4 percent) and intensive care unit (ICU) admission (4 to 5 versus <1 percent) [21]. Whether underlying conditions are associated with increased severity or a lower threshold for admission (eg, because of concern for complications) is unclear [107]. Age <1 year has also been associated with increased rates of hospitalization [9], although hospitalization of infants may not reflect severity of illness.
So, between 2.5 - 4% of kids with serology confirmed covid required hospitalization, and a third of those required ICU level care. That's not insignificant, and I can guarantee without a shadow of doubt that we won't see 2.5 - 4% of kids requiring hospitalization from vaccination.
my small self... like a book amongst the many on a shelf
Is it an ethical obligation for children to take the risk for the direct benefits from rare disease and indirect economic benefits? Couldn't the elderly bear the risk instead?
Life is risk. Every action we take has risk, as does every action we don't take. We all collectively have to take this risk.
I don't see any way that risk could be shifted to the elderly and away from kids, even if we thought that was a good idea.
This virus is likely to be with us for a long time. Kids grow up and at some point they'll be teens and then adults and they'll be at higher risk too.
my small self... like a book amongst the many on a shelf
Thanks, ORgirl, you make a compelling argument to dispel my fear. But I still have hope mutations can lead to viral extinction. This article says India has evidence of this presently.
Thanks, ORgirl, you make a compelling argument to dispel my fear. But I still have hope mutations can lead to viral extinction. This article says India has evidence of this presently.
After shortening the 2020 campaign due to the coronavirus pandemic, Major League Baseball is set to play a full 162-game schedule in 2021 with the vaccine rollout still underway.
And one top executive may know information regarding the league's plan to get the majority of players and team staff vaccinated by early May.
"We've got fairly good information that the vaccine will be accessible to our players and other major-league teams in the next two to three weeks or month," Toronto Blue Jays president and CEO Mark Shapiro told Kaitlyn McGrath of The Athletic.
Shapiro also discussed his club's potential return to Toronto after opening the season in Florida.
"So that if by the end of April or early May, all of our players or the bulk of our players and staff are vaccinated and other teams are as well and Toronto is a safe place, it starts to feel like the reasons for us not to be there, the risks start to be mitigated," he continued. "I would say that when we start to have that material progress that we see the vaccinations actually happening, we will start to formalize an ask."
Toronto Mayor John Tory recently extended the cancellation of public events in the city until July 1. The Jays announced their intention to open the 2021 season at their spring training facility in Dunedin and stay there through May 2. After embarking on a 10-game road trip, the Jays' next home game is scheduled for May 14.
MLB proposed a plan to postpone the season by one month and play a 154-game campaign, allowing time for players and staff to get vaccinated before the start of play. However, the MLBPA rejected the proposal because it also included expanded playoffs and a later end to the season.
The majority of MLB teams have already announced their intention to allow fans back into stadiums while limiting capacity. NBA and NHL clubs have done the same, though Canadian NHL teams continue to play without fans in attendance due to government guidelines. The NBA's Raptors, meanwhile, are playing their season in Tampa, but still with limited fans.
Thanks, ORgirl, you make a compelling argument to dispel my fear. But I still have hope mutations can lead to viral extinction. This article says India has evidence of this presently.
Actually, another thought on this. Not uncommonly, viruses become less virulent over time, and this is only partly because of host immunity. The virus doesn’t actually “want” to kill the host, because a dead host doesn’t move around and further spread viral particles. The most successful viruses cause illness but not so badly that they kill off their reservoir. So, we can have hope that severity of illness might decline, but that would still be for their benefit, not ours
my small self... like a book amongst the many on a shelf
Miami Beach Interim City Manager Raul J. Aguila has declared a State of Emergency throughout the City in light of the Miami Beach Police Department’s significant concerns relating to larger than expected spring break crowds.
In response to the emergency, and in order to safeguard the public health, safety, and welfare of residents and visitors, the Interim City Manager intends to immediately implement the following emergency measures:
Effective 8 p.m. tonight, a curfew shall be imposed in the area bounded by 5 Street on the south, 16 Street on the north, Pennsylvania Avenue on the west, and Ocean Drive on the east (the “High Impact Zone”).
Eastbound lanes on the Julia Tuttle Causeway shall be completely CLOSED to traffic from 9 p.m. through 6 a.m.
Eastbound lanes on the Venetian Causeway shall be completely CLOSED to traffic from 9 p.m. through 6 a.m., except to City residents.
Eastbound lanes on the MacArthur Causeway shall be CLOSED to traffic from 9 p.m. through 6 a.m., except to City residents, guests of hotels in the City, and employees of business establishments in the City.
Effective 8 p.m. tonight, Ocean Drive shall be CLOSED to pedestrian and vehicular traffic, except to City residents, guests of hotels in the City, and employees of business establishments. Other public roads within the High Impact Zone may be closed as deemed necessary by the Interim City Manager or Chief of Police.
All sidewalk café operations including expanded outdoor restaurant seating shall be SUSPENDED in the High Impact Zone, effective 7 p.m. tonight (pursuant to the City's High Impact Ordinance), and all sidewalk café operators are directed to stack or remove tables and chairs no later than 8 p.m. tonight.
Restaurants in the High Impact Zone can remain open until 12 a.m. for delivery services only.
The City strongly urges all businesses in the High Impact Zone to close voluntarily during the State of Emergency.
The Mayor has called an emergency meeting of the City Commission tomorrow, March 21, 2021 at 3 p.m. to discuss and take action with regard to the Declaration of a State of Emergency. Please click the following link to join the webinar: https://miamibeachfl-gov.zoom.us/j/81392857671. The Webinar ID is 813 9285 7671.
This Declaration of a State of Emergency and the measures set forth are separate from and in addition to the emergency measures currently in effect related to the COVID-19 pandemic. The foregoing measures shall be in place for a period of up to 72 hours, unless determined otherwise by the Mayor and City Commission.
Stay connected with Miami Beach PD on Twitter and Facebook. To receive real-time traffic text messages, send a message to MBTraffic at 888777.
Miami Beach Interim City Manager Raul J. Aguila has declared a State of Emergency throughout the City in light of the Miami Beach Police Department’s significant concerns relating to larger than expected spring break crowds.
In response to the emergency, and in order to safeguard the public health, safety, and welfare of residents and visitors, the Interim City Manager intends to immediately implement the following emergency measures:
Effective 8 p.m. tonight, a curfew shall be imposed in the area bounded by 5 Street on the south, 16 Street on the north, Pennsylvania Avenue on the west, and Ocean Drive on the east (the “High Impact Zone”).
Eastbound lanes on the Julia Tuttle Causeway shall be completely CLOSED to traffic from 9 p.m. through 6 a.m.
Eastbound lanes on the Venetian Causeway shall be completely CLOSED to traffic from 9 p.m. through 6 a.m., except to City residents.
Eastbound lanes on the MacArthur Causeway shall be CLOSED to traffic from 9 p.m. through 6 a.m., except to City residents, guests of hotels in the City, and employees of business establishments in the City.
Effective 8 p.m. tonight, Ocean Drive shall be CLOSED to pedestrian and vehicular traffic, except to City residents, guests of hotels in the City, and employees of business establishments. Other public roads within the High Impact Zone may be closed as deemed necessary by the Interim City Manager or Chief of Police.
All sidewalk café operations including expanded outdoor restaurant seating shall be SUSPENDED in the High Impact Zone, effective 7 p.m. tonight (pursuant to the City's High Impact Ordinance), and all sidewalk café operators are directed to stack or remove tables and chairs no later than 8 p.m. tonight.
Restaurants in the High Impact Zone can remain open until 12 a.m. for delivery services only.
The City strongly urges all businesses in the High Impact Zone to close voluntarily during the State of Emergency.
The Mayor has called an emergency meeting of the City Commission tomorrow, March 21, 2021 at 3 p.m. to discuss and take action with regard to the Declaration of a State of Emergency. Please click the following link to join the webinar: https://miamibeachfl-gov.zoom.us/j/81392857671. The Webinar ID is 813 9285 7671.
This Declaration of a State of Emergency and the measures set forth are separate from and in addition to the emergency measures currently in effect related to the COVID-19 pandemic. The foregoing measures shall be in place for a period of up to 72 hours, unless determined otherwise by the Mayor and City Commission.
Stay connected with Miami Beach PD on Twitter and Facebook. To receive real-time traffic text messages, send a message to MBTraffic at 888777.
Shit governor who only cares about bottom $$$ you get this, just like sturgis all these idiot kids bringing C19 back home to mom&pop..
Good article in Reuters that compares the side effect profile of the different covid vaccines and also with other common medications/situations. Link provided rather than copying the info because it's better to see the graphic displays.
Good article in Reuters that compares the side effect profile of the different covid vaccines and also with other common medications/situations. Link provided rather than copying the info because it's better to see the graphic displays.
Short form, though - risk of thromboembolism after getting the AZ vaccine is estimated at about 1.9 per million.
Risk of thromboembolism leading to pulmonary embolism in people taking long distance plane flights (12 hrs +) is about 5 per million.
Risk of thromboembolism in women on oral contraceptives - between 600 and 1000 per million, depending on the type of OCP.
Risk of some sort of clotting abnormality after taking acetaminophen - about 1000 per million.
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
Turns out that the (restaurant) Union last year saying my mom had 2 months termination of employment because of the restaurant changing owners now had to correct themselves and my mom has 6 months (because of working at the restaurant for so long).
So she will be employed till September. As what I am guessing the only employee outside of the owners. So if they do not go into bankruptsy and the corona-levels goes down towards summer - she could maybe keep her job.
THANK GOD FOR SOCIALIST COMMUNIST HAVEN OF THE MONARCHY OF SWEDEN WITH OUR LONG AND STURDY HISTORY OF UNION-EMPLOYER RELATIONS!
WHO NEEDS MINIMUM WAGE BY LAW WHEN IT IS THIS AMINGZLY COMMUNIST SOCIALIST BLONDE WOMEN EVERY WHERE AND POLAR BEARS TO RIDE TO SCHOOL
"Mostly I think that people react sensitively because they know you’ve got a point"
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https://www.nytimes.com/2021/03/19/world/europe/europe-vaccine-astrazeneca-interpreter.html
Europe’s Vaccine Ethics Call: Do No Harm and Let More Die?
European health agencies this week faced, with millions of lives in the balance, a staggeringly high-stakes incarnation of what ethicists call the trolley problem.
Imagine standing at a railway switch. If you do nothing, a trolley barreling down the track will hit three people in its path. If you pull the lever, the trolley will divert to an alternate track with one person. Which option is morally preferable: deliberately killing one person or passively allowing three to die?
In Europe’s version, German regulators identified seven cases of a rare cerebral blood clot, three of them fatal, out of 1.6 million who had received the AstraZeneca vaccine. Regulators had no proof they were linked, only a statistical anomaly. Still, continuing vaccinations might make them responsible for putting a handful of people in harm’s way — like pulling the lever on the trolley tracks.
Instead, the German authorities withdrew approval for the vaccine starting Monday. Neighboring countries followed, waiting for the European Union drug regulator to deem the vaccine safe, which it did on Thursday.
It might seem like a strange choice. With a third viral wave claiming thousands of lives per day in Europe, even a brief pause seemed all but certain to imperil many more lives than the unproven, very rare side effect.
Still, medical ethics can be tricky. Experts tend to view Europe’s decision as either an understandable, if risky, cost-benefit calculation or, as the Oxford University ethicist Jeff McMahan put it, “a disastrous mistake.”
Dr. McMahan, who studies life-or-death dilemmas, said that the extra Covid deaths likely to occur would “be by omission, or by not doing anything, rather than by causing. But you have to ask, does that make any difference in this context?”
But Ruth Faden, a Johns Hopkins University bioethicist and vaccine policy expert, called the pause “an extremely tough call.”
“If the only thing that mattered was deploying the vaccine in such a way as to reduce severe disease and death as quickly as possible, then you just go ahead,” Dr. Faden said. But it isn’t. While countries that continued vaccinations “probably made the right call,” she said, Germany and others faced real considerations around public trust and ethical duty.
And this will not be the last time in the pandemic, the experts said, that leaders will be forced to weigh a possibly flawed treatment against the heavy costs of caution.
Germany’s health ministry said in a statement, “The state provides the vaccine and therefore has special duties of care,” such as monitoring for risks and responding if certain conditions are tripped. Even, the statement acknowledged, if the decision cost more lives than it saved.
“This idea of the precautionary principle plays a big role in E.U. policy,” said Govind Persad, a University of Denver bioethicist. That principle calls for pausing any policy that might bring unforeseen harms in order to study those harms before proceeding. Imposing blind risk, however small, on unknowing citizens would be wrong.
For one, even if vaccinations did carry some risk or uncertainty, the risk and uncertainty introduced by withholding them, therefore allowing cases to spread, was surely higher. It was not as if infections paused for bureaucratic process.
For another, vaccinations are voluntary.
“This is not a case where you’re imposing risk on unconsenting people,” Dr. Persad said, and therefore violating the precautionary principle. “You’re allowing people to consensually protect themselves from a big risk by taking a very small one.”
Imagine, he said, “You have somebody who’s stuck on a subway track, and there’s a service ladder that they want to use to climb out.”
Europe’s approach, he said, was akin to pulling up the ladder, telling the stuck person that they couldn’t use it until it had been safety-tested for the general public.
“It’s true that a ton of British people use ladders like this and they’re fine,” he said, referencing the widespread use of the AstraZeneca vaccine in Britain. “But we can’t let you hurt yourself.”
In those situations, he said, it is usually considered more ethical to give people all the information so that they can make an informed choice on how best to protect themselves.
Such concessions are already common in medicine, many with exponentially greater risks and lower chances of success than the vaccine: elective surgeries, vaccine trials, experimental cancer treatments.
There are exceptions, like when companies recall a hazardous product rather than simply slap on a warning label. But limiting peoples’ access to cabbage during an E. coli outbreak doesn’t harm them; withholding a lifesaving vaccine does.
Do No Harm
“In Germany, there’s a very great reluctance to countenance imposing affirmative harm on people in trade-off situations,” Dr. Persad said. “It’s a very strong emphasis on not causing harm, even if you allow much more harm through inaction.”
This unusually high aversion to anything that might be seen as the government violating individual autonomy or dignity are, like so much in Germany, a reaction against the country’s Nazi past.
With Germany’s position as first among equals in the European Union, and a broader wariness against appearing permissive on vaccine safety, others quickly followed, including France, Italy and Spain.
Still, the thinking behind Europe’s decision also reflects something universal: the Hippocratic oath, “First, do no harm.”
Even so much as administering doses with an unproven potential to harm patients at about the same odds as being struck by lightning could be considered impermissible under that oath.
“But when the alternative to doing a small amount of harm is allowing a vast amount of harm, then the ‘do no harm’ slogan is a poor guide to policy,” said Dr. McMahan, the Oxford ethicist.
And while “first, do no harm” can feel like an iron law of medical ethics, it is in fact primarily a professional code of conduct. For centuries, it has reflected an inborn human bias that sees affirmatively causing harm as categorically different than passively allowing it.
“That doing/allowing asymmetry is of course not just in the medical codes but in the law,” Dr. McMahan said. Especially liability law.
The statement from Germany’s health ministry acknowledged as much, writing that, if it allowed vaccinations “to continue without properly informing the population and those receiving the vaccine, there could also be legal consequences.”
But in a country with 74,000 deaths and counting, Dr. McMahan said, for a public health agency to weigh its own liability against the survival of hundreds or thousands more “would be truly terrible.”
Much as policymakers might like to make a purely medical decision, Dr. Faden said, the vaccine bioethicist, they also have to think about guarding public confidence.
Vaccine skepticism was already high in Europe, especially toward the AstraZeneca shot, on which Europe has built its plans. The proportion of people willing to get the shot has, in some polls, dropped significantly below the 70 percent needed to achieve herd immunity.
“High-profile, vivid events that are really scary have a way of controlling the public imagination,” Dr. Faden said.
Pausing, she added, can be a way of “reassuring the public that you as a public health authority, or as a government, take super seriously any signal that comes up like this.”
The hope is that this builds trust in the health authorities, demonstrating that they put caution and safety ahead of rushing shots into arms. Even if people remain unsure about the vaccines themselves, perhaps high trust in the vaccinators could overcome this.
But on ethical grounds, Dr. Persad said, “It seems like a troubling line, to say that one person’s access to treatment should be dependent on how that might affect the comfort or psychology of a third party.”
It is also a gamble. The delay imposed by European governments risks a deepening of public doubts about the vaccine. And now officials must demonstrate they take these three fatal clots seriously, which means calling more attention to them.
“This is a safe and effective vaccine,” Emer Cooke, executive director of the European Union’s drug regulator, said on Thursday, urging countries reinstate its use. Still, she urged that governments “raise awareness of these possible risks.”
“Drawing attention to these possible rare conditions,” she said, “will help to spot and mitigate any possible side effects.”
Asked whether Americans might ever face such a dilemma, Dr. Persad countered that they already did. Though trials may show the one-shot Johnson & Johnson with a lower efficacy rate than two-shot variants, health officials hailed its simpler distribution as a breakthrough in the push for herd immunity. Americans have largely gone along.
“We don’t always see it,” Dr. Persad said of these ethical trade-offs, “but it actually comes up all the time.”
i'm not surprised. just pointing out that wherever trump goes, the virus follows.
"Well, you tell him that I don't talk to suckas."
Libtardaplorable©. And proud of it.
Brilliantati©
I'm sorry.
Can you foresee an ethical dilemma wherein children, who have low risk of severe COVID-19 complications are put at greater risk by taking a vaccine? It seems we would risk their health to achieve herd immunity and protect the vulnerable; whereas the vulnerable would not place themselves at risk to protect children.
I want my kid to get the vax....my wife does not.
Fun discussions.
Yes, it's possible that the situation will arise that there could be higher risk of direct consequences to a child from vaccination than from getting the disease. It's unlikely, given what we know about the current vaccines, but it's possible and that's why the studies are now being done on children. It's a very similar calculus with all vaccines.
This article from the NEJM discusses the issue: https://www.nejm.org/doi/full/10.1056/NEJMp2034765
Vaccinating Children against Covid-19 — The Lessons of Measles
List of authors.Imagine a highly contagious virus circulating in the community. Many infected children have fever and some general misery but recover without incident. Rarely, devastating complications occur, leading to hospitalization, severe illness, and occasional deaths. Susceptible adults fare worse, with higher rates of poor outcomes. Would you want your child vaccinated against this disease?
You guessed we were talking about measles, right?
As the first SARS-CoV-2 vaccines are rolled out to the highest-risk groups, the current stage of the Covid-19 pandemic is pregnant with possibility. Even as cases multiply and new restrictions loom, we gaze longingly toward the next few months, hoping vaccines will deliver us. Vaccination could liberate us to return to school or work, celebrate holidays, eat in restaurants, travel, run marathons, and [fill in your own deprivations]. Early announcements of vaccine efficacy send stocks soaring, and suddenly everyone knows about phase 3 trials and cold-chain logistics. We look to vaccines to give us back our world.
Children back in classrooms, on soccer fields, and at birthday parties are essential elements of that normal world — and we need children to help us get there. Since nearly a quarter of the U.S. population is under 18 years old — and the percentage is significantly higher in many other countries — effective herd immunity will require pediatric vaccination. Vaccinating children is likely to have benefits both direct (protecting children against rare severe pediatric cases of Covid-19 and postinfectious conditions such as multisystem inflammatory syndrome in children [MIS-C]) and indirect (protecting others by reducing spread).1 Those “indirect” benefits also reduce the family toll of parental illness, failing economies, and chronic stress.
So we need to think creatively and empathically about what motivates parents to accept vaccination for their offspring. How do the conversation and the stakes change when children are not themselves at highest risk? What do we owe children and their families for helping to protect the rest of us?
Robust safety data, including pediatric-focused studies and postlicensure monitoring for potential rare outcomes such as vaccine-associated MIS-C, are a bare minimum, as is ensuring just and equitable access to vaccination. Societal decision making that prioritizes children’s needs, including keeping schools open and safe, would be another step in the right direction. Flexible sick-leave policies, widespread access to testing, and financial support for parents, teachers, and other caregivers would help protect families in this stressful time. We must minimize children’s risk, maximize their chances of returning to school, and mitigate the pandemic’s effects on their families.
Measles and measles vaccination campaigns may offer relevant insights about parents’ decisions regarding vaccinating children they don’t believe are at serious risk; about trust, access, and equity; about using education campaigns and vaccination mandates to advance public health goals; and about how targeted disinformation about a safe and effective vaccine can endanger public health.
Measles is so highly infectious that it was once nearly universal in childhood. The Centers for Disease Control and Prevention (CDC) estimates that before a vaccine was available, the U.S. measles burden was several million cases a year, with 400 to 500 deaths, 48,000 hospitalizations, and 1000 cases of encephalitis. A measles vaccine developed by John Enders and colleagues was licensed in 1963. Because measles has no nonhuman reservoir, it seemed a feasible target for eradication, and in 1966 U.S. Surgeon General William Huffman Stewart called for eliminating measles in the United States by 1967 as a step toward global eradication. A CDC publication, Measles Eradication 1967, suggested that a public health victory of historic proportions was at hand: “Never before has the eradication of an important communicable disease been readily within reach.” President Lyndon Johnson publicly supported the campaign, as did medical and school health organizations, and Ann Landers columns and Peanuts cartoons urged the public to vaccinate.
Parents had volunteered their children as “polio pioneers” in 1950s vaccine trials, and the result — that the Salk vaccine was safe and effective — was celebrated as a national victory over a dread disease. But most children survived measles without serious sequelae. So the National Association for Retarded Children emphasized rare, severe complications with their 1966–1967 poster child, Kim Fisher, a 10-year-old who had developed measles encephalitis at 2 and been left “mentally retarded, hard of hearing, unable to walk, talk, or hold up her head.” It wasn’t only parents who needed convincing; a 1965 editorial in JAMA worried that many physicians didn’t take the disease seriously.2
The campaign reduced the incidence of measles but did not eradicate it. With the vaccine more readily available to children cared for by physicians in private practice, measles became disproportionately a disease of Black and Hispanic children. CDC officials blamed insufficient federal funding under President Richard Nixon, and there was growing support for stronger laws requiring immunization for school entry.3
The measles–mumps–rubella (MMR) vaccine was licensed in 1971, replacing monovalent vaccines for the three diseases. Mumps and rubella posed the same challenge of convincing parents (and some physicians) to vaccinate children against diseases that didn’t pose deadly dangers to most children. One of us vividly remembers the “rubella umbrella” campaign of the late 1960s and early 1970s, which advertised directly to children using television “commercials” formulated by Dr. Vincent Guinée of the New York City Health Department. It encouraged children to get protected so they wouldn’t spread the virus to pregnant women who were vulnerable to rubella’s serious teratogenic effects; the message to children was so effective that more than 17,000 parents called, and the approach was extrapolated for use in other public health campaigns.4
Using MMR, and buoyed by the success of school vaccination mandates in controlling measles outbreaks, in 1978 the CDC set a goal of eliminating measles in the United States by 1982. Again, the campaign reduced cases dramatically but didn’t meet the target date. Outbreaks among vaccinated children led to a recommendation for an MMR booster, and by 2000, endemic measles had been eliminated in the United States. Yet that victory has not held; the famous 2014–2015 Disneyland outbreak was followed by others, including a series of 2019 outbreaks involving more than 1000 cases in 28 states.
Since a now-discredited and retracted article suggesting a link between MMR vaccine and autism was published in the Lancet in 1998, media attention and parental anxiety have been deliberately exacerbated by antivaccine activists and organizations, despite extensive research that has failed to find any verifiable link to neurodevelopmental disorders. Many recent outbreaks have involved children left unvaccinated by parents who had been targeted with propaganda, including antivaccine messages developed to target specific ethnic communities. This disinformation entails both lies about dangers and impurities of the vaccine and false reassurance about the benign nature of measles. The downstream effects are global, with plateauing vaccination rates and rising measles mortality after decades of progress. Ongoing measles transmission in regions with fragile immunization systems can seed outbreaks elsewhere, including in countries like the United States, with pockets of undervaccination despite high overall vaccination rates.
Today, many Americans express mistrust regarding the safety of Covid-19 vaccines. This attitude is unsurprising in an environment where mask wearing is politicized and loud voices on social media express doubt about the severity — or even existence — of SARS-CoV-2. But the measles vaccine story reminds us that we have an obligation to provide equitable access and clear information; that coordinated, federally supported efforts are essential; and that doubt, distrust, and disinformation can undermine safe, effective vaccines and worthy public health initiatives. Planning for the implementation of SARS-CoV-2 vaccination requires not only working out details of distribution, priority, and cold chains, but also strategies for reaching people who are distrustful, hesitant, dubious, or frankly opposed.5
Protecting children against SARS-CoV-2 infection is both an ethical obligation and a practical necessity. We need data from pediatric trials to reassure parents about the safety and wisdom of this approach. We must prepare for disinformation campaigns that prey on parental fears and target communities made vulnerable through histories of medical neglect, health disparities, and racism. Trusted messengers may help deliver truth and reassurance. And we need to consider lessons from recent measles epidemics — not only about the power of legislative mandates, but also about their potential for sowing distrust if delivered without careful, sensitive, accurate public health messaging. Dare we imagine a campaign that would actually thank children and parents for helping to protect others, as the rubella campaign did, perhaps suggesting that they proudly display their SARS Stars or Corona Diplomas?
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
That sounds like something you should inform affected parties about immediately, does it not?
BTW: My wife informed me that it’s illegal for the superintendent to block me on Twitter. I don’t really give a shit. But this could get fun!
It only mutates to its benefit.
I'm not sure why you would assume that vaccination will provide greater risk to children that getting covid.
We are still waiting for data but it is extremely unlikely that vaccination for children would be approved it it led to greater risk than the risk associated with covid infection. That's just not how vaccine approval works.
For context, data that I was able to pull from UpToDate shows the effect of covid on children in the US - I couldn't find relevant data from Canada, due to our lower population and lower case counts. Although kids are more likely to have mild or asymptomatic cases, the idea that kids very rarely get sick is incorrect:
Despite the trend of increasing hospitalization, a minority of children with COVID-19 require hospitalization [21]. Among >69,700 laboratory-confirmed cases of COVID-19 in children <20 years reported to the CDC by May 30, 2020, the hospitalization rate ranged from 2.5 to 4.1 percent. Among children who were hospitalized with COVID-19 from 14 states by late July 2020, approximately 33 percent required intensive care and 6 percent required invasive mechanical ventilation [39].
In CDC surveillance of COVID-19 in the United States, underlying conditions are associated with higher rates of hospitalization (15 to 22 versus 2 to 4 percent) and intensive care unit (ICU) admission (4 to 5 versus <1 percent) [21]. Whether underlying conditions are associated with increased severity or a lower threshold for admission (eg, because of concern for complications) is unclear [107]. Age <1 year has also been associated with increased rates of hospitalization [9], although hospitalization of infants may not reflect severity of illness.
So, between 2.5 - 4% of kids with serology confirmed covid required hospitalization, and a third of those required ICU level care. That's not insignificant, and I can guarantee without a shadow of doubt that we won't see 2.5 - 4% of kids requiring hospitalization from vaccination.
Life is risk. Every action we take has risk, as does every action we don't take. We all collectively have to take this risk.
I don't see any way that risk could be shifted to the elderly and away from kids, even if we thought that was a good idea.
This virus is likely to be with us for a long time. Kids grow up and at some point they'll be teens and then adults and they'll be at higher risk too.
https://www.bbc.com/future/article/20200918-why-some-deadly-viruses-vanish-and-go-extinct
https://www.thescore.com/mlb/news/2137693
https://graphics.reuters.com/HEALTH-CORONAVIRUS/VACCINE-EFFECTS/xegvbglkrpq/index.html
Short form, though - risk of thromboembolism after getting the AZ vaccine is estimated at about 1.9 per million.
Risk of thromboembolism leading to pulmonary embolism in people taking long distance plane flights (12 hrs +) is about 5 per million.
Risk of thromboembolism in women on oral contraceptives - between 600 and 1000 per million, depending on the type of OCP.
Risk of some sort of clotting abnormality after taking acetaminophen - about 1000 per million.
Edit: ... because I didn't actually provide the link the first time
perspective. its a helluva thing.....
Not today Sir, Probably not tomorrow.............................................. bayfront arena st. pete '94
you're finally here and I'm a mess................................................... nationwide arena columbus '10
memories like fingerprints are slowly raising.................................... first niagara center buffalo '13
another man ..... moved by sleight of hand...................................... joe louis arena detroit '14
So she will be employed till September. As what I am guessing the only employee outside of the owners. So if they do not go into bankruptsy and the corona-levels goes down towards summer - she could maybe keep her job.
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OF THE MONARCHY OF SWEDEN
WITH OUR LONG AND STURDY
HISTORY OF
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WHO NEEDS MINIMUM WAGE BY LAW WHEN IT IS THIS
AMINGZLY
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AND POLAR BEARS TO RIDE
TO SCHOOL