The current state of the science says that we should end these mandates for our military personnel.
The current state of the science says that we should end these mandates for our military personnel.
T he Pentagon is now a theater in the fight over vaccine mandates. Last week, Republicans in the House of Representatives demanded the end of the Covid-vaccine mandate President Joe Biden imposed on the U.S. military in 2021. Republicans inserted language ending the mandate into the National Defense Authorization Act for fiscal year 2023, which sets the policy agenda and authorizes funding for the Department of Defense. Republicans, along with a few Democrats, insisted on tying the end of the mandate to the passage of this key bill, forcing the White House into a precarious situation.
The 2022 midterm elections made this result a fait accompli. Along with ending the military vaccine mandate, House Republicans ensured an 8 percent increase in overall military spending, and a 4.6 percent increase in pay for the troops. The White House and its progressive allies opposed the funding increases, but erupted in overt anger at the prospect of ending the Covid-vaccine mandate. But the House passed the measure 350–80, with substantial Democratic support. A Senate vote awaits before the bill gets to President Biden’s desk. The House has done the right thing; the Senate and the president should follow, as the vaccine mandate is bad policy.
The Biden administration remains uncomfortable with repeal.
John F. Kirby, a spokesman for the National Security Council, called the repeal of the vaccine requirement for troops a mistake. “Making sure our troops are ready to defend this country and prepared to do so, that remains the president’s priority, and the vaccine requirement for Covid does just that,” Mr. Kirby said. “But Republicans in Congress have obviously decided that they’d rather fight against the health and well-being of those troops, rather than protecting them.”
For all the complaints from the West Wing, there has been a slow and steady acceptance by the mainstream that the military mandate needed to end. Representative Adam Smith, Democrat from Washington and current chairman of the Armed Services Committee, said he agreed with the policy in 2021, but has since changed his mind. “But as we are here now, in December of 2022, does that August 2021 policy still make sense? Is it still the right policy? We don’t believe that it is.” Smith correctly mentioned that service members who received a first dose of the coronavirus vaccine early in 2021 — offering them little to no protection against new variants — were nonetheless allowed to serve under current rules.
The House bill will open the door for the return of thousands of military servicemen and servicewomen who were dismissed from the military for their refusal to take the vaccine. The vast majority of active-duty service members are in fact vaccinated. Only about 2 percent have not gotten both doses of a vaccine — but ending the mandate would also mean new recruits would not need to get vaccinated.
Support for the end of the military mandate has grown more bipartisan over time. This has largely been driven by the deepening knowledge and science around the efficacy of these vaccines. Last week, progressive stalwart Dr. Leana Wen came out publicly in support of ending the mandate:
Public health policy needs to adjust based on evolving science and changing circumstances. When the coronavirus vaccines were first made available, there was a compelling case for requiring them. Initial data showed that they reduced infections by more than 90 percent. In the fall of 2021, when the Pentagon announced its vaccine requirement, an unvaccinated person was five times more likely to be infected compared with someone who was vaccinated.
Things changed with the arrival of omicron. For months, research has shown that while the vaccines provide excellent protection against hospitalization and death, their effectiveness in reducing infection against the omicron subvariants is low and not lasting.
The essential part of this debate has been separating out the needs of public safety in 2020, when our therapies and knowledge of the virus were severely limited, from the reality near the end of 2022. Fear and lack of data limited health professionals’ ability to confront the pandemic in 2020. However, the arrival of the vaccine in early 2021 was a godsend, as it became the first real tool that specifically targeted the virus. Now, near two years later, we can re-evaluate. We have numerous therapies to confront the virus, and also know far more about the disease, especially how it affects people differently by age.
We also know how the vaccine really works in our greater population, what it can do, and what it can’t. These are key facts if we are to determine whether a universal vaccine mandate is necessary. So, first:
Do the vaccines significantly decrease severe disease from Covid infection? The answer is: yes, absolutely, without question.
Where the divergence comes is who, exactly, is at most risk of severe infection. When these data are evaluated, it is quite clear we are largely talking about the elderly, especially those over age 80, but also including all individuals over age 65. This, obviously, is not the cohort of patients being considered for military service.
Second: Do Covid vaccines stop transmission of Covid? Most of our current military vaccine mandates have been about stopping transmission of disease through our military ranks, in order to prevent mass casualties from an outbreak.
The problem is: They don’t do this very well.
An article in the New England Journal of Medicine showed a complicated immunity profile for those who had been infected, those who had been vaccinated, and those who had been both infected and vaccinated. Those who had Covid infections saw approximately 50 percent reduced risk from future infections. But — and this is the staggering finding — two doses of the vaccine were no better at stopping viral transmission after eight months than no vaccination at all. The authors concluded that “these findings are explained by the short-lived protection of primary-series vaccination against omicron infections and the more durable protection from natural infection as confirmed by the additional analysis of protection as a function of time after previous infection or vaccination.”
A study from the Centers of Disease Control and Prevention showed that 18- to- 49-year-olds who received the most recent bivalent booster showed a 43 percent decrease in infection. However, that paper only studied the first two months after vaccination. If the New England Journal of Medicine study is correct, it is only after this period that the vaccine’s efficacy in controlling transmission decreases dramatically. More studies seem to agree with the initial finding that transmission-protection decreases quickly. Another recent study in the journal Nature Communication showed the vaccine was only 50 percent effective at stopping transmission in the first three months after vaccination. As time progressed, the efficacy dropped to around 10 percent.
The current vaccines are not effective in stopping transmission of the disease after a few short months. Vaccination decreases transmission in the immediate term, but that almost disappears after two months. Even more disappointing is that those who had been vaccinated and then had been infected had no significant benefit versus those who had only been infected. Naturally obtained immunity appears to have far higher rate of protection.
Considering all the scientific analysis of and data about the mRNA Covid vaccines, we can draw a few conclusions. For people at high risk of severe disease (in the case of Covid, we are mostly talking about the elderly), there is a clear benefit to the vaccine: It decreases the occurrence of severe disease. However, in most patients, both young and old, the vaccine does little to almost nothing to reduce the rate of transmission.
So, in an age cohort where the vast majority of Covid disease is exceptionally mild (i.e., those under the age of 40), how can you rationalize a government-enforced mandate, when right now the data show the vaccine is very poor at stopping transmission?
Our public-health leaders have either been unwilling or unable to explain the reality of our current mRNA vaccines. The Covid vaccine is nowhere near as effective as the polio or chicken-pox vaccines have been in preventing transmission and disease.
This public-messaging failure has huge repercussions for the future of health care. Failing to make it clear that our traditional vaccines are far more effective than the Covid vaccine in this regard has actually decreased public faith in these essential vaccines, and may do greater harm in the future. By reducing faith in vaccines overall, we could be causing certain sectors of our society to reject those more established and proven vaccines, because of their diminishing faith in the new Covid vaccines. The polio vaccine is 99 percent effective in preventing polio transmission; the measles vaccine, 97 percent. The Covid mRNA vaccine? 40 percent — and that may be generous. To compare this vaccine to those more established vaccines does a disservice to not only the public, but to our children, and to science itself.
I fully believe in the overall safety and efficacy of the mRNA Covid vaccines, and until they are proven to be unsafe and ineffective, that won’t fundamentally change. But it is naïve and unscientific to compare this vaccine to other more established, proven and more efficacious vaccines. Both scientists and policy-makers should accept the current state of our Covid-19 vaccines, and shape our policy around that reality.
Our lead policy officials have not done the due diligence to prove that such mandates actually decrease transmission, or dramatically improve the readiness of our military, while failing to confront the reality that the mandates continue to hurt retention of current service members as well as the recruiting of new personnel. The military mandate, as well as other mandates involving young adults and children, do a disservice first and foremost to young Americans, but also to the science surrounding vaccines and the coronavirus. We should always follow the evidence and data first, regardless of where they take us. The current state of the science says that we should end these mandates for our military personnel, until such time that the evidence and data catch up to the intended policy.