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Health Care

The Problem with Biden’s Vaccine-Hardball Strategy

President Joe Biden delivers remarks on his administration’s efforts to increase vaccinations from the White House in Washington, D.C., September 9, 2021. (Kevin Lamarque/Reuters)

On the menu today: In the aftermath of President Biden’s fuming speech drafting America’s employers into becoming the enforcers of vaccine mandates, it is worth pointing out that SARS-CoV-2 is extremely likely to become endemic — and that if unvaccinated Americans really represent some sort of threat to the vaccinated — a contestable argument — then the administration needs to grapple with the several billion unvaccinated human beings beyond our borders.

Our Endemic COVID-19 Future

The virus SARS-CoV-2 is extremely likely to become endemic. This means that it will never go away completely, the way the first SARS did, or the way various Ebola outbreaks of the past disappeared after a frightening and deadly burst of cases. Almost 90 percent of immunologists, infectious-disease researchers, and virologists working on the coronavirus surveyed by Nature in February concluded the virus that causes COVID-19 was “very likely” or “likely” to become endemic.

This does not mean we are destined for a grim future of continually crowded hospitals, quarantines, restrictions, social-distancing, masks, and avoiding crowds. According to Nature, “Influenza and the four human coronaviruses that cause common colds are also endemic: but a combination of annual vaccines and acquired immunity means that societies tolerate the seasonal deaths and illnesses they bring without requiring lockdowns, masks and social distancing.” If SARS-CoV-2 becomes like other coronaviruses, it will become a virus that most future children will encounter early on in life, fight off, and develop a lasting ability to fight off in future encounters with minimal symptoms. In other words, someday, COVID-19 will become a public-health nuisance, not the society-disrupting force that it is today.

Yesterday, President Biden spoke at length, and angrily, about the 80 million American adults who have not yet gotten any vaccination shots.

The president’s message was somewhat muddled. He began by emphasizing that vaccinated Americans face almost no health risk from this virus. “Based on available data from the summer, only one of out of every 160,000 fully vaccinated Americans was hospitalized for COVID per day,” he said. “Recent data indicates there is only one confirmed positive case per 5,000 fully vaccinated Americans per day.” But then, Biden spoke as if unvaccinated Americans were endangering vaccinated Americans. “The bottom line: We’re going to protect vaccinated workers from unvaccinated co-workers.”

The only true health risk to vaccinated Americans is that they could face a crowded hospital. This could be solved instantly by prioritizing vaccinated Americans for care, but this is unthinkable for too many people. It also makes a mockery of the “health care is a human right” slogan preferred by so many Americans on the left side of the spectrum.

Many pro-vaccination Americans contend that unvaccinated Americans are putting the rest of us at risk, because the longer the virus is floating around, the more opportunities it will have to mutate into a variant that is not stopped by the current vaccines.

But there’s a real problem with this thinking. If any unvaccinated human being represents a potential opportunity for a terrible variant to arise, then yes, those 80 million American adults are a potential threat — but so are the roughly 50 million unvaccinated American children who will not be able to get vaccinated until “midwinter” at the earliest, according to the FDA. And both of those groups are a fairly small problem compared to the several billion unvaccinated human beings beyond our borders. A virus can mutate just as easily in the body of an Egyptian as it can in the body of an Alabaman.

The world has administered 5.63 billion vaccine doses so far, or 73 doses for every 100 people. But keep in mind, most of the available vaccines require two doses. Even if we decided to only give one dose to every person, we would only have 71 percent of the world’s nearly 7.9 billion people vaccinated. (It is also worth keeping in mind that other countries’ vaccines are not necessarily effective; there’s mounting evidence that the Chinese vaccines are particularly unreliable.) If every person required two doses, we would only have 35 percent of the world’s population vaccinated.

In other words, if SARS-CoV-2 will only go away when it no longer can find an unvaccinated human body to jump to, it will likely keep spreading for a long time — at least another year, and probably several years. (Although there is one scenario where it more or less disappears quickly, which I’ll discuss below.)

Yes, a particularly nasty new variant of SARS-CoV-2 could emerge in Louisiana, where only 50.3 percent of the population has received at least one shot. But it is much more likely that a truly dangerous new variant will emerge in highly populated, low-vaccination countries such as India, where 40 percent of the population has at least one shot; Russia, where only 31 percent of the population has at least one shot; Indonesia, where only 24 percent of the population has at least one shot; Pakistan, where only 23 percent of the population has at least one shot; or Bangladesh, where just 12 percent of the population has at least one shot. Nigeria has 211 million people; only 1.8 percent of the population has received at least one shot.

And if there’s anything we’ve learned from COVID-19, it’s that in an era of massive air travel, it is almost impossible to effectively quarantine against a virus that spreads this easily and quickly. You can set up what seems like a perfect system of strictly quarantining incoming air travelers for two weeks, and then watch it fall apart as the guards have sex with those who are supposed to be in lockdown. Human beings are going to interact with other human beings. Any pandemic-mitigation approach that depends upon human beings minimizing their contact with other human beings is one that cannot work for very long.

The Delta variant, or B.1.617, was first detected in the United Kingdom on February 22 and in the U.S. a day later. By the end of March, this variant had been detected in Ireland, Singapore, Germany, Denmark, New Zealand, Canada, Australia, Finland, Greece, Belgium, Sweden, South Korea, Uganda, Japan, Guadeloupe, Sint Maarten, and Switzerland — and this is in late February and March, when international air travel was a fraction of what it normally is. The entire philosophy and strategy of quarantines developed before mankind had the ability to fly from Beijing to Los Angeles in twelve hours. The influenza of the 1918 pandemic moved from one place to another the speed of steamships.

If your philosophy is, “Anyone who is unvaccinated is putting everyone else at risk,” then be prepared to live with risk for several years — because the risk does not just come from unvaccinated Americans, but also from unvaccinated Canadians and Mexicans and everyone else who’s not yet vaccinated in other countries. Oh, and remember, Europe is full of vaccine skeptics and anti-vaxxers, too.

As for that best-case scenario, we are now three-quarters of the way through the second year of this pandemic. The worst global pandemic of modern times, the Great Influenza pandemic, ran from February 1918 until April 1920 — really just two years and two months. That virus spread slower around the world, but human beings of that era didn’t have vaccinations and all of the medical advances we enjoy today.

John Barry wrote in his brilliant book, The Great Influenza: The Story of the Deadliest Pandemic in History:

By nature the influenza virus is dangerous, considerably more dangerous than the common aches and fever lead people to believe, but it does not kill routinely as it did in 1918. The 1918 pandemic reached an extreme of virulence unknown in any other widespread influenza outbreak in history. But the 1918 virus, like all influenza viruses, like all viruses that form mutant swarms, mutated rapidly.

There is a mathematical concept called “reversion to the mean”; this states simply that an extreme event is likely to be followed by a less extreme event. This is not a law, only a probability. The 1918 virus stood at an extreme; any mutations were more likely to make it less lethal than more lethal. In general, that is what happened. So just as it seemed that the virus would bring civilization to its knees, would do what the plagues of the Middle Ages had done, would remake the world, the virus mutated toward its mean, toward the behavior of most influenza viruses. As time went on, it became less lethal.

If the Delta variant represents the most contagious version of SARS-CoV-2, then reversion to the mean suggests that future mutations will make the virus less contagious. The Delta variant wave appears to have peaked in some states. We have 208 million Americans who have at least one shot, and we have more than 41 million diagnosed cases, meaning those people should have natural immunity from their past infection. Future variants and waves of SARS-CoV-2 may not find many people that can be easily infected.

Finally, if it’s so important that people get vaccinated that the Department of Labor must strong-arm employers into either firing them for not being vaccinated or force companies to run weekly tests of all employees . . . then why are employers with less than 100 employees exempt from Biden’s new rule? Are unvaccinated employees only a threat if they work at large companies? The ones working at small business just aren’t a big deal?

ADDENDUM: Because it needs to be said every day until it’s resolved, at least 100 American citizens, an unknown-but-considerable number of U.S. green-card holders, and more than 100,000 Afghan allies who qualified for Special Immigrant Visas remain trapped in Afghanistan, despite the president’s promise that, “If there’s American citizens left, we’re gonna stay to get them all out.”

It is September 10, and the U.S. government still cannot say, with any specificity, how many Americans or U.S. green-card holders remain in Afghanistan.

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