Vaccines

L.A. Superior Court Mandates Vaccination for All Staff,

once the vaccine gets final FDA approval (and subject to medical and religious exemptions).

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So reports the L.A. Times (Matt Hamilton). The approval is expected by early September, and after that staff will have 45 days to get the vaccine. Seems sensible to me (though perhaps proof of immunity stemming from infection should be allowed as an alternative to immunity from vaccination, if Todd Zywicki's theory is correct).

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  1. One practical issue with relying on post-infection immunity is that there is a very wide range of immune responses possible. Asymptomatic or low-grade cases may lead to weak immunity. Vaccines have the advantage of standardized doses, and of being designed to stimulate immune responses. The virus, at least at first, suppresses them: https://www.nature.com/articles/s41467-020-19706-9

    In May, a paper appeared in Nature with the first numbers on antibody levels versus degree of protection. One option would be to require some threshold to be reached on an antibody test. But with a vaccination being simpler than an antibody test, it’s not clear what reason there would be.

    1. Recent data is increasingly promising regarding the benefit/value of natural immunity overall…perhaps not enough to make the vaccine unadvised in such cases, but clearly enough to put it in the realm of a reasonably debatable matter (and thus not a matter for coercion).

      A lot remains to be learned about correlations between antibody levels and degree of protection, duration of protection for natural infection vs. for the vaccines, and of course the variability for those things (and more) across the overall population. But when there’s such uncertainty, we need to err on the side of letting people make their own decisions.

      Certain “big picture” issues about Covid are pretty clear – but this just isn’t one of them. Natural immunity is an area where many reputable doctors/experts disagree with each other; and notably, other countries are giving it at least some weight.

    2. re: “One practical issue with relying on post-infection immunity is that there is a very wide range of immune responses possible.”

      Sorry but that issue is identically presented in the wide range of possible immune responses to vaccination. That is not a sufficient justification to exclude natural-infective immunity.

      1. We all pine for a one-size-fits-all cost/benefit and level of acceptable risk.

  2. “One option would be to require some threshold to be reached on an antibody test. But with a vaccination being simpler than an antibody test, it’s not clear what reason there would be.”
    That seems like a sensible approach and puts all emplyees on an even playing field.
    We do know that even for the vaccinated, antibody level decay in time with a half-life that some epidemiologists estimate to be as low as 6 months from peak immunity. So every gets a serology test. Fail the test and get a vaccine / booster.

    1. A lawyer giving medical advice based on a completely novel theory? Boosters aren’t like candy … you can’t just give them as a “top up” whenever you feel like it. They can have cumulative effects, they need to be tested, etc.

      1. What completely novel theory.
        1) Serum levels of antibodies have been measures for many months
        2) “a “top up” whenever you feel like it. ” False. The booster shot will do just that and the second shot of a two shot vaccine does just that, And a single shot to a previously infected individual does just that.
        Before you snark, try educating yourself from the high quality medical literature.
        But just in case you’re too lazy to do the searching yourself, you can start here:
        “Distinct antibody and memory B cell responses in SARS-CoV-2 naïve and recovered individuals following mRNA vaccination”
        R. R. Goel et al., Sci. Immunol. 10.1126/sciimmunol.abi6950 (2021).

        1. Your novel theory is that a third booster with the same vaccine will improve outcomes against a variant that appears to evade the current vaccine (or is ineffective in those with pre-existing immune issues).

          It is well documented that adverse effects increase from the first to the second dose, and it is not unreasonable to extrapolate that they may continue to do so with third or subsequent events.

          Deciding whether or not to permit a third booster should be done based on sound clinical trials and backed by data.

          1. AtR,
            Are you really so dense?
            The use of a booster is NOT my theory. It is not novel. It is being carried out in multiple countries and Big Pharma is working on optimizing and testing.

            “it is not unreasonable to extrapolate that they may continue to do so with third or subsequent events.” That is nothing new with respect to any booster shots for any disease

            In other words, your post says nothing of any value.
            This is enough time wasted on you for today.

            1. Maybe before accusing AtR of being dense, you should look in a mirror. Other countries are working on them but not yet mandating them because, exactly as AtR said, “sound clinical trials … backed by data” are needed before making that decision.

    2. An antibody test is less intrusive and does not intentionally affect the workings of the body. Vaccines come with side effects — particularly the second COVID shot, when the body has some immune reaction to the antigen(s) involved. Unless the vaccine can be proven to be superior to what the antibody test will report, or booster shots somehow skip such reactions, it seems unjust to inflict a (brief) illness on an employee out of the employer’s preference.

      1. Michael,
        The antibody test serves only to put the recovered and the vaccinated on a level playing field of measured degree of immunity.
        It is not a replacement for immunity conferred either by vaccine or by previous infection.

        That the court will mandate either a measure level of immunity or prophylactic is the prerogative of the court that I am not commenting on

      2. Yes, taking blood for an antibody test is far less intrusive than receiving a shot of the vaccine. That’s just obvious.

        And here’s a comprehensive list of the side effects of my second Pfizer shot:

        1. My arm was slightly more sore than after the first shot.

        This concludes the comprehensive list of the side effects of my second Pfizer shot.

        1. Cool story, brah. My personal side effects were feeling totally wiped out for a day. For my wife, it was several days. For others, it is worse. I think the side effects are worth the protective effects. I also think that the science does not currently support a vaccine mandate for people where semi-quantitative antibody tests show a robust immune response to COVID. That’s the case that employers should have to make before imposing such a mandate.

        2. Otis,
          I’ll begin by saying that I am a strong proponent of vaccination and will get a booster when available.

          Now, proceeding to side effects: these appear immediately after vaccination
          1) for myself I get recurring flu-like symptoms absent fever every 10 days to two weeks. That causes me to lose a day in bed.
          2) for my son, dramatically reduced sense of balance making unassisted walking difficult. Worsened after the second shot. he is now in physical therapy.
          Neither of these conditions were reported by HMO as side-effects, although they did do extensive testing.

        3. I had the exact same side effects as Otis except my arm was not sore at all.

          1. A couple of days of >101° fever, attendant joint pain and chills. In my misspent youth I had hangovers that were worse. And none of them protected me against contracting and communicating a disease that’s taken more of my friends and loved ones than any other single cause in my six decades of life.

            Opposition to the vaccine and other COVID mitigation measures is a strong candidate for the sorriest manifestation yet of the toxic partisan rending of our social fabric.

        4. And if your one anecdote were data, that would be relevant. The documented side-effects range from none to very severe.

          Whether taking blood out of the body for a test is less intrusive that putting something into your body and causing lots of immunological changes is a matter of personal opinion. But, yeah, I think I’d agree that the external test is less intrusive than being forced to get a shot.

    3. “One option would be to require some threshold to be reached on an antibody test. But with a vaccination being simpler than an antibody test, it’s not clear what reason there would be”

      The clearest reason would be the adverse reaction after being vaccinated. In many people who have previously had a moderate to severe case of COVID, the vaccine resulted in symptoms of severe fatigue and general malaise for 1-2 days afterwards.

  3. Is proof of efficacy also a consideration, or is it enough that some bureaucrat in the CDC thinks this is a good idea. The latest data out of Israel shows pathetically poor efficacy, especially among the young, and questionable protection against hospitalization.

    See:
    https://www.linkedin.com/feed/update/urn:li:activity:6828887080794394624/

    1. You really need to work on the quality of your citations.

      1. You really need to work on the quality of your complaints. Don’t just leave a sneer hanging without any discussion. Say what is wrong with the link. Say what could be done to meet your approval.

        1. What is wrong with the link is that is a set of anecdotes that don’t establish anything comprehensively about the present experience in Israel

    2. That guy’s statistics are incompetent. His efficacy calculations, for example, take the raw number of hospitalizations within certain age groups. That is only statistically valid if the number of vaccinated and unvaccinated people are similar: his own source says the fraction of vaccinated people is between 70% and 90%, depending on which age group he cherry-picked and whether you count a single shot as vaccinated.

      1. Clarification: The fractions of vaccinated people I mentioned are in the total Israeli population, not among the hospitalized.

      2. His efficacy calculations are based on *rates* of hospitalizations (i.e., number per 100k), not raw numbers of hospitalizations. Please read carefully before you throw out accusations.

        1. The numbers he presents are implausible as hospitalizations per 100k. In the comments, he claims he used the “active patients per 100k” number. But see the “active patients” box at the top — the number of active patients is almost 100 times the number listed as being in the hospital.

  4. We have come so far since the Civil War: we now know what is the right course of prevention and treatment of every disease! And we can absolutely trust each and every one of our elected leaders… and can trust each and every bureaucrat each elected leader has installed!

    Makes me want to sing ( https://www.youtube.com/watch?v=xlCilKlqrvI [or the next song]). Or read some Shakespeare (without proper musical underlayment): “What a piece of work is a man! How noble in reason, how infinite in faculty! In form and moving how express and admirable! In action how like an angel, in apprehension how like a god! The beauty of the world. The paragon of animals.”

  5. I am curious what will happen with other vaccines and pathogens. Let’s assume for the moment the Jacobson rational basis threshold has to be met. I know many will quibble with the appropriateness of that standard for this, but hear me out.

    Covid certainly meets that rational basis threshold, especially considering all the alternatives available (masking, testing, exemption for disability, exemption for religious belief, possibly serology, etc).

    But what if some covid-light comes along in a few years? How about flu? You can do this hypothetical for any infectious disease. There’s going to have to be a workable set of standards by which we evaluate the reasonableness of a vaxx requirement for government employees or even non employees.

    In this case you’ve got a state, which certainly has more leeway to with such a requirement. I haven’t given careful thought to the federal situation because Congress hasn’t bothered to put forth anything yet, though perhaps they will someday.

    1. Perhaps we should leave it up to the elected branches (as rational basis intended) and pressure from the electorate. On the other hand, given the invasive nature of vaccines, it’s not unreasonable to ask for some judicial oversight that is far short of strict scrutiny. That being said, we should not be developing new doctrine based on COVID for which the arguments against vaccines are far weaker than other cases (e.g., the flu) which may remain forever as hypotheticals.

      1. One hopes that Congress would write something on this eventually. Not holding my breath there hehe.

        Seems mostly likely some state or other will pass some requirement for another vaccine for its own employees, or even some other categories of citizens. Or conversely, a state might prohibit state employers from mandating specific vaccines. There aren’t that many vaccines, they can afford to take a hard look at each one.

  6. The tests do not work as any sort of proof. The technician can cause any desired indication. Y’all lawyers must study closely and understand the PCR test instructions, particularly critical thresholds.

    1. Antibody tests don’t use PCR, because antibodies do not have the kind of known protein sequence that PCR tests exploit.

      1. PCR doesn’t do anything with proteins.

        1. Ok, that’s novel. The point of PCR is to replicate a certain set of specific proteins. DNA in fact. Do you just have a private definition of “proteins” that you are now using to try to win arguments ?

          1. DNA is not a protein.

        2. Well, indirectly. PCR multiplies RNA, which in most cases codes for a protein. So he misstated it, but had the right general idea.

          And, yeah, the fewer PCR cycles you run, the higher the rate of false negatives, in the limit, 100%. The more PCR cycles you run, the higher the rate of false positives, with again, a limit of 100%. You can manipulate the results by running the wrong number of cycles.

          But, that’s not unusual, you can manipulate most tests by doing them wrong.

          1. By the way, CDC has already foreclosed using antibody seriology as a way of getting around their ignoring infection generated immunity.
            In its July 15, 2021 update
            https://www.cdc.gov/coronavirus/2019-ncov/testing/serology-overview.html
            CDC says
            “Antibody testing is not currently recommended to determine if you are immune to COVID-19 following COVID-19 vaccination. Antibody testing should also not be used to decide if someone needs to be vaccinated. “

            1. So CDC’s decision to ignore immunity in the 35,000,000 Americans recovered from COVID-19 smells like a fatwa.

        3. Fine: Antibodies are proteins, meaning they not composed of either RNA or DNA, so PCR in a narrow sense can’t detect them at all. If you consider a broader set of polymers (such as proteins), a person’s antibodies do not have a known pattern for a polymer to be be detected by any technique like PCR.

          1. PCR doesn’t detect – it raises the concentration to make detection methods more effective.

            I don’t know much about serological tests, but I do know about PCR.

            1. This is correct.

            2. Sigh…. There’s nothing worse than someone being pedantic and failing to actually include the context.

              In the context of the COVID tests, the “PCR test” is shorthand for RT-qPCR, which includes detection.

              1. Interesting. Thanks for clarifying. I’m learning something.

  7. There is a new study which reports that vaccination after infection makes a real difference to the risk of re-infection.
    https://www.cdc.gov/mmwr/volumes/70/wr/mm7032e1.htm?s_cid=mm7032e1_w
    That conclusion is different from the Cleveland Clinic study, a massive one, that found adequate protection after infection. Of course I don’t know why they differ, but one obvious possibility is that the new study took place in a world of new variants. One surprise, almost a paradox, is that vaccines produce broader protection than natural infection. “Immunology is where intuition goes to die”.

    All of which is irrelevant in libertarian terms, under which the analysis would focus on how contagious people might be.

    1. Here’s an article for a popular audience, putting the science into plain language and explaining (accurately! Bless them!) the limits of the studies so far.
      https://www.forbes.com/sites/brucelee/2021/08/08/cdc-covid-19-reinfections-for-unvaccinated-over-twice-as-likely-compared-to-vaccinated/?sh=3adbad74ee81

      One limit is that they report averages, including the people who had the weakest responses. Someone like Professor Zywicki, who knows his antibody level, might decide that advice for the general population is not enough to guide his personal decisions for managing individual risk. I would emphatically choose the vaccine in his position (very low risk, unproven but likely benefit) but he’s the decision maker.

      His decision making about risks for those around him, in libertarian terms, is governed by his contracts with them except for extreme cases.

      1. His decision making about risks for those around him, in libertarian terms, is governed by his contracts with them except for extreme cases.

        Of course, in libertarian terms this is a question about what his employer can mandate as a condition of employment.

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