A vaccine can be bad for one person, but great for everyone

But if you tell an epidemiologist or public health expert that a drug given to 7 million people only had six bad results, they understand the tragedy and sympathize with the families, but they don’t see any sort of this as a global problem. They might even feel this if there were 600 bad results, or 6,000. It’s not just because of the obvious rarity of blood clots – the low risk. This is because of the benefit which is now denied to millions more, perhaps billions. People who get vaccinated are protected against Covid-19, but if a lot people get vaccinated, even those who are not protected from the pandemic tsunami by a vaccine-induced herd immunity wall. In this construction, the benefits to an entire population far outweigh the risks to individuals.

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices alongside doctors and individuals rather than public health and populations. This Friday, ACIP is meeting again and most observers think they will probably recommend opening the J&J faucet again. But people will almost certainly have less confidence in the vaccine itself. The global fight against Covid-19 now depends on widespread vaccination. Turn off the taps or imply that the well itself is dirty and that you are endangering the lives of millions of people.

I have written before on how Covid-19 challenged people’s senses Individual liberty and security in relation to their participation in a larger community. These philosophies are not exactly in opposition, but they do not completely overlap either. The pandemic has challenged Americans to bind your arms against him, and frankly, we mostly failed. “One thing that came out at the ACIP meeting that was striking, and that seems to be more the way people think about things in individual, clinical medicine than in public health, is that people don’t. kept talking about this idea that there was a ‘Do No Harm option,’ says Govind Persad, a bioethicist at the University of Denver Sturm College of Law and co-author of a Washington post editorial who criticized the break. “In public health ethics and public health practice, people think in terms of a harm reduction framework.”

“Do no harm” is at the heart of clinical medicine – the principle of non-maleficence, of doing nothing that could harm a patient. But harm reduction tends to apply more broadly: what can we do here that might not be great on its own, but that would reduce harm overall? Provide clean needle exchanges and safe injection sites for intravenous drug users to control the spread of blood-borne diseases; providing methadone to people addicted to opioids so that they do not have to obtain illicit drugs instead. In the event of a pandemic, the risk reduction aspects of mass vaccination seem clear: getting herd immunity to protect the lives of everyone, especially people who for some reason cannot afford to do so. vaccinate.

However, when doctors talk to their patients, they prioritize the principle of doing no harm. “It’s not all about evidence. It comes down to values, people’s fears, people’s anxiety. If their fear of having a blood clot after the Johnson & Johnson vaccine runs so deep for weeks afterwards, is it worth it for this patient? Asks Peter Chin-Hong, infectious disease physician at UC San Francisco. “It’s really the interesting shock that we haven’t talked about. We want a societal benefit ultimately, but we shouldn’t shy away from talking about what it means for individual patients.

This is a dilemma, however, as it can be argued that the benefits to society outweigh the individual benefits – putting the principle of harmlessness in conflict with harm reduction. Like: I’m a male over 50, so as far as anyone can tell, with extremely low risk of blood clots. But I’m also (maybe) at low risk of dying from Covid-19. I am cautious of exposure, with none of the comorbidities that tend to make the infection worse, I live in a place where the infection rate is low. I’m unlikely to get it and get a severe case if I do. Maybe the tiny risks of getting the shot don’t outweigh my risks of not getting the shot. Which doesn’t mean I’m hesitant. I’m not! Give me the juice, doc. But you know what I mean.

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