The Munk Debates Podcast - Be it resolved: To promote public health, governments should mandate use of COVID-19 vaccines broadly in society

Episode Date: September 14, 2021

What began as early summer optimism about the end of the pandemic has turned into frustration, anger, and worry over a steep rise in COVID cases and hospitalizations. Many are pointing the finger at the unvaccinated, accusing them of selfish and risky behaviour that puts everyone else's lives, and livelihoods, at risk. Hospital ICUs are filling up again, health care workers are being forced back to the frontline, and taxpayers are expected to foot the bill for those who refused the shot. Some schools are being required to go online again, and many businesses will not be able to recover. With only 61% of US adults fully vaccinated, the virus will be able to circulate, and we run the risk of developing a new breed of vaccine-resistant strains. Some medical practitioners are calling on the government to step in: if individuals refuse to do their part and get the shot, mandates must be introduced to force them to do so. Others argue that draconian edicts such as vaccine mandates harm public health. Not only will they erode trust and increase vaccine hesitancy, but they could also court unnecessary risks for youth and children. Young people are far less likely to develop serious health complications from COVID and therefore should not be required to take vaccines whose potential effects have not been studied over the longer term. And finally, mandating shots in wealthy countries indirectly denies protection for older, more vulnerable populations in the developing world. Everyone should be given the ability to choose what they put in their body, else we become a nation where our basic freedoms play second fiddle to public health. Arguing for the motion is Paul Offit, Professor of Vaccinology and Pediatrics at the Perelman School of Medicine at the University of Pennsylvania. Arguing against the motion is Martin Kulldorff, biostatistician, epidemiologist and Professor of Medicine at Harvard Medical School. QUOTES: PAUL OFFIT “This is a contagious disease, and it is not your right to spread this disease to others and cause harm... we have to compel people to do the right thing because they seem not to want to do the right thing on their own.”  MARTIN KULLDORFF “If we want to have long-term trust in public health, we cannot use coercion and mandates. We have to use education and mutual trust.” Sources:  ABC, NBC, CBC, FOX The host of the Munk Debates is Rudyard Griffiths - @rudyardg.   Tweet your comments about this episode to @munkdebate or comment on our Facebook page https://www.facebook.com/munkdebates/ To sign up for a weekly email reminder for this podcast, send an email to [e-mail].   To support civil and substantive debate on the big questions of the day, consider becoming a Munk Member at https://munkdebates.com/membership Members receive access to our 10+ year library of great debates in HD video, a free Munk Debates book, newsletter and ticketing privileges at our live events. This podcast is a project of the Munk Debates, a Canadian charitable organization dedicated to fostering civil and substantive public dialogue - https://munkdebates.com/ The Munk Debates podcast is produced by Antica, Canada's largest private audio production company - https://www.anticaproductions.com/   Executive Producer: Stuart Coxe, CEO Antica Productions Senior Producer: Ricki Gurwitz Editor: Kieran Lynch Associate Producer: Abhi RahejaBecome a Munk Donor ($50 annually) to get 72-hour advanced access to the full length editions of Friday Focus and Munk Dialogues. Go to www.munkdebates.com to sign up. Hosted on Acast. See acast.com/privacy for more information.

There are options, and that's why we need to take this opportunity seriously. No way you can prevent global warming unless China is part of the solution. This is not normal male behavior. This is predatory behavior. We don't know how bad this bug is. We don't know what this bug does. All of that was thrown away in those eight minutes and 46 seconds, and that's the moment that I became an abolitionist. Extraordinary claims require extraordinary evidence. Welcome to the Monk Debates. On every episode, we provide you with a civil and civil and substantive debate on the big issue of the day to arm you, the listener, with enough information

to make up your own mind. Today's debate, be it resolved to promote public health, governments should mandate the use of COVID-19 vaccines. Tonight, Delta driving COVID cases to dangerous highs. The variant now tied to 93% of U.S. infections. This evening, the alarming new forecast. Authorities now say we could see nearly 100,000 more COVID deaths by just December. The U.S. now recording its fourth day with more than 150,000 new cases in just the last week. Now let's look at the national picture, and it is stunning. This country is on track to record the highest number of daily COVID cases ever just in the next month. Canada's chief public health officer took particular aim at people 18 to 39, saying it is urgent to boost vaccine.

numbers in that age group. Hello, I'm your moderator, Rudyard Griffith. Well, what began as early summer optimism about a possible end to the pandemic has turned into frustration, anger, and worry over the steady rise in COVID-19 cases, hospitalizations, and death. Many are pointing the finger at the unvaccinated, blaming them for a so-called fourth wave that threatens to delay the reopening of businesses, the school year, and a return to normal life. Proponents of mass inoculation believe that the only answer to vaccine hesitancy is broad

public mandates, implemented by government and enforced by society at large. For the past several weeks, my administration has imposed new vaccine requirements on federal workers, the armed forces, people work in federal medical facilities, and nursing home workers. governors, mayors, and private sector leaders have done the same. Today I'm calling on more companies to step up with vaccine requirements that will reach millions more people. Many medical practitioners applaud government mandates for vaccines, arguing that if individuals refuse to do their part and get vaccinated, the only choice is government-mandated shots. Others maintain that mandatory vaccines are not the answer. Here's Florida Governor Ron DeSantis.

We can either have a free society or we can have a biomedical security state. And I can tell you, Florida, we're a free state. People are going to be free to choose, to make their own decisions about themselves, about their families. Critics of vaccine mandates argue that everyone should have the freedom to choose what they put in their body. or else we risk becoming a nation where some of our most basic liberties play second fiddle to public health. On this installment of the monk debates, we challenge the essence of these arguments by debating the motion, be it resolved to promote public health, governments should mandate the use of COVID-19 vaccines. Arguing for the motion is Paul Offutt, Professor of Vaccinology and Pediatrics at the Permanent School of Medicine at the University of Pennsylvania.

Arguing against the motion is Martin Koldoff. He is an epidemiologist and a professor of medicine at Harvard Medical School. Paul Martin, welcome to the Monk Debates. Thank you. Looking forward to it. Thank you. Great pleasure. I'm also looking forward to today's debate. This is, in many ways, the debate of the moment. It is gripping office places, families.

It is causing frissures in personal relationships between the vaccine. and the unvaccinated. This is in a sense all that people are talking about this moment as we kind of contemplate the continued effects of a fourth wave of COVID spurred on by this new Delta variant. So to have the two of you with your considerable knowledge, expertise, and strong views about this critical issue is a privilege indeed for our audience. And thank you, again, on behalf of the Monk Debates community for coming on the program. Our resolution today is be it resolved to promote public health, governments should mandate the use of COVID-19 vaccines broadly in society. Paul, you're speaking in favor of the motion.

So I'm going to put two minutes on the clock and turn the program over to you. Okay, so we've done the hard part. We created a vaccine using a novel technology. We were able to mass produce it, mass distribute it, mass distribution. it, mass administer it, put in at least in the United States, in place a public health system for the first time, really, to mass distribute the vaccine to adults. It's safe, it's free, it's easily accessible, and when the vaccine first rolled out, we would give one million doses a day, two million doses of day, three million doses of day until we finally hit a wall,

which is where we are now. We have a little over 50% of the American population that's been vaccinated, But there's a solid 60 to 70 to 80 million people who are simply choosing not to get a vaccine. They are claiming personal freedoms. They argue this is their right to not be vaccinated. It's their right to catch and transmit a potentially fatal infection. And so, or said another way, that it's their right to remain fertile ground for the spread of this virus, to allow it continue to do harm, to continue to cause suffering and hospitalization and death, continue to mutate, continue to potentially create variants that will be,

more and more resistant potentially to vaccine-induced immunity. And so we have two choices. We can stand back and say, sure, that's your right. There's really nothing we want to do it to interfere with that right. Or we can do what we're starting to do, which is to mandate the vaccine, to compel people to do the right thing because they seem not to want to do the right thing on their own. Thank you. Thank you, Paul. Concise to the point, a powerful argument. We appreciate that opening. Martin, your opportunity now, you're arguing against our resolution, be it resolved to promote public health, governments should mandate the use of COVID-19 vaccines broadly in society. Let's hear your opening statement, please.

Well, first of all, vaccines is one of the greatest inventions of mankind. I would put it together with the wheel and the plow and the writing as one of the top 10 most important inventions, which has saved millions and millions of lives throughout the ages. And if you are old and you haven't had... COVID, then I would urge you immediately to go and get vaccinated. It's very, very important. COVID is a serious disease for older people.

It is much higher risk than the annual influenza, for example. So I think that's an important message to send to anybody who is old and haven't had this disease should go and get vaccinated from one of the three at food vaccines in the US or another vaccine in other countries. A huge problem with the mandate is that we have many people who have hardly had COVID. They have immunity. We have known for over a year that if you have had COVID, you have strong, lasting immunity to this disease. And we now know more recently that the immunity from having had COVID is stronger and more durable than the immunity get from vaccines. So if you've had COVID, but now people, even though they've had COVID, they are mandated

to get the vaccines. And that makes zero sense from a scientific point of view. And it makes zero sense from a public health point of view. But it's worse than that, it actually creates problems because when people see that they are forced to take a vaccine that they don't need because they already are immune, then that source a lot of distrust in public health. And we have seen during this last year and a half that all the hard work we've done over many decades to build trust in the vaccines are now disappearing because we're making these mandates

that does make no sense from a scientific public health perspective. And I'll go into that more in detail as we move along today. I look forward to it, Martin. Now an opportunity for rebuttal. So, Paul, this is your chance to react now from what you've just heard from Martin. Let's hear your rebuttal. Sure. There are three points that Martin made that I'd like to comment on.

The first is that this is a disease primarily of the old, and therefore the old need to be protected, but less so the young. While it is true that about 93% of the deaths have occurred in people over 55 years of age, it is certainly true that the young can be infected. and seriously infected. We now know that two weeks ago, there were 200,000 reported cases in children in the United States. Last week, there were 250,000 reported cases. The hospitalization rate for those children is between 1 to 2%, which means that between 2,000 and 4,000 children were hospitalized over the last per week, over the last two weeks, and the death rate is 0.03%, which while low still means that at least over the last week, about 70 children died.

which now puts us over 450 children who have died from this virus, which is in the same category as we had for measles on a per year basis, and actually more than we would see for influenza, or more than we would see for chickenpox, where we also have mandatory vaccines for school entry. Regarding natural infection, while it is true that natural infection protects against serious disease, the study that Martin alludes to was a small study. There was a larger study that was done looking at people who were naturally infected

and dividing them in half. Half got essentially a boost to their immunogenicity by getting two doses of MRI vaccine. The other half didn't. And what they found was that looking forward in this prospective study, that there was a two and a half-fold increased risk of having symptomatic disease for those who were then boosted with an MRI vaccine after natural infection than in those who were not. Lastly, the notion that this vaccine has caused a distrust in vaccines because of the way that it's been handled. I think this is the point that we frankly have had distrust in vaccines from the first vaccine back in the days of the early 1800s when James Gilray drew a cartoon about people who while getting a smallpox vaccine were starting to develop bovine

characteristics. I would argue the birth of the modern American anti-vaccine movement was in the early 1980s associated with protussis vaccine. All you're seeing now with quote unquote distrust is just the typical shenanigans of the anti-vaccine people, putting a lot of bad information out there that's caused people to make bad decisions that have put them and their children at risk. Thank you, Paul. Martin, your opportunity now for rebuttal reacting to either Paul's opening statement or what you've just heard. So there's two different issues when it comes to having national immunity. One is that if you're vaccinated based on an Israel study, which I think is the best study that has compared a vaccine with national immunity.

Those who are vaccinated over 27 times more likely to have symptomatic COVID disease than those who have had a prior disease. So it's very, very clear that immunity is much better from having had COVID than from the vaccine. In the same study as well as studied from Kentucky, it was shown that if you compare people with COVID plus vaccine versus having high covia but not a vaccine, those who have vaccines have less risk of testing positive about twofold in Kentucky. I was about similar in Israel. But in the Israel study, they also looked at symptomatic disease and there they did not find any difference. But the key thing with the mandate that is troubling to people is that people have had the disease

already. They have stronger, more durable immunity than those who are vaccinated, but they are still force to be vaccinated. And that doesn't make any sense from a scientific point of view, nor from Republic Health point of view. So that demand that people who don't need this vaccine, because they already have better immunity than the vaccinated, the demand that they must have the vaccines, that shows a distrust because people are not stupid. They understand that you get immunity from disease. Then they start asking, so what's the, what's the, what's the reason for pushing these vaccines if you're pushing other people who don't need it because they're already immune. So there's no personal reasons for them to have the vaccine because

they are immune. There's no public health reasons. We know that if you're vaccinated, you can still transmit the disease. Well, there hasn't been any studies, but if you have less symptomatic disease in those with natural immunity, presumably they will transmit it a lot less. So there's no public health reason to do it. It's also a question of discrimination because what happened was that because of the way the lockdowns was done, it protected the rich laptop class who could work from home, but who then ordered food, take-on food from workers who were working in the restaurant kitchens and deliveries. So there has been a huge difference in that the lockdowns protected the wealthy and the professional class.

while the working class took the brunt of the burden of this disease being affected. So that was very discriminatory. I think it's the worst assault on the working class in segregation and the get now war. But now on top of that, we are requiring mandating and discriminating in people who have national immunity, even though they have better immunity than those vaccinated. So now we're getting discriminating against the working class who cannot go to a restaurant. in New York because they have natural immunity

instead of and don't want to take the vaccine while the professional class who have taken the vaccine and have less immunity, they can go to the restaurant. So this is highly discriminatory and that solves

a lot of distrust among a lot of people. There's also a global issue. There are many people in the developing world in South America, in Africa, in the Middle East, in South Asia and so on, who are desperate to get the vaccine because they haven't gotten it.

They're old people, they're high risk. They are very desperate to get to the vaccines. And by mandating vaccinations in the rich countries to people who don't need it, that means that there is less supply in the developing world. And of course, we can say that the developing world should also have it, and we should make sure that many governments send small batches of vaccines to other countries. But when you mandate vaccines people don't need it in one place, then unfortunately that means that there's less supply for poor people in Brazil, in India, in Pakistan, in Iran, in Nigeria, and so on, who really need these vaccines. So it's a very unethical and immoral and very selfish thing for us to do in the United States to,

give it to people who don't need it when there are a lot of people around the world who do need it and who are not getting it. Thank you, Martin. A lot to unpack there. And I want to go through all those different issues that you've raised and that Paul has flagged also. But let me begin, Paul, with you just by trying to understand the terms of your disagreement with Martin and Martin's with you. Do you accept Martin's argument here that for the vast majority of younger people, especially children, and you are not only a professor of vaccinology,

you are a specialist in pediatrics. Do you agree that children are at very low risk here of severe illness and death out of this disease, that they can acquire natural immunity through infection, and they can do so in a sense safely, on a level of safety that is certainly comparable to a vaccine whose long-term effect, are still, you know, something that has to be investigated.

As Martin has flagged in editorials that he's written, it usually takes a number of years to fully understand the potential side effects for very small portions of the population, but it can take years to truly understand what those risks are. So let's focus on that specific part of this debate first, and I'd like your analysis and insights. Well, first of all, it's, I work in a hospital. Children's Hospital, Philadelphia. We have a COVID ward. Right now, we're seeing in our COVID

ward what the national average is seeing, which is a dramatic increase in the number of childhood cases. Children now account for 27 percent of cases in the United States. Can children be hospitalized? Can children go to the ICU? Can they be intubated in the ICU? And can they die from this infection? Of course they can. That's why natural infection is never the better choice. I mean, obviously, the goal of a vaccine is to induce the immunity that's a consequence of natural infection. without having to pay the price of natural infection. Why would you ever want children to be in a position where they would have to pay the price of natural infection?

The allusion to the fact that there are potential long-term consequences of the vaccine, I don't know what one's talking about there. If you look at the history of vaccination over the last 200 years, while vaccines can cause serious adverse events that can cause permanent harm and even death, those events occur within two months of getting any dose of vaccine. I know of no long-term effect where you find out something 10 years later or 15 years later that you didn't know within, frankly, the first couple months. I mean, you may only find it out when the vaccine is in millions of people,

but you certainly know that it's 10-cent will occur within a couple months of a vaccine. So there's no advantage to natural infection, especially when you know that vaccination is remarkably effective. I mean, if you look at people who are vaccinated, they are 25 to 30-fold less likely to be hospitalized, less likely to die. and that also includes children. So, Martin, react to what Paul said. You never want to go down the root of natural infection

when you have an effective vaccine that substantially reduces your risks of hospitalization of severe outcomes of this disease. Children are showing up in hospital wards. There is a risk of illness here, so why not opt for a safe vaccine solution to mitigate that risk? Even if it's small, let's lower it through vaccination.

not natural immunity? So we don't have a vaccine that's improved for children as of yet, for children under 12. So we don't know yet what is the benefit risk ratio, the balance, because we haven't seen the data neither on efficacy nor on adverse reactions. So I cannot really voice an opinion on that, since that data is not available. But I can give an example on the question because I have. I have a five-year-old daughter. She's had COVID, so she has immunity. Why should we force her to get the vaccine instead of giving that vaccine to a 76-year-old lady living in the slums of New Delhi in India? She needs the vaccine because if she hasn't had it, she is at high risk or mortality. Why should we give it to somebody who has already immune, who don't need a vaccine? and mandating that they get it

instead of giving it to the people who really need it in other countries or in the United States. So, Paul, are you comfortable with the idea that Martin is positing here that people who've acquired immunity naturally through background infection in their community should be exempted from mandates?

Well, I guess you could argue that if you were shown to have been naturally infected by, you know, in their antibody studies, directed against, you can look at antibodies directed against the nuclear protein to see that somebody's already been naturally infected, that those people certainly are at far lesser risk than people who are unvaccined, which is really what I'm talking about. I mean, I think, you know, what we're talking about is roughly the 6 to 80 million people in this country who have not been natural infected and have not been vaccinated. I think so they should be mandated to receive a vaccine.

If you want to add a layer to that where you then screen people to see whether or not they have antibodies against the nuclear protein, so you know that. they are, that they've been previously infected, although knowing that from that Kentucky study, that if you, if you vaccinate them, you will also decrease their chance of developing symptomatic disease more so than people who have only been naturally affected. Plus, from the studies of people like Shane Crotty and John Wary at the University of Pennsylvania, Crotty at La Jolla, that you actually broaden the immune response with that, that booster dose, essentially, against variants like the Delta variant, perhaps the mu variant, you'll find

out. So there's no downside, really, to vaccinating someone who's already been naturally infected. And there's a tremendous upside to vaccinating people who haven't been vaccinated. I mean, we're never going to get on top of this pandemic in this country until we vaccinate the unvaccinated. And they've just told you they don't want to get vaccinated. So you can stand back and watch them continue to transmit this virus to others and cause harm or not.

And I think we really have no choice at this point, but to mandate vaccines for the unvaccinated. If you want to try and add a layer above that to sort of screen out who's been previously infected, who hasn't, I think that makes it a more difficult program. to institute with no downside to vaccinating the people who've already been naturally infected. But the point is we have to find a way to vaccinate the unvaccinated and mandates, I think, are the only way. Hi, Rudyard Griffiths here, your host and moderator. I have a favor to ask you, please consider becoming a monk member. Membership is free and you get access to a series of great benefits,

including a 10-plus-year library of some of our best debates, dialogues, and podcasts. You also get a free monthly newsletter featuring the debates that we're watching around the world, and you get a specially curated Friday weekly Monk Members Only podcast that focuses on the big international events and trends shaping our world. All of that, again, free at www. www.munkdebates.com. I hope you'll consider joining and becoming part of our community. Now, back to our program. So Martin, I'm almost working against myself here because I'm trying to find consensus. But look, that's the value of these conversations, try to push them to see where they go. So, Martin, would you agree with Paul that people who are unvaccinated, let's say 12 and up, 18 and up, pick your number, but including

a lot of people who are not elderly and high risk, do you think, Martin, that they should be subject to mandates with the proviso that Paul seems to agree that if you've been naturally, if you've naturally acquired immunity, you get an exemption, a pass. Well, if we can do it so that people have had COVID already, that they are not mandated, that will be a huge, huge advance. And it will actually increase the trust in vaccines for others who do need the vaccine. But one problem is that when you try to force people to get vaccinated, when it's clear to everybody that don't need it because they already have immunity,

then people start questioning and not trusting CDC or NIH. So that's very, very dangerous, very, damaging to the whole public health system that we have in this country. And that is trust in CDC, which has skyrocketed during this year and a half. That's doing enormous damage and not only in terms of the COVID, but also for other vaccines and other aspects of public health. Now, there are very important things that we should do to increase vaccination rates. And I think one thing that the CDC did an enormous mistake on was with the J&J vaccine, the Johnson and Johnson vaccine, because there were some reports of blood clots in younger women. So there was some concerned about if this was a serious problem or not.

but at that time there was very clear data for those over 50 and the people over 50 are the ones who are at the greatest need of this vaccine and at that time CDC decided to take a pause on the vaccine and that was exactly

the time when vaccination rates started to drop in the US. It had been going steadily up by that time and then it started to drop exactly at that time and the J&J vaccine never recuperated which is very very tragic because since it's only a one-shot vaccine, that's the ideal vaccine for the lower income people,

for example, homeless people or other people in rural areas that are hard to reach. So the fact that CDC made a pause on that vaccine for people over 50 did a lot of damage to the efforts to vaccinate people. And I think that was very tragic. but instead of sort of acknowledging the mistake, they actually removed people who oppose their pause, kicking them out of their vaccine effort systems. So that, to me, you can't start to blame people who are already immune, who don't want to take the vaccine when CDC made such,

a major mistake, I think, in the efforts to vaccinate people. Thank you, Martin. We're debating today the resolution on vaccine mandates, be it resolved to promote public health governments should mandate the use of COVID-19 vaccines broadly in society. In the remaining part of this debate, I want to move a little bit bigger picture with you both because you've been, you yourselves have been participants in this debate that we've been having about mandates for the last year or more. And I want to get to kind of people's attitudes in society. And Paul, you wrote a column recently that had a punchy phrase, to say the least, at the top of the column. The U.S. Constitution is not a suicide pact

guaranteeing a right to harm others. Maybe you could talk a little bit more about your views about how we should think of this in terms of our rights and responsibilities. as citizens in society today. And then, Martin, I'm going to come to you with a similar question. Right. I think that the interpretation of the Constitution by the Supreme Court has been clear twice.

The first was in the Jacobson v. Massachusetts case in 1905, where during a smallpox outbreak, there was essentially a mandate by Cambridge Board of Public Health to vaccinate its citizens because smallpox is a contagious disease. Henning Jacobson, a Lutheran minister, didn't want to do that.

Also, he didn't want to pay. the fine that was associated with choosing not to get the vaccine. And so that went to the Supreme Court, where basically the Supreme Court ruled that a public health agency can mandate a vaccine if they deem it important. That was reaffirmed in the Zuck v. King case 17 years later for a high school student who didn't want to get a smallpox vaccine as a requisite for attending high school. It makes sense that a public health agency can step in and say, look, it's not your right to catch and transmit a potentially fatal infection. I mean, you know, we're a country that's founded on individual rights and freedoms. And for some reason, a critical percentage of this population,

25, 30 percent are now saying this is their personal freedom. This is their civil liberty. And it's not. And I think that the only thing you can do there is either stand back and watch them transmit disease, which is what we're seeing. I mean, we can talk endlessly about booster dosing, giving a third dose to people who've already been vaccinated. That's going to do very little to change, I think, the contagious index or there are not of that person. But give two doses if we use the mRNA vaccine is an example, give two doses to people who haven't been vaccinated. That's going to make a huge difference. Look at where all these cases are occurring.

They're occurring in areas that have low vaccination rates like Florida, Texas, Missouri, Georgia, at Louisiana, et cetera. That's the problem. We need to vaccinate the unvaccinated. And the only way to do that, near as I can tell us with the vaccine, if people are saying to you, no, thank you, I don't want to get it. Yeah. So, Martin, what do you think of this argument that, you know, the harm principle, John Stewart

Mill, we can go back. back to our Polysy political theory courses in university. And remember that lesson that, you know, your own behavior is limited when it starts to cause harm to others. How do you feel about government stepping in using, in a sense, the harm principle to say, okay, this is no longer a matter of individual choice. You are not going to make your own decision about the efficacy of these vaccines, booster shots, age groups. We are mandating. this as part of what an ordered liberal society demands? My arguments against vaccine mandates is purely for public health, what is most efficient

public health strategy. And for public health to work, it has to be based on trust, trust in both directions. You have to have trust in public health agencies and you have to have, and public health agencies have to trust the population. to do mandates and coercion is not a good public health policy. It has never been a good public health policy. You have to explain to people why certain things are important. You also have to be extremely honest with people. So for example, to be honest and say that if you've had COVID, you're immune, you don't need a vaccine.

If you try to sort of cover that up and not be honest about those things, then people are not going to believe anything. else that public health officials say. So to do good public health, you need trust instead of mandates and coercion, trust and education. And I'm a native of Sweden. So I guess my perspective comes a little bit from there. Sweden has never had any vaccine mandates. Sweden has one of the most highest vaccination rates in the world, very compliant because people understand the benefits of vaccines. And I think in terms of the COVID vaccination, Sweden has had one of the best vaccine efforts in the world because it was very, very much targeted at older people. And there was some head of some health agency who were not eligible in the beginning because of age.

But he took it anyhow and he was fired because he took it out of line because when the When the vaccine first was available, it had to go to the oldest people and their caretakers, which was the right approach. It was very strict by risk status while, for example, many other countries have, I was shocked when people in their 20s were bragging about getting the vaccine when my 82-year-old neighbor hadn't gotten it yet. To me, that's unethical, immoral, and absolutely shocking from a public health perspective. So if we want to have long-term trust in public health, we cannot use coercion and mandates.

We have to use education and mutual trust. As for the comment about where there are more COVID right now, that has not very much to do with vaccination rates, which is fairly similar across the country and better in, for example, Florida than many other states. What's happening is that we have different seasonal patterns of COVID in different parts of the United States. So in the southern part, we have a summer wave for whatever reason, but they are all those seasonal. So we have a summer wave, and that's now going down in those states, while it's now increasing in the northern parts of the United States. So those are seasonal patterns that we would expect to see and has more to do with that than vaccination rates. So Paul, as we move towards closing statements, I just like to have you reflect a little bit on Martin's argument here that, you know, we're actually seeing this too much in a kind of legalistic, formalistic way of the individual, you know, vis-a-vis the state. And what's really at stake here is trust. And it's a fragile thing. It has to be nurtured. Once damaged, it can take years, if not decades, to repair. And we're just looking at this in the wrong way. We need to be.

much more cautious about mandates because trust is such a precious and scarce resource when it comes to vaccines. Right. No, I think the lesson here is that if you want to live in a country that trust public health agencies, that trust doctors that believes that when they hear recommendations from those groups, that they should be followed, move to a Scandinavian country. I agree. I think that's right. I think that that is not true in this country. It hasn't been true in this country for 40 years. The J&J's withdrawal, while I agree with Martin, that I think that was not done the right way. I think they shouldn't have put a pause on that vaccine. It certainly had virtually nothing to do with why there was a decline in vaccine rates because

such a small percentage of people had received the J&J vaccine. And I think they didn't then carry that over to the MRNA vaccines. I mean, ever since the early 1980s with the airing of the film DPP vaccine Roulette, a film that claimed that the whole cell pertussis vaccine, you know, caused permanent brain damage, there was a schism in this country. I mean, what happened was because of the flood of litigation, many companies left the industry. We went from 27 vaccine makers in 1955 to 18 in 1980 to four today, largely because they were driven off by litigation in the early 1980s because of that distrust created by that film.

So the trust ship has sailed in this country a long time ago and has nothing to do with the J&J vaccine and everything to do with just a very prominent anti-vaccine movement in this country that frankly doesn't exist nearly to that extent in the Scandinavian world. So that's the problem. And I think when you've lost that trust, I think we have with a certain percentage of populations who don't believe, who don't trust the government, they don't trust the pharmaceutical industry,

they don't trust the medical establishment. And so they're not going to get the vaccine. And they're going to continue to spread this virus. And unless you do something about it, that's going to continue to happen. This is a, it was called by the Biden administration, a pandemic of the unvaccinated. It's always been a pandemic. of the unvaccinated. The problem now is it's a pandemic of the willfully unvaccinated,

and what do you do? Just finally to take advantage of both of you being here, your knowledge and expertise is how closely you're following this pandemic. I think our listeners would be fascinated to know what you think the coming months into the fall in the winter will hold for the Delta variant and COVID-19. And maybe Martin, I can come to you first on that. What is, do you, do you have a view or you, I'm not asking you to predict here. I'm just asking you to maybe help us try to understand what the trends are that will shape this pandemic over the coming months? Well, I think the summer wave that we've had in the southern state is going to go down, and they might have a winter wave later on. But what we're seeing now is in all the northern

state, in the United States, cases are increasing, and I think that will continue to do so, and we don't know exactly how much. I think that there is a huge difference. between the sort of the anti-vax or vaccine-sceptic movement that we have seen the last couple of decades, which has sort of been a fringe movement. They've been a nuisance. They are very vocal. But they've never been able to make a dent in the overall trust in vaccines that we have seen in United States. Almost all children get vaccinated according to the sort of the standard schedule.

So we have had very high vaccine confidence. to people like Paul, for example, and others. I work on vaccine safety. I've done for a couple of decades. And I think that vaccine safety work is very important to maintain confidence in vaccines. So I think that we should move much more towards the Scandinavian model of being in trust. And one thing I've seen in the U.S., which has shocked me, and as sort of as an immigrant, I'm sort of a little bit of outside the tribal politics.

But I've been absolutely shocked that these vaccines are used as the political baseball bat to hit people with. And we have to reach everybody. And for example, when, well, somebody accuses some opponent of being anti-vaccine, when that's not true. That's hugely damage. So, for example, there was criticizing some of the Republican governors that had been criticized for being anti-vax when they were not. They've been very pro-vax. But then when you do that, if you criticize Governor X for doing that, then somebody who's supporting X might think, okay, he's anti-vax,

or maybe I should be too. So or when you criticize certain political supporters or certain politicians or being against vaccines when they might not be at all, that actually increases the distrust in vaccine and it is just the public health. So as public health scientists, we have to communicate with everybody in society, regardless of their political affiliation, and we have to care about the health of everybody and try to do this sort of tribalism of putting people in boxes is extremely damaging to public health.

And I'm shocked, actually, when some of my colleagues on Twitter, when every other tweet was about politics, about some politician was, like, for example, Trump was such terrible. And then every other tweet is about public health. Well, somebody reading that who likes Trump, they're not going to believe anything they say about the public health. So, of course, anybody can express political viewpoints. But I think during a public health crisis like this, if public health scientists and officials

wants to be trusted by everybody, you have to sort of put your own politics aside. and be willing to communicate with everybody in a very honest manner without shaming by listening, without shaming, without coercion and so on. And I think that we have utterly, utterly failed at doing that, and that's very tragic. And it's something that we're going to have to live with for a long time, because to be quite honest, it's going to take many years, probably at least a decade or two, and a lot of hard work and a lot of humility from public health scientists to re-revehers to re-revely. build that trust in public health that has flown out the window during this pandemic.

Thank you, Martin. Paul, some opportunity for you just to give us a little paint-by numbers in terms of what you think the fall is going to look like. And maybe just your thoughts, that's something I struggle with a bit is, you know, as Delta is so much more infectious, as we see an incredible amount of spread, should this at all make us hopeful that we're getting to a point here where simply in terms of wrong, numbers, feas of evocation and having acquired immunity naturally, so to speak, that were closer to the end of this pandemic as opposed to the beginning. Right.

It is striking that the, if you look at sort of hospitalizations and deaths, this Labor Day, as compared to last Labor Day, the numbers are, if anything, worse. Remembering that last Labor Day, we had essentially a fully susceptible population and no vaccine, This Labor Day, we have at least half of the country that's been vaccinated. If you'd look just at adults, it's in the low 60% range. And we probably had at least 100 million people who've been naturally infected. Now, those aren't two separate groups. There's overlap between those two groups.

But you're probably at a solid 70 to 75% population immunity induced by natural infection or immunization or both. But that's clearly not enough. And one of the reasons is that it's not equally distributed across this country in terms of vaccination rates. it is true that we are suffering, I think, the Delta variant this year is compared to the Alpha variant last year, which is different. We also behave much differently this year than last year. Last year, we were much more careful about masking and social distancing and the absence of

the vaccine than we are this year where we're having, you know, large-scale sporting events and marriages and weddings inside and birthday parties, et cetera. So those are all differences. But if you look at the 10 states with the highest vaccine rates total, this is about 58% vaccination, compare them to the 10th States with the lowest vaccine rates, which is around 42%. There's still a solid five-fold difference in hospitalizations than deaths. Vaccination does make a difference. This isn't just a seasonal issue. This is vaccines work.

There is no good reason not to get a vaccine. Just let's just put aside the issue of whether you've been naturally infected. If you've neither been naturally infected or vaccinated, you're putting yourself and others at risk. If I choose not to get a tetanus vaccine, that's the choice I make for myself. If I get tetanist, no one's going to catch tetanus for me. It's not a contagious disease. This is a contagious disease and is not your right to spread this disease to others and cause harm. So I think that mandates, sadly, I mean, I wish in a better world, in the Scandinavian world

where people actually believe public health folks and believe doctors, then you can have a high immunization rate. But in Ireland now, people have high immunization rates because people generally see themselves as being in it together. We don't. And I think that given that we're not, that given that we're not, we can't. we don't, we have to compel people to do the right thing for the same reason that we have stop signs at intersections.

Thank you, Paul. We've been debating today, be it resolved to promote public health, government should mandate the use of COVID-19 vaccines broadly in society. Let's move to closing statements. And because we've had such a fulsome discussion, maybe Martin and Paul, I could challenge you just, what's the one message, the one point that you'd like to leave our listeners with? and we'll use that as a summing up to kind of capstone this debate.

So, Martin, to you first. To the public, if you haven't had COVID, and if you're old, go out and get that vaccine. It's absolutely critical important. And do it now because your protection is not immediate. It takes a few weeks before you get protection. So do it now. That's my message to the public.

My message to the public health official is be honest with the public. Otherwise, they're going to trust you less and less. And as a country, we cannot afford to have a situation where the public health officials are not honest with the public. So that then the public health officials. Thank you, Martin. Similar opportunity for you, Paul. What's the kind of the one idea, the one clarion call you'd like to leave our audience with as we conclude this debate? Right.

And summarizes really the critical difference between me. Martin. What I would argue is that if you are living in the United States and you are over 12 years of age, get a vaccine because there's no good reason not to be vaccinated. Vaccines are safe and effective. And anybody in this country has the possibility of suffering from this disease. It's not just a disease of old people. I mean, I guess we're all influenced by our experiences, but I work in a hospital that is loaded with patients with COVID, children with COVID, who suffered not only the lung infections associated with COVID, but also the so-called multisystem inflammatory disease,

which is probably the most common reason for children to come to our hospital, where it's not just their lungs that are involved. It's their heart, their liver, the kidney, because this virus has the capacity to cause inflammation of the blood vessels, i.e. vasculitis. There is no good reason not to get a vaccine if you're over 12, and if you think that you

are, because you are younger, that makes you invulnerable to this virus, you're wrong because the 27% of all infections now are in children. This is a childhood disease. Hopefully we'll have a vaccine for children less than 12 years of age soon. And if it's been shown to be safe and effective, then we need to use it. So this is not just a disease of old people. Thank you, Paul. And thank you, Martin. You know, this is such a politically and culturally charged debate. As a result, it's often incoherent. It's hard as a layperson to make your way through the thicket of competing arguments for and again. So to have the opportunity,

not only to access your considered opinions, your deep knowledge of this area, but to do so with such civility and substance, a willingness to listen to each other, to engage each other's arguments, is just a privilege indeed. And wherever you come down on this debate, I just think we need more and better debate of the type that we just had. So on behalf of the Monk Debates community, thank you so much for coming on the program today

and debating vaccine mandates. Thank you. Thank you, Roger, and also thank you, Paul, both for participating in this debate, but also I want to take the opportunity to thank you for developing the Rota Tech vaccine against Rota virus, which is an enormous, fantastic vaccine. So thank you for doing that also. Thank you for saying that. Well, that wraps up today's debate.

I want to thank our participants, Paul and Martin. They certainly gave us a lot to think about. If you had feedback or reflections on what you've just heard, please send us an email to podcast at monkdebates.com. That's N-U-N-K, Debateswith-N-S.com. Tell us how we're doing with this podcast. Are we debating the issues and topics that are important to you? We want your feedback.

In talking about feedback, here's a note from Rose about our recent Monk members' podcast with Janice Stein, which comes out every Friday on our feed. Dear Rudyard, Rose writes, I appreciate your remarks on China's ban on excessive video gaming. While their approach is draconian, at least they recognize the seriousness of video game, addiction. Well, thanks, Rose. As I said in that podcast, as the parent of young children,

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