Opinion: An Ethical Mandate for Federal Law: Vaccination Against COVID-19

L.E. Gomez, MD MBA

An Emergency Medicine View of Vaccines and Treatment

No doubt all of you have seen the joint AAEM, ACMT, and ACEP Statement in support of the COVID-19 Vaccines. Our online assertion that toxicologists, pharmacologists, and emergency medicine specialists “highly recommend the vaccination” seems erstwhile, if cautious enough, let alone the call for universal vaccination from public health officials that had been out there for months before. Fewer of you may be familiar with a similar call for a universal vaccine mandate from the Association of Bioethics Program Directors. Yet, personally, some among us are still entertaining the legitimacy of fearing infringement on personal liberties or religious freedom. I would almost excuse our less experienced members for not being for passionately convicted of the ethical dimensions. Not so for those, like myself, who have had enough!

Twenty-four years as an emergency physician, over 100,000 patients seen, 1 in 500 of them so critically injured or with such advanced disease they couldn’t be saved, takes its toll. 1 I think of the lives I’ve helped save and the ones I couldn’t, the ones I’ve had to tell they had a lethal condition, and worst, sit in a cramped, undecorated room with their families to tell them their loved one had died. It alters one’s tolerance for taking reckless risks with human lives. Every life we lose, we consider the cause. Most are inevitable, a biologic failure of senescence, a system collapse, a personal one. Every one saved we think: a gift, a miracle of modern medicine, and for some, an act of God. Way before we give ourselves any credit as doctors, we are grateful for having had great luck.

Now comes this COVID-19 pandemic, syndemic, and deaths increase exponentially, especially among the most marginated and most vulnerable. Many of us fighting it so hard it leads to being fired for calling out an unethical, unjust healthcare system. A few of us even quitting on ourselves, taking our own lives. Over 100,000 hospitalized and more than 1,000 dying from it every day. 2 Yet some of us accept the surreal situation that an individual should have the right to invite that harm into their homes, their families, their bodies, knowing there is a solution. It should be unconscionable for any educated person, let alone a physician, to imagine all those souls might have been saved but for the fact that they were not forced them to take a life-saving treatment with, at worst, unpleasant non-lethal side effects. 3 Yes, that’s right, no one has died of that anaphylaxis reaction we all know to fear. What experienced physicians do know: that none refuse life-saving treatment when there is a chance to recuperate, and that families often demand it screaming in tears at the top of their lungs even when they know there is no chance of recovery. The obvious answer: a federal mandate for universal vaccination. 4

Vaccination and Safety Measures Debate Fuel ElectionsThis is not the first health crisis leading to vaccine mandates in the U.S. history, as courts clearly supported them in the case of smallpox over 100 years ago. 5 Never has the issue been more politicized than during this COVID-19 disaster. Emergency physicians in the eye of this storm of now over half a million pandemic deaths, shaking our heads as CDC epidemiologists continue to report 98% of those deaths occur in unvaccinated patients, while conservative politicians and their allies continue to mislead the public. 6 Despite the rising death toll, particularly where poverty and neglect limit access to vaccines for marginalized populations, those politicians turn a blind eye. 7 Emergency physicians cannot afford to put partisan politics ahead of saving lives and are well-aware we have long enforced other vaccination mandates, such as for measles in the public school system. 8 We are cannot stand by and allow this needless loss of life fueled by greed, facilitated by the spread misinformation, remove undermine disease mitigating safety measures, and potentiate refusal of vaccination, allowing unethical leaders to maintain power over the most vulnerable, poor, and uneducated, leading them to slaughter. 9

I have no issue with rare allowances made for medically justified exemptions, such as for immune compromised patients. But we must stop allowing oft cited excuses of ‘philosophical’ differences or religious exemptions as reasons to put others at risk. Not only should requirement of vaccination for admission to public schools be on the table and any forward-facing business should be required to comply, exceptional reasons for exclusion such as allergy to vaccination vehicle (the injectable solution itself) must require documentation, as the small percentage of allergic reactions have not been lethal and this represents an exceedingly small percentage of anti-vaxxers (no more than seven in one million according to one study on the Pfizer vaccine). 9 Other commonly voiced

concerns such as that the vaccine alters native DNA, causes infertility, or was developed too quickly correlate with a lack of information, education, and poverty. They are largely the result of willful political misinformation that has been shown, ultimately, to lead to economic failure, as even conservative economists acknowledge vaccination is not only key to the health of the public, but commercial interests that align them with public health interests. 10

THE TIME IS NOW FOR CLEAR LEGISLATION TO SERVE OUR ENTIRE SOCIETY AND FULFILL OUR COMMITMENT TO PUBLIC HEALTH.”

The Occupational Safety and Health Administration (OSHA) Rule is Not Enough

The Biden-Harris Administration recently announced expanded vaccination requirements will include staff within all Medicare and Medicaidcertified facilities, an incremental step after directing OSHA to write a rule requiring employers to force employees to be vaccinated or be tested weekly to prove they remain COVID free last month. As expected, healthcare organizations across the country announced vaccine mandates are set to be enforced, not as a matter of medical ethics, duty to care or guarantee of best health outcomes, but because non-compliance with federal requirements would have a devastating negative economic impact on the bottom line and equity investment that drives operations in our US health care industry. Under this economic pressure, no amount of protest over resignations and suspensions of staff (even if whole service lines are forced to close temporarily) will carry the day. But we need a mandate that applies to EVERYONE, not just forward facing business and health care workers.

The COVID-19 pandemic exposes some of the greatest weaknesses our for-profit health care system faces now and into the future. In the face of a lethal disease that has infected over a quarter of a billion and killed over seven million world-wide to date, including over 700 thousand deaths in the US, we cannot afford a debate, especially one fueled by disinformation from partisan political leaders, about whether vaccination should be mandated. 11 That wasteful process, multi-factorially fueled by greed-driven interests will result in short-term profits from restaurants, concerts, public gatherings, pollical rallies generating revenue keeping us in close proximity driving the spread of disease will continue to kill us all. Not just the most at risk are the most socially vulnerable: low education, poverty, food-insecure and insecure housing, limited access to health insurance and lack of representational leadership, and clinical caretakers, but ALL of us. The strong correlation between lower educational level and death from COVID will put everyone at risk. 12 If we wanted to reduce our $3.8 trillion outlay on health care, we should invest in vaccination rather than fuel the cost of treatment. 13

The time is now for clear legislation to serve our entire society and fulfill our commitment to public health. A federal law, mandating universal vaccination is long past due. Anything short of that, is fundamentally unethical.

References

1. https://www.cdc.gov/nchs/fastats/emergency-department.htm

2. https://www.reuters.com/world/us/us-reports-more-than-1000-coviddeaths-single-day-2021-08-18/

3. https://www.kff.org/coronavirus-covid-19/dashboard/kff-covid-19-vaccinemonitor-dashboard/

4. https://www.nature.com/articles/d41586-019-03642-w

5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1449224/

6. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/adverseevents.html

7. https://www.who.int/news/item/05-12-2019-more-than-140-000-die-frommeasles-as-cases-surge-worldwide

8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6067842/

9. https://www.cdc.gov/mmwr/volumes/70/wr/mm7002e1.htm

10. https://knowledge.wharton.upenn.edu/article/how-economic-recoveryhinges-on-the-vaccine-rollout/

11. https://www.worldometers.info/coronavirus/country/us/

12. https://www.hsph.harvard.edu/population-development/2021/02/24/finallya-look-at-covid-19-mortality-rates-by-race-ethnicity-and-educational-level/

13. https://www.cms.gov/Research-Statistics-Data-and-Systems/ Statistics-Trends-and-Reports/NationalHealthExpendData/ NationalHealthAccountsHistorical