The social contract of vaccination

The ideal situation for my individual immunity from serious common diseases is that everybody gets compulsorily vaccinated except me. That way there’s nobody to give me the diseases, but I avoid both the risks of the injection and that nasty prick in the arm.

Or so I used to joke with patients when discussing vaccination. In reality, of course, we aim to produce herd immunity via a social contract, in which each of us shares the risks and the benefits.

When Jenner investigated the folk-practice of innoculation with cow-pox by practising on a small boy, it may have been an irresponsible risk engendered by class callousness, but in fact the kid stood to gain immunity from one of the worst killers of the day. He did OK by it.

When as an infant I was taken for my diphtheria and, later, polio, TB and various travel jabs, it was essentially because my parents wanted to protect me from those lethal ailments. However, the public health guys who initiated the programmes had their eye on minimising the risk for everybody, including those who missed the vaccination or for whom it was ineffective.

Later, pertussis was added to polio and diphtheria in the triple vaccine – another dangerous, though less frequently lethal or crippling disease, except in the very young.

That same principle of mutual benefit continued in the infamous MMR, though in a rather fuzzier form. For measles, whilst a potential killer worldwide, was an uncommon cause of death in Britain in our more affluent times. Mumps, apart from rare cases of meningitis or encephalitis, is more problematic to adults above vaccination age. Parents used to have mumps parties so all the kids would catch it as young as possible.And rubella’s problems are almost exclusively limited to birth defects from infection in the first trimester of pregnancy. But despite this spectre and the fact that vaccination was far from universal even for girls when I started work, I never saw a single case of even mild rubella syndrome.

Still, boys grow into men who might become sterile (and will become very unhappy!) with orchitis, and it can damage ovaries too. And most boys will father children whose rubella deafness would be a burden for themselves too. So they all gain some potential benefit.

Influenza vaccination, viewed dispassionately, has pushed the social contract envelope further as it has spread across the various sub-populations. I never had a flu jab until the last few years of my general practice work, and had flu maybe once or twice in my whole career – not too pleasant, but a well-deserved rest from the stress of medicine. They used to say, rightly in general terms, that “Doctors don’t get the flu,” and that’s an interesting comment on the kinds of questions about immunity that scientists have been asking, and governments have been ignoring, during the present COVID thing. I was regularly coughed over by hundreds of patients, presumably giving my immune system plenty of practice on low virus-loads, and being physically active and happy also made harder work for the bugs.

But in any case the numerical risk of death to me from flu, as a male of working age, was pretty low anyway: in some years it was also significant for a few children and young people, and was always a killer for the elderly and those with respiratory ailments. But the elderly is the group in which the flu vaccine is least effective (varying between perhaps 50% and as low as 15% from year to year). So, for possibly the first time, a significant aim of the programme was to protect the vulnerable by preventing infection in those not vulnerable.

Nevertheless, the social contract, whilst perhaps stretched beyond the limit in terms of death or serious morbidity, still benefits us all in terms of our losing time off work or school, and sparing us what is always a miserable few days.

Not that this mutual benevolence is risk-free, despite Bill Gates’s scandalous over-simplification that “Vaccines are safe.” Swine flu was another worldwide pandemic scare, and though it killed far fewer than was predicted, these were largely among younger people and therefore more costly in health-economic terms than COVID. But the hastily produced GSK Pandemrix vaccine, whose safety controls governments bypassed and indemnified, caused 1 in 55,000 to suffer the long-term disability of narcolepsy, because of the adjuvant used.

1 in 55K is not a high number, but is of the same order of magnitude as the percentage of the world population that died. In other words, had the whole world been vaccinated, as is proposed for COVID, one case of narcolepsy would have been produced for every 1-4 who would have died from the virus. Is it part of the deal that one should suffer permanent damage if not at high risk oneself?

This question needs to be addressed seriously with SARS-CoV-2, now that they are developing vaccines in as much of a scramble as a school sack race, and in the current spirit of heavy-handed coercion are talking about making them compulsory. The current going rate for COVID penalties (for anything) is £10,000, but the bigger stick is the rumoured requirement for a vaccination certificate to travel abroad, go into restaurants or theatres, or whatever other suggestions can be borrowed from the Chinese Social Credit system.

But COVID is different from flu, and not because of the unusual SARS pathology that causes much of its lethality. Neither is the “long COVID,” that (I notice) is now being fed into the news items to keep the fear going amongst the jaded public, particularly peculiar. It remains to be seen what percentage of sufferers actually get truly long-term post-viral effects, since most of the reports seem to be from one month post-infection, which is not what I, having specialized in Chronic Fatigue Syndrome, regard as chronic. The definition actually requires over six months of symptoms to count, and it occurs with virtually any seasonal virus, probably including common Covirus colds.

No, the special thing about COVID-19 is the extreme restriction of high death rates to the elderly and already sick, and the extremely low mortality for everyone else. Furthermore, a large majority of those infected have no symptoms at all. The overall infection fatality rate (IFR), from antibody studies, is between 0.1 and 0.3%, and possibly much less if one factors in T-cell immunity in which antibodies never appear.

This means that the social vaccination contract is extraordinarily skewed in this pandemic. In order to protect the very elderly and those with multiple pathologies, the huge majority of those given the vaccine would never have got symptoms anyway, or would have been unknowingly infected before, or would at most have got a few days of moderately unpleasant symptoms. My own risk of death, as a 68 year old of otherwise sound body, is between 0.1% and 1%, depending on which research you favour. But given the low rates of infection in these parts, I’d have to go out of my way to catch it first (Cornwall, crowded out with summer tourists of whom 40% were over 60, had ZERO COVID deaths).

Against that is, as we are all aware, the untried nature of the many vaccines being developed, the bypassing of much of the usual time-consuming safety stages because of the alleged urgency of the situation, indemnities once more given to manufacturers, no doubt, and the political capital tied up in vaccinations, which don’t favour stopping the business very quickly if complications were to begin (remember thalidomide).

The vast majority therefore stand to gain nothing from being vaccinated, whilst facing possible risk. Most of those benefiting will be past the mean life expectancy already, and hence unlikely to gain more than a few months of life at most, and may well respond weakly to the vaccination anyway. That would seem to be a bad deal as regards our being “all in it together”.

But of course, it’s a very good deal for those collecting the money from our taxes for the vaccines, whether we want them or not. Not that I would ever doubt they only have our best interests at heart.

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About Jon Garvey

Training in medicine (which was my career), social psychology and theology. Interests in most things, but especially the science-faith interface. The rest of my time, though, is spent writing, playing and recording music.
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