COVID Vaccine: why is it not required for all DOD personnel?

[DrMetal]

Nearly 40% of Marines have declined Covid-19 vaccine

Nearly 40% of US Marines are declining Covid-19 vaccinations, according to data provided to CNN on Friday by the service, the first branch to disclose service-wide numbers on acceptance and declination.

www.cnn.com

Why is the COVID vaccine not required for all DOD personnel?

I've heard b/c it's not FDA approved. But it is FDA approved, for emergency use, and we have an emergency here. And since when does the DoD need FDA approval to issue an order? Nobody recommends the Anthrax and small pox vaccines for the general public, yet the DOD mandates it for deployments. Why not just make the COVID vaccine mandatory, so that I don't have to spend 20 minutes trying to convince some dumba$s who thinks he knows more then Dr. Fauci and the CDC?

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[Pedsanes]

As long as it's an EUA. Anthrax/smallpox weren't approved via EUA I don't believe. Give it time and the covid vax will be required I'm sure. Also the political environment leading immediately prior to the EUA tainted the situation a bit as well.

 

[Matthew9Thirtyfive]

As long as it's an EUA.

This. Once it’s approved and not EUA, I’m sure it will be.

 

[DrMetal]

This. Once it’s approved and not EUA, I’m sure it will be.

Why does EUA matter?

Last time I checked, we're a militant organization. The military can order it's members to do whatever it likes (for instance, the Navy wont allow me to sit down at a restaurant right now, despite local community restrictions being lifted).

So order members to take the f-in vaccine. Or are our leaders too scared to issue such a mandate? (it certainly wouldn't be the first time in 21st century military history that our leaders have been scared to enforce good order and discipline).

 

[Matthew9Thirtyfive]

Why does EUA matter?

Last time I checked, we're a militant organization. The military can order it's members to do whatever it likes (for instance, the Navy wont allow me to sit down at a restaurant right now, despite local community restrictions being lifted).

So order members to take the f-in vaccine. Or are our leaders too scared to issue such a mandate? (it certainly wouldn't be the first time in 21st century military history that our leaders have been scared to enforce good order and discipline).

It’s part of the EUA statute that all individuals be given the option to decline. According to 10 USC 1107a though, POTUS can make it mandatory. So it requires the president to do so while it’s still under EUA. There are already folks in the upper CoC asking him to do so.

 

[Spikebd]

Are soldiers required to receive the pneumovax? Regardless, while an brand new mRNA vaccine is still under emergency use I wouldn’t blame any healthy soldier for passing on the vaccine. The risk to benefit ratio is not the same for a 21-year-old soldier as it is for an 81-year-old diabetic.

 

[DrMetal]

Are soldiers required to receive the pneumovax? Regardless, while an brand new mRNA vaccine is still under emergency use I wouldn’t blame any healthy soldier for passing on the vaccine. The risk to benefit ratio is not the same for a 21-year-old soldier as it is for an 81-year-old diabetic.

The vaccine is at least safe. That's been shown. Whether or not it's truly efficacious remains to be seen and may require years of data collection to prove (we're still collecting data on the flu shot, which is about 50% effective, by some accounts . . .but it's a very safe vaccine, so the benefit/risk ratio puts it in favor). If it's at least safe, it's worth taking.

Most 21-yo soldiers/sailors don't understand this, thus a direct order from the POTUS would be welcome action.

 

[j4pac]

Just because they know how mRNA vaccines work doesn’t mean that they know how this specific vaccine will be handled for millions of people. If that was the case...they wouldn’t even needed to do a phased clinical trial. They also wouldn’t have a plan 2 year safety follow-up. A sample size of 20,000 doesn’t equal millions. A few months of safety data doesn’t equal indefinite. The Phase 3 trial also excluded those who have had COVID and many classes of unhealthy individuals. So many of the general population are a part of the study exclusion criteria.

Do I think that COVID vaccine is safer than getting COVID? Yes. I’m vaccinated. I personally believe that all adults should be vaccinated.

But saying the vaccine is safe is a very relative term. This is NOT the flu vaccine. I’ve had the flu vaccine my entire adult life...I’ve never experience ANY side effect. I’ve never had to miss work after a flu vaccine. How many years of safety do we have on the Flu vaccine? There have been billions of people who have received flu vaccines over the years, far exceeding the number of those that receive it on a yearly basis. So for you to say that “we’re still collecting data on the flu shot”. That’s a false equivalence. The COVID vaccine can wreck people...there have been a ton of people who have had vicious side effects. Of course people will die from this vaccine. To think otherwise is naive. And no...we don’t know exactly how they will die...nobody died in the trials...as the sample size was tiny relative to the number of people who will receive it.

The question isn’t whether the the COVID vaccine is safer than COVID with a mean age of 52 (in a country where the average 52 year old is obese). That’s pretty well established based on the trials. The question is whether the COVID vaccine is safer than COVID for 18-20 above average health individuals. I believe it likely is...but no certain because there was not subgroup analysis on the studies and the studies did have some limitations as I discussed. I’d hope they’d get it...but there should be autonomy on this topic.

 

[Gastrapathy]

They can be ordered to run up a beach towards a machine gun. They can be ordered to get a vaccine. The risk/benefit isn’t just about their individual safety. COVID stopped an aircraft carrier.

The bigger issue to me is that this reflects the political leanings of our military.

 

[DrMetal]

Do I think that COVID vaccine is safer than getting COVID? Yes. I’m vaccinated. I personally believe that all adults should be vaccinated.

Enough said, that's all we need. Everyone in the mil should be vaccinated.

They can be ordered to run up a beach towards a machine gun. They can be ordered to get a vaccine. The risk/benefit isn’t just about their individual safety. COVID stopped an aircraft carrier.

The bigger issue to me is that this reflects the political leanings of our military.

Not only is it reflective of political leanings, but it's also reflective of a general cowardice in our upper leadership, who in 2021 doesn't want to dish out orders and drop the swift hammer of UCMJ on those who disobey.

 

[Matthew9Thirtyfive]

Enough said, that's all we need. Everyone in the mil should be vaccinated.



Not only is it reflective of political leanings, but it's also reflective of a general cowardice in our upper leadership, who in 2021 doesn't want to dish out orders and drop the swift hammer of UCMJ on those who disobey.

They technically can’t order us to get it while it’s under EUA. Only the president can order that. People in our upper leadership have been pressing him to do just that. I completely agree. He should order it mandatory. It’s abysmal that less than half our force have gotten it. So many of the corpsmen here are refusing it because they don’t understand it.

 

[Gastrapathy]

Just curious why it’s an issue for you that more conservatives are willing to serve?

This is the issue:

Poll shows vast majority of Republicans trust Trump for medical advice over CDC, Biden and Fauci

At least 66 per cent of Republicans say they trust the former president, who suggested injecting disinfectants could cure Covid-19, for medical advice

www.google.com

 

[Gastrapathy]

What is the reference that only the President can order it?

 

[Matthew9Thirtyfive]

What is the reference that only the President can order it?

10 U.S. Code § 1107a - Emergency use products

(a)Waiver by the President.—
(1)
In the case of the administration of a product authorized for emergency use under section 564 of the Federal Food, Drug, and Cosmetic Act to members of the armed forces, the condition described in section 564(e)(1)(A)(ii)(III) of such Act and required under paragraph (1)(A) or (2)(A) of such section 564(e), designed to ensure that individuals are informed of an option to accept or refuse administration of a product, may be waived only by the President only if the President determines, in writing, that complying with such requirement is not in the interests of national security.

 

[LittleBrother]

What if we showed respect for what little agency servicemen and women have and try to convince them to get the vaccine?

Guess what - COVID vaccine isn't mission critical. Despite what the leader(s) of the Teddy Roosevelt thought, our military could function completely fine if literally every person in an operational billet got COVID today. These are people on the lower end of the risk in terms of complications, and the military is designed to take casualties. Unlike smallpox, or weaponized anthrax, or malaria, COVID is not going to lay an entire battalion low even if everyone in a battalion got it.

I think a mandate is coming but I am totally opposed to it. There is nothing that forced vaccinations would do that would make the military any more mission capable, not that that it cares about actual functionality that much anymore.

Furthermore, I think physicians should disabuse themselves of the medicine-at-gunpoint strategy. The medical community has a lot to regret in it's history, including it's recent history. Anti-vaxxing his people telling you they don't trust you. You aren't going to rebuild that trust with brute force. So long as many physicians continue to insist that the beliefs, attitudes, and agency of their patients come secondary to physician convenience, people will continue to willfully undermine the healthcare system.

 

[LittleBrother]

Just curious why it’s an issue for you that more conservatives are willing to serve?

It chafes liberals hard that the last respected national institution is also very conservative.

They can be ordered to run up a beach towards a machine gun. They can be ordered to get a vaccine. The risk/benefit isn’t just about their individual safety. COVID stopped an aircraft carrier.

The bigger issue to me is that this reflects the political leanings of our military.

No. Fear stopped an aircraft carrier. There was no operational thereat to the TR. The military is full of young and healthy people, you weren't going to get 10% mortalitily, 1% mortaility, or even .1% mortality on the TR. To take this virus and freak out and openly tell the world that a national strategic asset is combat ineffective is atrocious.

TR should have just circled Guam and been ready to casevac any serious cases to the island. Other than that, quarantine and test if possible or just let the damned virus run it's course.

 

[Matthew9Thirtyfive]

It chafes liberals hard that the last respected national institution is also very conservative.



No. Fear stopped an aircraft carrier. There was no operational thereat to the TR. The military is full of young and healthy people, you weren't going to get 10% mortalitily, 1% mortaility, or even .1% mortality on the TR. To take this virus and freak out and openly tell the world that a national strategic asset is combat ineffective is atrocious.

TR should have just circled Guam and been ready to casevac any serious cases to the island. Other than that, quarantine and test if possible or just let the damned virus run it's course.

Yes, because one death and a few ICU patients on the ship weren’t enough. Let’s just let them all get it.

 

[LittleBrother]

Yes, because one death and a few ICU patients on the ship weren’t enough. Let’s just let them all get it.

Ship. Shipmate. Self.

I remember when priorities used to be mission accomplishment followed by troop welfare. If this was a destroyer that is one thing, this was a carrier. A strategic national asset. A forward deployed aircraft carrier during a time of signficant geopolitical instability. The first priority should have always been maintaining combat effectiveness. That ship could have accepted whatever statistically likely casualties and remained combat effective, we expect casualties for tons of other reasons. People get killed from snapped arresting wires, they have heart attacks, they get put in the ICU over the flu, ect. What's important is that the world doesn't stop because people get hurt or killed in the military. The military is literally designed to accept casualties, and it's trained to willingly accept casualties in order to accomplish its mission.

Guaranteed if this was WWII that Carrier would have maintained combat operations.

 

[Matthew9Thirtyfive]

Ship. Shipmate. Self.

I remember when priorities used to be mission accomplishment followed by troop welfare. If this was a destroyer that is one thing, this was a carrier. A strategic national asset. A forward deployed aircraft carrier during a time of signficant geopolitical instability. The first priority should have always been maintaining combat effectiveness.

The ship can’t function if everyone is sick dude. Have you ever been ships company? Hard to complete the mission if the entire weapons department or air department is quarantined or casevaced.

Even with attempts at isolation, the virus ripped through the ship. What on earth do you think they would be able to do with 20-25% of your crew in isolation or sick?

 

[LittleBrother]

The ship can’t function if everyone is sick dude. Have you ever been ships company? Hard to complete the mission if the entire weapons department or air department is quarantined or casevaced.

Even with attempts at isolation, the virus ripped through the ship. What on earth do you think they would be able to do with 20-25% of your crew in isolation or sick?

Yes, I've been on deployed ships before.

COVID doesn't exactly stick everyone in the hospital. Most people who get it are asymptomatic or mildly symptomatic. As I've said, if everyone on that ship got COVID that ship could still function. People could go to work sick, most people in the US hardly know they have it. I thought I had allergies when I got it. The only thing that could have made that ship combat ineffective is the leadership's response, hence what I said:

Circle Guam, bpt casevac serious cases to the island. Try to stop the spread, but don't kill your operational ability just to do that.

Ever been to Guam? I gurantee you they don't have barracks on that island for 5,000 unexpected sailors. Begs the question, what are you going to do taking 5,000 sailors out of cramped quarters on a Carrier and putting them in an overcroweded barracks, or tent city? Probably weren't substantially better options for social distancing on the island than on the ship anyways. So, given that, might as well just keep everyone on the ship and keep the ship working while having the ability to casevac if needed, but remain able to respond to missions.

 

[Matthew9Thirtyfive]

Yes, I've been on deployed ships before.

COVID doesn't exactly stick everyone in the hospital. Most people who get it are asymptomatic or mildly symptomatic. As I've said, if everyone on that ship got COVID that ship could still function. People could go to work sick, most people in the US hardly know they have it. I thought I had allergies when I got it. The only thing that could have made that ship combat ineffective is the leadership's response, hence what I said:

Circle Guam, bpt casevac serious cases to the island. Try to stop the spread, but don't kill your operational ability just to do that.

Ever been to Guam? I gurantee you they don't have barracks on that island for 5,000 unexpected sailors. Begs the question, what are you going to do taking 5,000 sailors out of cramped quarters on a Carrier and putting them in an overcroweded barracks, or tent city? Probably weren't substantially better options for social distancing on the island than on the ship anyways. So, given that, might as well just keep everyone on the ship and keep the ship working while having the ability to casevac if needed, but remain able to respond to missions.

This is the most ridiculous thing I’ve read in a while. Just. Wow.

And yeah, I’ve been to Guam.

 

[LittleBrother]

This is the most ridiculous thing I’ve read in a while. Just. Wow.

And yeah, I’ve been to Guam.

It's hardly ridiculous.

Points of facts:

Military age folks are low risk for COVID complications.
COVID commodities are disqualifiers for service.
Most people who get Covid are asymptomatic or mildly symptomatic
Guam does not have barracks for 5,000 unexpected sailors
Cramped quarters on land are marginally better than cramped quarters on a ship.
Warships are resilient and prepared to take casualties.


Marine battalions in Afghan have taken upwards of 10% casualties and continued to fight an actual war. All TR had to do was circle Guam. Hell, they didn't even have to do any flight ops or anything else seriously operational.

Not that I ever had serious confidence in blue-side Navy but we are in real trouble if a disease that is 95% sniffles can take out one of the Navy's most valuable assets.

 

[militaryPHYS]

Let's remember we knew much less about true infectious rate and mortality risk at the time of the TR. No use arguing about what has happened in the past. Fact is we can't force anyone to get it as it stands right now. What use is it to continue to argue about it on an SDN forum?

What are the ethical/legal/moral points regarding leave/liberty restriction if not vaccinated? Data is showing less asymptomatic carriers and safer to travel when vaccinated so it wouldn't be a punitive thing...it's just science.

 

[Gastrapathy]

Well thanks for so clearly proving my point. Tribalism in American politics is a major reason why so many Marines have declined the vaccine. And the fact that the MAGA tribe is anti mask and anti vaccine is tragic.

as for the comment about conservatives serving, not the wealthy ones with their pesky bone spurs. But it’s not inherently surprising that people who are conservative are more likely to join an organization that exists to kill other humans. Anyway, I’m not particularly liberal but that wasn’t the point. The point was that because Trump made being unafraid of COVID a question of manliness and challenged his followers accordingly, we are swimming uphill to convince them to do the obviously right thing.

 

[Gastrapathy]

And the cognitive dissonance of writing:
Ship, shipmate, self and then supporting the idea of refusing the vaccine is almost funny if it wasn’t so sad.

 

[usma05]

What if we showed respect for what little agency servicemen and women have and try to convince them to get the vaccine?

Guess what - COVID vaccine isn't mission critical. Despite what the leader(s) of the Teddy Roosevelt thought, our military could function completely fine if literally every person in an operational billet got COVID today. These are people on the lower end of the risk in terms of complications, and the military is designed to take casualties. Unlike smallpox, or weaponized anthrax, or malaria, COVID is not going to lay an entire battalion low even if everyone in a battalion got it.

I think a mandate is coming but I am totally opposed to it. There is nothing that forced vaccinations would do that would make the military any more mission capable, not that that it cares about actual functionality that much anymore.

Furthermore, I think physicians should disabuse themselves of the medicine-at-gunpoint strategy. The medical community has a lot to regret in it's history, including it's recent history. Anti-vaxxing his people telling you they don't trust you. You aren't going to rebuild that trust with brute force. So long as many physicians continue to insist that the beliefs, attitudes, and agency of their patients come secondary to physician convenience, people will continue to willfully undermine the healthcare system.

You had a point about patient agency, but then the convo quickly devolved. While a mandate isn't ideal and hopefully approval comes soon enough, these soldiers, marines, and sailors greatly underestimate COVID and overestimate negative consequences of the vax. Intended or not, there's a lot of bravado in your tone that isn't justified with experience. A quick scan of your other convos on here show you are about to start med school. You have no real idea what it's like being a doctor. Your prior service isnt a substitute for a MD/DO. A lot of the individuals you belittle on these message boards have been attendings for years and have actuallly cared for COVID patients during the past year, myself included. I've seen enough morbidity and mortality, both in my patients and my family to last a while. My desire has nothing to do with physician convenience. It's a desire to get this beast under control and not let a subset of our population continue to serve as a reservoir to infect others and allow development of new variants because they refuse to see how getting a shot or wearing a mask helps them. Selfless service extends beyond deployments. I hope you actually pay attention in your medical education because you have a lot to learn.

 

[Gastrapathy]

The article was about Marines refusing the vaccine. I commented that their personal politics had something to do with that. And then you and that other guy who said the TR CO should be killed went off. Frankly, you proved my point better than I ever could have with all the anger, cursing and insults.

The reasons that Marines are refusing the vaccine are relevant to how best to get them to accept it. A substantial factor is the actions of Trump and the divided political landscape and tribalism.

You want to talk about nurses for some reason (at the same time you chastise me for changing the subject). Ok. The nurses in my organization are in the mid 70s for accepting the vaccine. Very disappointing but their reasons are different. Figuring out their reasons is exactly what needs to happen so that we can convince them. I’m part of that work but I don’t think you’re actually interested in that data or how we’ve intervened. We’ve made some strides, however, and convinced over half of the initial decliners.

For other interested parties, this guy tries to use data to explain the difference between liberal and conservative morals. It’s worth a listen and, for the liberals, should help you understand why there are so many conservatives in the military and how best to appeal to them. Regardless of whether it ends up mandatory, convincing them that it’s the right thing to do is worthwhile.

 

[Gastrapathy]

You took the time to edit your post to add that I wasn’t worth your time.

It’s like rain on your wedding day.

 

[GoSpursGo]

FYI, one post has been modified because it originally was advocating harm towards a specific individual.

Overall, this thread is on pretty tenuous standing... let's please leave the personal insults and political mudslinging out of it, otherwise this thread will be closed.

 

[j4pac]

Why does EUA matter?

Last time I checked, we're a militant organization. The military can order it's members to do whatever it likes (for instance, the Navy wont allow me to sit down at a restaurant right now, despite local community restrictions being lifted).

So order members to take the f-in vaccine. Or are our leaders too scared to issue such a mandate? (it certainly wouldn't be the first time in 21st century military history that our leaders have been scared to enforce good order and discipline).

With that rationale, why not force vaccination on the entire population? Of course in the global sense it is probably in the best interest of humanity. The reason is that it would be illegal.

I don't think that anyone is arguing that servicemembers SHOULD get the vaccine. Of course they SHOULD get the vaccine.. The question is if they should be FORCED into getting the vaccine. I personally have concerns over forced vaccination. I think that there are potential issues with autonomy, and I also have concerns about lack of appropriate informed consent. And I do not think that the COVID vaccine is equivalent to any of the current vaccines currently being performed on servicemembers.

We perform lots of medical procedures without great medical literature to support their use. But we don't FORCE patients to receive those medical interventions. As it stands, we have very incomplete studies regarding both side effects and efficacy of these vaccines, but short term and long term...not to mention there is NO SUBGROUP ANALYSIS. That is "good enough" to push ahead with emergency use of willing participants...but I have doubts that it is good enough for FORCED vaccinations. I'd love to hear the opinion of someone familiar with medical law.

 

[Matthew9Thirtyfive]

With that rationale, why not force vaccination on the entire population? Of course in the global sense it is probably in the best interest of humanity. The reason is that it would be illegal.

I mean they literally did that in England. If the people can’t be trusted to make the best decision for the greater good...?

 

[DrMetal]

With that rationale, why not force vaccination on the entire population? Of course in the global sense it is probably in the best interest of humanity. The reason is that it would be illegal.

I don't think that anyone is arguing that servicemembers SHOULD get the vaccine. Of course they SHOULD get the vaccine.. The question is if they should be FORCED into getting the vaccine. I personally have concerns over forced vaccination. I think that there are potential issues with autonomy,

You have none when you join a voluntary military. Do what your told, or GTFO when you have the opportunity to do so (you don't have to re-enlist, or continue your commissioned service beyond your payback agreement). However, many chose to do so, to get that sweet 20-yr retirement, yet they insist on being boneheads and not doing the right thing. And the mil is too timid to kick them out.

Do we think the Chinese or Russian militaries have this problem? If they require the vaccine, you'll get it, or you might disappear.

The fact of the matter is that the US military has become very un-disciplined, lazy, and is more reminiscent now of a social welfare state. Refusal to accept/take the COVID vaccine is just another manifestation of that. It's an E-4's way of 'stickin it to the man'. Well, said E-4 doesn't need to re-enlist next time, and go slug it out in the civilian world, where he'll probably make half as much money, have to work twice as hard, and will have no benefits for his 4 dependents. Officers the same.

 

[HighPriest]

I think there is a reasonable point to having this discussion, at least the original discussion regarding the value of mandatory vaccination for military personnel - because this is ostensibly a forum of military physicians, and this is a very important and topical for that career. Policy may be dictated from further up the food chain, but that doesn't mean military docs shouldn't be thinking about it. It is sad if they aren't. And just because a question isn't going to be answered in the forum doesn't mean it shouldn't be discussed. This is more or less an ethical question, and answers are rarely that easy.

Military personnel getting the vaccine isn't just about protecting military personnel. It's also about preventing the spread of the disease from military personnel to non-military personnel. Although I do agree that an aircraft carrier full of COVID patients is not going to function up to par. The argument "I had it and I did fine" is a major part of the disinformation and anti-intellectualism that we are all having to deal with on a regular basis. It's a faulty logical assumption. That being said, the data does have to drive the decision. If military personnel who get COVID have a low rate of hospitalization and a low mortality rate and a low rate of spreading the disease (which may very well be true considering the demographic) then it is probably reasonable to hold off on making it mandatory. If those criteria are not met, then it should be made mandatory. To an extent, stopping COVID IS a national security issue. We have started wars and killed soldiers for purely economic reasons before, and whether you agree with that premise or not this is probably one of the least-risky ways to use the military to help protect the country.

But, I also agree: it is too early to say whether the vaccine is as safe as, say, the flu vaccine. I'm fully vaccinated, and I would do it again in a heartbeat. Frankly, I'm tired enough of COVID that if the vaccine had a mortality rate approaching COVID I'd probably still get the vaccine just to get around this. It will almost certainly be far safer than COVID, but the data is still out. In vitro and animal studies don't necessarily correlate to actual in vivo studies. We all know this. We went to med school.

Conservative or Liberal aside: the issue is always anti-intellectualism. Both sides have it, but they display it in different fashions. Its hard to argue that having a global leader and demigog like Trump poopoo the whole concept of COVID damaged the recovery effort. But anti-intellectualism on both sides of the aisle started before Trump, and continued after he was voted out of office. Personally, I think there is a modicum of anti-intellectualism from the right and left regarding COVID. The right in terms of just refusing to accept the seriousness of a global pandemic, and the left with regards to how far things have been taken in certain circumstances. I see the latter every time I get a dirty look from someone 20 yards away from me when we're outside and I'm by myself and I don't have a mask on.

On another note regarding a comment above: Anti-vax doesn't exist because physicians force people to do things, however. Physicians make recommendations based upon available data. Period. Let me know the next time your doctor kicks in your door and holds you down while he injects you with a vaccine. Politicians can make things mandatory, and they may rely on the expert assessment of physicians, but ultimately physicians don't have the power to make you do anything. Fauci included. No matter what you heard him say, he wasn't the one signing orders.

It's ultimately all a moot point. You can disbelieve in COVID or the seriousness of the disease all you want. The world is in a pendulous swing between full lockdown and simply significant restriction on day-to-day life. If you want things to go back to any semblance of normalcy, you have to play along. If the plan is to just wait until it goes away on its own, it is a poor plan that will fail. The best you can hope for is to be one of the few hold outs in the end who "stuck to their guns" while the rest of the world made sacrifices on your behalf - which is pathetic. I would hope that anyone who willingly joined the Armed Forces would have at least a little interest in self-sacrifice for the betterment of the country if not mankind as a whole. The data tells us COVID is real. Even if it weren't, the vast majority of everyone who matters in the world thinks it is, so it doesn't really matter if you don't. To some extent history and policy are written by the powerful, and if not by the powerful then by the majority. Now, a discussion about what -exactly- is necessary to stop COVID is another matter entirely.

 

[Matthew9Thirtyfive]

I think there is a reasonable point to having this discussion, at least the original discussion regarding the value of mandatory vaccination for military personnel - because this is ostensibly a forum of military physicians, and this is a very important and topical for that career. Policy may be dictated from further up the food chain, but that doesn't mean military docs shouldn't be thinking about it. It is sad if they aren't. And just because a question isn't going to be answered in the forum doesn't mean it shouldn't be discussed. This is more or less an ethical question, and answers are rarely that easy.

Military personnel getting the vaccine isn't just about protecting military personnel. It's also about preventing the spread of the disease from military personnel to non-military personnel. Although I do agree that an aircraft carrier full of COVID patients is not going to function up to par. The argument "I had it and I did fine" is a major part of the disinformation and anti-intellectualism that we are all having to deal with on a regular basis. It's a faulty logical assumption. That being said, the data does have to drive the decision. If military personnel who get COVID have a low rate of hospitalization and a low mortality rate and a low rate of spreading the disease (which may very well be true considering the demographic) then it is probably reasonable to hold off on making it mandatory. If those criteria are not met, then it should be made mandatory. To an extent, stopping COVID IS a national security issue. We have started wars and killed soldiers for purely economic reasons before, and whether you agree with that premise or not this is probably one of the least-risky ways to use the military to help protect the country.

But, I also agree: it is too early to say whether the vaccine is as safe as, say, the flu vaccine. I'm fully vaccinated, and I would do it again in a heartbeat. Frankly, I'm tired enough of COVID that if the vaccine had a mortality rate approaching COVID I'd probably still get the vaccine just to get around this. It will almost certainly be far safer than COVID, but the data is still out. In vitro and animal studies don't necessarily correlate to actual in vivo studies. We all know this. We went to med school.

Conservative or Liberal aside: the issue is always anti-intellectualism. Both sides have it, but they display it in different fashions. Its hard to argue that having a global leader and demigog like Trump poopoo the whole concept of COVID damaged the recovery effort. But anti-intellectualism on both sides of the aisle started before Trump, and continued after he was voted out of office. Personally, I think there is a modicum of anti-intellectualism from the right and left regarding COVID. The right in terms of just refusing to accept the seriousness of a global pandemic, and the left with regards to how far things have been taken in certain circumstances. I see the latter every time I get a dirty look from someone 20 yards away from me when we're outside and I'm by myself and I don't have a mask on.

On another note regarding a comment above: Anti-vax doesn't exist because physicians force people to do things, however. Physicians make recommendations based upon available data. Period. Let me know the next time your doctor kicks in your door and holds you down while he injects you with a vaccine. Politicians can make things mandatory, and they may rely on the expert assessment of physicians, but ultimately physicians don't have the power to make you do anything. Fauci included. No matter what you heard him say, he wasn't the one signing orders.

It's ultimately all a moot point. You can disbelieve in COVID or the seriousness of the disease all you want. The world is in a pendulous swing between full lockdown and simply significant restriction on day-to-day life. If you want things to go back to any semblance of normalcy, you have to play along. If the plan is to just wait until it goes away on its own, its a poor plan that will fail. The best you can hope for is to be one of the few hold outs in the end who "stuck to their guns" while the rest of the world made sacrifices on your behalf - which is pathetic. The data tells us COVID is real. Even if it weren't, the vast majority of everyone who matters in the world thinks it is. So it doesn't really matter if you don't. To some extent history and policy are written by the powerful, and if not by the powerful then by the majority. Now, a discussion about what -exactly- is necessary to stop COVID is another matter entirely.

Great post. Do you believe that the small pool of long(ish) term safety data we have on mRNA vaccines (based on the couple hundred people who got the mRNA rabies vaccine from 2013-2016 who have continued to provide longitudinal safety data) is enough to justify making it mandatory in the military if the spread and mortality are sufficiently high? Or do you think we need long(ish) term data specifically on these vaccines?

 

[HighPriest]

As I said, it kind of depends upon the data regarding the effects of COVID on the military population as well as the effects of the military on the general population with regards to COVID.

If commanders feel that their numbers are being significantly effected by COVID, then making the vaccine mandatory makes sense. If cities and towns with military posts seem to be disproportionately effected by COVID, then making the vaccine mandatory makes sense.

I think its more about making data based decisions than it is about extrapolating the data from the rabies vaccine.

Personally, I think the vaccine is safe. But I understand the ethical argument with regards to making it mandatory.

 

[HighPriest]

Why not force patients into other interventions that would better all humanity?

We tried that once with eugenics. it's a bad idea. But to an extent also a strawman. making one thing mandatory doesn't mean you have to consider making everything mandatory.

 

[Matthew9Thirtyfive]

Why not force patients into other interventions that would better all humanity?

HP beat me to it. But to add onto that, there’s a difference between public health issues that affect individuals and public health issues that affect the people around them. Being fat hurts you. Vaccine refusal hurts you and the people around you.

 

[j4pac]

We tried that once with eugenics. it's a bad idea. But to an extent also a strawman. making one thing mandatory doesn't mean you have to consider making everything mandatory.

Just interested in defining issues relative to public health versus autonomy.

 

[DrMetal]

HIV treatment?

What about it? If you refuse it in the military, you're med-boarded out (and you'll get a high VA rating for contracting HIV while in service! Even if the mil had nothing to do with you getting HIV)

 

[LittleBrother]

HP beat me to it. But to add onto that, there’s a difference between public health issues that affect individuals and public health issues that affect the people around them. Being fat hurts you. Vaccine refusal hurts you and the people around you.

Ok. Except, obesity is a major comorbidity with respect to COVID. Being fat makes you as an individual more susceptible to a virus that the vast majority of healthy people can tolerate just fine. Thus we have sacrificed the freedoms and well-being of healthy people in order to protect the well-being of unhealthy people who have, until now, taken very little interest in their health.

In terms of human health Obesity is a leading cause of mortality in the US year after year, as it drives inflammatory conditions like diabetes, atherosclerosis, ect. If everyone that could be healthy was healthy, COVID would be much less of a threat. So, in world where people have no agency in the light of public health, why wouldn't the public have equal interest in compelling weight loss? It would be simpler than even a vaccine passport. Just put scales in front of places that sell food.

 

[j4pac]

The ship can’t function if everyone is sick dude. Have you ever been ships company? Hard to complete the mission if the entire weapons department or air department is quarantined or casevaced.

Even with attempts at isolation, the virus ripped through the ship. What on earth do you think they would be able to do with 20-25% of your crew in isolation or sick?

This is a good point. But let's be honest...it took a lot to go wrong for the USS Roosevelt to be infested. It hasn't happened since with better protocols in spite of the lack of vaccines. Now that the majority of servicemembers are vaccinated, I think that the likelihood of anything even remotely coming close to that happening would be highly unlikely. The number of stars that would have to align. But I do understand your concern...and I think that it is really the only argument i think that there is for servicemembers getting vaccinated against their will.

I'd just prefer that there would be appropriate subgroup analysis for safety/efficacy to be able to provide these members appropriate informed consent. If that was to take place with half decent studies, I'd be all aboard with COVID falling in line with the other mandatory vaccines. EVERYONE should be educated on risks/benefits of an intervention...even military servicemembers.

 

[ClipArtBananas]

Ok. Except, obesity is a major comorbidity with respect to COVID. Being fat makes you as an individual more susceptible to a virus that the vast majority of healthy people can tolerate just fine. Thus we have sacrificed the freedoms and well-being of healthy people in order to protect the well-being of unhealthy people who have, until now, taken very little interest in their health.

In terms of human health Obesity is a leading cause of mortality in the US year after year, as it drives inflammatory conditions like diabetes, atherosclerosis, ect. If everyone that could be healthy was healthy, COVID would be much less of a threat. So, in world where people have no agency in the light of public health, why wouldn't the public have equal interest in compelling weight loss? It would be simpler than even a vaccine passport. Just put scales in front of places that sell food.

So much wrong with this - intellectually, medically, grammatically.

Can't imagine why you are going into medicine, but for the sake of humanity I hope you get filtered out.

 

[Matthew9Thirtyfive]

This is a good point. But let's be honest...it took a lot to go wrong for the USS Roosevelt to be infested. It hasn't happened since with better protocols in spite of the lack of vaccines. Now that the majority of servicemembers are vaccinated, I think that the likelihood of anything even remotely coming close to that happening would be highly unlikely. The number of stars that would have to align. But I do understand your concern...and I think that it is really the only argument i think that there is for servicemembers getting vaccinated against their will.

I'd just prefer that there would be appropriate subgroup analysis for safety/efficacy to be able to provide these members appropriate informed consent. If that was to take place with half decent studies, I'd be all aboard with COVID falling in line with the other mandatory vaccines. EVERYONE should be educated on risks/benefits of an intervention...even military servicemembers.

Are the majority of servicemembers vaccinated? I don’t have data, but anecdotally a lot of people here have refused.

 

[LittleBrother]

So much wrong with this - intellectually, medically, grammatically.

Can't imagine why you are going into medicine, but for the sake of humanity I hope you get filtered out.

Um... wat?

1. Obesity is a major comorbidity with respect to COVID: "Risks for hospitalization, ICU admission, and death were lowest among patients with BMIs of 24.2 kg/m2, 25.9 kg/m2, and 23.7 kg/m2, respectively, and then increased dramatically with higher BMIs."

New Study Shows Overweight, Obesity Associated with Severe COVID-19 Complications

Evidence demonstrates that overweight and obesity are risk factors for severe COVID-19.

www.pharmacytimes.com

2. Obesity is a leading cause of mortality: "Obesity is also associated with the leading causes of death in the United States and worldwide, including diabetes, heart disease, stroke, and some types of cancer."

Adult Obesity

Causes and consequences of this complex health issue.

www.cdc.gov

3. Obesity is highly pro-inflammatory (you'd think this would be important during a viral infection, you know, cytokine storm ect).

"The excess of macronutrients in the adipose tissues stimulates them to release inflammatory mediators such as tumor necrosis factor α and interleukin 6, and reduces production of adiponectin, predisposing to a pro-inflammatory state and oxidative stress. The increased level of interleukin 6 stimulates the liver to synthesize and secrete C-reactive protein. As a risk factor, inflammation is an imbedded mechanism of developed cardiovascular diseases including coagulation, atherosclerosis, metabolic syndrome, insulin resistance, and diabetes mellitus. It is also associated with development of non-cardiovascular diseases such as psoriasis, depression, cancer, and renal diseases."

Obesity and inflammation: the linking mechanism and the complications

Obesity is the accumulation of abnormal or excessive fat that may interfere with the maintenance of an optimal state of health. The excess of macronutrients in the adipose tissues stimulates them to release inflammatory mediators such as tumor necrosis ...

www.ncbi.nlm.nih.gov

If the risks for hospitalizations, ICU admission, and death "increase dramatically" with obesity then maintaining a healthy weight would dramatically decrease the risk for severe negative outcomes due to COVID infection. I don't think that is a weird stretch to make. Not only would it reduce risks for bad COVID outcomes but it would reduce risks for plenty other bad healthcare outcomes that kill hundreds of thousands year over year. Some people have suggested that morbid obesity is responsible for as much as 20 years loss in life expectancy for males.

Obesity, in and of itself, is orders of magnitude more deadly than COVID. Not only does it predispose you to negative outcomes during a COVID infection, but it also predisposes you to almost every major cause of mortality in the US.

So, since people on this thread want to present vaccine mandates as merely a problem of the commons, I think it's worth posing the question of why we view vaccine noncompliance as uniquely problematic.

 

[Matthew9Thirtyfive]

Ok. Except, obesity is a major comorbidity with respect to COVID. Being fat makes you as an individual more susceptible to a virus that the vast majority of healthy people can tolerate just fine. Thus we have sacrificed the freedoms and well-being of healthy people in order to protect the well-being of unhealthy people who have, until now, taken very little interest in their health.

In terms of human health Obesity is a leading cause of mortality in the US year after year, as it drives inflammatory conditions like diabetes, atherosclerosis, ect. If everyone that could be healthy was healthy, COVID would be much less of a threat. So, in world where people have no agency in the light of public health, why wouldn't the public have equal interest in compelling weight loss? It would be simpler than even a vaccine passport. Just put scales in front of places that sell food.

Right, but again, to simplify things, you being obese isn’t making the people around you more likely to contract covid or have a worse course, and it certainly doesn’t confer the risks of obesity to the other aspects of health (not including the likelihood of your kids being obese and stuff like that). You not being vaccinated does expose people around you if you get it.

 

[Matthew9Thirtyfive]

HIV treatment? Tamiflu? Flu vaccine? HPV vaccine? All have interventions that are far more studied than the COVID vaccine.

We already require the flu vaccine for servicemembers, and we require HIV tests annually.

 

[j4pac]

We already require the flu vaccine for servicemembers, and we require HIV tests annually.

My statement was more directed for the general public. But that is taking away from the military theme...so in hopes of keeping this train on the tracts...ignore those statements. I'll remove them.

 

[LittleBrother]

Right, but again, to simplify things, you being obese isn’t making the people around you more likely to contract covid or have a worse course, and it certainly doesn’t confer the risks of obesity to the other aspects of health (not including the likelihood of your kids being obese and stuff like that). You not being vaccinated does expose people around you if you get it.

Yes, but the argument for vaccine mandates is the same argument that justified draconian lockdowns which have come with severe costs for those who had to participate in them. This is about offloading risks. We want to offload the risks of certain people who are predisposed to poor outcomes by reducing viral transmission, maintaining hospital capacity, ect. We did that through lockdowns which came at a severe cost, and now seek to deny the bodily autonomy of people in order to reduce risks for highly susceptible populations. However, just as you can say "Myself refusing the vaccine puts other people at risks" I can say "other people continuing to be obese puts themselves at risks." It's worth asking why should I have to give up my own agency to protect the health of people who show no interest in there health? Like, an individuals own state of obesity is a much larger factor in their response to COVID than my individual vaccination decision.

 

[Matthew9Thirtyfive]

My statement was more directed for the general public. But that is taking away from the military theme...so in hopes of keeping this train on the tracts...ignore those statements. I'll remove them.

Oh gotcha. Yeah I confused myself haha.

 

[HighPriest]

There's definitely a difference between mandating a vaccine for the military and mandating one for the general public.

Putting whether it -ought- to be mandatory for the military or not aside for a moment - joining the military is essentially saying that you want to give up a significant portion of your autonomy to do something good for your country and by extension the people who live in it. And as everyone on this threat knows, it isn't just about firing a rifle, it takes many forms. Ergo, I think it is a different conversation to mandate a vaccination for the military as opposed to the general public. So these are different conversations. The question is whether or not it is necessary for the military.