By Mathew Goldstein
Despite the Centers for Disease Control and Prevention recent announcement that Americans who are fully vaccinated do not need to wear face masks, I plan to continue to wear a face mask when I am indoors with others in public accommodation contexts. I am less inclined to visit those businesses that allow people to not wear face masks. The CDC concedes that we should continue to wear face masks at airports and on public transportation, in medical facilities, in jails and prisons, etc. Municipalities should retain policies that require face masks in public accommodation indoor contexts until the spread of the SARS-CoV-2 virus is under better control, post infection treatments and pre-infection prophylactics improve (such as more people vaccinated, better indoor air ventilation and disinfection), we know the duration of vaccine immunity and the long term health impacts of infection, and widespread vaccination is common in countries globally instead of limited primarily to the wealthier countries. Tony Blair was right when he said “virus circulating anywhere is potentially virus moving everywhere”.
The vaccination shortfall is now mostly on the demand side. Due in part to exaggerated, unbalanced, sometimes falsely grounded, yet widely promoted and accepted claims against vaccination, coupled with knowledge acquisition and applied reasoning shortcomings, lack of commitment to communal health, and the like, it is still unclear if we will achieve herd immunity from vaccination anytime soon. The vaccination percentages vary significantly by zip code, for Maryland overall it is now a little over 40% fully vaccinated and 50% partially vaccinated excluding children. The two dose Moderna and Pfizer vaccines against Covid-19 infection appear to be very effective against most of the current, known virus variants, the single dose Johnson & Johnson vaccine is less effective (policymakers should consider retroactively adopting a two dose protocol for J&J). Vaccination has not been more effective overall because too many people have not (yet) been vaccinated.
Governments should mandate those vaccinations against contagious diseases that have been proven to be safe and effective while excluding vaccination eligible children from public schools and adults from government employment who lack a medical justification for failing to obtain the vaccinations. Governments should consider establishing vaccination passports and granting teenagers (from age 12) a special privilege to obtain recommended vaccinations without parental permission. The three groups most likely to be vaccine hesitant in the United States are white evangelical Protestants who are 28% hesitant and 26% refusers, Hispanic Protestants who are 42% hesitant and 15% refusers, and Black Protestants who are 32% hesitant and 19% refusers, according to a recent Public Religion Research Institute poll. Without an enforced government vaccination mandate our society will be condemning people randomly to unnecessary sickness, injury, and death. Law is based on the hard-nosed concept that individuals have responsibilities to others that should be enforced to protect the community from behaviors that disrupt the functioning of the community here and now. Willfully not protecting oneself from contagious diseases qualifies as such a disruptive behavior.
Differences in the degree of exposure to the virus, the virus variant (particularly newer variants that did not exist, or were rare and unknown, when the vaccine was tested) and individual health related conditions may affect how effective a vaccine is. Some people are ineligible for vaccination due to medical conditions or young age. Some people who vaccinate are immunosuppressed so the vaccination is not as effective for them. We often do not know who, among those we share a public accommodation indoor space, is vaccinated and who is not, who is infected and spreading a contagious virus and who is not. The more this virus continues to circulate, the more new virus variants appear, some of which spread and may have differing, and potentially worse overall, negative risk profiles. By continuing to wear a face mask we make it safer for everyone to visit indoor businesses and for some people to avoid self-quarantine. Face masks also protect against particulate pollution (which have significant, negative long term health implications) and other viruses. Vaccination combined with wearing a face mask when adjacent to other people synergistically reduces the spread of contagious diseases. Face masks in congested situations may remain a good practice for years. Meanwhile, try to get some exposure to sun on your skin, maybe 15 minutes, while outdoors alone without a face mask on sunny days.
