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Op-Ed: Vaccine Passports — An Alt-Middle Perspective

— ZDoggMD isn't sold on the need to carry proof of COVID immunity

MedpageToday

ZDoggMD talks about how we might better and more inclusively think about this highly triggering topic.

Following is a rough transcript of his remarks (Note: errors are possible):

Hey, everyone. Dr. Z. All right, vaccine passports. The very phrase is triggering to many people. It sounds like, "Show me your papers," right? And people are talking about this now. So the European Union is talking about these green sort of certificates. It's like a QR code. You use your smartphone. It shows them that you have had both vaccinations or you've tested negative or whatever criteria they're using so that you can then travel freely between EU countries or potentially frequent certain restaurants, venues, sporting events, things like that. And the idea of using your vaccination status as a get-out-of-jail card, able to then access things that have been closed for the past year due to the raging coronavirus pandemic, has really, I think it's generated understandable emotional reaction on all sides.

So what I wanna do is I wanna look at why that is, what are the pros and cons from a kind of Alt-Middle perspective. Meaning, let's kind of see why people would disagree about this and then we can make a more rational understanding. So first of all, you've gotta start with this premise that the vaccines work and all the evidence so far points to the fact that they do. So these vaccines seem to reduce even asymptomatic spread and infection in addition to what we really care about, which is hospitalizations and death. So they're pretty effective. So encouraging people to get these vaccines, particularly when they're at high risk, early on is a no-brainer from everything that we've talked about on the show, including the early skepticism and continued skepticism and then being convinced by data that it's a good idea. So let's say to that, let's operate from a presumption that these vaccines do work, which is, I think, a correct presumption at this point.

If you do that, then the question is, well, we've damaged our economy, we've shut down kind of a lot of our way of life, is offering some evidence, a certificate of vaccination, a way to get businesses and the like to open up? Now, OK, first of all, you have to understand that these businesses are rightfully outraged at life's work being disappeared by the shutdowns and the closures in the economy, which were done to try to help people.

And I think when we understand the different moral taste buds that people have and why they might value one thing over another then you can start to look at policy solutions like vaccine passports critically and go, OK, well, does this make sense for the most number of people and where do you stand on it? So remember, these sort of moral taste buds are things like care versus harm. Like, you know, are you gonna hurt somebody? Are we gonna save lives?

That kind of thing. Liberty versus oppression, which is kind of self-explanatory, and fairness versus cheating are, I think, the three big moral taste buds that apply to vaccine passports. So let's look at care versus harm. A vaccine passport says, OK, I am vaccinated, which means my risk of getting sick, in the hospital, or dying of coronavirus in the current situation is negligible. It really is. It's negligible at this point. So from my standpoint, I'm pretty good, care versus harm for me. Could I hurt someone else? So in other words, could I be asymptomatically infected despite being vaccinated and then infect somebody else? Yeah, that's possible. It's less likely than if you're not vaccinated. Couldn't the vaccine, could I be one of those 5% that's failed the vaccine and I'm gonna get infected and potentially get sick? That's also possible, but again, lower risks.

So you have to make your own decision, OK? So from a care versus harm standpoint, it's very likely that a vaccine certificate allowing you to go to, say, a sporting event where everyone else is vaccinated, the chances of people dying of coronavirus there are negligibly small. So I think from that standpoint, the passports could work. From a care versus harm standpoint for businesses, allowing businesses an option to say, oh, you know what? We can fill our restaurant with people who've been vaccinated if they have these passports, allowing us to stay in business 'cause right now we're at half capacity or a third capacity or worse yet than that, and parts of Europe that are locked down were closed entirely. Could this then allow us to save these businesses and return to normalcy for people who've been vaccinated? That's a care versus harm moral taste bud and the answer is probably yes. It probably could do that. Hmm. Now we get to the fairness versus cheating part.

So this is a very strong moral taste bud in many people, particularly, actually interesting, care versus harm and fairness versus cheating are very strong moral taste buds in people who identify as liberal as opposed to people who identify as conservative tend to also favor things like authority versus subversion, loyalty versus betrayal, and sanctity versus degradation as well as liberty versus oppression. So this is why you start to see these things split along political lines, right? And it becomes understandable. You can go, everybody's trying to be the best person they can be. They see the world from a different moral taste bud standpoint, right? So if you look at fairness versus cheating and vaccine passports, you're gonna see something interesting.

There is very little equity in the distribution of vaccines. For example, the Europeans don't have enough. The Americans have enough for the high, you know, vulnerable people, elderly, healthcare workers, but not enough yet for everybody to get one, although we're getting there. And it turns out that minority groups who are at highest risk of dying and getting sick of COVID actually have the most vaccine hesitancy and are less likely to get the vaccine. So you can already start to see that there's not a fair distribution. So now you're, and this is the clincher, it's a generationally unfair distribution.

So for example, in Europe, where they're prioritizing elders and people at highest risk of dying, which is, I think, appropriate, young people are not yet in line to get the vaccine. So when you start talking about vaccine passports, being able to go to restaurants, being able to enjoy yourself, being able to travel, being able to go to spring break, being able to go on vacation, attend a sporting event, a vaccine passport by definition at the current time discriminates against young people, minorities, and people that don't have access to the vaccine.

It just does. So from a fairness standpoint, from an equity standpoint, that's a big ding, right? And in fact, it wouldn't be surprising if, you know, Gen Z gets really pissed off at this idea of a vaccine passport because they're the ones who are most in physical and mental shape to go out and party and they can't do it in the prime of their life. So you can see now there's an equity issue and you can see why people would then bristle at this idea, all right? Now, add in the moral taste bud of liberty versus oppression. This is a powerful one particularly in more conservative schools of thought.

So liberty versus oppression says, you don't tell me what to do unless it's gonna kill someone else or I'm shouting fire in a crowded movie theater or something like that. You know, the limits on free speech and things like that. The liberty versus oppression taste bud here is very powerful with vaccine passports. It's the show me your papers thing, right? The liberty versus oppression moral taste bud says, why are we closed in the first place for a disease that affects a certain subset of people more? Why can't we protect that subset and let everyone else get on with life? That's what the liberty versus oppression taste bud kinda says. And vaccine passports for that group is akin to a, not only is it discriminatory, it's anti-freedom and it's another aspect of what people with a strong sense of that taste bud feel has been happening. So people with that taste bud from the beginning have said, "OK, they want us to wear masks now but believe me, that's gonna creep." And then they say two masks and so there's more evidence that they were, they feel like they were right.

Then they say, "Well, they're talking about vaccines. Pretty soon they're gonna compel us to get vaccines." Like, it should be a choice. Well, when you talk about vaccine passports, in a way, that's compelling you to get the vaccine because if you don't, you can't participate in human life, right? And they feel like, well, with kid's vaccines that have been established, that's one thing. With a new vaccine that isn't FDA-approved, it's emergency use authorized for a pandemic, is that fair to require this, right? And then they'll say, "Well," and then they'll say, "Well, but the idea with the vaccines was that you do get to open up and not wear a mask and do all these other things, but now they're saying even with a vaccine you have to take all these precautions." So you see how the liberty versus oppression folks can get very triggered by this.

Now, instead, I think, the 30,000-foot Alt-Middle integral view of this looks like this. All these guys are right from their perspective. Each viewpoint is true but partial. We don't have a full set of data to know anything at any given time. We have the best data that we have and we have to make policy decisions that are not simply reducible to, what's the science? What's people's emotions? It has to take into account all of those things and the goal being the most good for the most people at the least cost. Well, that's how we have to look at vaccine passports.

Now, if you ask me what's my take looking from this Alt-Middle perspective, it's this. I think the question of vaccine passports is not even the right question we should be asking. We shouldn't be spending a lot of energy trying to figure out what's the most secure, non-forgeable, fairness-versus-cheating vaccine passport that we can use for people who both have smartphones and people who don't and solving the equity problem and the other issues. How about this?

Every single drop of our energy moving forward should be going into getting vaccines into as many willing people as possible, educating people on how these vaccines work and why you really ought to get them, and letting them make decisions and getting them the vaccines. If we do that, we get to herd immunity or something that looks like herd immunity effectively, dropping hospitalizations, dropping deaths. Cases may still be up there because young people are now getting more infected, again, because the vaccine went to the highest risk people.

So hopefully they're not gonna die and that's gonna, we're gonna see what they say. Get to that semblance of herd immunity and then we can actually open up instead of having to require vaccine passports and the like, particularly for schools where I think vaccination should not be required for children to go back to school, and I've talked about that before. Does that make kinda some sense? So my hope is you'll share this video with people who both agree and disagree with you in a compassionate way so people can then understand the issues and make their own decisions instead of the knee-jerk hatred that social media and our current polarized situation seems to encourage. If we can all think with a little more Alt-Middle perspective, it would be better.

Now, I'm probably missing some stuff. I'm not an expert in all these things. So come at me in the comments and tell me where I'm wrong in a thoughtful and constructive way if you can. If you can't, that's fine. I'll just block you on Facebook 'cause it's fun to do that. It's just, block, block, it just gives you a little rush of dopamine. I love you guys. And we're out. Peace.

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