That doesn't answer the question. What about contagious diseases ? How much risk is someone allowed to create for another person ?

@mcuban Aren’t vaccines effective?

Yes they are. But contagious diseases mutate. You realize this. Correct ? And people who are uncompromised, like cancer survivors, don't always get the full benefit of a vaccine ? You know this as well ? Correct ? And that 6.6pct of our population is immunocompromised ? And that vaccines are not always prophylactic? They may provide protection against death, or serious illness, but the recipient could still get ill ? Losing the ability to earn a living for their family. Or becoming disabled in some manner ? You know this right? Prevalence of Immunosuppression Among US Adults | Allergy and Clinical Immunology | JAMA | JAMA Network share.google/JdGiTcmMKal2FH…

@mcuban So the solution is vaccine mandates, lockdown, or both?

@GeBaiDC We aren't in COVID any longer. How many unvaccinated kids dying this year is acceptable collateral damage for your dogma ? Whooping cough, measles, influenza 200? 300? 500? How many dead kids are you ok with to prove a point ?

@mcuban So the solution is vaccine mandates?

@GeBaiDC For kids. Absolutely. But you didn't answer the question. How many kids are you ok with dying, without vaccine mandates ?

@mcuban Understand why they didn’t get vaccinated and persuade without coercion

@GeBaiDC You are avoiding the question. What is acceptable collateral damage to you ? 200? 300? 1000? More ? At what point would you say it's acceptable to mandate that every child be vaccinated ?

@mcuban Mandated to be vaccinated for what? Flu, COVID, measles, or polio?

@GeBaiDC You keep avoiding the question. Are you suggesting you don't care how many kids die ? Let the market decide ?

The goal of any intervention is to reach your goal 100% of the time. Perfection is the goal. So we strive for 100% good outcomes, 0% unnecessary interventions, and 0% bad outcomes. As of right now, I don’t know of any interventions that have these outcomes. I don’t know of anyone nor anything that can predict future events 100% of the time. An effective vaccine would protect me 100% of the time and have zero downside. No intervention has 100% certainty, which is why we provide informed consent, risks, benefits, and alternatives. Mandates don’t do this. To then shield the manufacturers from risks is a bit absurd. I’m vaccinated. I’m pro vaccines. And I know the vaccines I have protect me (and protect others by me not spreading a disease). If a vaccine requires everyone else I’m around to have the vaccine for it to be effective, then it isn’t a very good vaccine. This is the same for any other intervention. Vaccines are really preventive care. It’s like eating healthy, living a healthy lifestyle, and living a safe life. I’m not sure if there’s a good way to mandate preventive care of one’s self.

This, “If a vaccine requires everyone around me to be vaccinated, then it isn’t a very good vaccine”, is just a completely wrong perspective. Maybe stick to opinions about neurosurgery and ask your ID/Epi colleagues about this topic. Let’s just say you wanted to quantify “good” here, it would be some balance between risks and benefits. Assessing that would require some complex analysis regarding the efficacy of the vaccine immediately and in perpetuity for all possible outcomes of the infection, the morbidity/mortality of the infection, the harms of the vaccine, logistics of administration, cost of the vaccine, and myriad other factors. It would be very easy to envision a situation where your statement above is completely wrong. Imagine a virus with 50% mortality and devastating morbidity. It has a R0 of 1.3. We have a vaccine with no known harms after three decades of use, it costs a penny, can be stored at room temp, and can be administered orally. The vaccine is 30% effective at inducing permanent immunity to morbidity and mortality the day after it is administered. So about 77% of people need to be vaccinated to eliminate the disease. That’s a great vaccine. It would make no sense to develop a better one. You only need 77% for herd immunity. The virus is capable of exponential growth with that R0 and will kill a lot of people but it isn’t particularly contagious. The issue here is you and many (probably most) people think of vaccines in terms of personal preventive care. That is wrong thinking. Vaccines, properly construed, are population interventions to reduce the morbidity and mortality of the population. It is literally protective infrastructure. Think of it this way, if a sewage system is 99% effective, but requires 100% of neighbors to connect to it to prevent cholera from seeping into the groundwater, one would not say, "If a sewage system requires my neighbor to use it to keep me safe, it's not a very good sewage system." It is a collective infrastructure project where the efficacy is emergent from the network, not the individual.

1. You just described Ebola. So you think we should mandate the Ebola vaccine for every American? 2. As I’ve said, I’m pro vaccine. But vaccines are preventative. Should we force everyone with hypertension to take their blood pressure medicine? The NNT is similar to the NNV for most of the vaccines we have. Difference is a faulty medication can result in damages agonist the producer, but not with vaccines: this is absolutely insane. 3. Thank you for bringing up clean drinking water and sewage systems. These have had the greatest impact on child mortality and life expectancy than all other interventions over the last 200 years combined. These were fantastic public health initiatives that were led at the local municipality levels. And they weren’t created by mandates. They were widely adopted because they worked.

1. That question doesn't make sense. Ebola is not endemic to the US. Moreover, while the infection is similar to what I described the logistics of the situation are not. Again, I'm not sure how to be more clear about this... a purely medical definition of "good" is the same misunderstanding you exposed in the original post. There are a lot of other issues at stake to determine if something is a "good" vaccine. The logistics of vaccine administer in Ebola endemic countries is far less trivial than my description. But in DRC, if the logistics were as trivial as I suggested, then yeah, everyone should be vaccinated... obviously. 2. You're still misunderstanding vaccines. Your blood pressure does not affect my blood pressure in any causal manner. Vaccines have a dual purpose of preventing disease in an individual person to some extent and reducing the spread of the disease in the population; the second is much more important than the first. Thus, you having an infectious does have a causal impact on other people. When an individual's choices can affect other people's health, it is common to legislate it. Whatever the liability structure of vaccine products has nothing to do with the wrongness of your earlier opinion or your misunderstanding about the dual purpose of vaccines. Even if we both agreed vaccine liability law is dumb, that has nothing to do with whether ‘if others need to be vaccinated, it’s a bad vaccine’ is a coherent statement. It isn’t, for exactly the same reason your safe sewage system needs neighbors to use it. 3. This is just completely incorrect. There are all kinds of laws about septic systems. Where you can use them, how they must be constructed, and how they are maintained. In virtually all areas of the US there are laws about how close they can be to water reservoirs. It is illegal to defecate in public in most places in the US. These are mandates to isolate and clean wastewater in various important ways. Whether they are federal, state, or local mandates, they are mandates. If it were not a mandate, the local municipality would say, "We strongly recommend not piping your home wastewater directly into the reservoir lake, but we don't require anything in particular in that regard."

I suggest you read your history. That is not at all how sewage systems and clean drinking water systems propagated in the US. Again, I’m very much pro vaccine. And medications or even diet and lifestyle are great examples to compare to vaccines because preventable diseases are the most common drivers of hospitalizations and healthcare dollars used in the US. Non adherence to medications and preventative lifestyle drive up healthcare costs, which affects me much greater than if someone has the flu shot or tetanus shot. Even obesity has a much greater effect on our health system in the US than vaccines. So my real issue with mandates are the slippery slope. And the fact that vaccine manufacturers are protected from litigation. The fear of litigation and not being guaranteed mandated revenue sources would actually drive innovation and improvement.

Sure, I’ll go read more to make sure I understand the topics in my courses. That’s a silly proposition. It is just blatantly incorrect to suggest that wastewater systems are not mandated. They are. Please take an environmental health course or speak with an environmental attorney. Being pro-vaccine is great and non-communicable diseases matter, but that doesn’t change the incorrectness of your opinion about the goodness or badness of a vaccine or your lack of understanding of vaccines as public health infrastructure or the misunderstanding regarding the differences between communicable and non-communicable diseases management at the population level or the various other misunderstandings in your posts. Just to reiterate this, whether or not we agree on the liability issue is irrelevant to the fact that your initial post was incoherent and betrayed a serious misunderstanding about what makes a good vaccine. We should just acknowledge that fact. There certainly can be a good vaccine that requires high population adherence. That is just true and you claimed otherwise.

Firstly, regarding sewage and clean drinking water, I have been referring to the history of its modern development and adoption in the US, which occurred over 100 years ago prior to federal government mandates. Secondly, mandating something, no matter how effective it is statistically, and one person having a negative side effect or still getting sick and dying may still show statistically it worked and was “worth it,” but that is not how the patient or family feels. The lives saved aren’t seen because it is preventative. Even lowering severity of disease isn’t seen because it’s preventative. So now you’ve mandated something where one person and their family only experienced the failure. The mandate creates a problem because you’ve paternalistically forced others to take a vaccine where they had no choice and they had one of the negative effects. A mandate doesn’t include a real informed consent because there isn’t a choice. People aren’t statistics. The statistics don’t matter for that one family. So the goal should be 100% effectiveness and 0% risks. That should be the goal.