You Have No Mandate: A Preemptive Argument Against Mandating Bivalent Boosters

Guest post by a Cornell Professor

Today's guest post features Dr. Paul Fenyves from Cornell University. Dr. Fenyves has a unique perspective. He initially believed, like so many, that COVID vaccines would halt transmission, and supported mandates. As it became clear that no amount of vaccination could stop variants, he changed his view. He is the rare example of someone who changed his mind when the facts changed.

Halting transmission-- a benefit to third parties—is a prerequisite for mandating medical interventions, but, even when a third party benefit is present, reasonable people may disagree about the role of mandates. My conclusion was always that the societal harm of mandates far exceedes any benefit, and as such I always opposed mandates.

But despite our initial disagreement, I have tremendous respect for people like Dr Fenyves for his thoughtfulness about when mandates can be considered, and when they cannot. And that is the subject of his essay today.

Vinay Prasad MD

You Have No Mandate:  A Preemptive Argument Against Mandating Bivalent Boosters

            The bivalent Covid vaccine boosters have arrived.  I suspect many organizations are considering welcoming the winter with a bivalent booster mandate, requiring that all employees or members take the vaccine, whether they want to or not.  My message to these would-be mandators: Don’t do it!

            I was initially supportive of Covid vaccine mandates in the Fall of 2021.  At the time, I was told that Covid vaccines don’t only protect the individual receiving the vaccine, but they also benefit the community by reducing spread of the virus.  I was told that vaccinating all Americans would create a “wall of immunity” that could bring the pandemic under control.

This assertion of a communal benefit was the strongest argument for vaccine mandates.  The rights of individuals are often put into tension with what’s best for the community.  In the midst of a deadly global pandemic, I believed that it was reasonable to prioritize societal welfare over individual autonomy.  The only problem: Covid vaccines failed to substantively prevent transmission, and only succeeded in protecting the individual.  

To be clear, there was never any direct evidence that Covid vaccines would prevent transmission, but for a time it seemed like that must be true.  After all, the vaccines were so damned effective.  For example, in clinical trials Pfizer’s Covid vaccine was shown to prevent 95% of infections.  

Surely a vaccine that prevents almost all infections would halt community spread, right? 

Wrong.  Perhaps there was a time when Covid vaccines could significantly reduce community transmission, but that time was short-lived, and the virus quickly evolved and learned to evade vaccine-induced immunity.  For me, the inability of vaccines to detain Covid cases was demonstrated most dramatically in Portugal, which suffered a tremendous surge of Covid cases in December 2021, despite having a 90% vaccination rate.

The arrival of Omicron destroyed our dreams that the vaccines would hold back the waves of infection.  The supposed community benefit of the Covid vaccines evaporated, negating the strongest moral argument for vaccine mandates.  I had argued in favor of vaccine mandates believing that the holdouts were selfishly endangering their neighbors, and I was proven wrong.  Even though the data has continued to demonstrate that Covid-naïve adults are greatly helped by vaccination, without a meaningful communal benefit, I see no moral justification for compelling others to vaccinate against their will.

I understand that there were other arguments for mandating vaccines.  Some argued that vaccine mandates might prevent hospitals from becoming overwhelmed.  Others argued that it is not unreasonable to force someone to do something “for their own good.”  I find these arguments to be weak justifications for violating an individual’s autonomy and mandating a medical intervention.  Furthermore, these arguments are completely inadequate when applied to young people, whose risk of hospitalization from Covid is low, and whose likelihood of benefiting from vaccination is similarly low.

Those in the medical community who, like me, argued that vaccines should be mandated to protect the community should feel chastened.  When considering mandating vaccines in the future, we should proceed with humility, acknowledging that our knowledge is far from perfect and our truths are often transitory.

Paul Fenyves is a primary care doctor in New York City with Weill Cornell Medicine, where he is Associate Director, Digital Care and Innovation.  Unfortunately, his thoughts on vaccine mandates do not necessarily represent the views of his employer.