The consequences of vaccine mandates
My conversation with Canadian social scientist Kevin Bardosh, lead author of a recent paper on COVID-19 vaccine policy in the BMJ Global Health medical journal
Last week, amid growing pressure, the Canadian government suspended vaccine mandates for domestic and outbound international air and rail travel — as well as for the federal civil service and the federally regulated transportation sectors. But this debate is far from over, as the government stated that it will not hesitate to reimplement vaccine mandates in the future.
The question is: Is such a policy backed by science?
A recent peer-reviewed paper in the BMJ Global Health medical journal argues that vaccine mandates are, in fact, scientifically questionably — and likely to do more societal harm than good. My guest today is the lead author on that paper, and he hopes to trigger a broader public conversation about pandemic policy.
Kevin Bardosh is a Canadian social and political scientist and an expert in global public health. He’s an affiliate assistant professor at the University of Washington, an honorary lecturer at the Edinburgh Medical School, and has worked on Zika control in Haiti and on Ebola in Africa.
Today on the podcast, Kevin Bardosh joins me to talk about the unintended consequences of COVID-19 vaccine policy. Below is an edited and condensed transcript. For the full interview, download the podcast.
TH: Kevin, welcome to Lean Out.
KB: Thank you for having me, Tara.
TH: It’s nice to speak with you again. I want to speak about the situation in Canada later in this episode, but first, I want to dig in to the paper. Your co-authors are a pretty esteemed group of people involved in public health. I’ll just mention a few: Trudo Lemmens from the University of Toronto’s Faculty of Law, with cross-appointments to the Dalla Lana School of Public Health, the Faculty of Medicine, and the Joint Center for Bioethics. Your group also includes Salmaan Keshavjee, professor of global health and social medicine at Harvard Medical School, and Stefan Baral of Johns Hopkins. This is a Twitter success story, in that your group found each other on that platform. Talk to me about the goals that brought this group together to author this paper.
KB: Yeah, thanks, and that’s a great introduction. Essentially, we were seeing this policy momentum in one direction. It’s kind of like a Titanic ship. Once you make a policy decision, let’s say to mandate a vaccine, you start going in that direction. And as you have contradictory evidence — in this case, quite a substantial amount of contradictory evidence, that emerged in mid-2021. It was quite clear that the vaccines were not durable or sterilizing. That you could be vaccinated and still get infected with COVID. But the ship kept on sailing in one direction. And so, I think all of us were trying to shout out, saying, “Look, this is not completely science based. And there’s also going to be a tremendous amount of harm from these policies.”
We were seeing this from the discussion on Twitter. It has its limitations, but it does provide a good pulse of public sentiment, in certain demographic groups, depending on who you’re following. We were seeing this drive towards suspicion, anger, people being fired from their jobs, and also a solidification of power theories about why government is using these heavy-handed hammers.
We came out of lockdown — an unprecedented policy lever for public health — and then we went into vaccine mandates, if you kind of broadly try to parcel out the pandemic response. Both of those are really harsh interventions and they have a lot of externalities and harms. So, I think, broadly, we felt like that wasn’t being discussed adequately in the public arena, also amongst our colleagues in global health departments and in the university system more generally. I think all of us felt it was our responsibility to put together a piece expressing those viewpoints. Obviously I’m speaking for myself, but I think that holds true for everyone.
TH: To set this conversation up, for listeners, this paper puts forward a set of hypotheses that cover four domains: behavioural psychology, politics and law, socioeconomics, and the integrity of science and public health. The purpose of the paper, as I understood it, is to start a public conversation around these topics and to outline potential areas of study for others in this field. It looks at a dozen unintended consequences of vaccine mandates and takes the position that the mandates are scientifically questionable and likely to do more harm than good. Walk me through the main reasons why you’ve taken this position.
KB: The main position is that we do have vaccine mandates in our societies. Most of those are for schools, for kids. Those vaccines have been safety-tested for many, many years. People are comfortable with them. And those mandates are typically implemented during moments of political calm, where the national temperature is low. Also, you know, there is some controversy about school mandates, especially ones like in Australia over the last couple of years, where they’ve reduced the ability for exemptions. So, there are controversies about vaccine mandates from a policy standpoint. But we have never had adult mandates for a vaccine. Especially, if you think about it: You’re employed, you’ve been hired already, and then your employer says, “Now we have this new condition that you need to get this vaccine or else you’re going to be fired.”
There’s a bunch of legal [issues] from an employee standpoint. But also just at a population level, very novel behavioural and social issues, and political issues, that these vaccine mandates solidified around.
I think that it’s important to appreciate that this is unprecedented. And it dovetails into a political project. Which is that we have this vaccine, and we are going to take the coercive mandate strategy. We also haven’t done a good job, especially in Canada, of presenting to the public the age distribution of COVID in terms of mortality statistics. We’ve ramped up fear for two years. The media has played, I would say, a somewhat deceptive role. There’s a lot of negative consequences to the way the media has talked about the pandemic.
It was a political decision to go down the mandate route, and I just don’t think it was wise. I don’t think it was necessary … A lot of the policies that we have end up taking have their own social life, their own consequences. They often snowball and make things worse. I think vaccine mandates fit into that.
I also think, from a scientific and medical standpoint, people were willing to be vaccinated for COVID. There was quite a large group of people who were willing to voluntarily be vaccinated. The mandates — and we do cite these studies in our paper — tended to have the most impact for younger people. So, those under 30 or under 40, who, looking at the epidemiological data, just thought, “Okay, well, I don’t have a very high risk of COVID, so I’m not going to get vaccinated.” Or, “I’ve already had COVID, so I don’t want to get vaccinated.” But those types of considerations weren’t built into the vaccine policies. They didn’t consider natural immunity or prior infection. They didn’t consider age-based risk, people’s health status …
Anyhow, there’s all these different reasons why people wouldn’t want to get vaccinated. But we said, “No, we’re going have a one-size-fits-all policy because the vaccine stops transmission.” That’s how it was sold. If you don’t accept that as a premise, all of these policies don’t make much scientific sense. And the problem is that was clearly shown to have not been the case. Actually, it was known beforehand. I’m very curious to see, going forward, how much Pfizer and some of the other pharmaceutical companies knew about this — and when they knew about it. I think that’s a very important question that needs to be asked.
TH: Let’s dig in to some of the unintended consequences that you explore in the paper. Last time you and I spoke, we touched on the issue of cognitive dissonance, which I very much relate to. Today, I want to start by talking about reactance. What is reactance, and how does it operate in this context?
KB: Reactance is the idea that if you’re going to try to take away freedoms from me, I’m going to respond by trying to get freedom back. Maybe I won’t be able to get freedom back in the same way that you’re taking it away from me, but I will try to reassert my personhood, my dignity, and my agency as a human being.
A perfect example of that would be the trucker convoy movement in Canada. We wrote this paper right before the convoy. We put it on the preprint server, I think, the week that the convoy started. I see that as we were effectively feeling the social pulse. Not just in Canada, right? These protest movements were going on in Europe; everywhere where there were these mandates, there were street protests … I would say that that is a reflection of that reactance effect. “We’re going to take to the streets. This is unjust, these policies are not fair. We don’t agree with them.” I think in this context, it’s clear that in Canada there is a group of people who were negatively affected by these mandates, who lost their jobs, who were socially ostracized. And even lots of individuals who were vaccinated and just felt like this is a step too far — this is going in a direction that I don’t feel politically comfortable with.
Justin Trudeau, I think, plays a big role. He is a left populist. He has done an incredible amount to make this into a political issue. On the campaign trail, he was constantly referring to “anti-vaxxers” as right-wing agitators. That’s not a direct quote, but he was inflaming the topic immensely for political gain. I think it did, sadly, work for him. The NDP also came along with him to support these mandates.
Now, the irony is that as the trucker convoy was taking place, there were more and more studies every day coming online, showing that Omicron was infecting unvaccinated and vaccinated at the same rate. From a transmission standpoint, the freedom convoy was following the science at that time. That’s now going to be very difficult, or impossible, for certain people in the medical community and the Liberal establishment — people with the Liberals and the NDP — to admit.
The media has played a big role in inflaming this social polarization, this notion that the Freedom Convoy was about these mythological stereotypes. It was a diverse movement of lots of different types of people. Sure, it had a lot of working-class individuals, which now somehow is equated with the far-right. I don’t buy that narrative. I think that narrative itself is actually going create the type of social polarization that we have south of the border, where I live. Which is also a dangerous outcome of the mandates, and we discussed that in the political polarization section.
TH: Returning to stigma, you mentioned the feelings of unvaccinated Canadians. I get letters all the time from unvaccinated Canadians who feel incredibly hurt, who feel demonized and ostracized. I want to quote from this section of your paper: “Political leaders singled out the unvaccinated, blaming them for the continuation of the pandemic, stress on hospital capacity, the emergence of new variants, driving transmission to vaccinated individuals, and the necessity of ongoing lockdowns, masks, school closures, and other restrictive measures.” Stigma used to be something that public health really worked to avoid. What happened here?
KB: That’s a great question, and one that I’m grappling with still to this day. I’ll give you a sense of the reaction to the paper, which helps to contextualize this. It’s been shared over 10,000 times on Twitter. But I’ve noticed that established people in global health have, for the most part, stayed away from sharing it, or reaching out to me about this. I think that that holds true during the pandemic. Heterodox or dissenting views have, for the most part, been relegated to the sideline.
The anti-stigma movement, that comes out of HIV Aids research for the last 30, 40 years. And, yeah, I don’t know … I have different ideas about this, but I don’t feel like I’ve been able to really strongly come to a conclusion. I think people respond differently when they’re thinking about the marginalization of “others.” So, street drug addicts, or prostitutes that have HIV. “Oh, we need to have an anti-stigma approach. We need to think about human rights.” Then you sort of set up this dichotomy of the left, who are advocating for that, and the right, who are against it. It falls along these classic political lines that people feel comfortable with. I think what the pandemic has done is it has shredded those typical ideological lines. Individuals don’t know how to respond to that.
If you’re a progressive — and most people in the public health world tend to be leaning on the progressive side politically — if you’re on that side, you suddenly now have to defend people who support Trump, who are not vaccinated, and who are saying, “I’m not going to get vaccinated. This is a global plot to bring in the globalist coup and take over nation states.” You’re defending those individuals. From a scientific standpoint, it makes sense. But I think people have a hard time putting their ideology to one side. I also think that there’s a lot of career consequences to speaking up about the harms of vaccine mandates. When I say this, I also mean lockdowns; I mean the whole regalia of restriction-based public health.
Essentially, you hit the nail on the head. Most of the community in public health, especially global public health, went from anti-stigma, anti-marginalization, equity, human rights as a framework — to suddenly, “We need to support restrictions. We need to support governments having these hammers over individuals, and we need to maximize compliance.” That’s sort of the transition that took place. I think it’s been confusing for a lot of people.
TH: Indeed. You also write about distrust. A recent Canadian survey showed that 52 percent of interviewees believed that official government accounts of events can’t be trusted. You also touch on social and economic inequality. And this is so interesting. You did a recent event for the University of Toronto, and you were joined by a physician from the shelter system here. He spoke about how the vaccine mandates resulted in homeless people being turned away from businesses and excluded from warm spaces in the dead of winter. How else can vaccine mandates potentially acerbate economic and social inequalities?
KB: It’s important to distinguish between the vaccine mandates, as in the pressure to get vaccinated, and then the way that these tools are used in society. So, if you’re a vaccinated elderly person, you might not be able to get a passport on your phone. You don’t have a phone; you just don’t understand how that can work. I think there’s been videos from Italy, for example, that I’ve seen where elderly people are denied access to a bus because they just don’t know how the system works. Then there’s also, and we cite this in the paper, cases in Israel where Palestinians who are vaccinated are being denied access to crossing borders. It can be used as a tool to coerce people and impose your will.
I also think there’s a strong correlation between lack of trust and historical marginalization. When you look at vaccine studies about trust, people who are socioeconomically marginalized, or have been treated unfairly by the medical profession — I’m actually very interested in this group of people, who don’t trust pharmaceutical companies because their lives have been destroyed by pharmaceutical products. There’s quite a lot of them in the United States. This is pretty well documented, with federal fines of billions of dollars. Think of the drug opioid crisis as one contemporary example. So, these individuals are just less trustful of the state. They’re less trustful of corporate monopolies or pharmaceutical companies. And so, they’re going to be less likely to be vaccinated. Essentially, creating a mandate, you are penalizing this cross-section of people who have less trust in established narratives or established policy. In a way you are selecting, and clearly ostracizing, that group of people.
TH: Getting back to the reception of the paper. One of the criticisms I’ve seen is that the paper did not provide enough alternative policy. Professor Bill Bogart, for example, made this point at your event at the University of Toronto. I am against the vaccine mandates, and have been vocal about that. This is a counterargument that I hear a lot: “How else could we have done it?” How do you respond to that argument?
KB: I would say, again, the studies that are online right now show that there was a huge number of people — especially high-risk individuals — who are willing to get vaccinated voluntarily. In fact, we haven’t focused enough on those high-risk, vulnerable people for booster shots in Canada, and also the United States. I actually think the mandate has detracted from prioritizing the most high-risk groups.
I would also ask the question to those individuals: What level of vaccination is acceptable to you? 100 percent? 90 percent? 70 percent? 60 percent? If the goal is to prevent adverse clinical outcomes, focusing on the high-risk vulnerable groups should have been the policy from the beginning. Rather than, I think, detracting from that, and saying, “Okay, we’re going to treat this virus as if — it’s not explicit but implicit — the risk is distributed equally across society, and hence everyone needs to get vaccinated.” I just don’t think that that was wise public health.
And vaccines are an interesting technology right now in our society. Ideologically, it sort of has a totem status. Because if you question vaccines, you’re seen as an anti-vaxxer or conspiracy theorist, which to me is equivalent to being called a communist during the Red Scare. You’re discredited from the beginning. It’s hard to recover from that type of accusation.
But vaccine science is very complicated. It changes over time. We’ve seen that in the pandemic — myocarditis risk being one thing that was downplayed at the beginning. People who said, “Look, there’s a safety signal here” were dragged over the mud, in Israel and elsewhere. And they were shown to be correct. Even today, I think there’s some serious questions. For example, if you’re under 30, what’s the relative benefit and cost to getting two or three doses of the current mRNA vaccine, especially if you’ve had a prior infection? Those types of cost benefit analyses have been challenging to do. There’s a lot of outstanding questions.
TH: Let’s spend a moment on the situation in Canada. The vaccine mandates for domestic and outbound international travel have been suspended, along with mandates for the federal public service and the federally regulated transportation sectors. This just happened this past week. But some mandates remain. The City of Toronto, for example, has not lifted its mandate for its workforce. So, this is far from over. And the government has indicated that it will not hesitate to reimplement vaccine mandates in the fall if necessary. What do you make of this?
KB: I think we’re continuing to follow this extreme version of the precautionary principle. It’s not sufficiently evidence-based to justify it. It flies in the face of the notion of proportionality in public health ethics. Which is that you are going to impose liberty restrictions to a minimum. To maximize the positive impact and minimize the negative impacts of those policies. I think that we’ve substituted the proportionality principle for this extreme precautionary approach, which implicitly assumes that we should not have any COVID cases — and any COVID mortality is unacceptable. So, we’re still living in a world where we haven’t resolved the tension between Zero COVID and the herd immunity debate. And I think Ontario is similar to Australia or New Zealand, in many regards, with that current conversation.
[The Canadian vaccine mandate] is suspended, it’s not finished. It’s still on the books. They can reinstate it whenever they want. So that’s not giving people a lot of confidence that we’re moving on. The truckers, they’re still under the mandate … If you’re an unvaccinated person in Canada and you travel, let’s say to see somebody in the U.S., your family member. You come back to Canada, you have to quarantine for 14 days. So, there’s still these sort of penalties. This has nothing to do with a science-based policy. This is everything to do with a punitive political vendetta that Trudeau has. The conversation in the Canadian parliament is mind-blowing. This sort of obfuscation and doublethink that’s going on is very worrying. I’m quite concerned about the direction that things are taking in Canada.
I do actually think that there needs to be an investigation, a commission set up to investigate — not just COVID mandates, but lockdowns and other restrictions that governments have taken. But we are living in this very polarized world where there’s two extreme camps. It’s hard to know how those are going be reconciled …
There are these stories that we’ve told ourselves over two years. And the question is: Are people going to be able to revisit those stories? In the paper, in the last section, integrity of science and public health, we rather provocatively say, “If public health and governments want to build trust, one core aspect of that is to admit when you went too far, when you made mistakes, when you didn’t do things in the most proportionate manner.” Is the medical community going to do that? Is the government going to do that? I don’t know.
In Trudeau’s ideological world, the adults in Canada who are unvaccinated are far-right extremists who probably have racist views. They are the Canada that should be left behind. I think that is just not the sort of rhetoric of a national leader who wants to lead a Canada of tolerance and multiculturalism — [the Canada] that I grew up with, having been born in Montreal and grown up there. So, yeah, I think it’s worrying.
TH: Just lastly, I want to pose a question to you. On Twitter recently, you argued that a consensus is emerging that lockdowns and restrictions did more harm than good. And you pose a question to researchers: Why did this happen — and why did so many smart people go along with it? So, I ask you that. Why did so many smart people sign on to vaccine mandates?
KB: Great question. That Twitter comment was also a question to myself … [Now,] going back to this idea that vaccines are totems. “Vaccines are inherently good. There’s no side effects for anybody, a hundred percent safe. Everyone should get them. Why aren’t you getting them?” It’s just this very simplistic worldview. We don’t have that for any other pharmaceutical drug, or any other lifestyle choice. We always have this nuanced approach, and we consider people’s life circumstances. But we don’t have that for vaccines. It’s become part of this very simple good/bad dichotomy.
I think that liberal institutions jumped on board to this — to use Jonathan Haidt’s term — safetyism. Where safety is the highest value, safety is a virtue in and of itself that trumps any other consideration for policy, or for social life, or for meaning in human existence.
There was a lot of career pressure for people to fall into line, and to not speak up against these measures. The classic idea of what we call groupthink. Group psychology. I also think that a lot of individuals who held positions of authority were in the higher economic strata. They got to redo their yards during lockdown. They got to have their kids attend language classes online. They sort of had a vacation for a period of time. But, you know, not everyone did. So we have this clash right now, between the liberal establishment and the working class, who still deliver all of our food, and move our trucks around the country. Who take care of our kids at daycare, and who stock our shelves in supermarkets. And those individuals had a very different time with these restrictions.
When I say that the restriction-based philosophy has had more harm than good, I’m also thinking about this at a global level. It’s clear that what happened is we had the Wuhan lockdown, then we had the Italy lockdown — and then you had a global domino effect across every country in the world. No matter whether it was Somalia or Haiti or Iceland, everyone followed this for at least three, four months. The evidence from low- and middle-income countries is clear: COVID was not a major cause of mortality. It didn’t kill a lot of people in most Sub-Saharan African countries, or Haiti, where I work. But it had huge amounts of economic effects. You know, children being out of school for up to a year plus, where school is the only source of education, or safety, or food. A lot of women dropping out of school, having teenage pregnancies, and those individuals are never going back to school. So, it’s disrupted a whole generation, and has had impacts in very different ways, depending on the country and the demographic group.
So, you can’t really extract the notion of lockdowns, or restrictions, in Canada from this global policy effect. Oxfam had a report that came out just as the Davos billionaire class were meeting in Switzerland a couple weeks ago. They estimated that 160 million people are going be thrown back into poverty, extreme poverty, because of the pandemic. Now, I think it’s interesting that Oxfam mentions the pandemic — and not lockdowns, or restrictions, or the economic crisis that’s been driven by lockdowns. I still think that there’s a reluctance to call out lockdowns as a failed policy experiment. And of course, there are some places you can point to, for example Australia or New Zealand, where it had a beneficial effect. And there is a lot of nuance to the conversation if you want to think about lockdowns for the first month, let’s say, when we didn’t understand the virus. But the age distribution and the comorbidities that are related with the virus — that was known pretty quick. It was known in April of 2020 what kind virus we were dealing with.
And we had all sorts of strange interventions, like telling people they can’t go outside and exercise, and closing off basketball courts. Actually, you want to exercise. You want to go out into the sun and be healthy. But instead, people were locked in at home. And what did they do? Well, they became further addicted to video games, to screens, to self-isolation. With all its incumbent effects: domestic violence, suicide, psychological harm. I find it incredible. Even the term lockdown, it comes from the criminal, penal system. And yet we were using it to protect our health.
TH: There’s lots of questions to be asked in the coming years. And I’m so glad that you are out there asking them. I really appreciate you coming on the show today.
KB: Thanks for having me, Tara. I appreciate it.
This transcript has been edited and condensed. For the full interview, download the podcast.