If this is the end of the pandemic, do I still need to get vaccinated or boosted?
Yes. This virus is not going to go away completely. It is likely to be a persistent nuisance. And by nuisance, it may kill 50-100,000 people annually once endemic. If your goal in life is to take minimal risks for maximal benefit, vaccines are for you. Need some excitement trying to earn your Darwin Award. Your body, your choice.
How often are we going to have to boost?
Unless the risk from the vaccine changes, who cares. Poke me every five months if needed. I want to live to be 100, if I can do so while healthy. Cent’Anni! Currently, there is no known answer for need to boost multiple times yet. There is gray area on the topic of boosting in general (more on that in a bit). We get lifelong immunity from a smallpox vaccine, a couple of doses of MMR vaccine, four doses of polio vaccine. We need boosters annually for influenza, every five years if in certain risk categories for pneumococcus, and every ten years for tetanus and pertussis. Science will provide the answers regarding covid vaccine boosters in all good time.
The data of who is hospitalized will be our guide. If vaccinated, how many doses and when were they vaccinated? How old are they? It may be that elderly need it yearly, middle aged folks once every five years, and kids twice until older. We simply do not know yet. We must continue to collect data and make educated recommendations. Until then, make boosters available to those that want them.
How should society approach access those that choose not to vaccinate?
Depends on what type of risk they expose others to.
We, as a society have set the expectation that those who prepare our food wash their hands prior and wear gloves when doing so. We similarly expect barbers to sterilize, or use a fresh blade, when they shave a client. We mandate all sorts of protections in this country where appropriate. This is not a new concept.
I think it is fair to expect healthcare workers to be vaccinated. You do not expect to contract illness from your providers. I think the client (ie: patient) has the right to expect such. Same with nursing home workers. What other industries? Tough question to answer. Ultimately that answer may change based on what we learn from the initial decisions we make. Again, we must be open to reassessments as we gain data/knowledge.
I also think it is fair for a private business to decide how they wish to conduct business. A vegan restaurant does not need to serve meat. You get to choose who to patronize. They get to decide the rules of their business. Not vaccinated should not be considered discrimination if not permitted into a private establishment. You may be fine with the risk. They may choose to cater to those who are not. Their body, their choice. It works both ways.
Public spaces – enter at your own risk. That applies to all in a land with no mandates. And why there is a niche for private businesses to cater to vaccinated only.
How should we approach the costs of decisions not to vaccinate?
If you smoke cigarettes, have fun getting life insurance. What about vaccinations? Insurance companies are a business be they private or public. If private they seek profits, if public they just raise taxes or screw someone else out of proper care to balance costs. If you want to take on that additional risk, great, but there is a cost to it, and you should bear it. I should not have to be financially impacted by your decision making. Same for all types of preventative medicine: this includes well care visits, flu vaccines, colonoscopies, mammograms, etc. Differential risk based on choice yields differential cost based on those same choices.
Will the covid vaccine be mandated for schools?
I am betting they do, but should they? Are the kids high risk? Nope. Have we mandated flu vaccines? Not universally, but in some areas, they have. Since kids are at higher risk for bad outcomes from the flu, we need to decide our pain point – admit both or neither to the schedule. As before, is the mandate really about the kids anyways?
These are going to be very hard to prove necessary due to their low overall risk. My opinion – don’t go there unless there is data to show you need to. This ultimately goes for all ages.
Don’t confuse “not harmful” with beneficial. Don’t confuse beneficial with recommended. You may elect to make something not harmful available to all. You should make something beneficial available. You make something recommended when there are significant benefits to be had. Of course the definition of “significant” can be debated. We have been operating with war time rules. Now that the smoke is clearing, the data collection must continue, with ongoing analysis of real endpoints (such as prevention of negative outcomes). Recommendations follow from that analysis.
As mandates pertains to children – the data underlying them must apply to children. You do not get to use them as a means to an end. An example of such would be not mandating a teacher to be vaccinated, but mandating the student with the goal of protecting said teacher.