In “Vaccination Mandates: The Public Health Imperative and Individual Rights,” published in the Oxford University Press, authors Kevin M. Malone and Alan R. Hinman view the concept of herd immunity through the lens of Garret Hardin’s classic essay, “The Tragedy of the Commons.”
Hardin’s 1968 article examined individual livestock owners co-mingling their animals in a shared common pasture. While the community’s grazing area is fixed, individual owners are incentivized to continuously introduce additional animals because it increases their individual wealth, despite the diminishing returns received for each added animal.
The tragedy occurs when too many animals are added and the common collapses due to overgrazing.
For Malone and Hinman, “a community free of an infectious disease because of a high vaccination rate can be viewed as a common.” Both the vaccinated and the unvaccinated share the benefits of this common and this “leads to tension between the best interests of the individual and those of the community.”
Consider the case of measles. In order to be protected from measles outbreaks, 93 percent to 95 percent of the community must be vaccinated. Unvaccinated individuals still have some risk of disease, but that risk is greatly reduced because herd immunity reduces the spread. Unvaccinated individuals also benefit because all vaccines pose some risk, a risk the unvaccinated aren’t taking by definition.
In the case of herd or community immunity, the tragedy occurs in part because vaccines have been so successful at eliminating diseases. In 1980, measles killed 2 million people worldwide. A robust global vaccination program reduced those deaths to 73,000 by 2014. As the threat posed by measles declined in both memory and raw case numbers, individuals more concerned about vaccine risk than outbreaks chose not to get themselves or their children vaccinated.
As a result, the vaccination rate for measles has fallen to 90 percent in the United States in recent years and measles cases are once again on the rise here and worldwide. If the vaccination rate continues to decline, large scale measles outbreaks could return in the near future.
To prevent that from happening, the measles vaccination is mandated, with some health and religious exemptions provided, for school children in all 50 states. So are vaccinations for diphtheria, tetanus, pertussis (whooping cough), polio, rubella and chickenpox.
Vaccine mandates—government intervention—is one solution to avoiding the tragedy of the commons in the case of infectious diseases and pandemics such as COVID-19.
As the number of mandatory vaccinations required to gain entry into public schools has increased over the past several decades, so has the number of people rejecting vaccines.
But the majority of people appear to agree that the interest of protecting the community from illnesses by building up herd immunity through mandatory vaccination outweigh any individual reservations they might have about the vaccines. That includes the new vaccines now available for COVID-19.
As Malone and Hinman note, the U.S. Supreme Court has found that the Constitution grants states the police power necessary to protect public health and public safety, including the power to declare vaccine mandates.
Citing the landmark 1905 U.S. Supreme Court Case Jacobson v. Massachusetts, they write, “The Court held that a health regulation requiring smallpox vaccination was a reasonable exercise of the state’s police power that did not violate the liberty rights of individuals under the Fourteenth Amendment to the U.S. Constitution.”
The court’s decision is worth quoting at length:
“The liberty secured by the Constitution of the United States to every person within its jurisdiction does not import an absolute right in each person to be, at all times and in all circumstances, wholly freed from restraint. There are manifold restraints to which every person is necessarily subject for the common good. On any other basis organized society could not exist with safety to its members.”
All of the foregoing serves to inoculate the reader in advance to the situation on the ground in Shasta County, where a growing mob of anti-mask, anti-vaccine, anti-do-anything-about-COVID-19 fanatics has convinced itself that an imaginary construct called “medical freedom” exempts healthcare workers, teachers, administrators, school employees and other workers subject to the state’s mandatory COVID-19 jabs.
For more than a year, members of this mob have held Shasta County hostage. They have hectored, threatened and slandered elected officials and county staff in board of supervisors meetings and on social media almost since the beginning of the pandemic.
They were at it again two weeks ago, an unmasked, unvaccinated throng of vaccine mandate protestors packing the board chambers as the fourth and most deadly surge of COVID-19 so far rips through Shasta County at the rate of 70 new cases per day.
Once again blamed for a state COVID-19 policy the board has nothing to do with, District 1 Supervisor Joe Chimenti offered the by-now familiar refrain:
“This is just political banter,” he said. “We don’t have the authority, but the best way for us to do this, is to not enforce. The best way to do this is through enforcement through education, which is what we’ve done for the last 14 months. We’ve never written a ticket. We’ve never closed a business. We’ve never done any of those things.”
“Enforcement through education” may have kept the mob at bay for the past year, but at this point, it’s fair to say it’s not getting the job done. As of last week, COVID-19 has infected nearly 21,000 people and killed 364 people in Shasta County since the pandemic began.
Nearly 5 million people have been infected with COVID-19 in California; 72,289 people have died since the pandemic began. Nationally, 46 million people have been infected and almost 750,000 people have died. Globally, some 250 million have been infected and 5 million have died from COVID-19.
Heading into winter, as people move indoors in Shasta County, it’s possible a new COVID-19 surge, in conjunction with the flu—a twindemic—may begin before the present wave fully subsides.
Eighteen months into the pandemic, we’re still lost at sea. More than half of the 180,000 people in the county are fully vaccinated, but the unvaccinated other half continues to catch COVID-19, especially since the advent of the more infectious delta variant this summer and fall.
Some 382 people have been hospitalized for COVID-19 and 101 have died since July 26, according to Shasta County Public Health statistics.
According to state COVID-19 statistics, Shasta County’s current death rate over a seven-day average is 1.2 per 100,000 people, six times the state’s death rate of .2 per 100,000 people. Last month, Shasta County topped the state’s average cases per day list and currently resides at No. 7 out of 58 counties with 34 cases per 100,000 people (seven-day average).
Our local hospitals are understaffed, stressed out and facing further staffing shortages from colleagues refusing to obey the state’s vaccination mandate for healthcare workers.
It didn’t have to be this way. When Shasta County’s non-essential businesses closed and public schools switched to remote learning in March 2020, COVID-19 cases remained low, less than five new cases per day, for the next couple of months.
But Shasta County never fully locked down, and the anti-mask faction began champing at the bit for its “freedom.” After then-Shasta County Sheriff Eric Magrini refused to enforce the state’s stay-at-home order in May 2020, COVID-19 cases began to rise. The county’s first COVID-19 wave crested at 16 cases per day in mid-July.
Several weeks later, at the Aug. 11 board of supervisors meeting, former Marine Carlos Zapata infamously threatened to turn his combat skills loose on the county if the board didn’t stop enforcing the state’s COVID-19 regulations. The fact that the board of supervisors wasn’t enforcing the regulations in the first place did not stop Zapata’s militant speech from going viral nationally.
Lost in Zapata’s limelight that day was Dr. Paul Dhanuka, the Redding gastroenterologist who failed in a self-financed, no-party-preference bid for the Assembly District 1 seat in the 2020 March primary election. (For the record, Republican Megan Dahle currently holds the AD-1 seat, won’t publicly say if Trump lost the election and opposes the state’s vaccine mandates.)
Dhanuka, speaking immediately before Zapata in a chamber emptied of spectators because of coronavirus, told the supervisors, “The problem is our response to COVID is driven by an excess of fear causing us to overreact, shutting down the economy for six months.”
As already stated, Shasta County never went into full lockdown mode. Which is a shame, because subsequent studies have shown that non-pharmaceutical interventions such as school and non-essential business closings, bar and venue closings and mask mandates were highly effective at tamping down the virus.
“Do no harm,” Dhanuka advised. “Don’t make the disease treatment worse than the disease itself.”
One month later, Shasta County COVID-19 cases began spiking again as the second wave slammed into northern California. Cases per day peaked at 174 in mid-November and were still notching more than 100 cases per day in January, when District 4 Supervisor Patrick Jones and District 5 Supervisor Les Baugh opened up the board chamber to the anti-mask, anti-vax mob.
The public chamber was supposed to be closed due to COVID, and Jones and Baugh were later censured by Chimenti, along with District 2 Supervisor Leonard Moty and District 3 Supervisor Mary Rickert for their actions. That hasn’t stopped Jones from repeating the same stunt.
Indeed, Jones’s shenanigans and outright lies helped provide the impetus for the recall movement targeting supervisors Chimenti, Moty and Rickert that formed earlier this year. It is comprised of three organizations, Recall Shasta, the Shasta County General Purpose Committee and the Red, White & Blueprint production company.
Co-founded by Zapata, music producer Jeremy Edwardson and grow-store owner Jon Knight, RW&B produces highly polished fake news campaign videos for the recall movement masquerading as episodes of a so-called docuseries. Like its two sister organizations, RW&B’s finances are being investigated by the Fair Political Practices Commission.
Episode 3 of the RW&B docuseries was cleverly titled “Count to Three” and revealed Jones’s master plan for enslaving Shasta County: If just one supervisor could be replaced with a right-wing Jones protégé, he’d have a three-to-two majority on the five-seat board and the State of Jefferson’s long dreamed of Christofascist lebensraum would be at hand.
Dr. Dhanuka also makes an appearance in “Count to Three” with Dr. Richard Malotky, another local physician who’s been publicly critical of the state and federal government’s overall response to COVID-19. Neither doctor is an epidemiologist, an infectious disease specialist or a public health expert. Neither doctor has shown any qualms about undermining Shasta County Public Health’s messaging.
In the episode, which has been viewed 13,000 times, Dhanuka offers up this bizarre and ahistorical assessment of public health’s history:
“Until 100 years or so ago, public health was mostly based on shaming, stigmatizing, exclusion and mandates. But over the last hundred years we realize that mandates and enforcements are counter-productive.”
In fact, when it comes to vaccines, the exact opposite is true.
“What works better is education, empowerment and encouragement,” Dhanuka insists.
Which is exactly what the board of supervisors has been doing all along!
And guess what? It isn’t working!
Or perhaps it’s more accurate to say it’s not working fast enough. To achieve herd immunity from COVID-19, epidemiologists estimate 70 percent to 90 percent of the population needs to be vaccinated or have natural immunity after surviving an infection.
We know 52 percent of the eligible population is vaccinated in Shasta County; 10 percent of the population has been infected with COVID and survived. If we don’t mind double counting the infected who’ve been vaccinated, that’s 62 percent. How do we close the gap, which ranges from 10 percent to 20 percent, depending on how infectious the virus is, the efficacy of vaccines and the longevity of natural immunity?
(People who’ve survived a COVID-19 infection and are now depending on natural immunity to keep them safe should keep abreast of the research on this topic, which is constantly evolving.)
In Shasta County, we know there are infected survivors who have not been counted because they’ve never been tested, and just this week the FDA approved the Pfizer vaccine for 5- to 12-year-olds, expanding the population eligible for vaccination. A mandated testing and vaccination program for all eligible groups could help close the gap.
Enforcement, not just education, may be the only way to do it.
As the recall movement gathered support through the summer, and one COVID-19 wave after the other rolled through Shasta County, Chimenti, Moty and Rickert publicly stuck to the “education, not enforcement” party line. To do otherwise was to risk the wrath of the pro-recall death cult.
The cult succeeded in gathering enough signatures for an upcoming Feb. 8 election to recall Moty. The fact that the recall movement failed to gather enough signatures for Chimenti and Rickert has been taken by some as a sign that not all local Republicans are on board the COVID crazy train.
Not resting on their laurels, the recallers pivoted to aggressively opposing the state’s vaccine mandate for healthcare workers, teachers, administrators and school employees, staging a successful student/staff walkout of local schools on Oct. 18. They were enthusiastically endorsed by Bethel Church, which has 11,000 local members. There was no major local opposition to the protest.
Dr. Dhanuka, who frequently advertises his status as a born-again Christian, also got in on the anti-vax action, publicly advocating against what he calls “forced universal COVID vaccination,” in a conspiratorial Facebook post last week in which he alleges the pandemic is a plot by Big Pharma to destroy America.
“I give you a parallel from the Opiate Epidemic that has destroyed lives and families in our rural America,” Dhanuka writes. “For 25 years, in 1990s and 2000s, so-called ‘experts’ from big-city ivy league colleges promoted widespread opiate prescriptions as ‘safe’ to overtreat any pain; and big government from big cities in DC & Sacramento enforced it by threatening the doctors. Who paid these ‘experts’ and politicians ? Big Pharma!”
“Same thing is happening again. Follow the money!”
Dhanuka wears a mask at work and admits he’s vaccinated because the science says it protects his many at-risk patients. At the same time, he’s against forced universal COVID vaccination—his scare phrase for vaccine mandates—for everybody, but especially for children. In his post, he cites three reasons:
1. They are forcing a vaccine that’s only been around for less than a year; unlike other vaccines that have been around for decades
2. They are forcing this vaccine for everyone even those with very low risk of harm from the virus. This is especially true for the immunocompetent children with a survival rate better than 99.998%
3. They are forcing this one even on those who have proven natural immunity.
These are fairly debatable claims made by opponents of the COVID-19 vaccines, in this case lodged by a prominent local physician. I asked Shasta County Public Health to comment on Dhanuka’s three rationales for not getting vaccinated. Deputy Branch Director Kerri Schuette offered the following detailed responses, found below after Dhanuka’s italicized text.
1. They are forcing a vaccine that’s only been around for less than a year; unlike other vaccines that have been around for decades.
From Johns Hopkins: There are many reasons why the COVID-19 vaccines could be developed so quickly. Here are just a few:
• The COVID-19 vaccines from Pfizer/BioNTech and Moderna were created with a method that has been in development for years, so the companies could start the vaccine development process early in the pandemic.
• China isolated and shared genetic information about COVID-19 promptly, so scientists could start working on vaccines.
• The vaccine developers didn’t skip any testing steps, but conducted some of the steps on an overlapping schedule to gather data faster.
• Vaccine projects had plenty of resources, as governments invested in research and/or paid for vaccines in advance.
• Some types of COVID-19 vaccines were created using messenger RNA (mRNA), which allows a faster approach than the traditional way that vaccines are made.
• Social media helped companies find and engage study volunteers, and many were willing to help with COVID-19 vaccine research.
• Because COVID-19 is so contagious and widespread, it did not take long to see if the vaccine worked for the study volunteers who were vaccinated.
• Companies began making vaccines early in the process—even before FDA authorization—so some supplies were ready when authorization occurred.
2. They are forcing this vaccine for everyone even those with very low risk of harm from the virus. This is especially true for the immunocompetent children with a survival rate better than 99.998%.
From Johns Hopkins: Even younger people can have severe complications from COVID-19, although their risk is not as high as older people or those who have serious health conditions. Herd immunity also depends on most people becoming immune to stop or slow the spread of disease.
While COVID-19 primarily affected older adults and people with pre-existing health conditions at the start of the pandemic, the delta variant is affecting people of all ages. Most children do not generally become as sick as adults do, but some have become severely ill with COVID-19, particularly those with conditions such as obesity, diabetes, asthma or other conditions. Children can also experience extended COVID illness, called “long COVID,” even when they have mild illness or no symptoms. This is a systemic illness, and we still don’t know the long-term impacts of COVID-19 in children, such as on the heart and nervous system. Children can also spread the disease to people in their family and others who may be at risk of severe disease, hospitalization and death.
3. They are forcing this one even on those who have proven natural immunity.
A recent CDC study has shown that vaccination offers higher protection than previous COVID-19 infection.
I invited Dr. Dhanuka, via Facebook messenger, to respond to Public Health’s comments on his statements. He declined and inexplicably replied:
“My official response: ‘You are just a paid mouthpiece.’ ”
Then he blocked me.
I asked Schuette if COVID’s impact would have been reduced if Shasta County had mandated and enforced mask usage and other non-pharmaceutical interventions from the beginning of the pandemic.
“When people wear masks in public, avoid crowds, stay home when sick, etc., it slows the spread of COVID,” she said.
When I asked Schuette if Shasta County’s anti-mask, anti-vaccination mob had affected the way Public Health has conducted its work during the pandemic, her response implied the agency has been too busy to notice. She described Public Health’s mission in what is the longest complete sentence I’ve ever received from an interviewee:
“Public Health has many roles in a pandemic, and during COVID-19, this has included issuing isolation and quarantine orders, investigating cases, contact tracing, analyzing data, supporting congregate settings (including jails, shelters, schools, skilled nursing facilities, etc.), issuing health advisories to healthcare providers, requesting staff and ordering personal protective equipment and other medical supplies from the region and state for medical providers when they can’t obtain them through their regular channels, managing and tracking numerous funding sources, providing daily informational updates to the public, updating and monitoring social media and informational websites, responding to media requests, collaborating with other municipal and community organizations, ensuring adequate testing and vaccination, working with fire camps to ensure firefighters have proper resources, preparing to stand up an alternate care site if needed (ultimately our hospitals developed surge plans that utilized space on site), engaging businesses to ensure they were aware of the requirements and helping them to mitigate outbreaks, securing temporary housing for high-risk homeless people, and distributing informational materials.”
“These have been just some of our many responsibilities over the course of the pandemic,” she concluded.
Translation: Shasta County Public Health has been working very, very hard to protect the common good, earning few public accolades in the face of a right-wing political movement that literally called for the abolition of public health during a pandemic.
It has been refreshing in recent weeks to see the recall movement fall short of its goal to recall three supervisors, even as one of the movement’s leaders, Carlos Zapata, was convicted for disturbing the peace for his part in the assault on sous chef/internet comedian Nathan Pinkney in April.
For more than a year, members of the recall movement have publicly hectored elected officials, threatened the citizens of Shasta County and embarrassed us in the eyes of the state and the nation. For once the bullies took a couple of thumps on the nose, metaphorically speaking.
So far, no legitimate challenger has emerged to take on long-serving District 2 supervisor Moty in the February recall election. It’s vitally important that Patrick Jones, the de facto head of the anti-vax recall movement in the wake of Zapata’s misdemeanor conviction, be deprived of his wish to count to three. If Jonestown comes to pass, rest assured toxic individualism based on a chauvinistic distorted view of personal liberty will crowd out the common good in Shasta County.
These self-proclaimed patriots never memorized the preamble to the Constitution. Otherwise, they’d understand that individual freedom sometimes takes a backseat to establishing justice, ensuring domestic tranquility, providing for the common defense and promoting the general welfare. Lacking such knowledge, they’ve fallen to the tragedy of the commons.
You can read their obituaries, with schadenfreude or not, on the Herman Cain Award subreddit. Cain, the former Republican presidential candidate and Trump supporter, famously refused to wear a mask at a Trump rally and later died after being infected with COVID-19. The subreddit scours social media to find outspoken anti-maskers and anti-vaxers, all of whom seem to share in their posts a love for both Jesus and Trump, and later recant after catching the virus and dying. Death is a prerequisite, as the award is only given posthumously.
Grim humor defines the divide between the vax and the un-vaxed in America today. COVID-19 is now the No. 1 killer of police in the United States, in large part because conservative law enforcement officers are refusing to get vaccinated. Some social media observers aren’t sorry to see the officers leave the force—whether they get fired for refusing the vaccine or exit in a COVID casket. They hold the same sentiment for all members of the anti-vaccination movement in general: Their Herman Cain Awards await.
Meanwhile, the federal and state vaccine mandates will continue to be implemented. In many cases across the country, the mandates have worked, and vaccination rates have increased despite initial protests.
Still, according to professors from John Hopkins Bloomberg School of Public Health in a recent article, “Rethinking Herd Immunity and the Covid-19 Response End Game,” it may not be enough to return us to anything resembling normal soon.
“It will be very challenging to get to the level of population immunity against COVID-19 that we have seen with measles in the U.S.,” the professors write. “We should therefore expect to see some level of ongoing coronavirus transmission in our population for many years (if not forever).”
The good news is, “as we build immunity to SARS-CoV-2, the risk of severe illness will decrease, and future waves of infection won’t be as disruptive.”
But forever sure sounds like a long time.