Thread by @t0nyyates

Objections to vaccine passports often stress liberty. But society infringes our liberties all the time to help the collective good. Our access to weapons. What we can do with them. Our ability to drive cars or ride motorbikes or pilot planes. Our rights to privacy.

Vaccine passports should be weighed on their merits. Harm caused to those who feel compelled to get vaccines who wouldn't do it otherwise, or have to avoid venues and services they previously had access to, vs the suffering alleviated by suppressing covid.

The suffering has many components: the regret an unvaccinated person and their loved ones have later when hospitalized or facing death. The illness and death of others fostered by less impeded spread of covid; and the fear of it. Leaning more on other tools like lockdowns.

By contrast the suffering and cost caused by vaccine passports is minimal. The infinitessimal risk of a bad reaction to the vaccine if accepted. The loss of a liberty intrinsically valued. Denial of access to venues if the vaccine is refused. Some personal admin.

Marcus Fysh talks about vaccine passports being the 'thin end of the authoritarian wedge', in an ill-judged comparison to the activities of Nazi Germany.

But given the multiple ways in which we have already submitted to having our liberties constrained, this is incorrect. Rather we are already feeling and benefiting from the fat end of the 'authoritarian' wedge.

Digging into a point made above, vaccine passports mean, other things equal, less recourse to lockdown measures. In this sense they represent the infringement of one kind of liberty to preserve the continuity of other kinds of liberties.

In this case the vaccine hesitant trade either a right to their unvaccinated status, or the right to go to whatever venues they please, so that they and the rest of us can enjoy more time when we can all go and do what we please.

Many of those MPs objecting to vaccine passports also object to lockdowns, of course, so this calculation would not persuade them.

Vaccine passports are not mandatory vaccines. Hestitants have alternatives [not going to that pub]. But there's still an element of coercion: the alternatives may be far inferior, or be non existent in some cases [eg passports for a job in which a hestitant has years invested].

But wandering around unvaccinated involves a similar element of coercion. It forces higher risk of infection on others than they would choose for themselves. It forces them to avoid high risk activities that they would otherwise enjoy.

Obviously vaccine passports are not new. They exist for international travel already, for conditions other than covid too. This is just a new use case.

The whole argument rests to some extent on the effectiveness of vaccines in preventing onward transmission of the virus. The effects are uncertain, but studies attest to it.

'To some extent' because leaving yourself unvaccinated, and making it more likely you catch the disease, means that statistically you will be placing a burden on the NHS via the risk of hospitalization, and displacing healthcare resources from others who need them.

I've seen debate about whether the unvaccinated could instead or in addition be charged for the care they receive if they fall ill with covid later on. I think this is completely unworkable.

Stylized econ models could be written down in which the externality - that's what the health burden imposed by the unvaccinated is - is charged for and recouped from those who pollute the nation's health in this way. But that does not mean there is a good case for it.

First, many would not have the resources to pay for the externality up front or later on. So this becomes a permit for the rich to make the rest of us ill [making us financially whole of course].

Second, the cost is highly uncertain. Third, the financial value of the suffering imposed varies a lot from individual to individual. Fourth, the burden of any one antivaxxer on the rest of us depends a lot on how many others choose not to get vaccinated.

Implementing such a sheme would require information that we cannot get to make a system like this practical and fair and mimic the stylized modelling equivalent.

One reply, making a fair argument, says - what other health externalities would we start to collect on?

Something to worry about. But note that we already do this. Taxing cigarettes and alcohol, which cause all kinds of health problems, like crazy, for example. And private health insurance usually excludes or charges premia for risky hobbies like mine [rock climbing]....

A fair comment here that is worth addressing:

https://twitter.com/ks_1968/status/1470832330684215304

One reply raises the possibility that rather than charging, we could simply exclude the unvaccinated from intensive care.

I don't like this. It relies on an informed decision before the event, which many [see reply above about groups that are vaccine hesitant for reasons that exculpate them] won't be able to make. It would likely also favour the rich, who might bid up the price of private care.

[For non UK followers, this thread was prompted by today's planned vote on whether to introduce covid vaccination passports for some venues, which has now passed in Parliament, despite 126 MPs from the government side voting against].

I thought I'd add to this thread something on a reply to another thread which speculated that vaccines won't reduce onward transmission for omicron.

So, we know that they do reduce onward transmission with delta. And there is evidence now that infection reduction itself is recovered to something like 70-80% with a third/booster dose.

It's too early to have attempted to trace contacts of cases to gain evidence of whether boosted individuals are less likely to transmit than the unvaxxed. But the starting position is that since infection risk itself is still reduced, so will transmission.

It's clear that we don't yet know until we get the evidence. What do we do then? I think we still go for these vaccine passports. It is what economists/engineers would call the 'robust' thing to do, the policy that leads to the least worst mistake.

Suppose we presume that boosters do reduce onward transmission and impose passports. But we find out later that this isn't so. This means we will have needlessly interfered with the liberty not to get the vaccine/go where you want to unvaxxed for those that value this.

Actually not quite! Although we won't have saved any transmissions doing this, we will have saved some hospital capacity by increasing take-up and keeping the unvaccinated out of some high risk venues.

Suppose, by contrast, we make the opposite mistake: in the face of uncertainty about the efficacy of vaccines in preventing transmission, we don't go for vaccine passports, but it turns out later that the boosted are significantly less likely to transmit.

In this case we would have failed to prevent transmissions and infections that could have been prevented [obvs killing people in the process]. This is for me quite clearly the most costly mistake, and we avoid it by introducing passports until the evidence contradicts us.

A classic example of the eroneous slippery slope argument here from Clive Lewis MP:

https://twitter.com/labourlewis/status/1470832554894843907

We already coerce people in many ways to try to make our lives better. Slippery slope arguments rely on some conjectured future, automatic, extra draconian legislation that will be enabled down the road.

The worse legislation is just a foreast. Based on what? And there's the sidelining of the fact that we can have another vote at that point. Assess the case on its public health merits [which are contestable] not spurious scare stories.

Slippery slope arguments almost always fail because society is so complicated and states so activist in addressing its problems and causing them that almost all slopes have been descended somewhat. If you give ground to a slippery slope argument, then there is telling where...