Steven Lewis: Four lessons for the next pandemic

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Steven Lewis: Four lessons for the next pandemic
© Provided by Leader Post A health-care worker fills a syringe with Pfizer COVID-19 vaccine.

If fortune smiles on us, the COVID-19 pandemic will burn itself out in 2022. But there will be another one sooner or later. It might mimic this one or be entirely different. Managing pandemics is an inexact science, but there are better and worse ways to do it. Canada can do a lot better next time by applying the hard lessons learned over the past two years.

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The first lesson is that a national problem requires a national solution — actually, an international solution, but that’s beyond our control. It’s folly to leave pandemic policy to provinces and territories. Borders mean nothing to viruses. Different control strategies are confusing and sometimes conflicting . Loud minorities can paralyze governments in certain political environments, with spillover effects on their neighbours. Pandemics are a test of cooperative federalism. If the provinces and territories are wise, they will agree to a single authority, a clear chain of command and a common playbook.

That playbook will inevitably be based on incomplete and evolving evidence. The contagion, long-term health impact and total cost of containing pandemics aren’t fully known until they have run their course. But it’s still a huge benefit to confront the next one armed with a decision manual that has been proposed, debated, and adopted. It won’t cover every contingency, but it would lock in the learnings from COVID, eliminate the need to go back to square one on every issue, and facilitate more agile and decisive responses.

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The second lesson is that once a pandemic becomes a serious threat, some individual rights are off the table. Rights are absolute only where exercising them doesn’t affect other people. In a pandemic, every person’s decision about whether to get tested, self-isolate or wear a mask affects the health and safety of others. It is settled law that governments can close schools and businesses and cancel entertainment events to limit pandemic damage. Many Canadians oppose these restrictions but it is impossible to accommodate their views and protect the public simultaneously.

The right to choose which substances, medical or otherwise, to put in your body is about as fundamental as rights get. Mandating a vaccine should have to clear at least four hurdles : Is the vaccine sufficiently safe and effective? Is the burden of getting vaccinated reasonable? Is the remedy proportional to the threat posed by the virus(es)? And are there less intrusive but equally effective ways to protect the public?

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By any reasonable assessment, the case for mandatory COVID vaccination (with legitimate medical exemptions) has cleared all four hurdles, but governments have been reluctant to act. It’s time to settle the issue once and for all. Hold a public debate about whether and when to impose a vaccine mandate. Fight it out philosophically, legally and politically. Propose the criteria for making vaccines mandatory, let parties and candidates declare their positions, and have the public decide.

Where effective vaccines exist, the only alternative that could conceivably be as effective as good vaccines would be a combination of universal behaviour change, major economic disruption and diligently applied rules. The evidence to date suggests that humans are neither inclined to nor capable of that degree of disciplined solidarity for long periods of time. The most resistant are those who also refuse to get vaccinated. The price of going unvaccinated has been artificially low for them, and needlessly high for the vaccinated. Next time, set it properly, and people can choose either to get vaccinated or lead a severely restricted life to protect others from the threat they pose.

The third lesson is to get the logistics right and err on the side of excess capacity. If testing is critical to intelligence gathering and better health outcomes, don’t make symptomatic people line up for hours (and put each other at risk). Train every health science student to administer tests and vaccines and deploy them as surge capacity to get as many shots into as many arms as quickly as possible. If dedicated, mass clinics can do the work faster, make them the default option.

The fourth and most important lesson is that no amount of reason, patience, or sincere engagement is going to change the minds of the five to 15 per cent who are either hardcore pandemic denialists and/or committed anti-vaxxers. The differences are irreconcilable. Misinformation is a pandemic’s greatest ally and a threat to human progress. The Age of Reason is suddenly on shaky ground, and we need to shore up its foundations against this worst of all contagions.

Steven Lewis spent 45 years as a health policy analyst and health researcher in Saskatchewan and is currently adjunct professor of health policy at Simon Fraser University. 

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