The Erosion of Trust
In the U.S., we can draw a line from the Vietnam war all the way to the COVID-19 pandemic and easily mark where institutional trust may have been compromised. Within this arc, events and themes like Watergate, the failure of globalization to sustain the middle class, the Iraq war, the 2008 financial crises, racial injustice, and the final culmination of a protracted Afghan war have all played a role. The juxtaposition of far greater institutional transparency and the destabilizing echo chamber of social media are also to blame.
The Organization for Economic Cooperation and Development (OECD) asserts that citizens' trust is derived from an assessment of competence and values within public institutions. The values serve to inform and guide institutional action and they are in part guided by the principles of fairness, openness, and integrity. It therefore seems that the old adage holds: trust is earned not given. The COVID-19 pandemic has laid bare the lack of trust within U.S. institutions. Yes, we are now naked and exposed. We have witnessed, at times, asymmetric and feckless COVID-19 policies lurch from one extreme to the next like a pierced vessel foundering at sea. Some of this is to be expected. It is not easy to make policy decisions based on limited information and especially with a pathogen that doesn't seem to follow the playbook of its predecessors. Or really any playbook at all. This particular virus, while deadly, doesn't seem to incite the same fear that say Ebola or avian H5N1 might. If case fatality rates of COVID-19 were indeed higher, perhaps there would less debate and behaviors would homogeneously fall in line. But this clearly has not been the case.
The Issue With Sweeping Mandates
The Biden administration's decision to mandate vaccination for federal workers and institute other vaccine or testing mandates covering broad swaths of society will only serve to further abrogate institutional trust within the U.S.
The policy lacks the precise language needed to adequately speak to those who understand something about this virus. There now exists the need to make distinctions between categories and eventually degrees of immunity. One can imagine that with continued scientific examination we may perhaps better understand correlates of protection and transmission as they relate to a variety of means of immune acquisition. There will be small differences in immunity imparted by the severity of natural infection, vaccine constructs, vaccine dose, and other factors that may have real-world impact. The simple classification of vaccinated versus unvaccinated lacks the nuance required to satisfy the scientific mind. With many of our top journals reporting COVID-19 publications in open-access format, scientific literacy is at an all-time high. Discourse on virology, epidemiology, and immunology is something that may just as easily be understood by a barista at Starbucks as one of our healthcare professionals.
The Biden policy, unfortunately, continues to ignore other means of acquiring immunity, which may include natural infection and single doses of mRNA vaccine. We cannot turn away from that which has been known all along: this is not a pandemic of the unvaccinated. Many of the unvaccinated have been previously exposed to SARS-CoV-2 or had COVID-19. They have some immunity. This is a pandemic caused by a highly infectious virus that mainly manifests in the immunologically naive. Recent data from Israel continues to build upon the notion that immunity in people who survived a prior SARS-CoV-2 infection is robust and durable -- perhaps even more so than in the unexposed but vaccinated. Ignoring these facts and blindly forging ahead with blunt policies will continue to unravel vital threads of trust that remain in the system.
There is no doubt that vaccination continues to be the single most important strategy to lift us out of this pandemic, and people should not seek out natural immunity. But we must be honest, fair, and open (according to the OECD) in order to maintain trust.
What Biden and others really should require is not proof of vaccination, but rather proof of immunity. This could mean showing a vaccine card, evidence of sufficient antibody levels, or past documented infection. A sufficient antibody level or standard would need to be set and antibody testing would need to be made more accessible.
This more capacious directive of an "immunity mandate" affords a release valve for those who do not subscribe to the orthodoxy of vaccination but have recovered from an infection. It reduces the pressure contained in the system while conserving the safety a vaccine mandate affords. It also provides cover to those who have elected for partial vaccination. This may be a particularly important strategy for children, those previously infected with COVID-19, or those who simply want to watch and wait. There is also precedent. The EU, U.K., and Israel are countries making room to better accommodate natural infection. But most importantly, it signals that we are open to the idea that we are imperfect and don't always have the answers. That the possibility exists for evolving science to allot for more than one answer and that we are not enslaved to the inertia of dogmatism. It is precisely by showing that we are fallible that our policies become more believable and engender ... well, more trust.
