Some wise person – I have a strong sense it may have been our own Christopher Fildes – once offered a compelling theory of the cyclical nature of financial crises. They happened, he argued, shortly after the last person at the bank to remember the most recent crash reached retirement age and cleared his desk.
For NHS staff, I think there’s a pretty strong case to be made – given their constant contact with lots of immunocompromised people – that being vaccinated should be a condition of employment
At this point, he said, the buccaneering young things who came after started to imagine that the recent period of stability and prosperity was the natural order of things. They mistook the various tedious regulations (formed in the aftermath of the previous crash) that underpinned this period of stability and prosperity, and protected the world from financial disaster, for ‘red tape’.
They imagined, as they started to circumvent all this red tape, that they were the first generation in history to discover a new way to defy the laws of financial physics. They came to think that bubbles could inflate limitlessly without ever going pop, and they thought themselves very much cleverer than their fuddy-duddy, risk-averse predecessors. Then, of course, splat. Chesterton’s fence, to strain a metaphor, doesn’t just keep the bulls in: it keeps the bears out.
It’s easy to think that the same sort of pattern might apply in the world of medicine. I mean, for instance, that if it’s been simply ages since anyone you’d ever heard of got measles or polio, you might get a bit cavalier about vaccination. You might start to think that decent public health was the natural order of things rather than the result of sustained vigilance. Perhaps you’d start to wonder if vaccines didn’t do more harm than good. You might get a bit of a kick out of your contrarianism – certain as habit had made you that you weren’t in any danger of getting measles or polio yourself because, goodness, that disease belongs to the before-times.
By this logic, then, you’d think that this generation would be one of the most vaccine-positive in history. We are not half a decade from the most serious global health crisis in a century – a pandemic that took millions of lives and would have taken many millions more had it not been for a Herculean programme of vaccination. Scientists scienced the heck out of Covid, and had they not we’d all have been cooked. (What’s more, they helped nice Mr Gates’s microchips ensure we can come to no future harm.)
We can and will argue for years about the origins of the virus, the efficacy of lockdowns and the grisly trade-offs that public policy required in the crisis. But you’d think, wouldn’t you, that Covid was nothing if not an advertisement for vaccines.
Yet exactly the opposite situation seems to have obtained. It’s not just that more and more ordinary people are resisting vaccines: figures published yesterday show that even front-line health staff are declining them. For the four years since the pandemic, the uptake of flu vaccines among NHS staff has gone down year on year. It now stands at a 15-year low of 37.5 per cent. In one health trust 90 per cent of staff last year refused the jab.
As should be obvious, this is a double-whammy. If medics aren’t leading by example – and these medics, be it noted, are precisely the people who have most first-hand experience of what contagious illness can do – you can’t very well expect the general population to take the matter seriously. Plus, of course, NHS staff are the people most likely to have day-in, day-out contact in crowded spaces with people whose immune systems are already on the fritz. Physician, vaccinate thyself.
There are, I suspect, a couple of things going on here. One is temperamental. What’s euphemistically called ‘vaccine hesitancy’ is in one respect an epiphenomenon of our age of steroidal individualism. Professor Heidi Larson of the London School of Hygiene & Tropical Medicine speculates that it has a component of refusing to be bossed about. Her studies, she says, show that having the Covid vaccine made all-but-compulsory resulted not in gratitude but resentment: ‘Some people, maybe subconsciously, are angry about having been pushed into taking them. They feel enough is enough towards vaccines.’
There is a sophomoric libertarianism that thinks the argument about vaccines is a simple as ‘my body, my choice’. And much as there may be virtue in that argument, it’s not an uncomplicated virtue. No man is an island, entire of itself. When you refuse a vaccine, you aren’t simply making a choice about your own body. You’re making a choice about the body of everyone who bumps into you over the next few years.
There are all sorts of personal decisions we restrict for the collective good. It’s why, for instance, you don’t get to decide which side of the road you drive on or whether you stop at traffic lights. The people who take a principled decision to refuse vaccination rely for their continued health and the health of their children on a majority of the supposedly unprincipled taking the jab. Once the refusers reach a critical mass, we’re in trouble.
There again, the basic presumption against having paramilitary paramedics kicking in the doors of crackpots and vaccinating them by force is sound. We are, rightly, squeamish about the sort of intervention that takes the form of a demand rather than a prohibition. A vaccine is, like it or not, an invasive procedure. So far, as far as I understand it, the hope has been that so long as the crackpots are outnumbered we can just about let them be.
At this stage it’s hard to predict how long they are going to be outnumbered. That temperamental resistance flows into a wider current in the culture. Covid made vaccines a giant part of the daily news cycle and associated them with exactly the sort of state authority that the disinformation cesspools of social media love to rail against.
There are profitable clicks to be had from people ‘doing their own research’ and already, heaven help the measles-suffering children of Texas, we have a raw-milk-chugging vaccine-sceptic in charge of health policy in the US.
Those knotty issues – and the tricky trade-offs between individual liberty and collective safety – apply to the population at large. You can see why we still try to walk the line of nudge politics, public information campaigns and gentle encouragement in trying to keep the crackpot ratio in the safe zone. But NHS staff? I think there’s a pretty strong case to be made – given the point about their constant contact with lots of immunocompromised people – that being vaccinated should be a condition of employment rather than a take-it-or-leave it option.
A passing mention in yesterday’s report suggested that ‘problems include hesitancy by black and minority ethnic staff and communities towards vaccines’. The quietism there strikes me as patronising. It effectively implies that you it’s unreasonable to expect non-white staff to do what’s medically right because of some nebulous and unchangeable account of their cultures. The culture of public medicine also has a professional claim on them – and if anyone is going to bring about change in the vaccine-hesitant cultures of those communities, it will be the NHS staff who belong to them.
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