Institutional trust is essential for the proper functioning of government and society. Its erosion is probably complicit in the decline and fall of many ancient and historical civilizations, including the Greeks, Romans, and dynastic Chinese. A few hundred years ago, the breaches of trust caused by the Ancien Régime in the form of the French Bourbon Kings or by George III of England were major factors in inciting the French Revolution and the war of independence of the United States. Benjamin Disraeli, the 19th century Prime Minister who presided over the height of the British Empire, understood the wider ramifications of trust when he said: “All power is trust; we are responsible for its exercise. In the United States, institutional confidence has declined since its measurement began in 1958.
Fast forward to the present day when recent data from Pew highlights the fact that only 24% percent of Americans “really trust” the government. Given this dismal level of confidence, it is unclear why the government has decided to move forward with rigid and far-reaching mandates on COVID-19 vaccines that will only further erode the trust of the government. public.
Erosion of trust
In the United States, we can draw a line from the Vietnam War to the COVID-19 pandemic and easily mark places where institutional trust may have been compromised. In this arc, events and themes like Watergate, the failure of globalization to support the middle class, the war in Iraq, the financial crises of 2008, racial injustice and the climax of a protracted Afghan war. all played a role. The juxtaposition of much greater institutional transparency and the destabilizing echo chamber of social media are also to blame.
The Organization for Economic Co-operation and Development (OECD) asserts that citizens’ trust stems from an assessment of skills and values within public institutions. Values serve to inform and guide institutional action and are in part guided by the principles of fairness, openness and integrity. So it seems that the old adage holds: trust is earned and not given. The COVID-19 pandemic has exposed the lack of trust within American institutions. Yes, we are now naked and exposed. We have at times witnessed asymmetric and thoughtless COVID-19 policies swinging from one extreme to the other like a pierced ship sinking at sea. Some of that is to be expected. It is not easy to make political decisions based on limited information and especially with a pathogen that does not seem to follow the manual of its predecessors. Or really any playbook. This particular virus, while deadly, doesn’t seem to instill the same fear that Ebola or avian H5N1 might. If COVID-19 case fatality rates were indeed higher, there might be less debate and behaviors would align evenly. But that clearly was not the case.
The problem of extended mandates
The Biden administration’s decision to make vaccination mandatory for federal workers and institute additional vaccine or testing mandates covering large swathes of society will only serve to further undermine institutional trust in the United States. .
The policy does not have the precise language necessary to properly speak to those who understand something about this virus. There is now a need to distinguish between categories and possibly degrees of immunity. One can imagine that with continued scientific examination, we may be able to better understand the correlates of protection and transmission with respect to a variety of means of immune acquisition. There will be small differences in the immunity conferred by the severity of the natural infection, vaccine constructs, vaccine dose, and other factors which may have a real impact. The simple classification of the vaccinated versus the unvaccinated lacks the nuance required to satisfy the scientific mind. With many of our leading journals reporting COVID-19 publications in open access format, scientific literacy is at an all-time high. The discourse on virology, epidemiology and immunology is something that can just as easily be understood by a barista at Starbucks as it is by one of our medical professionals.
Biden’s 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 what has always been known: this is not an unvaccinated pandemic. Many unvaccinated have previously been exposed to SARS-CoV-2 or had COVID-19. They have some immunity. It is a pandemic caused by a highly infectious virus that manifests itself mainly in immunologically naive people. Recent data from Israel continues to build on the idea that immunity in people who have survived a previous SARS-CoV-2 infection is robust and long-lasting – perhaps even more so than in people not exposed but vaccinated. Ignoring these facts and blindly moving forward with brutal policies will continue to unravel the vital threads of trust that remain in the system.
There is no doubt that vaccination continues to be the most important strategy to get us out of this pandemic, and people should not be looking for natural immunity. But we have to be honest, fair and open (according to the OECD) in order to maintain trust.
What Biden and others should really demand is not proof of vaccination, but rather proof of immunity. This could mean showing a vaccination card, evidence of sufficient antibody levels, or a previous documented infection. A sufficient level or standard of antibody should be defined and antibody testing should be made more accessible.
This broader directive of an “immunity mandate” offers a relief valve for those who do not subscribe to the orthodoxy of vaccination but who have recovered from an infection. It reduces the pressure contained in the system, while preserving the security offered by a vaccine warrant. It also covers those who have opted for partial vaccination. This can be a particularly important strategy for children, those who have already been infected with COVID-19, or those who just want to watch and wait. There is also a precedent. The EU, UK and Israel are countries making room to better adapt to natural infections. More importantly, it signals that we are open to the idea that we are imperfect and that we do not always have the answers. That there is the possibility for evolving science to ascribe 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 credible and generate… well, more confidence.
Jesse Pelletier, MD, is an ophthalmologist in private practice in Miami and Co-Founder / Chief Medical Officer of Veloce BioPharma.