COVID19

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earthling
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Re: COVID19

Post by earthling »

I did point out it's a perspective that most probably won't agree with. I'm personally taking the vax. However be careful not to assume there is only one solution. Treatments to prevent death are improving.

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Re: COVID19

Post by phuqueue »

earthling wrote:
Fri Mar 19, 2021 3:50 pm
phuqueue wrote:
Fri Mar 19, 2021 3:05 pm
It seems pretty irresponsible for a pathologist to discourage people from getting vaccinated...
I didn't at all imply he 'discouragted people' from getting vax, was careful not to suggest that. Have mentioned he actually encourages vax (of most any kind) for those at high risk but more cautious about recommendations to the masses and he himself is not taking the COVID vax. That's not at all the same as discouraging. The rest of what I pointed out was the challenges of weighing a vax to the masses vs just to those at risk, especially when treatments are improving. It's a valid point but I do intend to get vax anyway.
Ah yes, nobody would ever be discouraged after hearing that a pathologist thinks getting the vaccine will do more harm than good unless he explicitly tells them, "don't get the vaccine."

earthling
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Re: COVID19

Post by earthling »

Is not really positioned as irresponsible though to discuss what the challenges are with mass vax for a highly mutating virus vs. just for those at risk when meanwhile other treatments are improving. And there are many COVID vax's globally that came out quickly w/out long term trials. We'll apparently come to this crossing point again if/when HIV vax released, though for very different situation. It will be great for those at risk but should the masses be encouraged to take it. It doesn't come across to me as an anti-vax or irresponsible perspective but rather about appropriate approach, especially as the situation shifts. I personally want the vax but wouldn't vax-shame others who choose not to.

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Re: COVID19

Post by FangKC »

The more you allow the virus and the mutations to spread freely, the more likely it will be that the new mutations will emerge that will be more easily spread, and become more deadly -- even among young people. Young people and vaccine-avoiders might come some day to regret their actions. A future version of COVID might end up killing millions of young adults and children, healthy loved ones of the anti-vaxxers, and then the anti-vaxxers themselves -- all in much larger numbers than we are seeing now. Those that survive it might have severe lung and heart damage that makes their survival miserable enough where they wished they had died in the initial infection.

The numbers of future sick may make today's numbers seem like nothing, and could render life unrecognizable when the supply chains all start failing.

I personally think annual COVID booster shots will become commonplace for the foreseeable future.

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Re: COVID19

Post by DaveKCMO »

Got my first Moderna shot this week since Tier 3 opened in Missouri.

Agreed about the mutations. The fact that "wild" COVID didn't really impact younger children was a fluke that could change quickly as the virus evolves.

earthling
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Re: COVID19

Post by earthling »

The P1 variant taking over Brazil is concerning as it may be impacting younger at a higher rate than other variants. No real data yet.

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Re: COVID19

Post by FangKC »

The horrific scale of the 1918 influenza pandemic—known as the "Spanish flu"—is hard to fathom. The virus infected 500 million people worldwide and killed an estimated 20 million to 50 million victims—that’s more than all of the soldiers and civilians killed during World War I combined.

While the global pandemic lasted for two years, a significant number of deaths were packed into three especially cruel months in the fall of 1918. Historians now believe that the fatal severity of the Spanish flu’s “second wave” was caused by a mutated virus spread by wartime troop movements.
...
Yet the first wave of the virus didn't appear to be particularly deadly, with symptoms like high fever and malaise usually lasting only three days. According to limited public health data from the time, mortality rates were similar to seasonal flu.
...
Reported cases of Spanish flu dropped off over the summer of 1918, and there was hope at the beginning of August that the virus had run its course. In retrospect, it was only the calm before the storm. Somewhere in Europe, a mutated strain of the Spanish flu virus had emerged that had the power to kill a perfectly healthy young man or woman within 24 hours of showing the first signs of infection.
...
From September through November of 1918, the death rate from the Spanish flu skyrocketed. In the United States alone, 195,000 Americans died from the Spanish flu in just the month of October. And unlike a normal seasonal flu, which mostly claims victims among the very young and very old, the second wave of the Spanish flu exhibited what’s called a “W curve”—high numbers of deaths among the young and old, but also a huge spike in the middle composed of otherwise healthy 25- to 35-year-olds in the prime of their life.
...
Not only was it shocking that healthy young men and women were dying by the millions worldwide, but it was also how they were dying. Struck with blistering fevers, nasal hemorrhaging and pneumonia, the patients would drown in their own fluid-filled lungs.

Only decades later were scientists able to explain the phenomenon now known as “cytokine explosion.” When the human body is being attacked by a virus, the immune system sends messenger proteins called cytokines to promote helpful inflammation. But some strains of the flu, particularly the H1N1 strain responsible for the Spanish flu outbreak, can trigger a dangerous immune overreaction in healthy individuals. In those cases, the body is overloaded with cytokines leading to severe inflammation and the fatal buildup of fluid in the lungs.
...


https://www.history.com/news/spanish-fl ... resurgence

This cytokine explosion that people experienced from the Spanish Flu is similar to that experienced by those infected with COVID.

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Re: COVID19

Post by phuqueue »

earthling wrote:
Fri Mar 19, 2021 5:24 pm
Is not really positioned as irresponsible though to discuss what the challenges are with mass vax for a highly mutating virus vs. just for those at risk when meanwhile other treatments are improving. And there are many COVID vax's globally that came out quickly w/out long term trials. We'll apparently come to this crossing point again if/when HIV vax released, though for very different situation. It will be great for those at risk but should the masses be encouraged to take it. It doesn't come across to me as an anti-vax or irresponsible perspective but rather about appropriate approach, especially as the situation shifts. I personally want the vax but wouldn't vax-shame others who choose not to.
It's irresponsible for people who don't actually have any idea what they're talking about (such as all of us, myself included, on this message board) to spread scaremongering information that is possibly incomplete or even outright incorrect, and it's irresponsible for people who should know what they're talking about, like a pathologist, to casually share opinions like that with laypeople who lack the expertise to use it appropriately.

If public health experts (and it should be noted, most doctors are not public health experts, because public health is actually a very distinct field from healing individuals) share your friend's concern, they should absolutely be discussing it amongst themselves, and maybe they are. But it is significant that no public health agency anywhere in the world has, as far as I can tell, publicly alluded to any such concerns. So at worst, they have judged that the risk of discouraging mass vaccination is higher than the risk of "stronger variants" arising in response to vaccines (at best, they have judged that there is no appreciable risk of vaccines nurturing "stronger variants"). Dealing with actual anti-vaxxers is one thing, but doctors who understand the effectiveness of vaccines should not be planting ideas that run counter to the efforts of public health workers.

I think it's also worth pointing out that the concern, as you have described it here, is founded on at least two shaky premises. The first is that we will fail to reach herd immunity, which I've already discussed. The second is that the virus is "highly mutating," which, as far as I can tell, is false. The only articles I've read that have opined on the speed with which it mutates have invariably noted that it is a slow mutater relative to other viruses. You keep invoking HIV as a comparison, but HIV actually does mutate rapidly, which is part of the reason that there is no HIV vaccine even after forty years of study (compare to the less than one year it took to develop multiple covid vaccines). The risks of failing to vaccinate are clear enough, but the risks of vaccinating, simultaneously, too many but also not enough people seem to be wildly speculative.

It doesn't in any way come across as an interesting alternative viewpoint that we "don't have to value" but that raises "a pretty valid point." It comes across as the sort of "just asking questions," trying to be too clever contrarian bullshit that in more extreme cases leads the Dunning-Kruger types of the world to go all in on conspiracy theories, exactly as WoodDraw mentioned on the previous page. If your pathologist friend or anybody else has published a peer-reviewed paper on the risks of a mass-vax campaign that fails to reach herd immunity, let's take a look at it. Otherwise you should probably advise your buddy to keep his opinions to himself.

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Re: COVID19

Post by earthling »

Vaccines Are Pushing Pathogens to Evolve
https://www.quantamagazine.org/how-vacc ... -20180510/
Immunization is also making once-rare or nonexistent genetic variants of pathogens more prevalent, presumably because vaccine-primed antibodies can’t as easily recognize and attack shape-shifters that look different from vaccine strains. And vaccines being developed against some of the world’s wilier pathogens — malaria, HIV, anthrax — are based on strategies that could, according to evolutionary models and lab experiments, encourage pathogens to become even more dangerous.
I posted about it because of the vax-shaming that also goes on toward those who choose not to take. The knowledge of vaccine-induced mutations is hardly fringe science, and that they can be more dangerous than natural mutations. The COVID vax's haven't gone through the typical years of trials to vet out potential for vax triggered mutations. Bringing that up is not fear mongering, it's kind of a big glaring red flag that many want to bury and suppress (by proclaiming it's just 'fear mongering'). I personally think it's worth the risk as the majority also do. Some in the field apparently do not and think that we're playing with fire, at least for mass usage. But yes, I should have posted such a related article initially and approached it differently. I see that error now.

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Re: COVID19

Post by WoodDraw »

The argument just fails. Coronaviruses have been around and are well understood.

It’s already mutating everywhere because it’s spreading so fast.

It’s a silly argument. Please, for the love of god, get vaccinated.

earthling
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Re: COVID19

Post by earthling »

Coronaviruses have been around but the vax's haven't been trialed through normal multi-year process. For obvious reasons but the risks are still real (acceptable to most of us) and I posted about it because of those bashing those who decide not to take as there are some in the field not planning to take it. I'll drop it if others do.

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Re: COVID19

Post by im2kull »

WoodDraw wrote:
Sat Mar 20, 2021 2:36 pm
The argument just fails. Coronaviruses have been around and are well understood.
You fail to mention that there has never before in our history been a vaccine for Coronaviruses.

That is important information. This isn't as closely related to influenza as you and countless others make it sound. It is completely different.

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Re: COVID19

Post by phuqueue »

earthling wrote:
Sat Mar 20, 2021 12:45 pm
Vaccines Are Pushing Pathogens to Evolve
https://www.quantamagazine.org/how-vacc ... -20180510/
Immunization is also making once-rare or nonexistent genetic variants of pathogens more prevalent, presumably because vaccine-primed antibodies can’t as easily recognize and attack shape-shifters that look different from vaccine strains. And vaccines being developed against some of the world’s wilier pathogens — malaria, HIV, anthrax — are based on strategies that could, according to evolutionary models and lab experiments, encourage pathogens to become even more dangerous.
I posted about it because of the vax-shaming that also goes on toward those who choose not to take. The knowledge of vaccine-induced mutations is hardly fringe science, and that they can be more dangerous than natural mutations. The COVID vax's haven't gone through the typical years of trials to vet out potential for vax triggered mutations. Bringing that up is not fear mongering, it's kind of a big glaring red flag that many want to bury and suppress (by proclaiming it's just 'fear mongering'). I personally think it's worth the risk as the majority also do. Some in the field apparently do not and think that we're playing with fire, at least for mass usage. But yes, I should have posted such a related article initially and approached it differently. I see that error now.
That article is not super clear about what the papers it cites to actually say, but both of them deal specifically with what the article calls "leaky vaccines," which prevent illness in, but not replication/spread from, vaccinated hosts. As far as I've heard, the jury is still out on the extent to which the covid vaccines are "leaky," although Pfizer/BioNTech claim that their vaccine isn't (and insofar as they're correct, these studies/your article are irrelevant). The papers both argue that "leaky" (or "imperfect," as the papers themselves call them) vaccines can create evolutionary pressure that selects for strains (they don't "induce" or "trigger" mutations, which occur naturally and at random) that are more virulent in unvaccinated hosts. This seems to me like all the more reason that anybody who can be vaccinated should be, rather than an argument against "vax-shaming." Those who can get vaccinated should have even more incentive to do so.

And to whatever extent the covid vaccines do reduce spread (which, again, at least Pfizer apparently does, and it is likely the others do too, to at least some extent), they are helping to protect those who can't be vaccinated, but only if enough people get vaccinated. So people choosing not to vaccinate for any reason should be "shamed," a consequence far lighter than the one they recklessly risk imposing on people who can't vaccinate, and choosing not to vaccinate because you're concerned we won't reach herd immunity just becomes part of a self-fulfilling prophecy. So yes, it's all just stupid scaremongering bullshit, and if you think I'm trying to "bury and suppress" your buddy's "valid" concern by calling it that, then congrats, you are now explicitly invoking the language of conspiracy theorists in addition to behaving like one.

BTW, also from your article (emphasis mine):
If this all sounds terribly scary, keep a few things in mind. Many pathogens, including measles, do not seem to be evolving as a population in response to their vaccines. Second, experimental data from a lab, such as the malaria study described above, don’t necessarily predict what will happen in the much more complex landscape of the real world. And third, researchers concerned with vaccine-driven evolution stress that the phenomenon is not in any way an argument against vaccination or its value; it’s just a consequence that needs to be considered, and one that can potentially be avoided. By thinking through how a pathogen population might respond to a vaccine, scientists can potentially make tweaks before it happens. They might even be able to design vaccines that encourage pathogens to become less dangerous over time.

earthling
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Re: COVID19

Post by earthling »

phuqueue wrote:
Sun Mar 21, 2021 1:46 pm
And third, researchers concerned with vaccine-driven evolution stress that the phenomenon is not in any way an argument against vaccination or its value; it’s just a consequence that needs to be considered, and one that can potentially be avoided.
To the pathologist's point, because the timeline of COVID vax trials was so short there wasn't an opportunity to research potential for more dangerous vaccine-induced mutations. Is why it's higher risk than other vaccines that do go through years of trials that can spend time on testing/avoiding that. He said that's what HIV trials (which he follows closely) are now concerned about. Given HIV is relatively hard to get, a vaccine-induced mutation may occur that makes it much easier to acquire and/or more deadly. Doesn't mean that COVID vax shouldn't be used for emergency use but it is still classified as emergency use yet applied to the masses not just those at risk.

Also, I took my elderly uncle in FL to get vax and had to sign form that he accepts that Moderna is still designated an 'experimental vax not yet approved by the FDA for general use' and loaded with complex hard to understand liability language that apparently removes any accountability to the drug maker. Sounds like we're essentially in a public trial with a product still in beta. Not sure if that's a Florida form or if that's everywhere. For better transparency they should provide that when signing up, not minutes before taking shot.

These are still worth the risk to me and most people/govts given pandemic but not appropriate to shame those who choose not to take an experimental vax even if the short term consequences appear nearly perfect now (at least with the 3 used in US). Some in the medical field aren't taking it as treatments are also improving.

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Re: COVID19

Post by phuqueue »

Once again, vaccines don't "induce" mutations. Pathogens are not sentient hive minds searching for weaknesses in our immune system so that they can kill us. Mutations occur naturally and randomly in all organisms. The vast majority of them are harmful to the organism. Much more rarely, they provide some kind of survival/reproductive advantage, which makes the organism more likely to survive and reproduce and thus pass on the advantage to its descendants. The main reason that viruses typically evolve to become less deadly over time is that a virus that kills its host shortens its own window to spread to new hosts, so over time, strains that are less deadly have more opportunities to reproduce than deadlier strains, and the latter gradually get supplanted by the former.

All of this is important because the papers at the heart of that article that you linked to suggest that "leaky"/"imperfect" vaccines that don't provide sterilizing immunity could allow those more deadly strains to continue to reproduce in vaccinated individuals, who could get infected without ever getting sick, so that these strains never get selected out of the gene pool. This is not relevant to a vaccine that reduces or eliminates transmission, which, as one of the papers notes, "is the case for nearly all vaccines used in humans" (and, as I noted in my previous post, seems to be the case for at least the Pfizer vax and probably the others as well).

You keep talking about HIV, but HIV mutates rapidly and covid does not, and this is why no vaccine currently even exists for HIV. And you are speculating about a hypothetical HIV vaccine "inducing" (as you put it) a mutation that would make HIV easier to acquire, but that isn't what your article talks about. The article is about the potential for non-sterilizing vaccines to block ordinary selective pressure against more deadly strains of a pathogen, and the theoretical relationship between the vaccine and the more deadly strain's reproduction and spread is clear. It's true that, through random mutation, strains could also emerge that are easier to catch and/or less susceptible to the immune response provoked by the existing vaccination (preliminary evidence suggests that the UK variant might be easier to catch and that the South African variant might be less affected by the J&J vaccine, for instance), but there is no proposed relationship here between the new strain and the vaccine in which the vaccine actually facilitates the reproduction and spread of the new strain. And on the contrary, to the extent that the vaccine provides sterilizing immunity and/or otherwise reduces or eliminates transmission, more vaccinated individuals = fewer opportunities for the virus to reproduce = fewer opportunities for spontaneous mutation.

Casting doubt on the vax because your uncle had to sign a liability waiver and the vax is "experimental" is another classic conspiracy theorist tactic, so way to go there. I'm pretty sure I've had to sign a waiver literally every time I've gotten even the annual flu shot. I suspect that my parents probably had to sign waivers when I received my various childhood vaccinations. Liability waivers are, uh, not unusual. And while I don't know exactly what the waiver your uncle had to sign said, the fact sheet that is required to be provided with the Moderna vax is easily found on the internet (as are the fact sheets for the other vaxxes), and it just discusses all of the ordinary side effects (rash, feeling ill, etc) and potential complications (e.g., allergic reaction), which are par for the course with any vaccine. None of this has anything to do with your supposedly primary concern about "vaccine-induced mutations," of course, but pointing out that the vax is "experimental" and hasn't received FDA approval is just another way to plant the seeds of uncertainty about the vaccine. You seem to have this idea that, under the ordinary approval process that the FDA has not had time to undertake for the covid vaccines, a new vaccine is specifically studied to determine whether it will "induce" unwanted mutations. I'd be very surprised to learn that the FDA looks at potential vaccine/evolutionary relationships at all (obviously they wouldn't look at whether the vaccine "induces" mutations, because that does not happen), and the CDC's own explanation of how a vaccine gets tested and approved seems to indicate that the main criteria for approval are (as should be obvious) safety and efficacy. Though some future researcher might choose to study the ongoing effects of a vaccine on viral evolution, this isn't part of the FDA approval process (how could it be? It would delay approval by years, with no especially obvious point at which you could decide "ok, I guess the virus just isn't going to evolve that way, so we're good to go"), so raising the vax's "experimental"/unapproved status is all really just a red herring.

In conclusion, Libya is a land of contrasts, and also yes, it is still entirely appropriate to shame those who choose not to take the vax, and it's still extraordinarily irresponsible for a doctor like your friend to discourage vaccination.

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Re: COVID19

Post by earthling »

Wow so blow off the experimental status and essentially take away rights to make one's own risk decision just because anti-vaxr's also point that out. Got it. That's an approach ideology extremists take. If the vax's were equally safe as approved vax's they'd give it approval status. We're in a public trial with a product still in beta.

If these were an officially approved vaxs it would be more appropriate talk about the moral social responsibility to participate but there were short cuts taken.. with time. And therefore it would be morally wrong to pressure others to participate in something literally deemed as experimental. However it's fantastic these are available for those who choose to use.
Last edited by earthling on Mon Mar 22, 2021 5:36 pm, edited 1 time in total.

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Re: COVID19

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phuqueue wrote:
Mon Mar 22, 2021 1:18 pm


In conclusion, Libya is a land of contrasts, and also yes, it is still entirely appropriate to shame those who choose not to take the vax, and it's still extraordinarily irresponsible for a doctor like your friend to discourage vaccination.
Just so I'm clear on your take. You think it's 100% ok to shame anyone who decides not to get the vaccine? Disagreeing with their choice isn't enough, you think they should be shamed and told they're killing people?

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Re: COVID19

Post by Anthony_Hugo98 »

phuqueue wrote:
Mon Mar 22, 2021 1:18 pm
it is still entirely appropriate to shame those who choose not to take the vax, and it's still extraordinarily irresponsible for a doctor like your friend to discourage vaccination.
Why should people be shamed? Someone in my age bracket (early 20’s) with no underlying health conditions shouldn’t be forced into taking something if they can’t legally hold the manufacture of the vaccine liable if something goes wrong. I don’t think that’s entirely unreasonable.
For all my military brothers and sisters out there, thanks for paving the way, ill do my best! AIRBORNE!

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Re: COVID19

Post by earthling »

For now it seems the demand to take vax is higher than the supply. I would hope that when the FDA switches the status from experimental 'emergency use authorization' to 'fully approved' it's based on their normal process of approvals and not just because they want to entice all to take a vax that should otherwise still be deemed in experimental stage. In the meantime, shaming those for not taking is just wrong. I'm personally willing to participate in what is essentially a public trial.

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Re: COVID19

Post by phuqueue »

earthling wrote:
Mon Mar 22, 2021 2:25 pm
Wow so blow off the experimental status and essentially take away rights to make one's own risk decision just because anti-vaxr's also point that out. Got it. That's an approach ideology extremists take. If the vax's were equally safe as approved vax's they'd give it approval status. We're in a public trial with a product still in beta.

If these were an officially approved vaxs it would be more appropriate talk about the moral social responsibility to participate but there were short cuts taken.. with time. And therefore it would be morally wrong to pressure others to participate in something literally deemed as experimental. However it's fantastic these are available for those who choose to use.
I guess now we are just gonna completely shift the goalposts and switch over from the bogus "vaccine-driven mutations" argument to speciously fretting that something sinister may be afoot with this "experimental" vax. The vaxxes aren't unapproved because they aren't "equally safe," they're unapproved because the full approval process takes time that isn't available in the midst of an active pandemic. Like a good conspiracy theorist, you are leveraging people's lack of familiarity (including, it seems, your own) with specialized knowledge (in this case, how a vaccine gets developed and approved) to insinuate that there is good cause for concern. Would it make you feel any better to know that the vaxxes are not just "experimental" but have been fully approved in a number of other countries, including Australia, the entire EU, Iceland, Norway, and Japan? The FDA has its own approval process that hasn't been completed yet, but plenty of our socioeconomic peers (/health care superiors) have already seen enough. It's funny, a couple of pages ago, you seemed worried that we might not reach herd immunity, and you even premised your "vaccine-driven mutations" thing on that possibility. Now you seem to be actively working to prevent herd immunity by spreading anti-vax talking points.

And lol at the drama queen hysterics of "essentially take away rights to make one's own risk decision," like I'm proposing that anyone healthy enough to receive the vax be strapped down and forced to take it. No, I'm just saying that your pathologist friend shouldn't spread scaremongering bullshit, and neither should you.
DColeKC wrote:
Mon Mar 22, 2021 5:36 pm
phuqueue wrote:
Mon Mar 22, 2021 1:18 pm


In conclusion, Libya is a land of contrasts, and also yes, it is still entirely appropriate to shame those who choose not to take the vax, and it's still extraordinarily irresponsible for a doctor like your friend to discourage vaccination.
Just so I'm clear on your take. You think it's 100% ok to shame anyone who decides not to get the vaccine? Disagreeing with their choice isn't enough, you think they should be shamed and told they're killing people?
Anthony_Hugo98 wrote:
Tue Mar 23, 2021 1:09 am
phuqueue wrote:
Mon Mar 22, 2021 1:18 pm
it is still entirely appropriate to shame those who choose not to take the vax, and it's still extraordinarily irresponsible for a doctor like your friend to discourage vaccination.
Why should people be shamed? Someone in my age bracket (early 20’s) with no underlying health conditions shouldn’t be forced into taking something if they can’t legally hold the manufacture of the vaccine liable if something goes wrong. I don’t think that’s entirely unreasonable.
I'm not actually the one who introduced "shaming" into the conversation in the first place, I'm just responding to the concern that earthling brought up, unprompted, about it. But yeah, in most cases, it is fine to shame people who could get the vax but choose not to and to tell them that they're killing people, because they are. And no, nobody should be "forced" to take something, but yes, people in their early 20s with no underlying health conditions should get the vax and shouldn't be coddled and told that there really was no right or wrong answer, just whatever felt right in their hearts, if they choose not to. Vaccination isn't only about protecting the vaccinated individual, it's not just your choice to take a risk with your own health. Vaccination is about building herd immunity so that people who are unable to be vaccinated are also protected. When you choose not to get vaccinated, you're putting other people at risk.

It's also funny that you're concerned about being unable to hold a vaccine manufacturer liable "if something goes wrong" (what, exactly? I don't know!) while your elected Republicans at both the state and federal level have been trying to shield employers from liability for forcing their employees to work in-person through the pandemic. There is a pretty clear risk associated with in-person work during a pandemic, but I haven't seen anyone in this thread raising this concern, while the risks associated with vaccinating, on the other hand, seem...well, "speculative" might actually be kind of generous, considering that these vaccines cleared Phase III trials (tested in thousands of people) before receiving emergency authorization (full authorization in other countries) and have since been administered to millions more. What kind of "something" are you afraid could still be lurking? Do you even have any ideas? Are they based on anything?

To be clear, I think there are some people who it would not be appropriate to shame. There is some apprehension in black and other minority communities about the vaccine because of our history of testing shit on them without their knowledge or consent. Apparently "vaccine hesitancy" in Pakistan is notably high, in part because the CIA administered a bunch of fake vaccines during the hunt for Osama bin Laden. So I think in situations like these, people are still making the wrong choice, but their lack of trust is understandable, and there isn't really an easy answer. But I also think that for purposes of our discussion here, exceptions like these are not really relevant, given that nobody here has raised any concerns based on their membership in a historically-exploited community (although I look forward to earthling's inevitable pivot in this direction once the "experimental" scaremongering has run its course).

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