A Ramble on Peter Singer, the Seatbelt Analogy for Vaccine Mandates, and HIV

Peter Singer has written an article wherein he defends the commonly used 'Seat Belt' analogy for compulsory vaccinations against COVID-19. 

The analogy is as follows: vaccines are said to be like seat belts since both are extremely effective ways of gaining protection against serious injuries and death, for oneself and others. Additionally, given the contagiousness of most vaccine-preventable diseases, catching an infectious disease is not only equivalent to being victim of a car accident, but to being victim of a car accident in such a way as to become a lethal threat to others.

Singer states, ‘[e]ach time we get into a car, the chance that we will be involved in an accident serious enough to cause injury, if we are not wearing a seat belt, is very small... The same reason justifies making vaccination against COVID-19 compulsory: otherwise, too many people make decisions that they later regret.’

Car accidents occur whether or not seat belts are worn, and these accidents are products of driving cars: which we allow. 

The seat belt doesn’t prevent accidents and collisions from occurring – they prevent serious injury or death to the wearer. Just like the vaccines - as we're told. 

If one is speeding down the road and hits a pedestrian at a cross walk, the seat belt played no role in preventing that accident. It only prevents injury to the wearer. Ditto for instances of multiple vehicles colliding. 

Singer also states that '[t]he oddity, here, is that laws requiring us to wear seat belts really are quite straightforwardly infringing on freedom, whereas laws requiring people to be vaccinated if they are going to be in places where they could infect other people are restricting one kind of freedom in order to protect the freedom of others to go about their business safely.' 

I think that the real oddity is saying that vaccinated people need other people to be vaccinated in order to protect the former from a disease that their vaccination is supposed to protect them from. To link this back to the seat belt analogy: how does you wearing your seat belt protect me from injury?

By taking the vaccine, one has engaged in a preventative measure to protect one's self from infection - or at least serious illness/death. Requiring that others take that same preventative measure to protect others, when those others have already taken the preventative measure to protect themselves seems bizarre and belies the confidence that we're supposed to have towards these vaccines. (Which have been shown to rapidly decrease in efficacy over the course of several months). 

So, perhaps the seat belt analogy is more accurately constructed like this: we're all driving our cars (living life) which is dangerous. We have the protective feature of the seat belt (vaccines) that we can/should use. In fact, it should be mandatory to wear that seat belt (get vaccinated) in order to drive our car (live life freely).  

This, however, is different from the original analogy, and builds coercion into the analogy instead of self-interest and altruism. 

Singer acknowledges this, stating that such laws violate John Stuart Mill’s famous principle that 'the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others.' Thus, coercing others for their own good is morally unjustified. 

This concern is quickly handwaved away by Singer. 

While he agrees that such a principle is good for protecting homosexuals from laws seeking to criminalise their 'victimless acts', for example, people are just less rational today than back in Mill's time, and so we need a little paternalism.

To speak to Singer's victimless homosexuals: whereas roughly 38,000 people die from car crashes in the US annually, approximately 35,000 people get infected with HIV each year, as well. 

Some may contest that the comparison between HIV and COVID-19 is a mistaken since HIV is no longer the death sentence it was at the beginning of the HIV/AIDS epidemic. Some may say that such a comparison is also bigoted as it compares a vulnerable and marginalised community with a deadly viral scourge – even tangentially, this comparison amounts to a dog-whistle harkening back to some of the darkest days of homophobia.

Well, argumentum ad misericordiam is a fallacy, and Dr. Anthony Fauci, who had been at the helm of the HIV/AIDs response as well as the current COVID-19 response, has made such a comparison – and so I feel free to use it.

The problem for Fauci, however, is that such a comparison highlights the fact that we’ve not learnt important lessons from that crisis – and it is the contrasting elements found in this comparison that make it more instructive.

To begin: HIV, unlike COVID-19, is incredibly lethal (without lifelong and expensive treatment) and was primarily spread by younger people without symptoms. Despite this, officials didn’t attempt to quarantine people who were known to be infected, nor did they lockdown communities and activities that were known hotspots for transmission (gay bath houses, gay bars, etc.).

One may retort by saying that the lack of a serious response was due to a) the lack of any real understanding of the virus at the time, and b) that since it mainly impacted the stigmatised group that was ‘gay men’, there was little incentive to more swiftly. These reactions are knee-jerks that have little to no basis in the history of the medical response.

The HIV crisis was treated as a medical problem to be solved, not as death-dealing society-smothering menace that needed sacrifices of liberties and freedoms, and large-scale coercion even though HIV is far more dangerous and has killed far more people, especially young people, than COVID-19 ever will.

With that in mind, let's us this comparison between HIV and COVID to assess the seat belt analogy. 

If we wanted to be consistent in our imposition of seat belts and vaccines, shouldn't we also impose restrictions on those groups that are most impacted with HIV?  

A possible response could be: since HIV transmission is tightly correlated with certain activities, and since COVID-19 is far more easily transmitted via airborne particles and droplets in public spaces, it makes little sense to compare the two. Since COVID-19 is more easily transmitted, measures to restrict its transmission will inherently impact more aspects of people's lives. That's just the nature of dealing with a very contagious communicable disease. 

An opposing case can be made: HIV, by virtue of having such a restrained means of transmission, can be more easily targeted, and we should thus impose restrictions. After all, the costs both to lives and livelihoods of HIV are far from negligible - even when considering the significant advances in medical interventions to prolong life. 

Additionally, the economic burden of HIV in the United States in the era of highly active anti-retroviral therapy is no small matter. These estimated total cost of HIV is substantial at $52.8 billion per year - with productivity losses accounting for $44.8 billion, and direct medical costs equaling $8.0 billion. Car crash deaths and injuries cost $70 billion in medical and lost work costs, all in. 

These numbers pale in comparison to the whopping $16 trillion COVID-19 has been estimated to cost the USA, but surely we shouldn't only be looking at the dollars to determine the value of a course of action, right? 

In fact, instead of trying to impose restrictions of activity that spreads HIV, we're seeing an apparent loosening of restrictions. For example, the state of California had recently passed a law (Bill 329) that it makes it no longer a felony for people who are HIV-positive to have unprotected sex and not disclose their status to their sexual/romantic partner. Instead, such behaviour is a misdemeanour with options for civil suits. In Canada, the ban on gay men from donating blood is likely to be lifted, too. Instead of banning gay men from donating blood, such men are eligible to give blood if it has been more than three months since their last sexual contact with a man. 

Canadian Blood Services’ goal is to stop asking men if they’ve had sex with another man and instead focus on high-risk sexual behaviour among all donors.  Instead, all potential donors would be asked if that have had sex with new/multiple sexual partners. If  they answer in the affirmative, they would then be asked if they had anal sex. 

This all seems to be rather circumlocutory since the causal links between homosexual activity and HIV are strong enough and concerning enough for blood donations that even the pro-LGBT folks can't deny it or override it. They can only get this half-measure stuff, and its clear that there is a thin line being walked between appealing LGBT interests and doing basic due diligence to protect public heath. 

And so, what we have here is the conflict between values, costs, and benefits. 

In the case of vehicle travel, we allow the danger, injury, and deaths caused by automobiles – and yet car crashes are the leading cause of death for people under 50 years of age, and the leading cause of death for children 5-29 years old. Overall, about 1.4 million people die every year from car crashes. The data goes on. 

But car crashes are not even close to the top of heap, when it comes to mortality in our context. 

Whereas roughly 38,000 people die from car crashes in the US annually, about 385,000 people died of COVID-19 in 2020. That is a stark difference that should be taken into account, but next to heart diseases (690,000 deaths) and cancers (599,000 deaths) COVID-19 is the third leading cause of death in the US. 

Despite these numbers we don't seem to wish a top-down authoritarian state that seeks to impose health standards and medical treatment to curb deaths from heart disease do we? Nor should we want to.

So perhaps the matter isn't with numbers of deaths, per se, but the frequency of the deaths. After all, we've seen health care systems grind to a halt due to over-crowding of in-patients and lack of staff due to infection and/or burn-out. 

But wouldn't it be a good idea to promote healthy living in the citizenry? Isn't comparing COVID-19 to heart disease more accurate than to driving a car? After all, severe COVID-19 illnesses were linked to other underlying health problems such as hypertension, diabetes, and obesity. Coincidently, these conditions are also linked to heart disease. 

Now, these are tough questions. But the over-arching point, here, is that we, as a society, allow/endure certain costs in order to preserve certain values, and this fact has been lost in this conversation about COVID-19 because the discourse has been overrun with medical authoritarians who a trying to keep their system stable.

It's time to wrap this up. 

This seat belt analogy isn't great. 

Is it paternalistic? Yes. Is it an acceptable amount of paternalism? Debatably. 

What we have seen over the past year, here, with vaccine mandates and other COVID-19 related restrictions is hardly the paternalistic nudge, it is more like an abusive relationship. In fact, the discourse round vaccines has created strong antagonisms between the pro-vaccine/anti-vaccine clubs. 

There are differences in attitudes towards the unvaccinated in the realm of healthcare, with doctors and ethicists sayings that unvaccinated people should be triaged to the back of the line when it comes to receiving treatment. Would the same statement apply to those who didn't wear a seat belt? 

Overall, the analogy is shallow in its comparison, and inconsistent in its application. It doesn't accurately map onto the facts of the pandemic and is only being used as a thought-terminating cliché to engender compliance in the population and normalise increasingly coercive measures. 

The analogy argues that people should be coerced into getting vaccines because of the benefit that'll accrue to third parties - particularly the vulnerable - like seat belts. The problem with this analogy is that seat belts do not protect third parties: the seat belt only protects the wearer, and it protects them no matter what others do, too. 

With vaccines, the protection accrued to the vulnerable is only achieved if people, collectively, get vaccinated; and if the vaccine provides the requisite level of prolonged protection (which they don't). So, whilst the seat belt only requires individual action, the vaccines require collective action. If the collective cannot be convinced, then it'll be compelled. 

This, in turn, increases already simmering distrust in the citizenry which exasperates efforts to address the pandemic's impacts on public health and its institutions. 

All of these are ingredients for a bad recipe which should be given the adherence it has garnered.