Should we all get the seasonal flu vaccine? An introduction to cost-benefit.

In this episode, David discusses the moral imperative behind the COVID-19 vaccine and how it differs from the seasonal flu vaccine. He talks about cognitive dissonance and finally introduces a theme that will be revisited in a future episode, the cost-benefit analysis.

Contents:
- COVID-19 vaccines
- seasonal flu vaccinations
- Is there a moral imperative to get vaccinated?
- blood donation
- organ donation
- cost-benefit analysis
- cognitive dissonance

My email address:
david.tonner2010@gmail.com

Links:

Cognitive dissonance
https://en.wikipedia.org/wiki/Cognitive_dissonance

Cost-benefit analysis
https://en.wikipedia.org/wiki/Cost%E2%80%93benefit_analysis

Transcript

Should we all get the seasonal flu vaccine? An introduction to cost-benefit.

 Podcast introduction

Welcome to the Reasoned Intuitions podcast. My name is David Tonner, and I discuss personal ideas on moral issues in modern society and try to come up with improved ways of thinking and behaving, in the hopes of becoming a better person and causing the least amount of harm. As a disclaimer, I'd like to state that I am not an expert in either philosophy, psychology, or anything else, for that matter.

My opinions and positions are provisional and open to change with new information or an improved understanding of the issues I discuss. My intent is not to provide definitive rules or to tell anyone how they should live their life. I merely want to share my ideas and insights, in the hopes that they can be inspirational or in some way helpful.

I employ pragmatic ethics and try to reason from as broad and objective a perspective as possible. Some of my basic assumptions are that unchosen suffering is bad, and we should strive to minimize it. Joy is the most pleasurable sensation, and thus we should strive to maximize it. Empathy is universal, with some exceptions, and it should be the starting point of any good ethical system. 

Intro

Hello and welcome to the first episode of Season Two of Reasoned Intuitions. I'm so glad you could join me again as we explore a variety of ethical dilemmas and other philosophical conundrums. So, let's kick things off with something light, say, Covid vaccines. As we'll soon find out, however, vaccines are just one facet of a bigger topic that we'll explore here and in a future episode.

The world is still gradually emerging from the Covid-19 pandemic, and if you recall, not long ago, one of the biggest points of contention and acrimony between people, not least on the internet, was a number of questions related to Covid vaccinations. Are they safe? Is it our moral duty to get vaccinated for the sake of other people? Is it appropriate for governments to impose mandates on us? Etc. The level of vitriol that the various intertwined questions about vaccines created seems unprecedented, at least in recent history, and I have no doubt that beyond the more obvious manifestations of the support and opposition to everything vaccine- and mandate-related, such as the so-called freedom convoys in Canada and elsewhere, many people likely suffered a variety of injustices, indignities, and injuries in the name of this prickly topic. To those of you who are new to my podcast, you should know that I liberally sprinkle my episodes with puns and dad jokes, so bonus points if you can catch them.

Is there a moral imperative to get vaccinated?

To be clear, I'm not going to be talking about the safety or efficacy of Covid vaccines, except in passing, and neither will I address the topic of vaccine mandates. Rather, what I'm interested to explore today is the idea that there might be a moral imperative for people to get vaccinated against infectious agents, both within the context of a pandemic, such as Covid 19, and also outside of it, with respect to seasonal pathogens like influenza, and yet many of us, including myself, hesitate when it comes to being subjected to these interventions.

From the moment that approved vaccines against Covid became available, public messaging quite strongly impressed upon people the need to get vaccinated, not only for their own benefit, but that of everyone else, with the ideal outcome being the achievement of herd immunity, which means the state of having a sufficient number of immunized people, so as to reduce the rate of infectivity. Apart from public messaging, there was also a significant social movement, largely propagated over the internet, but also through social signalling, that essentially promised to marginalize anyone who chose not to get vaccinated. The undercurrent running through both official and unofficial communication channels was that getting the shot was the morally correct thing to do, and conversely, to remain unvaxxed was immoral.

As the pandemic continued and time went on, people were encouraged to get their first booster and eventually, a second one. This is still where we are today, even though the messaging is no longer as strong, and it seems that the conversation has mostly died down.

At this point, at least in many liberal nations, we seem to have come to terms with the idea that Covid is here to stay, and that it's a condition we will have to deal with on a seasonal basis, just like the flu—and that like the flu, we will most likely have to get vaccinated on a regular basis.

Flu vaccine

Flu shots are overwhelmingly safe and generally considered to have a high degree of efficacy against the spread of influenza. During flu season, whenever you go to a supermarket or a clinic, you'll be faced with signs encouraging people to get their shots. Even though the flu isn't dangerous to most of us, it does affect some demographic groups—especially seniors—disproportionately, and within that group, it can often be fatal. So, apart from providing protection from an unpleasant health condition, the encouragement to get vaccinated on a seasonal basis exists in order to protect the more vulnerable segments of society. Personally, I decided relatively early in the pandemic that getting vaccinated against Covid was the right thing to do, and I did get my two shots and eventually my first booster. I didn't feel at great risk from the virus itself, and my decision was motivated by what I considered to be a moral duty. However, even though it's been available for quite a few months now, I haven't gotten my second covid booster. By the way, I have never once in my life been vaccinated against the flu—mind you, I don't recall ever catching that virus, even as a child, but that's really beside the point.

The question I ask myself is, if I originally felt so strongly that it was morally important for me and others to get vaccinated against Covid, why do I feel indifferent about the second booster and similarly, why do I not care to get the seasonal flu vaccine? After all, if herd immunity against a pathogen is achievable, and more importantly, if every individual who doesn't catch a virus reduces its rate of transmission, isn't getting vaccinated the right thing to do, even for the sake of protecting one vulnerable person and potentially saving just one life?

Blood donation

Let's now switch focus slightly. I am a regular blood donor. I believe I perform a good deed by giving away a small amount of my blood as often as possible, and I know that every time I do this, I am potentially saving at least one person's life. The reward I get from this is a good feeling, and that motivates me to make the sacrifice. Could I be doing more? Sure! I'm only able to donate blood every couple of months, but I could go in every week and donate plasma instead. What I could also do is give away one of my kidneys. I mean, I've got two of them, and somebody with my lifestyle and level of physical activity is able to lead a relatively normal life with only one kidney, and that extra kidney could make the difference between living and dying for another person, so why don't I undergo that operation? Wouldn't doing so make me a better person? If I am rewarded by the knowledge that my blood is helping to make someone's life better, wouldn't the reward be so much greater if I knew that one of my kidneys could add numerous years to someone's life? When I first thought of this question, I ran up against a wall and didn't know how to proceed, so I left it (not the wall, the question). Recently, I had been thinking about another concept, and when I revisited the question of vaccination, it suddenly clicked for me: the reason I haven't considered it important, or necessary, to get my second covid booster, why I've never bothered to get vaccinated against influenza, and also why I haven't given up one of my two precious kidneys, is quite simple. 

Cost-benefit analysis

It comes down to a cost-benefit analysis. Now, I know that sounds dry, and some of you may think that bringing an economics concept into questions of morality not only doesn't make sense, but it has an air of cold, calculating repugnance about it. Please keep listening though, as I'm hoping to convince you that it is absolutely relevant. I think that most, if not all decisions that people make, whether consciously or not, ultimately come down to a cost-benefit analysis, otherwise known as return on investment, and I feel quite strongly that this is what motivates my choices when it comes to any morally tinged decision that I make.

I'm going to talk more about cost-benefit in a separate episode, but for the time being, I want to focus on what might better be called a risk-benefit evaluation. Let's go back to the Covid vaccine. Now, I know the debate about this particular point still rages on the internet, if perhaps not so much in the outside world, but I'm fairly convinced that the coronavirus vaccines that have been approved by the FDA are safe for human use. Both the mRNA vaccines and the more traditional ones have shown themselves to be not only overwhelmingly safe, at least compared to any other vaccine—none of which is 100% safe or free of side effects, by the way—but also overwhelmingly effective at reducing the infection rate of the virus.

These are not the points I'm interested to discuss at the moment, however. What I want to look at is the risk-benefit evaluation that I mentioned earlier. Whenever we make any decision, what we are fundamentally trying to establish, whether implicitly or explicitly, is what it will cost us—and in this context, cost includes risk, or danger—versus what kind of reward we can derive from making that decision.

In this instance, you can think of it as the benefit of that decision, not only to yourself but overall, to everyone concerned. When it comes to vaccines, if we agree that they are safe, despite some unpleasant side effects, then the risk, or cost, is low. It includes the brief discomfort of the injection itself and the potential temporary side effects, which may include nausea, fatigue, numbness or aches, etc., but that's it! For most people, there is very little risk or cost greater than that. The benefit, on the other hand, is the reduction or prevention of the spread of a lethal virus. So even though it's difficult to quantify the benefit from one person getting vaccinated, this isn't really necessary, as it's easy to consider that by not catching the virus yourself, you are also not putting anybody else at risk of contracting it and potentially dying, and of course, we know that the fatality rate of the Covid-19 virus was quite high. So, without getting too much more technical, it seems clear to me that the benefit here is much higher than the risk.

What about donating blood? Again, the risk, or cost, to me is very low. It includes the momentary discomfort of a needle being inserted into my vein and the approximately twenty minutes of time that I spend waiting for the procedure to be completed. That's it! There's no other cost, or risk to me. The worst thing that can happen as a consequence is that I pass out at the end, which does happen to a small percentage of people, but since it's never happened to me, I don't really think about it as a risk.

What about the benefits? Well, the cookies and juice boxes I get at the end, duh! Oh, there's also the fact that I may be saving someone's life. So again, without getting too technical, the benefit of donating blood far outweighs the cost of the procedure. So those are things that I'm willing, even glad to do, because I've decided that the returns on my investment are worthwhile.

Cognitive dissonance

Now, let's go back to the question I find most vexing: if I am a good person, and I clearly demonstrate this by getting the covid vaccine and by regularly donating blood, why won't I seasonally get vaccinated against the flu, and why won't I donate one of my kidneys? What distinguishes the cost-benefit analysis I make between Covid and the flu and between donating a pint of blood and a vital organ?

The risks of the flu shot and the covid shot are approximately the same: minor inconvenience, a little bit of pain, nothing more. The benefits also appear pretty similar: reduction in the spread of a virus that can cause severe respiratory symptoms, even death, for some, or many people.

The choice seems straightforward then, right? The benefits outweigh the cost, so I should get the flu shot…but I don't. What's going on here?

I'm going to let you in on a little secret: I am not a perfectly rational human being. I know, big surprise! Sorry to disappoint anyone out there who thought that maybe I was Vulcan. One way in which my irrationality manifests is through cognitive dissonance. Cognitive dissonance is when somebody holds two contradictory ideas in their head, and despite this seeming conflict, they are able to function in a relatively normal way. Everybody experiences cognitive dissonance, some more than others.

In one of my previous episodes, I talked about the various beliefs that people hold and the fact that these beliefs do not match objective reality, so in essence, they are not true. The belief in gods is one of the more prominent examples of this. Millions of otherwise highly intelligent people go through life believing that a supreme being exists somewhere and ultimately has control over everything that exists and occurs. They believe this despite the fact that a logical reasoning process easily demonstrates how it is not possible. And so, this is an instance of cognitive dissonance. These people, who are highly intelligent, are fully capable of thinking rationally, and yet they believe something that is patently irrational. Despite this seeming conflict, what we call cognitive dissonance, they do just fine. In a similar way, even though I am a mostly rational and logical person, I also experience cognitive dissonance.

One form of this relates to my beliefs about vaccines, or as some might say, “putting a foreign substance into my body”. I have a tiny irrational fear of the unexpected consequences of vaccines that dissuades me from getting them if the benefits don't strongly outweigh the risks. Consider that I had to get the yellow fever vaccine before going to Central America a few years ago, and had it not been a requirement, I would've likely foregone this precautionary measure. My fear of it even caused me to nearly pass out right after I got the jab. Of course, the yellow fever vaccine carries a not insignificant risk of death for a small percentage of people, which likely influenced my feelings around it. Regardless, I imagine this is the reason that so many people refuse to get the Covid vaccine. The idea that despite what all the experts are saying, “what if it isn't safe? What if something bad happens to me if I put this stuff in my body?”

So again, if I think about it rationally, I realize that the risk to me from getting the flu shot is tiny and yet, that fear, in combination with the discomforts I mentioned earlier, dissuades me from making the morally superior choice. Crucially, and you'll notice that I glossed over this earlier, the benefit of the Covid shot is far greater than that of the flu shot, and this makes a huge difference in my calculation, even subconsciously. I know that while the pandemic was raging, thousands of people were dying every day, and stopping this massive body count was a total no-brainer. How many people die from the flu every year? I don't know, but I'm confident the numbers are nowhere near the fatality rate of Covid, and this ultimately influences the cost-benefit analysis I perform when deciding how to act.

Another thing I should point out is that even though my evaluation of the risks and rewards may be flawed, that's not what matters to me in the moment. What matters is my perception and understanding of the situation and how I balance out those two factors. The same goes for why I don't donate my kidney. I know the risks are low, I know that I can live a normal life with only one kidney, and I know that one organ can save a person's life. The less rational part of my brain, however, tells me that the survival of one person—one stranger, especially—is not more significant than my immediate discomfort and the potential decrease in my long-term quality of life. Ultimately, I choose personal comfort and safety over the life of another human being and morally, this is a flawed decision.

Summing up

So, to sum up: as relates to medical situations such as getting vaccinated or donating some component of my body, the benefit that I perceive, whether correctly or not, has to be significantly greater than the cost, or risk, in order for me to make the sacrifice, and as we will explore in a future episode, this calculation applies to every decision we humans make, whether we are cognizant of it or not. The balance between the cost and the benefit has to add up for each individual. It doesn't have to be a logical decision either, as it depends entirely on what makes sense to each one of us, and this is why different people often make contrary decisions, even though we all have access to the same information.

With that, I'll say goodbye for now. Thank you, as always, for listening, and I look forward to your feedback.