A compromise on the military COVID vaccine mandate
Many readers vehemently disagreed with my recent column in favor of ending the coronavirus vaccine mandate for the military. As they argue, there is a key difference between the military and everyone else: Force readiness is a matter of national security, and even a small reduction in infection or severe disease is worth a mandate.
This is an excellent point and has led me to partially reconsider my position. There might be a compromise: Keep the mandate in place but create an opt-out for those who have already contracted COVID-19.
In a way, this debate is moot. Last Thursday, the Senate voted 83-11 in favor of reauthorizing the defense budget, which includes repealing the vaccine mandate. So whether the Pentagon likes it or not, it is almost certainly going away.
Nevertheless, I hope my proposed compromise might change how people think about coronavirus vaccines. It’s crucial to discuss immunity from infection, because abundant research shows natural immunity conveys excellent protection against COVID. One Centers for Disease Control and Prevention study found that vaccinated people who never had COVID were at least three times as likely to be infected as unvaccinated people with prior infection. And a Lancet study found that those who were vaccinated but never had COVID were four times as likely to have severe illness resulting in hospitalization or death compared to the unvaccinated who recovered from it.
Protection from natural immunity also wanes at a slower rate than from vaccination. A recent large Israeli study published in the New England Journal of Medicine compared two groups of people: one that had been vaccinated and never had COVID before, and another that never received vaccines but had recently recovered from COVID. The results are striking: Two months after their shots, members of the first group had twice the number of infections as the second. And after six months, the first group’s infection rate was nearly three times higher than the second’s.
An updated booster dose could temporarily increase effectiveness, but the Pentagon doesn’t require it. The existing mandate is for the first two doses, which most service members probably received a year and a half ago. If that’s all those individuals received, they are almost certainly less protected from COVID than people who have had the virus.
Which is most of the unvaccinated. According to a CDC analysis, more than 90% of adolescents have contracted the virus. Of the estimated 8,000 troops who have been discharged for not being vaccinated against COVID, the vast majority probably have recovered from the coronavirus and have better protection than those who were never infected but received the two required inoculations.
To be clear, vaccination is still a much safer way to develop immunity. I would never encourage “chickenpox parties” for COVID. But that doesn’t mean we should deny the existence of natural immunity. If the goal is to ensure a high level of protection among troops, then test for prior infection. There is precedent for this; recruits can be exempt from getting chickenpox and measles vaccines if a blood test demonstrates they have recovered from those illnesses.
Still, some critics will ask, why there should be an opt-out? What’s the downside of requiring everyone to be vaccinated? And while we’re at it, if boosters provide some temporary protection against infection, why not do as some readers suggested and boost all the troops every three months?
Besides the logistical difficulty of such frequent inoculations, we need to be upfront that nearly every intervention has some risk, and the coronavirus vaccine is no different. The most significant risk is myocarditis, an inflammation of the heart muscle, which is most common in young men. The CDC cites a rate of 39 myocarditis cases per 1 million second doses given in males 18 to 24. Some studies found a much higher rate; a large Canadian database reported that among men ages 18 to 29 who received the second dose of the Moderna vaccine, the rate of myocarditis was 22 for every 100,000 doses.
While most cases of vaccine associated myocarditis resolve without long- term consequences, some individuals become very ill and require intensive care. In mild cases, the heart muscle can take months to heal. Those arguing in favor of mandates because they keep the military operational must acknowledge that coronavirus vaccine side effects can sideline service members, too.
That’s why, at this point in the pandemic, the coronavirus vaccination should not be a one-sizefits-all recommendation. There are those, such as the elderly, who are clearly better protected with regular boosters. Young, generally healthy people who have never been infected with COVID would probably benefit from the first two shots. For this group, I could understand a requirement for the military.
But for those who with documented prior infection, I’m not convinced that the mandate makes them — or others around them — any safer. And that’s why, despite all the anger from both sides, repealing the mandate would make little difference in the battle against COVID or the force readiness of our troops.