t has been often said that the very intelligent are not immune to bad ideas, often because they underestimate the powers of their own biases and often cannot step back. The US Senate and Congress are full, both sides, with bad faith actors. They are tribal and toe party lines without without much reason, or if so, it's with forced reason. There are a few who forcefully show reason, often forcefully in opposite directions, and Rand Paul, the Republican Senator for Kentucky, is one of those.
For those that don't know, he is the son of another senator, Ron Paul, who as a maverick independent ran for President on several occasions, but as an outsider to the Republican establishment failed, a bit like a libertarian Bernie Sanders but not getting quite so close. The son thinks closer to Republican orthodoxy and ran, like his dad, for the Republican nomination in 2016, which was when Trump smudged out the opposition to be the contender and eventual president.
Anyway, he is one that can put a thought or more together and here I give you a smart man with wrong ideas. (1) Rand Paul Attacks Dr. Fauci (Again) Over Vaccines, Covid Mandates - YouTube
I like smart people who disagree with me because it is an interesting mental challenge which forces you to ask yourself how entrenched are your own biases are, or whether it is reason or truth that makes their words have power. He is a convincing speaker.
But I would still argue, despite his conviction, that his reason is more a product of his biases. Let's look:
The opening has him saying that the US vaccination situation is not perilously placed because "over 90% of people over 65% are vaccinated". To be clear, the United States has pretty much hit its ceiling for willing recipients and resorting to mandates and they're not that far along. For perspective as of today, 65% of the whole US population has at least partially vaccinated (compared with 72% for NZ) with 56% fully vaccinated (compared with 52% in NZ), but New Zealand is still steaming along! We'll probably pass them for double within the next week.
But does he not have a point: Covid-19 is particularly harsh on those 65 and older, and it has long been a suggested strategy that we somehow shield the old and let the young go about their lives, and vaccination should be that shield. And this fits a very libertarian view of the world that has a lot of merit, that people should make the choices that suit them: Young people want to play. Old people should hunker down. And with a much vaunted highly effective vaccine the libertarians, even the circumspect ones, would want to return to their principles.
Except you can't and the representative for Kentucky should know that almost 25% of their death toll for the duration of the pandemic has been in the last two and half months, when the majority of the vaccinations in his low vaccination state have already had plenty of opportunities to vaccinate.
The difference of course is in the herd immunity concept, and that is where the libertarian bias is exposed. Vaccination, even before Covid, was not just for individual protection but to have a community protection, because even if the elderly are vaccinated, they will still be vulnerable, albeit much less so. The probability of them meeting this virus when their immune system is low is a function of their environmental level of protection, the people around them. And while kids have the lowest risk, they are the grandchildren who spend time with their elders. And this is the aside because age is only one aspect of risk.
Paul thus overstates the personal responsibility that in economic terms would be reasonably rational and applies it to pandemic public health. But community responsibility has little part in his consideration - it has a whiff of socialism and collectivism and the greater good. These would not be part of this speech.
The part about multiclonal antibodies has more than a trace of bad faith. The treatment costs about $2000 compared to over $20 for a Covid jab, and was in limited supply, bankrolled by the Federal Government which pre-ordered it, and best used in the early stages of the condition when the virus, rather than the body's response to it, can be curbed. Public health is caught in this dilemma that any treatment detracts from the push for vaccination, but Paul is also one for autonomy and choice of healthcare and resents people not having the choice. The central government control is something that chaffs a libertarian; in New Zealand we have a similar situation with regard to Pharmac which allows medicines to be purchased by the state and subsidised for use in public health services.
His discussion about masks could be more relevant. There is no doubt that there are masks of differing effectiveness, and in the situation he specifies you would hope that the elderly positive case was in hospital for care, in the usual isolation practiced; and if not, that all the precautions and guidance for care made. But any mask, especially for the infected is better than no mask. And almost any mask in a poorly ventilated room over a long enough time will fail. In the end, it's a matter of probabilities. When we go walking, we generally wear cloth masks, but more as a consideration for others. But if I go to the supermarket, I'll wear a surgical mask. Now that the pandemic in Auckland is getting a bit worse, I think we'll upgrade to N95 if they are available. Really the argument is really just picking a fight with his nemesis "Dr Fauci".
His final argument seems a strawman. Or a couple of strawmen. The idea of targeting the vaccine in the US is not an issue unless he is suggesting what he would never suggest: the mandatory vaccination of the elderly. But that never would be more reasonable to him than the mandatory vaccination of children as part of a childhood vaccination. He is not suggesting forcing the unvaccinated elderly to get the jab. His argument about doing antibody tests prior to getting vaccination seems reasonable except for the fact that it again puts up more drag and resistance to the vaccination campaign, and thus the community protection. And how many pre-existing antibodies are enough? As was found early in the pandemic, asymptomatic infection is reasonably common, which might cause a very mild immune response but perhaps detectable antibodies.
To be clear, I think if someone can prove their previous infection and antibodies to it, which is probably something becoming more commonly done and more feasible to do, I'd say let them have an immunity passport but it should also be understood as having an expiry.
The final conclusion is where the bias, which is his pre-existing lens for which all of public health is understood comes out: individual responsibility; personal choice is king; dissension should be encouraged. In most contexts I agree, except for a time when we should be pulling together like now.
A final note: I'm not sure how I feel yet about the YouTube, Twitter and Facebook censorship of "misinformation". I think like all things it is something that is easier said than done, and almost any rule for it is likely to have unintended consequences, or require a byzantine system that will certainly seem unfair to some. Right now the by-catch of reasonable discussion is getting hit to the extent of exacerbating the sense of an authoritarian plot.
Anyway, I enjoy listening to Rand Paul even if he cannot get down from his a priori views.
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