No jab, no job: a case for compulsory vaccination

I have been puzzled by the insistence of politicians and journalists that no-one should feel compelled to be vaccinated.

The place to start, perhaps, might be John Stuart Mill’s classic, On Liberty.

The object of this Essay is to assert one very simple principle … That the only purpose for which power can rightfully be exercised over any member of a civilised community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant. … The only part of the conduct of any one, for which he is amenable to society, is that which concerns others. In the part which merely concerns himself, his independence is, of right, absolute.

The people who are arguing against compulsory vaccinations have focused on the sentence in the middle: that we should not do things to people just because it is good for them.  Fair enough – but that is not what is being proposed.  The principle behind the slogan, ‘no jab, no job’ is that people have a duty to ensure that they do what they can not to infect others.  That principles protects us, but it also protects other people.

Now, I am not personally a liberal, or anything like as liberal as Mill; I do think that there are clearly defined circumstances where we do exercise power over individuals for their own benefit, and we are right to do so.  One example is compulsory education; another is compulsory sanitation.  There are reservations to make: we do this to enhance people’s independence and autonomy, not to undermine them.  When it comes to subjecting other people to avoidable harm, however, the same reservations do not arise.  People are not entitled deliberately or recklessly to endanger the lives of others, and that’s what the current dispute is about.

There is one part of the case that is uncertain.  It has not yet been shown for certain that vaccines reduce transmission, and transmission, not infection, is crucial to the welfare of others.  The main risk of transmission is probably while the disease is  asymptomatic, so that people carrying the disease do not know that they are infectious.  The current advice from the JCVI, the government’s expert committee, is this:

There is emerging evidence that vaccination may prevent asymptomatic infection, which may be inferred as evidence of an impact on transmission. However, while these data are very encouraging, they are still limited and currently there is no strong real-world evidence of an impact of vaccination on transmission.

I’m going to treat the argument as having two stages.  First, let’s take it that the effect of vaccines on transmission is possible, or even likely, but unproven.  As soon as that is admitted, it raises a critically important question for any employer: is it legitimate for them to expose either their clients, or their workers, to the entirely unnecessary risk of breathing the same air as someone who refuses to be vaccinated?  I think the answer to that has to be ‘no’, and it is unsurprising to read that Care UK  has elected to tell its employees that if they do not get vaccinated, they will be treated as not reporting for work.  What is surprising is that any responsible employer or service provider would think that they might be able to take a different position.  If the obvious happens, and one of the people they serve dies, they are inviting legal action, and saying ‘we weren’t completely sure that the vaccines would actually work’ is a pretty feeble defence.

Second, let’s ask what happens if the link is proved, and it becomes evident that vaccines suppress transmission.  At that point, it becomes clear that the effect of not being vaccinated is to expose other people to serious risk of infection, disability and death; and at that point, the argument for compulsion becomes unanswerable.

In memoriam, Robert Pinker

I have only just seen, belatedly, an obituary for Robert Pinker in the Telegraph (5th February).  Bob was the supervisor for my PhD thesis, on stigma, which he had written about in Social theory and social policy (1971).  Highlights of the supervision sessions included him accusing me of ‘unregenerative antinomialism’ and ‘intellectual joyriding’.  When it came to the viva, there was a crisis to resolve.  There was a bus and train strike, no public transport in London, and Bob had done his back in and couldn’t walk.  I borrowed my sister’s car and picked up Noel Timms, the external examiner, and we travelled together to Bob’s house.  We had the viva by his bedside, with Bob in blue pyjamas.   (I was sent out while they made a decision, which took some time.  I suspect, but don’t know, that Bob talked Noel round into letting me have the PhD without resubmission.)

Intellectually, Bob probably made the greatest splash in his defence of traditional social work for the Barclay report, but there was much more to his writing.  Talent, Schopenhauer once wrote,  is about being able to hit a target that no-one else can hit; but genius is hitting a target that no-one else can see.  In The idea of welfare, he worked through the implications of a series of relationships for welfare, finishing with the relationships between states.  The idea of global and international social policy had hardly registered at the time; Bob was too far ahead of the game to be fully appreciated.

I also fondly remember Bob performing a music-hall number, with his thumbs in his braces, at an impromptu singalong at a Social Policy conference.  He confessed that he’d thought about a career in music hall, but had opted to become a probation officer instead.

 

 

Social care: a tale of two countries

You wait for ages for a review of social care, and two of them come at once.  One is in Matt Hancock’s rather strangely timed proposals for reform of the NHS; the other is the Feeley report for the Scottish government, proposing a National Care Service for Scotland.

The English report has the catchy title, Integration and Innovation: working together to improve health and social care for all – I wonder if  they hired a consultant to come up with that one?  It’s a proposal for legislation on a range of topics, but lots of topics are listed as the subjects of a forthcoming bill, and the topics that are listed are difficult to match to any text that lays out the rationale.   In relation to the integration of health and social care, the main proposal seems to be that there will be a law telling people they will have to collaborate more eagerly. We all know, it seems, that the real problem is that we need a supervisory body to bang heads together.  And that, as far as I can tell, is about it.  Not a word about finance, or budgets, or professional barriers, or liaison, or … much at all, actually.  I can’t help feeling that I’m missing something, but I can’t tell what.

The Feeley report, by contrast, is rather good.  For one thing, it starts by asking people, both service users and professionals, what the issues are it needs to address. It points, for example, to the current arrangements for getting specific services to people: “It’s the equivalent of NHS staff having to make a case for funding every time someone needs a blood test.”  The panels knows that care workers are woefully underpaid.  It recognises, as the Hancock report doesn’t, that there has to be money.  The report argues:

There is a gap, sometimes a chasm, between the intent of that ground-breaking legislation and the lived experience of people who need support. In the improvement world, there is a maxim which reads something like “every system is perfectly designed to get the results it gets”. … We have inherited a system that gets unwarranted local variation, crisis intervention, a focus on inputs, a reliance on the market, and an undervalued workforce. If we want a different set of results, we need a different system.  … We need a transformation of the way in which we plan, commission and procure social care support.

I don’t agree with everything in the report, but that’s what happens if people who know what they’re talking about make their case with a rationale  and evidence.

If not now, when?: a report on social renewal

The title of the new report from Scotland’s Social Renewal Advisory Board is, ‘If not now, when?’  It’s a great title, but not a great report.  There are some areas about which I’d have minor reservations, and others where I’d have major ones.  The minor reservations are, for example, the recommendations that:

      • “It is time to trust (third sector and community) organisations to do good work without onerous requirements.”  Have we forgotten the abuse of charitable status that led to the reform of charity regulation?  Look up ‘Moonbeams‘ on Wikipedia.
      • “There are several themes that run throughout the report, again with links to Christie.  We need to make sure we embed the best partnership and practice.”  Partnership is already embedded.  On the positive side, it can focus attention on issues that get overlooked, such as poverty or learning disability, and it puts agencies into contact (such as the NHS and the police) where there didn’t used to be much.  On the negative side, it eats time and resources, and it can be as much an obstacle to delivery as a help.  The Christie Commission took the misconceived  position that every organisation should have a ‘common set of duties and powers’, including  a general power to ‘advance well-being’ (pp 46-7).  That would make every agency responsible for the work of every other agency.   Do we really want the health service to share the responsibility for developing railways?  If we want agencies to work together, we need an appropriate functional division of responsibilities, effective liaison at the sharp end, and budgeting practices that don’t set up walls between agencies.
      • “Hate crime must be addressed for all affected groups. We want to see significant investment in preventative approaches to hate crime, based on evidence of what works. … we want to see a significant improvement in the accessibility of reporting a hate crime or hate incident over the next five years so that hate crime reporting is more closely aligning with actual incidents. We also want to see an increase in people reporting street harassment to Police Scotland whenever they experience it.” This is saying nothing that isn’t already happening.  Yes, as someone who’s been responsible for maintaining a synagogue, I’ve been on the receiving end of hate crime; no, sharpening the criminal law is not going to stop it.

All right, these points are not really that ‘minor’.  But the ones that got my goat are in a different class.  On universal basic services, the Board has this to say:

“calls on the next Scottish Government to adopt the principles of ‘Universal Basic Services’  … In particular, the Scottish Government should undertake pilots into specific actions that could deliver reductions in energy, travel, housing, childcare and digital costs … These could include: … Social tariffs for broadband and other essential digital services – providing free and discounted digital access to low-income families across Scotland. …”

This misses the point of universal basic services completely.  They’re not meant to be targeted on people on low incomes; they’re supposed to be there for everyone.  I carried on to specific example of broadband, because it shows the point clearly – they’re talking about means-tested or passported services, not universal ones.   We should be looking at open-access, community-based broadband.

And then there is anti-poverty policy, where they recommend that the Scottish Government should “develop an approach to anti-poverty work,
including personal debt, that is designed around the needs of the individual”.  Of course I want to see well-funded advice and support for individuals, but it’s not an anti-poverty strategy.  It’s not even an anti-debt strategy.  People are in debt because (a) their incomes are inadequate and (b) the legal terms on which debt is enforced are pernicious.  The Scottish Parliament has the power to do something about both of those.

Universal Credit is not ‘spending’; it’s a transfer payment

At the risk of generating more fog than light, I’ve just tried to squeeze a complicated little argument into a tweet. Benefits are commonly presented, in public accounts and in the media, as a form of public spending.  That’s not strictly true.  Benefits are technically a form of ‘transfer payment’.  The government doesn’t actually spend the money; they pass the money to the people who receive benefits (pensioners, families and so forth) so that they can spend it.

This has one of two effects.  If the transfer is paid for by personal taxation – that’s not the only way for governments to raise money – then benefits are simply redistributive.  On the face of the matter, redistributive transfers are economically neutral  – they have very little effect.  If they do have an effect on economic activity, it’s because people on lower incomes may well spend their money differently from people on higher incomes.   Typically, they save less (so the money is used more) and they spend more on food as a proportion of their income.

If the transfers aren’t paid by personal taxation, the situation is a little more complex.  If the cost can be tracked to a specific form of finance, that may imply a different pattern of economic behaviour, and the transfer payment may not be so neutral.  However, government finance doesn’t work to a strictly balanced budget, and it’s quite possible that the money will simply have been created, like ‘quantitative easing’ or ‘helicopter money’.  In the present circumstances, there’s a very strong argument for government to maintain a flow of money in order to shore up economic demand.  Quite apart from that, of course, the case  for protecting people on low incomes while that happens is strong in its own right.

Stephen Kidd on universal social security benefits

I’ve just heard a superb  presentation by Stephen Kidd, of Development Pathways.  He argues that developing countries should be focusing on universal benefits, like child benefit or a universal pension, rather than the means-testing which is being rolled out in many poorer countries.  The  report, by Development Pathways and the Church of Sweden, is here.

To give a flavour of his argument, here are two graphs.  The first highlights the failure of selective benefits.  The best performing selective programme, in Brazil, excluded 44% of the eligible group.  The worst performing, in Rwanda, used community based targeting, and excluded more than 97%.

The second graph shows something about the tax take.  Offering universal benefits means that people feel included in the support offered by governments – and that means that they are more ready to pay tax.  Kidd argues that universal benefits create trust, and the sense of a social contract.

The simplicity of Universal Credit

I’ve just finished giving evidence to the Commons Scottish Affairs Committee about welfare in Scotland – the video is here, the transcript here.  The main point I stressed in the hearing is that we no longer have either a minimum threshold for income, or an effective safety net.  The first part is true because there are reasons for benefits not to be paid in full: the repayment of advances, notional income, the two-child limit  and overpayment recovery.  The second part is true because people may find themselves with no support: that can apply because of the five week wait, the 3 week wait for legacy benefits, sanctions, self employment status, immigration status or the treatment of capital.

I have to admit that I’m completely flummoxed by the repeated claims from politicians that Universal Credit is ‘simple’.  This seems to mean, that the UC works by comparison with the legacy benefits; but many of the complexities of legacy benefits, such as managing overpayments, conditionality, assessments and the benefit cap, are recent introductions.

Universal Credit is complicated by design.  It brings together disparate benefits within a common framework of rules. Pre-existing rules relating to worklessness, incapacity, and housing largely remain, and that means that UC is really a group of benefits clumped together under a shared masthead – a ‘portmanteau’ benefit.  Lumping benefits together doesn’t make them simpler.  First, there are the complications built into its design.  People can’t tell when they’re entitled, how much for, or when entitlement stops.  The amounts of benefit can change suddenly and unpredictably.  Second, there is the reliance on technology to fix the problems – tough for those who don’t have the facilities, tougher still when they’re locked down and free sources are cut off.  And then, third, there are all the rules  – multiple, finely discriminating rules, which turn the process into an obstacle course.  Examples are the rules for partners, reporting changes across multiple dimensions, capital rules and managing overpayments.  There are too many rules, and too many moving parts.

 

 

Comments from Twitter:

‘Welfare’ doesn’t mean what it used to mean

The Nevada County Sheriff’s Office is not, I have to admit, one of the sites that I regularly monitor for information.  I get daily notifications from Google on a range of topics, including  ‘benefits’, ‘poverty’ and ‘welfare’.  It was the third of these that pointed me towards a police report from Nevada. Here it is:

12:16 p.m. — A woman dialed 911 accidentally. She was told to provide her address or law enforcement would perform a welfare check. She said, “I’m not on welfare and never have been,” before hanging up.

‘Welfare’ in the United States used to mean social assistance – Aid to Families with Dependent Children, then Temporary Aid to Needy Families. However, I’ve noticed, over the last three or four years, that nearly all of the notifications I’ve been getting from the United States have been about something else: a ‘welfare check’, which usually means a visit from a police officer or other official to make sure you’re alive. The term is also used by police forces in the UK, Canada and Australia. Try this, from Cleveland:

Woman tries to run from police during welfare check … Police responded to a business at 9:16 a.m. Nov. 3 regarding an employee who was “acting strangely” and refusing to leave the property. The employee appeared to be upset when police arrived and tried to jump into her car to flee at one point.  Suspected marijuana was found inside the woman’s car and she was taken to a nearby hospital for evaluation.

And this one is from a recent report in Texas:

Welfare check leads to large police presence at Smith County home

Authorities have cleared the scene of a welfare check at a home in Smith County. A SWAT team, Tyler police officers, Smith County sheriff’s deputies, and an ambulance could be seen at the home in the 5500 block of Old Henderson Highway during the noon hour Friday. Traffic was blocked while law enforcement surrounded a home. … the welfare check started with an individual calling the VA hotline and threatening to harm himself … the man did possess a handgun.

A SWAT team is just what you need if you’re thinking of killing yourself.  The Samaritans seem to be missing a trick.  But back to Nevada.  The report throws up two other issues.  One is that this woman, whoever she was, obviously thought that ‘welfare’ did still refer to social assistance.   The second is that an accidental call to 911 is considered to be a good reason for police to come out for a ‘welfare check’.  I can see the reasoning behind that – someone who is being threatened might have been intimidated into dropping a call.  However, it does seem to be part of a new interpretation of ‘welfare’, up to and including calling out the SWAT team.

Funeral support payments: how much information is too much?

When I’ve written about social security payments before, I’ve at times referred to  Funeral Payments as a example of where the system goes wrong – as in my blog, here.  It has too many moving parts to be workable.  I was interested, then, and pleasantly surprised, to see that applicants have few complaints about the application process. You can see what’s asked here,  because the Scottish Government has understood that people need alternatives to on-line processes.  It’s still a convoluted process: applicants are asked about themselves, whether they get benefits,  their relationship to the deceased person, the estate’s resources and the funeral arrangements.

Most complaints in the  claimant feedback, however, are about something else entirely: the details on equalities, which account for the last five pages of the form.  People resent those questions, it seems, because they’re not really about the process at all – and the questions are consequently seen as intrusive, in a way that the earlier questions are not.  People should be able to bury their mother without having to tell a government agency that they’re gay.

The Danmask-19 trial has not told us if masks work or not

A study from Denmark has put into question the effectiveness of wearing a mask.  It’s based on a randomised control trial of 6024 people, assigned either to a mask-wearing group or a control group that didn’t wear a mask.   42 people who wore masks, and 52 people who did not, contracted Covid during the test period.  The study notes that “the findings are inconclusive, with CIs [confidence intervals) compatible with a 46% decrease to a 23% increase in infection.”  Prof. Carl Henegan, writing for the Spectator, has seized on this as proof that any effect masks have is small.  (The Spectator, of course, has serial form in seeking to belittle or deny the seriousness of the disease.)

The problem with that conclusion (or the lack of it) is that the Danish study has not actually tested whether masks are doing what they’re supposed to do, which is to slow the rate of infection.  The graphic which follows, from the New Jersey Department of Environmental Protection, explains what should happen.   The control trial has been looking at people on the top two lines – putatively, groups at higher risk.  The distinction between the higher and lower risk (lines 1-2 and 3-4) depend on people who are infectious wearing masks to stop the spread.  There are claims on the web that the risk on line 1 is 90%, the risk on line 2 is 70%.  I don’t know whether those numbers are well founded, but if they are right, the expected values from 94 cases would be 41 masked cases (42 actual) and 53 unmasked cases (52 actual), which is bang on the nose.  The claim that the risk of transmission reduces to 5% on line 3 is potentially far more important, but Danmask-19  can tell us nothing about that.  Whatever the true figures may be,  the risk of transmission is not the subject of the control trial.

Mask Up!