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Sunday May 9th

We talked with an epidemiologist about vaccine ethics, new CDC guidance and more

<p>Dr. Jim Thomas, as photographed in 2012, is an associate professor in the department of epidemiology at the Gillings School of Global Public Health. His research interests include the ethical practice of public health during a pandemic.&nbsp;</p>
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Dr. Jim Thomas, as photographed in 2012, is an associate professor in the department of epidemiology at the Gillings School of Global Public Health. His research interests include the ethical practice of public health during a pandemic. 

One year ago, experts, government officials and the public grappled with uncertainty regarding COVID-19, unsure of the proper protocol and precautions. 

Now, as the public faces an optimistic vaccination timeline, people are eager to receive the vaccine. But as researchers come to better understand the effectiveness of vaccines at reducing transmission, changing recommendations have left some feeling confused or skeptical.  

As of March 16, over 1.3 million North Carolinians have received complete doses. 

The Centers for Disease Control and Prevention recently released new guidance, stating fully vaccinated people may gather indoors without wearing a mask. They can also gather indoors with low-risk unvaccinated people from one other household.

People are considered fully vaccinated two weeks after their second dose of the Pfizer or Moderna vaccine, or two weeks after the single dose of the Johnson & Johnson vaccine. 

But how should people adapt their behavior as things continue to change? 

Jim Thomas is an epidemiology professor in the UNC Gillings School of Global Public Health. He helped advise the CDC and created a Pandemic Ethics Dashboard to guide policymakers through ethical dilemmas posed by the pandemic. 

The Daily Tar Heel sat down with Thomas to reflect on the past year of ethical dilemmas under COVID-19 and how both institutions and individuals can make better decisions as vaccines become more widely available. 

The communication from the CDC is more about effectiveness of disease control. They're not really getting into the ethics of things, but they're talking about how even if you're vaccinated, you shouldn't do this or that, because who knows what kind of things you might be transmitting. And your question is how can we know? Well, one of the things we're faced with is a lack of scientific evidence. Public health and public health ethics desire to be guided by evidence, and we're lacking it with this virus. Things are moving so fast that it's really hard to gather the evidence in time.

That argues for taking actions on the side of caution, to wear a mask a little bit longer than you think you should or in a few more places than you think you really need to, with a few more people than you think — to be conservative in the steps that we take.

Now, I don't want to argue for being overly conservative because if we're really stringent, it gets quite depressing. We all want relief. And there's a lot of optimism that comes with being vaccinated. We don't want people to think there's no benefit to being vaccinated that it's just always going to be like this. So I think the guidelines about if you're vaccinated and the group of people that you're meeting with are vaccinated, you can get together without masks. That's the kind of thing that we need to be clear about, that we need to celebrate, that we can finally get together for these things.

The way that vaccines are being distributed around the country is the states are organizing the vaccination programs. Within the states, they allocate to counties. There is criticism for people who are crossing state lines. That's generally considered unethical. But the state is trying to distribute vaccines according to demand, but there it ends up that there are some counties where the ratio of vaccines to people is more favorable than others in our county.

Here in Orange County, at least initially, it was less favorable — there were fewer vaccines for the number of people within Orange County. There were some who were traveling to Chatham or to other countries nearby, and I don't think that's unethical. You could kind of tie yourself into a pretzel and think about how you're taking that away from somebody else. But on the other hand, you're freeing up a slot in the county that you're not getting vaccinated in. You could actually be helping to even out the distribution if it's really hard to get one in Orange County, but it's easier to get one in a neighboring county.

Younger people are less often symptomatic, but they can have long-term consequences of infection. I would hate to see them postpone it too much because they can get infected and there can be serious consequences.

There does continue to be the risk of becoming infected but also the risk of transmitting to others. The number of people who can be affected by that will decrease as we move towards what we hope we can achieve of herd immunity. But public health has this challenge built into it, for as it approaches zero or as it approaches completion, we lightened up our efforts.

And that's a very dangerous point in time because it can quickly lead to a resurgence. That happened back in 1918 and it has happened in other epidemics. So I think that we still have this balance of concern for self. Even for those who are less likely to get symptomatically infected or seriously infected, there is still that concern for the overall population, there are still old people who are unvaccinated, there are still essential workers who are unvaccinated and can have serious consequences.


@Jacob_M_Andrews

@DTHCityState | city@dailytarheel.com

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