Honor System for Vaccination?
post by jefftk (jkaufman) · 2023-09-24T11:50:05.809Z · LW · GW · 22 commentsContents
22 comments
In June the social dance I help organize decided to drop its requirement that people be vaccinated and boosted:
Checking vaccination cards at the door requires an additional volunteer, is a hassle for attendees, and at this point the communities we draw from are overwhelmingly vaccinated. While we still recommend staying up to date on vaccinations (including your flu shot and covid booster in the fall!), we're dropping this requirement starting with our July 2nd dance.
One question we got, both in person and electronically, was why not keep requiring vaccination on the honor system? Speaking for myself and not BIDA, I think this is rarely a good policy for events.
(I'm setting aside the question of whether vaccination is helpful in reducing risk to others, and writing all of this under the assumption that it is. I do think this is unclear, especially if a policy does not require a recent booster.)
The issue is, an honor system is a bad fit when getting caught is very unlikely and the harms of violating the rule are diffuse and unclear. If an unvaccinated dancer ignores the policy and does happen to bring an infection to the dance that vaccination would have prevented, it's very unlikely that anyone will ever know. There's no feedback mechanism promoting honesty here. Instead, you're filtering unvaccinated people for ones who are ok violating the policy, and nudging more unvaccinated people toward being dishonest in this way.
Compare this to a dance in a small community that does payment on the honor system: an unattended fiddle case by the door for you to drop your money into. If someone doesn't contribute it's much more likely that people will notice, and it's also much clearer that when you defect you're hurting people. There's still some pressure toward dishonesty, but there's enough pushing the other way that it still works well.
The honor system can work well in some cases, but I don't think this is one of them.
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comment by AnthonyC · 2023-09-26T15:46:00.698Z · LW(p) · GW(p)
I agree that the honor system does not seem likely to accomplish the stated goal of reducing the presence of unvaccinated, unboosted people. Either of the other options (require proof, or don't require the vaccine) seems better.
However, and please point me to the countervailing recent data if I'm missing something major, I really do find it baffling that this could be a context where that would be actually make a meaningful difference to a vaccinated and boosted attendee's expected health outcomes. From what I have read the impact of vaccination on transmission falls off pretty sharply within a couple of months of getting boosted, even if the booster has the "right" strains. Plus, we're all around unvaccinated people all the time without knowing who. Yes, there's less close contact outside a dance, but it's far more frequent. In other words: at this point I think we really should be treating vaccination as a way to reduce seriousness of infection, and accept that the choice of an event to mandate vaccination or not makes very little difference to the odds of getting covid. The rest of the world isn't thinking that way, and dominates the risk profile.
And as disingenuous as this argument was in 2021, based on death rates this year, I have to ask: I assume if you require a covid vaccine you're also requiring a flu vaccine? The numbers are obviously different, but they're well within the same OOM of risk at this point.
Replies from: jkaufman↑ comment by jefftk (jkaufman) · 2023-09-26T15:56:02.041Z · LW(p) · GW(p)
accept that the choice of an event to mandate vaccination or not makes very little difference to the odds of getting covid
I don't disagree [LW(p) · GW(p)].
I assume if you require a covid vaccine you're also requiring a flu vaccine?
I mean, I'm not requiring anything. But I do think that events that decide to require covid vaccinations should generally also require flu vaccination, yes.
Replies from: AnthonyCcomment by Ninety-Three · 2023-09-24T14:24:36.971Z · LW(p) · GW(p)
This explains why the honour system doesn't do as much as one might hope, but it doesn't address the initial question of why use explicitly optional vaccination instead of mandatory + honour system. If excluding the unvaccinated is desirable then surely it remains desirable (if subtoptimal) to exclude only those who are both unvaccinated and honest.
comment by Dagon · 2023-09-24T15:55:28.632Z · LW(p) · GW(p)
I don't think this analysis is comparing the right things. The honor system for vaccinations is worse than enforcement, as you note, but it's probably not worse than nothing at all, which is what you actually chose.
Honor system has other bad effects, like turning some people into the honor police, who go further than others would like in investigating. And implying that disagreement or inability to comply is "dishonorable". But in pure effectiveness terms, it's above zero.
Replies from: jkaufman↑ comment by jefftk (jkaufman) · 2023-09-24T17:37:29.713Z · LW(p) · GW(p)
My claim is that if you're considering doing "mandatory + not checked" you'd be better off with at least one of "mandatory + checked" or "optional".
Replies from: Dagon, Firinn↑ comment by Dagon · 2023-09-24T19:41:42.351Z · LW(p) · GW(p)
I don't think you've shown that "mandatory + not checked" is worse than "optional" for this case. Presumably there's nonzero positive impact by explicitly stating that members are attending under the expectation that everyone is vaxxed, even if it's not verified.
Replies from: jkaufman↑ comment by jefftk (jkaufman) · 2023-09-24T20:47:36.345Z · LW(p) · GW(p)
> I don't think you've shown that "mandatory + not checked" is worse than "optional" for this case.
But I'm not claiming that. I'm claiming that , not , where is mandatory and checked, is optional, and is mandatory but not checked.
That is, if an event is considering they're better off with at least one of or .
Replies from: Dagon↑ comment by Dagon · 2023-09-25T14:32:19.466Z · LW(p) · GW(p)
[note: this is a minor point, and not worth the electrons we've already spilled - I'm pursuing it because I don't quite understand your position, not because I (necessarily) disagree. I value the post and conversation, and thank you for sharing very concrete examples of thoughtful decision-making. Feel free to ignore me if this is getting annoying. ]
That is, if an event is considering they're better off with at least one of or .
I don't know how to read the "or" or "at least one of" that doesn't lead me to the reduction that C<A and C<B, so a group at C would be better off by moving to A and would also be better off moving to B.
Let's use (made-up, used for ordinal rather than cardinal values) numbers. C (mandatory but not verified) is effectiveness 2. A (mandatory and checked) is 5, say. I think that B (optional) is 1.9 (ok, I couldn't avoid opining about magnitude). I'm reading your post and comments to imply that B is 2.1.
Replies from: jkaufman↑ comment by jefftk (jkaufman) · 2023-09-25T15:27:14.906Z · LW(p) · GW(p)
[ I agree that this is getting a bit silly, but happy to keep going if you're interested ]
if an event is considering C they're better off with at least one of A or B
I don't know how to read the "or" or "at least one of" that doesn't lead me to the reduction that C<A and C<B
I think this is the core misunderstanding. I take my quoted text as pretty clearly claiming that exactly one of the following is true:
- C < A
- C < B
- C < A and C < B
I think you're reading it as claiming only (3)? For my quoted text to claim only (3) I think it would need to be something like "if an event is considering C they're better off with any of A or B".
Replies from: Dagon↑ comment by Dagon · 2023-09-25T15:36:31.333Z · LW(p) · GW(p)
Interesting. It's pretty clear that 1 is true. I think 2 is false, and therefore 3 is false. I don't understand the inclusion or discussion of B (which seemed to be the bulk of the post), if no claim is being made about it.
Replies from: jkaufman, jkaufman↑ comment by jefftk (jkaufman) · 2023-09-25T17:04:45.051Z · LW(p) · GW(p)
It's pretty clear that 1 is true. I think 2 is false, and therefore 3 is false.
In which case a group should not choose C, because A is better.
My overall point with this post is that groups should not be choosing C.
↑ comment by jefftk (jkaufman) · 2023-09-25T17:02:45.011Z · LW(p) · GW(p)
I don't understand the inclusion or discussion of B (which seemed to be the bulk of the post)
The bulk of the post is about my objections to C, though?
Replies from: Dagon↑ comment by Dagon · 2023-09-25T17:28:13.831Z · LW(p) · GW(p)
Seemed to me that they weren't so much objections, but reasons it wouldn't be particularly effective. In particular, it didn't seem to make the case that the actually implemented policy of B (no requirement) is the correct choice, when someone proposed a switch to C after eliminating A from consideration.
It would seem, in that discussion, that comparing B to C is the only relevant consideration. "both are ineffective and B is easier" is a fine answer, but didn't seem to be your position. I read your post as "switching from B to C would be a mistake, because C is ineffective", and perhaps-mistakenly assumed that this implied that B is not (as) ineffective. At which point I noticed I was confused.
Edit: if you were simply saying that "C may or may not be slightly better than B, but neither are good enough and we need to switch back to A", then I get it, but I fully missed that on the first and second reading of the post and comments.
Replies from: jkaufman↑ comment by jefftk (jkaufman) · 2023-09-25T18:13:32.438Z · LW(p) · GW(p)
At the current time, I think . When conditions were different I thought . I have a lot of trouble imagining a situation in which I wouldn't think .
A decision procedure where you eliminate and then decide between and even if you think or is a pretty bad one.
Replies from: Dagon↑ comment by Dagon · 2023-09-25T18:26:14.656Z · LW(p) · GW(p)
Ok, I follow. I read the intro paragraph as EXACTLY the (pretty bad) situation where the group had eliminated A and implemented B, and someone had proposed switching from B to C, and your analysis being mostly about why that proposal was wrong. Which caused my confusion when it didn't compare B and C very directly.
I'm still a little unsure of your reasons for those current orderings (both A<B and C<B (transitively) surprise me, if considering only effectiveness and not convenience or other factors. Considering social equilibria, any ordering could apply to a given group). I would put myself at B < C < A.
Replies from: jkaufman↑ comment by jefftk (jkaufman) · 2023-09-25T19:17:47.482Z · LW(p) · GW(p)
The organizers considered A, B, and C, and chose B. An attendee asked why not C, and I wrote up my personal views on why I don't think C is a good choice.
(I was trying pretty hard not to get into the object level stuff here, but ok, let's go. On why I don't rank A very highly, I think vaccination, especially the initial series, is great at protecting the recipient from the severe effects of covid. In terms of protecting others, which is the main thing that matters if you're deciding whether to restrict some people from attending the event, I think someone who had covid three months ago is probably less of a risk to others than someone who was boosted nine months ago. Other people's vaccination status just isn't a very good proxy for how much risk they pose.)
↑ comment by Firinn · 2023-09-24T18:51:12.389Z · LW(p) · GW(p)
What would you think about a solution like "if you're not vaccinated and you loudly say so then we'll ban you, but otherwise you'll get away with it"?
I can see how it'd be negative to filter out "unvaccinated and honest about it", creating selection for "unvaccinated and willing to lie about it"; you don't like liars. But I also think I'm more willing to accept someone who's quietly unvaccinated because they're very scared of needles (but who also basically agrees that vaccines are good, and is sort of ashamed about being unvaccinated), and less willing to accept someone who regularly posts on Facebook about how vaccines were invented by Satanists in government to inject compliance drugs so the Illuminati can take over. When I frame it as selecting for people who are "unvaccinated and willing to shut up about it", rather than selecting for people who are "vaccinated and dishonest about it", I think I like the sound of that selection effect a lot more. So I think I'd be interested in a policy like "if we find out that you're unvaccinated then we'll ban you, but we're also not trying very hard to find out". Maybe there's a useful distinction between requiring dishonesty and requiring silence?
Replies from: jkaufman↑ comment by jefftk (jkaufman) · 2023-09-24T20:51:19.245Z · LW(p) · GW(p)
I don't really understand what you're trying to accomplish with this policy? I can't think of any social dances that exclude unvaccinated people because the organizers find anti-vaxxers annoying; they're trying to reduce infection risk.
Replies from: Dagon, Firinn↑ comment by Dagon · 2023-09-25T17:41:17.840Z · LW(p) · GW(p)
There are (at least) two channels at play. Unvaxed people are more likely to spread Covid. Visible acceptance of anti-vax sentiment is more likely to attract more unvaxed people (and likely to reduce boosters among the ambivalent vaxed). When you're not checking vax cards, you can adopt policies that make vaxx the default, obvious preference, even without formal enforcement.
↑ comment by Firinn · 2023-09-25T02:43:49.730Z · LW(p) · GW(p)
I think antivaxxers could plausibly pose a higher infection risk because they're unusually likely to hang out with other unvaccinated people, or to do other bad decisionmaking. Someone who's unvaccinated because they're scared of needles might still make good decisions otherwise - like they might stay home if they're feeling a sniffle, or test themselves for COVID if their housemate is sick.
Also, you want to exclude unvaccinated people because they pose an infection risk, so you already wanted to exclude anyone who posts "I hate vaccines" on Facebook. You're just worried about the incentives or selection effects if you use an honour system, because some people will lie and say they're vaccinated when they aren't. I'm suggesting that the incentives or selection effects aren't as negative if you only require silence, so nobody has to actually lie.