Being unvaccinated and infected and going out in public might be like drunk driving. But being unvaccinated isn’t.

That’s just … driving.

But then Wen’s always been an extreme COVID hawk even by the standards of restrictionist medical professionals. She may be the only commentator in American media today who’s criticizing Biden’s new mandate policy for having not gone far enough. In particular, she’s been a hardcore proponent of vaccine passports, wanting to choke off the unvaccinated’s access to public spaces until they basically have no choice but to get their shots. She’s disappointed that Biden wasn’t more aggressive on that front yesterday:

For starters, why didn’t Biden announce that he will mandate vaccinations for plane and train travel? The federal government has authority over interstate travel, and it already uses this power to require that masks are worn in airports and on planes and trains. Requiring vaccinations for those eligible for them will make travel safer, but that’s not the primary reason for taking the step. The Biden administration needs to make clear that there are consequences to remaining unvaccinated. If you want the privilege of traveling, you need to do your part and get vaccinated.

Similarly, the White House should urge businesses to implement “no vaccine, no service” rules. San Francisco and New York have been out front by requiring vaccines to enter indoor restaurants, bars, gyms and other venues. The president should support these efforts by providing financial incentives to jurisdictions and businesses with such mandates and encouraging vaccinated Americans to preferentially frequent these establishments.

There she was on CNN last night, pushing her “drunk driving” analogy:

Remaining unvaccinated & going out in public is equivalent to driving under the influence. You want to be intoxicated? That’s your choice, but if you want to drive a car, that endangers others. No one should have the “choice” to infect others with a potentially deadly disease. pic.twitter.com/a4itLS2upX

— Leana Wen, M.D. (@DrLeanaWen) September 10, 2021

“Beyond being a terrible metaphor that has no bearing on the matter at hand, articulating this thought reveals a discrediting level of paranoia,” Noah Rothman wrote in reply. “The data do not in any way indicate that those who are immunized against COVID are threatened by those who are not any more than they are by many other communicable diseases.” That was one of the most common complaints about Biden’s new policy yesterday: If the vaccinated are already well protected from severe illness, why do we need to further protect them by forcing the unvaccinated to get their shots too?

We are going to protect the vaccinated workers from unvaccinated coworkers. pic.twitter.com/QMuEz9ynis

— President Biden (@POTUS) September 10, 2021

To borrow Wen’s analogy, if an infected unvaccinated person is a drunk driver, how much should we care about them being “on the road” in the workplace if the vaccinated are driving around in armored vehicles?

I don’t mean for that to sound glib. There’s a debate worth having about how much the unvaxxed should be made to capitulate in the name of protecting the vaccinated from even mild illness, which can be not so mild in substance. If the vaxxed were getting severely ill and landing in the ER from COVID at a meaningful rate then the case for requiring the unvaccinated to get their shots would be easy. But if, to put it in Wen’s terms, the worst a vaccinated person stands to suffer from an unvaccinated “drunk driver” is a dent in his fender, is that reason enough to keep the unvaccinated off the roads?

Relatedly, is being very sick for a week (as some people with breakthrough infections are) the equivalent of a dent in the fender or is it more like a broken arm or leg? If the latter, does that change the calculus on the unvaccinated? Do we want drunk drivers routinely causing accidents that leave other drivers with broken limbs so long as they don’t actually kill anyone?

Dr. Ashish Jha tried to answer the objections to Biden’s new policy in a Twitter thread this afternoon. All of his points are sound. But none justify the logic of Biden’s mandate:

3. Raging infections shut down restaurants, stores, make it hard for folks to get people back to offices

4. High infection rates put vulnerable people who can't get immunity at risk

Pandemics sicken and kill a lot of people

But they also disrupt the social fabric

3/4

— Ashish K. Jha, MD, MPH (@ashishkjha) September 10, 2021

We should get people vaccinated because:

1. The unvaccinated are our friends, our neighbors and we should care

2. It will keep hospitals open for everyone

3. It'll protect the vulnerable

And it'll let us get back to our lives & spend less time worrying about the pandemic

Fin

— Ashish K. Jha, MD, MPH (@ashishkjha) September 10, 2021

Remember that the OSHA statute authorizes regulations that are “necessary” to protect employees from “grave danger” caused by toxic substances. Biden explicitly framed his new policy as a measure designed to protect the vaccinated from the unvaccinated. But even Jha doesn’t assert that the vaccinated are in danger from COVID. The closest he gets is point 1, in which the vaxxed might be at risk of not getting timely hospital care if they have a health crisis unrelated to COVID. Point 4 imagines an immunocompromised vaccinated person being put at risk, but Biden could have limited his mandate to workplaces that employ immunocompromised if that were his priority.

He didn’t. He’s explicitly hoping to protect all vaccinated workers from the unvaccinated. Does he know something that we, and Jha, don’t about the risk of infection to the vaccinated in the age of Delta?

The latest CDC studies are certainly no cause for alarm:

Three studies that drew data from different U.S. regions evaluated the protective power of the vaccines. One looked at more than 600,000 virus cases in 13 states, representing about one quarter of the U.S. population, between April and July, and concluded that individuals who were not fully vaccinated were far more susceptible to infection and death from the virus.

They were 4.5 times more likely than vaccinated individuals to become infected, 10 times more likely to be hospitalized, and 11 times more likely to die from the coronavirus, the study found.

Vaccine protection against hospitalization and death remained strong even when the Delta variant was the dominant form of infection. But the vaccines’ effectiveness in preventing infection dropped from 91 percent to 78 percent, the study found.

Those numbers are so strong that some scientists are pulling their chins this afternoon, wondering if boosters for the general population are necessary after all.

The true unspoken intention of Biden’s mandate is to protect the unvaccinated from each other, i.e. protecting them from a risk they’ve willingly assumed. One could say that the owner of a business that employs unvaccinated staffers has a financial interest in making sure that his employees are healthy and fit for work, and that it’s his interest that Biden is championing by trying to force the unvaxxed to get their shots. But in that case, why does the business owner need the president to swoop in and force this mandate on him? Why doesn’t he just institute it himself?

The answer is the “collective action” problem, I guess. Any company that mandates vaccinations for workers risks having its unvaccinated employees quit and go elsewhere. But if all major companies are under the same mandate, that’s less of a risk. Biden could have framed his mandate that way but preferred the dubious — yet far more emotionally satisfying — “we’re protecting the people who did the right thing by getting vaccinated from the people who didn’t” spin.

Here’s a little more of Wen, casually suggesting that being able to travel is a privilege, not a right. That’s incorrect. You do have a constitutional right to travel between states. Whether you have a constitutional right to travel between states *by airplane* is another matter.

.@DrLeanaWen: “There are privileges associated with being an American. That if you wish to have these privileges, you need to get vaccinated. Travel, and having the right to travel in our state, it’s not a constitutional right as far as I know to board a plane." pic.twitter.com/eyhEVooV20

— Tom Elliott (@tomselliott) September 10, 2021