Like The Hub?
Join our community.
Join

Harry Rakowski: When it comes to vaccine safety, let’s examine the evidence, not demonize the questions

Commentary

The controversy over vaccination and boosters continues to rage. Recent guidance by Florida’s Surgeon General, Dr. Joseph Lapado, recommends that men aged 18-39 not get the new bivalent mRNA boosters. This is based on local data suggesting that there is an increased risk of cardiac death in this population which outweighs the possible benefit.  

This decision required a careful analysis of whether there is data that may support such an opinion. Rather, it received immediate censure from those very much in favour of vaccination. Dr. Lapado’s tweets were also taken down by Twitter (although the decision was quickly reversed). Any concerning reports about vaccine safety require serious review, not knee-jerk reaction, even if believed to be politically motivated. 

Let’s review what we know

Original vaccines and boosters now protect mainly from hospitalization and death rather than infection itself. 

Most of the North American population has experienced infection regardless of vaccination status. Most infections have occurred with a less severe Omicron variant, and currently almost all are due to the BA.4 or BA.5 variant. 

Newer bivalent boosters were developed to try and prevent infection from these evolved Omicron variants. Unlike the original vaccines, which had a 95 percent benefit in preventing infection, very little human data is available about the efficacy of bivalent boosters. There is a reasonable presumption based on animal and lab studies that they will be protective from infection. Their safety is also based on a reasonable presumption that their small risks will be similar to those documented in the very large number of very similar mRNA vaccines already administered. 

Benefits and risks of vaccination vary with age

Very few people ages 18-40 have died of COVID-19 throughout the pandemic, even prior to the availability of vaccines. Canada has reported about 480 deaths in people aged 20-39 from the start of the pandemic until November 7 of this year, compared to about 47,000 total deaths. Thus the 20-39 age group represents only about one percent of all COVID-19 deaths.

The rate of death in this young age group is historically extremely low and even lower now with less severe disease from Omicron variants. Most people have protection from serious outcomes by a combination of primary vaccination or previous infection. Even the unvaccinated face lower risks from the Omicron variants than during Delta, which was primarily a disease of the unvaccinated. 

Myocarditis is a relatively rare but real potential complication of mRNA vaccination, occurring in about 1/10,000 people, most of whom recover fully. This complication occurs much more frequently in people under the age of 40, especially young men. A population-based study published in JAMA on June 24, 2022, looked at reported myocarditis complications in an Ontario population of 14.5 million people who received 19.7 million doses of mRNA vaccines between December 2020 and September 2021. Surveillance was greater after June 2021 so earlier cases may have been undercounted. There were 297 reports of myocarditis or pericarditis from either the vaccine registry or passive surveillance.

The risk was highest in men (76.8 percent) and especially after the second dose (69.7 percent). Indeed the risk for men in the 18-24 year age group was about 3/10,000. This analysis may be an underestimate of risk since it is likely that mild cases were not tracked or reported. We don’t yet know if a third or fourth booster dose further increases the risk. 

While most people who develop myocarditis do well and death is rare, it remains a complication of concern. Sudden cardiac death in the young can occur with even mild myocarditis. There are reports of significantly increased rates of sudden death in athletes in 2021, the year vaccination was introduced. Some of these deaths may be due to clinical or silent vaccine-related myocarditis. It is, however, likely that most of these deaths were related to complications of increasing rates of infection by more serious variants since infection has a much higher risk of causing myocarditis than vaccination itself. 

The Florida Department of Health study that Dr. Lapado based his recommendation on, showed an apparent 84 percent increase in cardiac-related deaths in young men 18-39, within 28 days of becoming vaccinated with mRNA vaccines. Many epidemiologists have challenged the findings based on flawed methodology and data analysis in a report that has not undergone the critique of peer review required of high-level scientific studies. A key omission was the lack of a comparison group for rates of cardiac death in those who became infected without being vaccinated. 

Analysis of the benefits of vaccination and the risk of infection has been plagued by junk science and political science both by proponents and opponents of vaccination. Just because Dr. Lapado and Governor DeSantis are against vaccination in younger adults, or you may not like their politics, it doesn’t mean their concerns should automatically be discounted. 

Their data needs more critical assessment and publication in a peer-reviewed journal. We also need to analyze cardiac deaths in younger adults more carefully in other jurisdictions to see if there is a worrisome trend. 

The current focus of giving bivalent boosters should be for people aged 50 and older and those with other important risk factors for poorer outcomes. Younger people who currently are at low risk may make their decision about further vaccination based either on the faith that it is personally beneficial, or will prevent cross-infecting those at higher risk. Many may choose to wait while the disease burden is low for clearer clarification of risk versus benefit. They shouldn’t be shamed or shunned for exercising their rights. However, they should also be influenced by quality science, not disinformation. 

Alex MacDonald: What could (finally) solve Canada’s housing crisis

Commentary

Within the variety and volume of pieces The Hub has published on housing, the following theme has seemed to emerge: municipal governments are the most responsible for housing; while provincial governments have a political incentive to engage but little to offer, and; that the federal government also has a political incentive to engage, but even less to offer. 

The principle of subsidiarity—that when the government is needed, programs are best delivered by the lowest level of government that can meet that need—has been used to validate this theme and drive policy suggestions that concentrate both the problem and apparent solutions in the hands of municipalities. 

I too am a fan of the principle of subsidiarity. But in the context of housing policy, I think it has been applied in a rather one-dimensional fashion that has constrained the creativity of conservative-minded policy thinkers. This constraint has produced policy suggestions that municipalities have little to no incentive to enact, or suggested interventions by higher orders of government that could easily be contested or enrage intergovernmental relations. 

The principle of subsidiarity, however, can allow for multiple levels of government to be engaged in the same policy issue area while allowing each to bring an expertise, satisfy a particular responsibility, or offer a unique resource. In this way, subsidiarity can and often should be multi-dimensional. 

Subsidiarity, after all, should not be conflated with rightly ordered federalism. Subsidiarity is not ultimately a legal principle, but rather a moral-social principle in that its ultimate aim is the flourishing of the human person.

The Ford government’s most recent proposed legislation on housing demonstrates that multiple levels of government have particular responsibilities toward housing. The proposed legislation would, among other things, curtail the misuse or even abuse of housing regulations and planning authorities by municipalities, namely development charges, off-site levies, and parkland fees, all of which add hundreds of thousands of dollars onto the bottom line of new homes. 

This bold approach reminds us that provincial governments actually have a particular and unique responsibility in housing governance: to protect their constituents from short-sighted regulatory regimes that curtail economic prosperity and social advancement through thoughtful policy design and a fair regulatory environment. This is the second dimension of a multidimensional approach to subsidiarity. 

The third dimension of this multidimensional approach is the role of the federal government. This is perhaps where the mindset of one-dimensional subsidiarity has most constrained policy creativity and, in some cases, produced harmful federal policies on housing. In favour of localism, current federal policies have almost exclusively engaged the demand side (e.g. First Time Home Buyers Incentive or the new Tax-Free First Home Savings Account) or simply been performative (e.g. a ban on blind bidding, a house flipping tax, or a homeowners bill of rights).

One of the more popular policy ideas suggested by those of a conservative disposition has been the tying of federal infrastructure funding to housing densification. Sean Speer and Brian Lee Crowley suggested this back in 2016, it was in Erin O’Toole’s platform in 2021, and was more recently advocated for by both Pierre Poilievre and Scott Aitchison in their leadership bids. 

Realistically, this is the weaponization of the federal spending power, which although blunt in its character, has become more popular as a federal policy tool (but this doesn’t mean it’s a healthy form of federalism). Nonetheless, the prominence of this policy idea should remind us that a particular order of government may be most responsible for, or closest to, a policy issue that they are also sometimes the least likely to act on, or have the least incentive to do so. 

But let’s turn this idea on its head—what can the federal government do with its wealth of funding to incent homebuilding and densification? Rather than dictate, what could be done through partnership and the sharing of resources? 

The federal government could step in and help to reduce the bottom-line cost of homebuilding by establishing a grant program available to municipalities and designed to cover some of the most costly regulatory fees associated with homebuilding. For example, development charges and off-site levy fees are assessed by municipalities to maintain and build community infrastructure (e.g. sewers, wastewater treatment, sidewalks, highway on-ramps, local schools, libraries, and sports facilities) could be covered. While its common practice that developers pay to construct all the necessary infrastructure for a new development, like roads and sidewalks, they also are required to pay these fees to aid the municipality in managing and responding to the increased demand on and for community infrastructure. 

The federal government should recognize these aspects of homebuilding and community growth as traditional infrastructure—as it does highway overpasses, interchanges, or road widening—and fund it as they do other infrastructural projects. Namely, through cost sharing which is often done in partnership with the province. 

This could make a noticeable impact on the current cost of homes. According to a C.D. Howe Institute report, in 2020 it was estimated that municipal housing charges and taxes in Vancouver can result in an extra cost of up to $644,000 for the average new house. While in other major cities across the country home buyers paid an average of $230,000 extra. 

While the infrastructure associated with these charges is necessary for communities to comfortably grow and function, the question is who is best situated to fund their construction. Municipalities have long thrust this on to developers who have pushed the cost onto homebuyers, which has continually increased the cost of homeownership. 

With the help of the federal government, there is a better economy of scale to be had. While developers pass the cost on to a small segment of the economy, namely homebuyers, the federal government could distribute the cost across the entire tax base of the country, as it does with its usual infrastructure spending.

But should all taxpayers help to fund community infrastructure across the country? I say yes. These are public goods that are enjoyed indiscriminately by the local community at large, not just the new homeowners in the newly constructed subdivision or tri-plex. 

Rarely has it been controversial for the federal government to use tax dollars towards local community infrastructure projects (e.g. a hockey arena, overpass, wastewater treatment, etc.) in some town you will probably never visit in a province on the other side of the country from you. In our communities, we all have access to public goods that are funded by all Canadians. Housing infrastructure should be no different. 

This policy suggestion far surpasses those that call on municipalities to pause or waive their charges on new home construction at their own initiative (they have little to no incentive to do so, anyhow), or for provinces to mandate this via legislation. It’s necessary to go further because a pause or reduction will likely just delay the building of community infrastructure or make it prohibitively expensive to do so. Someone, at the end of the day, needs to pay for community infrastructure. The cost of affordable housing shouldn’t be a lack of community infrastructure. 

The federal government could support such a grant program without any net new spending by reallocating current infrastructure and housing spending. Specifically, federal funding allocated to the Canadian Infrastructure Bank and the National Housing Strategy could be utilized. While these two programs are exceptionally well funded they have woefully underperformed, as found by studies of the Parliamentary Budget Office, Office of the Auditor General, and the Standing Committee on Transport Infrastructure and Communities. It’s shameful to have a “housing strategy” with an annual budget of $3.7 billion that isn’t making any meaningful difference on the supply side.

The one-dimensional application of subsidiarity to housing has too often led to circular policy debates and buck-passing. Multidimensional subsidiarity where each level of government shoulders its particular responsibility, offers its expertise, and expends its unique resource may actually solve this crisis by getting more homes built at a more affordable price point for everyday Canadians.