Patient receives Covid-19 vaccine.

What’s the Law on Vaccine Exemptions? A Religious Liberty Expert Explains

This article is republished from The Conversation under a Creative Commons license. Read the original article.

By Douglas Laycock, University of Virginia

For Americans wary of COVID-19 vaccine mandates, like the sweeping requirements President Joe Biden announced Sept. 9, 2021, it seems there are plenty of leaders offering ways to get exemptions – especially religious ones.

No major organized religious group has officially discouraged the vaccine, and many, like the Catholic Church, have explicitly encouraged them. Yet pastors from New York to California have offered letters to help their parishioners – or sometimes anyone who asks – avoid the shots.

These developments point to deep confusion over how to win a religious exemption. So what are they, and is the government even required to offer the exemptions in the first place?

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Picture of Ivermectin tablets.

Legal and Ethical Analysis of Court-Ordered Ivermectin Treatment for COVID-19

By Jennifer S. Bard

A judge in Ohio ruled on Monday that a hospital in the region must administer ivermectin to a patient very sick with COVID-19 in their ICU, despite the decision by the medical staff, in agreement with recent statements by the U.S. Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC), that ivermectin is not an appropriate treatment, as it has been shown not to work against COVID.

The patient’s prescription came from a doctor who has no authority to treat patients at this particular hospital, although he is licensed to prescribe medicine in Ohio.

This case tracks a swelling interest, which some ascribe to the efforts of a group called America’s Front Line Doctors, among people for the anti-parasitic medication as both a treatment and prophylactic for COVID-19 — despite warnings from the medical establishment that it doesn’t work, and, if taken in the form normally given to farm animals or at the dosages being suggested, can be harmful.

The Ohio ruling is just the latest of several successful law suits (see similar cases in New York and Illinois) to order hospitals to administer ivermectin to hospitalized COVID-19 patients, despite the objections of the treating physicians.

There is also evidence of a global trend, as evidenced by the order of a court in South Africa to allow the prescription of ivermectin for COVID-19, something that was previously not permitted by the country’s drug regulatory agency.

This trend of courts ordering that treatments requested by hospitalized patients be made available by that hospital — so long as they are prescribed by a physician — opens the door to substantial administrative, legal, and ethical chaos. This post analyzes some of the most pressing legal, regulatory, and ethical concerns.

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Map of remote execution requirements for advance directives.

Advance Care Planning in an Online World: State Law Activity and Challenges Since COVID-19

By Nikol Nesterenko, Jonathan Chernoguz, and Sarah Hooper

Advance care planning — the process by which an individual documents their wishes for health care in the event that they become incapacitated — has become particularly urgent during the COVID-19 pandemic.

However, individuals that wish to engage in advance care planning, and specifically to document their plans in a written form (i.e., advance directives), have faced significant hurdles due to legal execution requirements. State advance directive law often requires or presumes live, in-person witnessing or notarization, actions which were prohibited by social distancing orders or simply unsafe during the pandemic.

In this piece, we summarize the state of remote execution requirements for advance directives before and during the COVID-19 pandemic. Broadly speaking, while many states took some action in this regard, most did not enact comprehensive changes, and therefore failed to meaningfully facilitate remote execution of advance directives.

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police cars lined up.

Policing Public Health: Carceral-Logic Lessons from a Mid-Size City

By Zain Lakhani, Alice Miller, Kayla Thomas, with Anna Wherry

When it comes to public health intervention in a contagion, policing remains a primary enforcement tool. And where a health state is intertwined with carceral logics, enforcement becomes coercive; emphasis is placed on the control of movement and behavior, rather than on support and care.

Our experience in New Haven during the first few months of the COVID-19 pandemic well illuminates this, while also revealing a logic of exceptional force lying dormant in municipal health practices.

Attending to the local is all the more important, albeit difficult, for fast moving and intensely quotidian practices, as COVID in the U.S. seems to be settling in as a pandemic of the local.

Our experience as activist-scholars working with a New Haven-based sex worker-led harm-reduction service and advocacy group, SWAN, suggests that by focusing on municipal practices, we can better understand what public health police power actually is. By orienting our scholarship toward the way social movements engage with local politics, we can then address how these police powers complicate the ability of those most at risk of both disease exposure and police abuse to engage with local authorities. Absent this engagement and critique, progressive policies for constructive state public health powers may be more vulnerable to attack from the right.

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doctor holding clipboard.

Preventing Misuse of COVID-19 Vaccine Medical Exemptions

By Ross D. Silverman and Gabriel T. Bosslet

As COVID-19 vaccination mandates become increasingly common, we can expect exemption requests (and misuse) to become increasingly widespread, too.

Most entities requiring vaccination mandates or proof of vaccination upon entry may offer limited grounds upon which an individual may request an exemption, usually based upon religious beliefs or medical reasons. Recent history with childhood immunization programs shows less rigorously-structured and -enforced vaccination exemption policies are vulnerable to increased usage, relative to narrower or more stringently-monitored programs. That history also shows there is a possibility some health care licensees may be willing to support individuals seeking to circumvent COVID-19-related requirements through offering questionable medical exemptions.

Entities imposing COVID-19 vaccination mandates, and state health care licensure boards, can take several simple but significant steps to counter misuse of medical exemptions and better protect communities from COVID-19. These safeguards also can decrease the temptation for licensed health professionals to recklessly undermine critical, lawful, evidence-driven public health efforts.

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Beverly Hills, CA: April 7, 2021: Anti-mask protesters holding signs related to COVID-19. Beverly Hills and the state of California have a mask mandate requirement.

What Makes Social Movements ‘Healthy’?

By Wendy E. Parmet

Social movements can play an important role in promoting population health and reducing health disparities. Yet, their impact need not be salutatory, as is evident by the worrying success that the anti-vaccination movement has had in stoking fears about COVID-19 vaccines.

So, what makes a health-related social movement “healthy?” We need far more research about the complex dynamics and interactions between social movements and health, but the experience of a few health-related social movements offers some clues.

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mask

COVID-19 is Still a Crisis for All

By Chloe Reichel

Recently, a narrative that COVID-19 is now a “pandemic of the unvaccinated” has emerged.

Setting aside the callousness of the claim, the biggest problem with this narrative is that it’s wrong. COVID-19 continues to threaten the health and well-being of all, regardless of vaccination status.

As we now know, vaccinated individuals can be infected with and transmit the delta variant. “Breakthrough” infections are not rare — countries with better data collection efforts than the U.S., including Israel and the United Kingdom, estimate vaccine efficacy against infection by the delta variant at around 40-50%.

This isn’t to say that the vaccines are worthless. We should continue to work to promote vaccine uptake, as the vaccines do provide a level of protection against the most severe outcomes.

But we need to understand: We can’t end this pandemic with vaccines alone.

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Blue house in grass field.

Community-Based Response to Intimate Partner Violence During COVID-19 Pandemic

By Leigh Goodmark

Intimate partner violence has been called “a pandemic within the pandemic.”

A study of fourteen American cities found that the number of domestic violence calls to law enforcement rose 9.7% in March and April 2020, compared to the previous year. A hospital-based study spanning the same time period found significant increases in the number of people treated for injuries related to intimate partner violence. And a 2021 review of 18 studies relying on data from police, domestic violence hotlines, and health care providers found that reports of intimate partner violence increased 8% after lockdown orders were imposed.

Although almost half of people subjected to abuse never call the state for assistance, our responses to intimate partner violence are largely embedded within the state and rely heavily on law enforcement. A disproportionate amount of funding under the Violence Against Women Act — by one estimate, 85% — is directed to the criminal legal system. A growing number of activists skeptical of state intervention are arguing that responses beyond the carceral state are essential.

The pandemic showed that community-based supports, like pod mapping, mutual aid, and community accountability, originally developed by activists critical of law enforcement responses to violence, can foster safety and accountability without requiring state intervention. The pandemic could spur advocates seeking to distance themselves from state-based responses to expand their services.

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Medical staff work in the Intensive Care Unit (ICU) for COVID-19 patients in University Hospital of Liege in Belgium on May 5th, 2020.

The Legality of Pandemic Detection and Prevention Technology

*This article is adapted from a longer paper published in the University of Michigan Journal of Law Reform. To access the original paper, please click here.

By April Xiaoyi Xu  

A test-and-isolate system for detecting and monitoring new pathogens could avert future pandemics, but may face legal challenges in implementation.

The test-and-isolate model is described in a 2020 Scientific American article by biochemist David Ecker. Ecker recommends strategically placing modern, high-speed metagenomic sequencing technology in urban hospitals across the United States to flag previously-unknown pathogens before the infectious agents have the opportunity to spread widely and potentially start a new pandemic.

Under this model, during a time period without any apparent pandemics, the 200 biggest metropolitan hospitals in the U.S. would automatically run diagnostic tests up-front for novel causative agents among patients who visit the emergency room with severe respiratory symptoms that are possibly infectious. If such a system detects a sufficiently serious pathogen, public health agencies will send out diagnostic tests to all residents in the affected geographical area(s) within weeks and isolate those who test positive. This system also will be integrated with contact tracing and more standard outbreak response.

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Police car.

Blurring the Line Between Public Health and Public Safety

By Jocelyn Simonson

Collective movement struggles during the twin crises of COVID-19 and the 2020 uprisings have helped blur the concepts of public safety and public health.

These movements have shown how all of our public health and all of our public safety suffers when we use the police, prosecution, and prisons to solve our collective problems. Their collective resistance to the status quo underscores how these terms — public health and public safety — too often carry with them an exclusionary understanding of which “public” matters.

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