Sometimes there’s a simple, commonsense way to refine public policy. Surely there’s need for a better public health policy to address the COVID-19 pandemic. It’s time to let medical evidence overcome stubbornness by public health agencies and disagreements among physicians. It’s time to give Americans medical choice without sacrificing public health.
Here I use long-used personalized medicine principles to define a two-part pandemic policy that most Americans can understand and support, and that could bring together parts of society in conflict with each other over COVID-19 vaccine mandates.
Part One: Individuals decide either on their own or with the advice of their personal physician to be vaccinated for COVID-19. And to accept what government officials have decided are the best COVID-19 medical solutions.
Part Two: Individuals choose a preferred medical professional who, on the basis of their education, training, experience, and successful clinical results, offers alternatives to vaccination and government promoted medical solutions for outpatients and inpatients. The medical professional uses the patient’s medical history, biologic and genetic conditions, and unique personal circumstances to reach the best personalized medical solution.
This flexible policy has the potential to bridge the ugly gap between pro-vaccine and anti-mandate camps.
In terms of medical science, this two-part policy recognizes that there’s a huge array of reactions to both SARS-CoV-2 infections and vaccines based on diverse biology, genetics, and medical conditions of individuals. Missing from current government policy is recognition of fundamental differences among people.
These medical truths contrast with mass use of off-the-shelf, one-size-fits all drugs and vaccines.
The medical literature and government databases tell us that there are myriad different responses to SARS-CoV-2 infection and to COVID-19 vaccines. The differences are indisputable and extreme. Most people who get infected either have no symptoms or only minor ones. Others get terribly ill, require hospitalization, and sometimes die.
Many who get vaccine shots feel a slight discomfort for a few hours or days; others are falling ill with a broad range of blood and neurological problems and sometimes die despite having been very healthy.
When people are profoundly different in their biological makeup, when reactions to SARS-CoV-2 infection are remarkably different, and when a broad range of adverse vaccine impacts are acknowledged, then one thing is crystal clear.
There can’t be one pandemic “solution” pushed by the government that makes common sense. By not respecting all the differences, the inevitable result is what we’re seeing in our society: division, conflicts, and anger among millions of people who want more choice, more medical freedom.
The two-part policy recommended here would not deny use of COVID-19 vaccines for those who want the shot. But it would see the truth that vaccine mandates for the entire population are not consistent with medical science and the diversity among people. Mandates rub so many people the wrong way because they eliminate sensible choice. They replace medical freedom with medical tyranny.
Interestingly, in the first months of the pandemic there was considerable thinking in the medical and public health community that personalized medicine should be pursued. That soon gave way to vaccine fixation, not just for a small, high-risk part of the population but for everyone.
Here are examples of some early interest in personalized medicine for addressing the pandemic:
“When COVID-19 spread across the U.S. in March 2020, the Mayo Clinic Center for Individualized Medicine urgently responded to accelerate research, development, translation and implementation of novel tests, lifesaving treatments and diagnostics. Now, collaborative teams of scientists are continuing to unravel the mysteries of the novel virus, including using advanced genetic sequencing technologies to investigate how the virus can infiltrate a person’s immune system and wreak havoc on organs, tissue and blood vessels, leaving some patients with long-term effects.”A September 2020 article had the intriguing title “How to use precision medicine to personalize COVID-19 treatment according to the patient’s genes.” Here are excerpts:
“In recent years, a gene-centric approach to precision medicine has been promoted as the future of medicine. ... But the imagined future did not include COVID-19. In the rush to find a COVID-19 vaccine and effective therapies, precision medicine has been insignificant. Why is this? ... If precision medicine is the future of medicine, then its application to pandemics generally, and COVID-19 in particular, may yet prove to be highly significant. But its role so far has been limited.”The specialty germane to a personalized pandemic strategy is called pharmacogenomics. It’s the study of the role of the genome in drug response. It combines pharmacology and genomics to discover how the genetic makeup of an individual affects their response to drugs, including vaccines. The central goal is to develop rational means to optimize drug therapy, including vaccination, with respect to the patients’ genotype, to ensure maximum efficiency with minimal adverse effects.
By using pharmacogenomics, the goal is that pharmaceutical drug treatments, including vaccination, can replace or at least complement what is dubbed as the “one-drug-fits-all” approach.
“Pharmacogenomics may allow individualization of these drugs thereby improving efficacy and safety. … Pharmacogenomics may help clinicians to choose proper first-line agents and initial dosing that would be most likely [to] achieve adequate drug exposure among critically ill patients; those who cannot afford a failure of ineffective therapy. It is also important to minimize the risks of toxicity because COVID-19 particularly affects those with comorbidities on other drug therapies.”A July 2020 NPR show was titled “Research On Personalized Medicine May Help COVID-19 Treatments.” This was deemed newsworthy:
“The nationwide All of Us Research Program aims to tailor medical treatments of all kinds, including treatments that may be developed for the new coronavirus. So far, more than 271,000 people nationwide have signed up to share data with the initiative. ...
