Evaluating the number of unvaccinated people needed to exclude to prevent SARS-CoV-2 transmissions

BackgroundVaccine mandates and vaccine passports (VMVP) for SARS-CoV-2 are thought to be a path out of the pandemic by increasing vaccination through coercion and excluding unvaccinated people from different settings because they are viewed as being at significant risk of transmitting SARS-CoV-2. While variants and waning efficacy are relevant, SARS-CoV-2 vaccines reduce the risk of infection, transmission, and severe illness/hospitalization in adults. Thus, higher vaccination levels are beneficial by reducing healthcare system pressures and societal fear. However, the benefits of excluding unvaccinated people are unknown.MethodsA method to evaluate the benefits of excluding unvaccinated people to reduce transmissions is described, called the number needed to exclude (NNE). The NNE is analogous to the number needed to treat (NNT=1/ARR), except the absolute risk reduction (ARR) is the baseline transmission risk in the population for a setting (e.g., healthcare). The rationale for the NNE is that exclusion removes all unvaccinated people from a setting, such that the ARR is the baseline transmission risk for that type of setting, which depends on the secondary attack rate (SAR) typically observed in that type of setting and the baseline infection risk in the population. The NNE is the number of unvaccinated people who need to be excluded from a setting to prevent one transmission event from unvaccinated people in that type of setting. The NNE accounts for the transmissibility of the currently dominant Delta (B.1.617.2) variant to estimate the minimum NNE in six types of settings: households, social gatherings, casual close contacts, work/study places, healthcare, and travel/transportation. The NNE can account for future potentially dominant variants (e.g., Omicron, B.1.1.529). To assist societies and policymakers in their decision-making about VMVP, the NNEs were calculated using the current (mid-to-end November 2021) baseline infection risk in many countries.FindingsThe NNEs suggest that at least 1,000 unvaccinated people likely need to be excluded to prevent one SARS-CoV-2 transmission event in most types of settings for many jurisdictions, notably Australia, California, Canada, China, France, Israel, and others. The NNEs of almost every jurisdiction examined are well within the range of the NNTs of acetylsalicylic acid (ASA) in primary prevention of cardiovascular disease (CVD) (≥ 250 to 333). This is important since ASA is not recommended for primary prevention of CVD because the harms outweigh the benefits. Similarly, the harms of exclusion may outweigh the benefits. These findings depend on the accuracy of the model assumptions and the baseline infection risk estimates.ConclusionsVaccines are beneficial, but the high NNEs suggest that excluding unvaccinated people has negligible benefits for reducing transmissions in many jurisdictions across the globe. This is because unvaccinated people are likely not at significant risk – in absolute terms – of transmitting SARS-CoV-2 to others in most types of settings since current baseline transmission risks are negligible. Consideration of the harms of exclusion is urgently needed, including staffing shortages from losing unvaccinated healthcare workers, unemployment/unemployability, financial hardship for unvaccinated people, and the creation of a class of citizens who are not allowed to fully participate in many areas of society.RegistrationCRD42021292263FundingThis study received no grant from any funding agency, commercial, or not-for-profit sectors. It has also received no support of any kind from any individual or organization. BH is supported by a personal research grant from the University of Wroclaw within the “Excellence Initiative – Research University” framework and by a scholarship from the Polish Ministry of Education and Science. None of these institutions were involved in this research and did not fund it directly.Competing interestsThe authors have no competing interests to declare.Ethical approvalNot applicable. All the work herein was performed using publicly available data.Data reportingThe data used in this work are available at https://tinyurl.com/4m8mm4jh and https://decision-support-tools.com/.

Green on Green: Issues of Public Opposition to Proposed Renewable Energy Projects

Renewable energy is widely recognised as a significant tool to combat climate change, achieve carbon neutrality and realise sustainable development. However, even with widespread support, renewable projects may trigger conflicts and lead to green on green tension – a conflict between the environmental benefits of renewable energy projects (REP s) and public concerns over consequential environmental detriments. This article clarifies both the environmental impacts and the environmental-related impacts that can be caused by REP s and contribute to green on green tension; and examines how these can be weighed against the positives of such projects. The article argues that the stage of public participation in decision making on REP s provides the appropriate mechanism to identify and mitigate the impacts and weigh the competing interests; and that to guide this process national policies should establish a presumption in favour of REP s, rebuttable when significant harm is likely to result from the proposed project.

Interest and Disinterestedness

This chapter explores the abuse of trust when an official’s interest conflicted with that of the entrusting power or beneficiary of the trust, or where an agent’s multiple roles conflicted with each other so that the performance of a trust was compromised. Trust and interest were, it is argued, intertwined, since entrusted power demanded disinterestedness. The chapter relates the emergence of the ‘language’ of interest in the seventeenth century to debates about the competing and conflicting interests. Over the period, measures were put in place in both commercial and political office to go some way to separating competing interests and to subordinate the pecuniary self-interests of officials to the trusts from their companies or the public. Long before 1850 ‘conflict of interest’ had become an established lexicon and concept, used to debate, define and tackle corruption in office.

Life of Christopher

Christopher, a native of Baghdad who became patriarch of Antioch in about 349/960, was assassinated by Muslim rebels in 356/967 because of his loyalty to their Muslim ruler. When the Byzantines conquered Antioch two years later, his story was told in a variety of ways by those with different and competing interests. Christopher was mentioned in Byzantine histories and in Antiochian liturgies. However, by far the most extensive and detailed version of the story comes to us in the Life of Christopher, written by Ibrāhīm b. Yūḥannā, a Byzantine bureaucrat and translator who grew up in Antioch and knew Christopher when he, Ibrāhīm, was a young boy. The hagiography was originally composed in Greek and translated by its author into Arabic, but only the Arabic survives. Here I provide, for the first time, both a critical edition of the two known Arabic manuscripts and a full English translation. This text is a valuable testimony to Christian life in Antioch under both the Ḥamdānids and the Byzantines, and to the difficulties of life along the constantly shifting frontier of medieval northern Syria.

Public nudity and the right to freedom of expression: Balancing competing interests

<p>With little case law concerning nudity and the right to freedom of expression, this paper aims to uncover the appropriate frameworks to be used to determine the following questions: (a) when is public nudity “expression” for the purposes of s 14 of the New Zealand Bill of Rights Act 1990, and (b) in what circumstances involving “expressive” public nudity would it be reasonable and demonstrably justifiable to limit the right to freedom of expression using s 4(1)(a), as per s 5 of the Bill of Rights Act? As regards the first of these questions, this paper critiques the current test in use in New Zealand for determining whether conduct is expression – the test developed by the Canadian Supreme Court in Irwin Toy Ltd v Attorney-general (Quebec) – and advocates for the adoption of a purposive approach to determining the scope of the right to freedom of expression. As for the second of these questions, this paper advocates for the adoption of “the modified Hansen sequence” proposed by Professor Claudia Geiringer. This paper then uses recent examples of public nudity involving naturists and protestors to test these frameworks and to illustrate how they would operate in practice.</p>

Public nudity and the right to freedom of expression: Balancing competing interests

<p>With little case law concerning nudity and the right to freedom of expression, this paper aims to uncover the appropriate frameworks to be used to determine the following questions: (a) when is public nudity “expression” for the purposes of s 14 of the New Zealand Bill of Rights Act 1990, and (b) in what circumstances involving “expressive” public nudity would it be reasonable and demonstrably justifiable to limit the right to freedom of expression using s 4(1)(a), as per s 5 of the Bill of Rights Act? As regards the first of these questions, this paper critiques the current test in use in New Zealand for determining whether conduct is expression – the test developed by the Canadian Supreme Court in Irwin Toy Ltd v Attorney-general (Quebec) – and advocates for the adoption of a purposive approach to determining the scope of the right to freedom of expression. As for the second of these questions, this paper advocates for the adoption of “the modified Hansen sequence” proposed by Professor Claudia Geiringer. This paper then uses recent examples of public nudity involving naturists and protestors to test these frameworks and to illustrate how they would operate in practice.</p>

Exiles as Stakeholders

This chapter examines how much influence exiles are entitled to wield in the homeland. I situate this question in the broader boundary problem in democratic theory: how to determine who is entitled to participate in collective decision-making. I examine two leading principles of inclusion, and then elaborate on and apply the stakeholder principle: insofar as exiles have particular interests at stake, they are entitled to a correspondingly weighty say. The stakeholder principle admits of a hierarchy of stake and say, which protects against the moral hazards of ‘long-distance nationalism’ while reaffirming that identification alone entitles exiles to some say. I outline three types of interests exiles can have at stake and illustrate the competing interests within a stakeholder community, and the problem of some exiles having disproportionate influence. The stakeholder principle correctly diagnoses worries about ‘armchair revolutionaries’: the problem with exile influence is not when exiles have a say, but when they have too much of a say relative to others.

Introduction

The introduction sets out the parameters for the inquiry. It summarizes part I on the harms of pornography, including the sexual aggression against women it engenders and its production’s exploitative abuses. The findings canvassed are situated in the context of gender-based violence and sex discrimination, pornography being found to be one of the more potent linchpins in this hierarchy of oppression that contemporary democracies allow, despite their equality ideals. A problem-driven approach is taken to answer what is in the way for democracies to address pornography’s harms legally. A theory of hierarchy to be tested and applied is summarized, including its postmodern and classical liberal critics. The analytical leverage gained by comparing most similar systems of democracies with significant constitutional and legal differences is explained. Solving the equation of the competing interests involved is considered to provide insights to unraveling other intractable problems of oppression by legal means.