Comments on COVID Vaccine Hesitancy and Traffic Crash Risk

Redelmeier et al1Redelmeier D Wang J Thiruchelvam D COVID vaccine hesitancy and risk of a traffic crash.Am J Med. 2023; 136 (153-162.e5)Google Scholar claim that people who had not received any COVID vaccine in Ontario by July 2021 were more likely to be involved in traffic crashes; hypothesize that this was because they are more reckless; and conclude that raising car insurance premiums would be a desirable policy option. We challenge this paper on its methodology, its conclusions, and its mean-spiritedness. First, there are several obvious confounders—miles driven, occupation, type of vehicle—any of which probably erode an already modest adjusted relative risk (1.48). Important confounding is suggested by the observations that the same increased risk applied also to unvaccinated pedestrians and passengers. Second, the timing of the study is critical. The authors state that those who were unvaccinated on July 31, 2021 are “individual adults who tend to resist public health recommendations.” However, Ontario's staged vaccine rollout opened for all in August of 2021,2Government of Ontario – Ministry of Health. COVID-19 distribution plan. Available at: https://files.ontario.ca/moh-covid-19-vaccine-distribution-plan-en-2021-02-19.pdf. Accessed February 3, 2023.Google Scholar meaning that on July 31, 2021, not all Ontarians had access to vaccine (or if they did, it was quite recent), especially not the young and healthy. The unchanged risks of those who were vaccinated in the subsequent 2 months suggests differences in population risk—likely because of uncontrolled differences (eg. type of work, distance driven). Similarly, the lack of risk difference in those over age 65 years (who had the largest period of eligibility prior to the study) argues against the primacy of vaccine hesitancy as an explanation for increased traffic risk. Third, although the study focuses on the 16% of Ontario residents who had received no COVID immunization by mid-2021, the authors extrapolate their conclusions to the broader category of “vaccine hesitancy.” Arguably, this designation could apply to some or all of the 72.5% of adult Canadians who have not received a COVID vaccine for more than 6 months.3Government of Canada. COVID-19 vaccination in Canada. Available at: https://health-infobase.canada.ca/covid-19/vaccination-coverage/. Accessed February 3, 2023.Google Scholar Fourth, the authors appear to endorse higher car insurance premiums for vaccine-hesitant drivers. It is unclear whether this is intended to be merely punitive or an incentive for vaccination. However, the opportunity for lower car insurance premiums in exchange for immunization would be, de facto, a financial inducement to accept immunization. This would be unprecedented in Canadian vaccine policy and ethically questionable. Furthermore, widespread natural immunity post-Omicron and a better understanding of the failure of the vaccines to provide reliable prevention against infection have undermined any public health rationale for using extraordinary policies to promote COVID immunization. Finally, although the authors’ claim their “research agrees with past studies about psychology contributing to traffic risks,” this paper does not actually study psychology at all. Rather, they pejoratively assume negative psychological characteristics about unvaccinated people based on no direct evidence, and apply these unsubstantiated assumptions to explain their observations. The unvaccinated 16% were almost certainly a disparate group with many different reasons for not yet being immunized at that point in time. Assuming a common “psychology” is unjustified. We agree with the authors that COVID vaccines are a very important tool in reducing the risk of COVID pneumonia and protecting vulnerable people against hospitalization and death. Vaccine hesitancy is a substantial problem. We need a better understanding of the issues and concerns driving vaccine hesitancy so that we can address them effectively. Stigmatizing and punishing vaccine hesitancy has backfired. Time to move on.