AMA needs our help.

This week the American Medical Association house of delegates published an emergency resolution on their website.

The end of the resolution calls for the creation of alternative evidence-based vaccine advisory structures. This is, in my opinion, a great opportunity for anyone interested in the future of democratic decision making to build a new structure that would support the AMA's goals.

We can harness our knowledge of how democratically run decision making bodies work best and use it to build a system initially limited in its scope to focus on obtaining the consent of the governed for vaccine recommendations. One reason I think this is a good starting point for building an online democracy is because most people already agree that vaccines are useful and necessary, so building consensus in these areas of dispute regarding vaccines will be a much simpler task. It also helps that vaccine usage operates mostly at the intersection of hard science and social science. The people who are eligible for election to the vaccine recommendation decision making body will necessarily be well qualified experts in the field.

How might this new decision-making body be structured?

Obtaining the consent of the governed requires that the governed have some voice in the selection of their governors. We could build a new layer on top of an existing open-source social network like Bluesky, using the AT Protocol.

The voting system would operate under the principle of one person one vote, with the main challenge being how to verify that a network user is not a bot and not using multiple accounts to vote. There are various methods that could be employed to overcome this challenge, some automated and some manual, the automated methods would filter out users that behave obviously like bots, the manual methods might allow for a vouching system where users can vouch for the actual personhood of other users.

Users could vote for their preferred members of "Medical Congress" in a variety of ways, I won't go into possible details here because this is not the type of thing that should be decided by one random person typing on the internet. In 2025 there are simply too many interesting options for how elections might best work in the information age to detail the pros and cons of each one in this brief leaflet.

The Medical Congress members could in turn vote for committee members. There could be various committees with different areas of focus depending on the needs of the decision-making organization. The committees themselves would be the ones with the power to issue decisions about things like which vaccine should be approved for use and at what age people should get certain vaccinations.

A Model Democracy

The vaccine issue would be a great proof-of-concept for building an online democracy. If it is successful and people end up liking and listening to the recommendations of this "Medical Congress", it could be used as a model for building democratic decision-making capacity in other areas. In the 21st century, most people live part of our lives online and part offline. A democracy that is good and useful must also be a combination of online and offline. We can't continue to use the internet as little more than a high-tech yap station. We must use it to give everyone a voice in making important decisions about their lives.