Despite a sputtering start, vaccine distribution hit its stride this spring. By May, all Americans above the age of 12 were eligible to receive the vaccine, and by the Fourth of July, we were celebrating the return of recently foregone freedoms. Happy hour was no longer over Zoom, family gatherings were once again without FaceTime, date nights were back inside restaurants and ballgames were played with fans in the stands.
Such springtime hope has wilted with the heat of summer. A cocktail of misinformation, mistakes and tribalism, garnished by a more infectious viral variant, is once again making such freedoms a thing of the past. Infections are up, hospitals are full and social distancing is back.
But this time we are being forced to cede our freedoms not because they are our only means of flattening the curve, but to protect the “freedom” to not vaccinate.
We have made the vaccine free and widely available. You can get it at a football stadium or your doctor’s offices, while you shop for groceries at Walmart or at your corner pharmacy. We have orchestrated ad campaigns, garnered celebrity endorsements, funded statewide lotteries and even tried bribing with beer. And yet, 70 million eligible Americans remain unvaccinated.
While we must push forth with such incentives to persuade the undecided, we’ve adequately proven that when misinformation and mistrust are the problem, no amount of incentives, ease of access, reliable information or expert input will be an adequate solution. Recent survey data support this, showing two-thirds of unvaccinated individuals are unwavering in their opposition. They are worried about side effects, don’t trust the science or just don’t like getting shots. With the more infectious delta variant running rampant, we can no longer pin our protection on the hope of convincing unwavering holdouts. It is time we widely employ mandates. They remain our only route to freedom.
Using mandates to increase freedom may sound oxymoronic, perhaps even Orwellian. It is not. We mandate against all sorts of faux freedoms to protect true freedoms for the population. One is not “free” to drink and drive, smoke inside restaurants or punch a passerby on the street. Even the most libertarian agree that it is just for a society to control actions that infringe on the rights of others to live a prosperous life.
Applying these principles to vaccines is not new. We require childhood vaccinations for elementary school, annual flu shots for health care workers and meningitis shots before college, just to name a few. They’re required because they do more than protect the recipient; they protect us all. And the COVID-19 vaccine is no different.
Despite recent reports of breakthrough infections both evidence and experts remain clear: Vaccines substantially lower your likelihood of infection and transmission even against the delta variant. Moreover, their ability to protect against death or hospitalization prevents surges from overwhelming hospitals and health care workers.
Most important of all, perhaps, is that vaccine-induced herd immunity remains our best way to protect the vulnerable — immunocompromised patients, who often don’t fully respond to vaccines, and the young children who remain ineligible for vaccination. These groups rely upon us to keep them safe, and we are letting them down.
Recent weeks show that America is warming to the reality that we need more mandates. President Joe Biden has mandated the vaccine for federal workers and the military. California Gov. Gavin Newsom has mandated state employees be vaccinated, and Mayor Bill De Blasio announced vaccination requirements for teachers, city employees and indoor dining in New York City. As of today, 48 state facilities in Maryland will also require employees prove they were vaccinated or follow strict masking and testing rules. And on Tuesday, Baltimore officials announced similar rules for city employees, effective Oct. 18.
Some of the most promising advances have come from outside government. The American Medical Association and nearly 60 health organizations support vaccine mandates for all health care workers. And each day more colleges and universities, public and private, are joining the over 500 already mandating immunizations. Even the private sector is joining the fray with corporations like Walmart and Disney announcing employee vaccine mandates.
While a welcome start, we need mandates to reach more Americans than these changes will touch. And now that the Pfizer vaccine has full FDA approval, few sound arguments remain against vaccine mandates.
Knowing this reality, we must push for an even broader approach, leveraging the abilities of government, employers, retail, restaurants, schools and churches, to finally trigger the unvaccinated to roll-up their sleeves.
There will be holdouts and protesters, no doubt, but the experience of early adopters show they will be few. For perspective, when Houston Methodist Hospital mandated their workers vaccinate, there were a few vocal holdouts, but over 99% of their employees simply got their shots and moved on with (a much safer) life.
If this approach were applied more broadly, we could all move on and once again we could enjoy more of the real freedoms of life.
Michael Rose (firstname.lastname@example.org) is a resident physician in Internal Medicine and Pediatrics at the Johns Hopkins University School of Medicine in Baltimore, Maryland. Taimur Safder (email@example.com) is a board-certified internal medicine physician and currently a fellow in Cardiovascular Disease and Advanced Imaging at Northwestern Memorial Hospital in Chicago, Illinois.