Vaccine Mandates Work—but Only If They’re Done Right

The point is, formal FDA approval wasn’t necessary for a mandate, but it’s turning out to be sufficient. Businesses, schools, and local governments that wanted to avoid a backlash over requiring “experimental” vaccines now feel like they have an even greener light. (This might’ve been a feint anyway; Texas governor Greg Abbott’s anti-mandate policy used to cite the EUA, and after approval it changed to specify any Covid-19 vaccine.) “They were worried about litigation, they were worried about employee perception, they were worried about public perception,” says Lawrence Gostin, a public health policy expert at Georgetown University. “We’re going to see, I think, an avalanche of companies and universities following suit in the coming weeks.”

The most important thing about vaccine mandates, though? “They work,” says Saad Omer, director of the Yale Institute for Global Health and an expert in vaccine acceptance. “A lot of the evidence comes from childhood vaccinations. For adults, it comes from influenza vaccinations for health care workers. It shows that having mandates is effective. It gets you from 70 or 80 percent to 90 or 95 percent.”

Public schools across the US require kids to show proof of vaccinations against various illnesses; different states have different levels of permitted opt-outs. One analysis of those requirements showed they increased overall vaccination rates by 18 percent. Flip side: Back in 2006, Omer and his colleagues showed that states where it was easier to get exemptions for kids also had higher rates of pertussis, one of the childhood diseases with a widely available vaccine. (It could be worse; Australia fines parents for skipping kids’ vaccinations, and Uganda puts parents in jail.)

There’s a catch: You have to do it right. For one thing, mandate policies seen as extraordinarily harsh can spark an anti-vaccine backlash. But the real problem is one size can’t fit all. People are unvaccinated for lots of different reasons. Sure, some of them have political or philosophical disagreements. Some people don’t believe the (very good, very robust) science behind vaccines, or subscribe to conspiracy theories about their creation. According to a Civiqs poll, 91 percent of people who identify as Democrats have been vaccinated, as have 64 percent of Independents; only 53 percent of Republicans have. And according to a different poll from the Kaiser Foundation, 5 percent of those Republicans say the only way they’d ever get vaccinated is if it was required. So … hi! It is now. Welcome!

But some people aren’t vaccinated because of forces outside their control. Covid-19 has hit certain groups particularly hard—people at lower socioeconomic levels and people of color, especially. They’re at the center of a lot of Venn overlaps: more likely to have the health issues that can make Covid infection deadly, less likely to have ready access to health care, more likely to be in high-risk jobs with lots of exposure, less likely to have good internet access, more likely to have jobs that pay by the hour and don’t allow sick leave. If you have all that going on, it can be hard to imagine getting a vaccination appointment, much less taking time off if you have side effects that send you to bed. If vaccine mandates deny access to certain spaces, and the unvaccinated are, say, Black people, that’d make the effect of the mandates racist.

The answer? Don’t do that. “You shouldn’t require a vaccination of someone who can’t get access to it,” Gostin says. “Bringing vaccination to the workplace or the campus, or giving paid time off to get the vaccine—including paying for rideshares to get there. You have to focus on access and equity.”

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