Mandating the COVID-19 Vaccine
By: Daniel Goldman
Tags: Vaccines, Science, Government, Politics, Public Health

Mandating the COVID-19 Vaccine

Getting the population vaccinated and protected against COVID-19 is of great importance.

Photo by CDC on Unsplash

SARS-CoV-2 and its associated disease, COVID-19, has caused an unprecedented public health response. It has caused many peoples’ lives to grind to a halt. Getting back to “normal” is a goal for many. An effective vaccine that can generate herd immunity is would allow us to do just that. But for herd immunity to occur, a vaccine has to be effective at preventing the spread of the infection, and enough people must be vaccinated to generate herd immunity.

For this reason, some have floated the idea of mandating the newly released vaccines. A new your legislator has recently put forward a bill that would allow New York’s Department of Health to mandate the vaccine (A11179). This proposal may seem like a good idea, as it “should” improve vaccine uptake. However, the proposal is actually quite dangerous, for a number of reasons.

Emergency Use Authorization

Regardless of one’s stance on vaccine mandates in general, there’s an important distinction to make between general vaccine mandates and mandating the current SARS-CoV-2 vaccines. The current vaccines being released by Pfizer, Moderna, etc have only gone through initial testing stages. As a result, the FDA and other similar bodies have allowed for the vaccine to be distributed under emergency use authorization. This authorization recognizes that the vaccine has not been fully tested for safety and efficacy, but the need to start finding some form of intervention is great enough to compensate for the risks.

This places the current vaccines somewhere between interventions that are used under “right to try” and fully studied medical interventions. It is a recognition that more research needs to be done. To mandate a vaccine that has not been fully studied would be dangerous in its own rights, but it would also set a precedent to mandate poorly tested medical interventions.

Fueling Additional Medical Hesitancy

The goal of a vaccine mandate is to improve pubic health, as a whole. Medical hesitancy, including refusing vaccination and avoiding doctor visits, harms public health. Therefore, the public health community must be cautious about fueling additional medical hesitancy.

Unfortunately, as I’ve mentioned in other articles, mandates tend to be antagonistic to trust in the public health system, and can counterintuitively reduce vaccine uptake. Even when there are no philosophical or religious exemptions, the requirements, and ability to track vaccination status, only apply to those going to public schools.

Vaccine mandates can therefore drive people away from the public school system, and this result seems to occur, based on the systematic reviews of available literature on the topic. Moreover, COVID has driven many people to remain home and learn remotely already. Therefore, the hurdle to shift from public school to home schooling is even lower than it was before.

Further Reading

Instead of focusing on mandates, we need to treat antivax sentiment as we do any disease, and apply actual public health science to the issue. It requires understanding why people are hesitant against vaccines. It is not simply that people are ignorant. Not even close to all vaccine hesitancy is fueled by conspiracy theories. The goal, instead of trying to make people act safely, is improving the population’s trust in the public health system

While a vaccine would help with COVID, it will be some time before we eliminate it from the population. Moreover, there is always the threat of a new pandemic. We need to be prepared to reduce the spread of infectious diseases, at all times.