Employers and schools will do more to get Americans to roll up their sleeves for a Covid-19 shot than a universal vaccination mandate, legal scholars and public health officials said.
The first vaccines could be available as early as Dec. 11 or 12 in the U.S. after
With vaccines produced at record speed, the next challenge is to ensure enough people receive it to end the pandemic. About 60% to 70% of the population—or 200 million Americans—would need protection from the virus in order to reach herd immunity.
It’s “vanishingly unlikely” that states will require universal vaccination even though they have that power, Lawrence O. Gostin, director of Georgetown University’s health law institute, said.
Where a state mandate could cause a political backlash and discourage vaccinations, schools and employers are more likely to drive demand for inoculations. As long as they don’t single out any groups based upon a pre-existing condition or other disability, requiring vaccinations for re-entry would be legal, Gostin said.
Employers Push Compliance
Workplace mandates tend to push vaccine rates up more than 90%, even without strong enforcement, said Dorit Rubinstein Reiss, a professor at the University of California Hastings College of the Law, who writes about school mandates and other vaccine issues.
That buy-in will be particularly important when nearly half of the American public said they wouldn’t take a vaccine. Many expressed concerns about the pace of the vaccines’s development and its safety. However public health leaders have stressed the speed is due to manufacturing that’s happening alongside the clinical trial process and not because of any shortcuts in testing or evaluation.
“If it’s just sitting on the shelf and no one’s willing to take it, then we may as well not have it,” Dial Hewlett, an Infectious Diseases Society of America fellow and spokesperson, said.
Universal vaccine requirements are “constitutionally doubtful,” difficult to enforce, and the courts could go either way on a broad public health mandate, Reiss said. But a targeted enforcement is probably justified at schools and workplaces.
“One of the reasons co‑mandates and work mandates work is that they come with a natural enforcement. A person doesn’t do it, you can kick them out of school or fire them,” Reiss said.
Addressing the Unknown
One wrinkle for employers will be whether they want to enforce vaccine requirements for a shot based on the limited data needed to receive an emergency use authorization versus full FDA approval, Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security, said.
“Even if you’re an employer and you want to try and mandate it, you’re on shakier ground when it’s only an emergency use that the FDA has issued,” Adalja said.
Childhood vaccination programs have been some of the most successful in the country, but that’s unlikely to happen until clinical trial data show the vaccine is safe and effective in children.
“The goal is really to get it to the point where it’s a standard childhood vaccination,” Adalja said. “But again we have to do clinical trials on pediatric patients, which are just starting now.”
Herd immunity won’t happen until well into 2021 because there won’t be enough vaccine to immunize the nation for some time, Adalja said. There will be a need for a broad public health campaign coupled with steps to make getting the vaccine as convenient as possible, especially when Pfizer and Moderna require booster shots.
“The first step is going to be gaining trust,"said Hewlett, who is the medical director of the Westchester County Department of Health disease control division in New York. “It’s our job as the medical people to explain to everyone that we understand the process, that we have actually looked at the data. We have looked at not just the press releases that are coming out from the companies.”
The public awareness campaign will be important because a successful vaccine could lead some to prematurely assume the virus’ risks have diminished.
“If high-risk individuals are not getting hospitalized, and hospitals aren’t talking about the stress that they’re under, and if the death count goes down, that’s going to change how people view the virus,” Adalja said. “We’re going to have to show how the vaccine is achieving that, and hopefully people will comply with it.”