Damian Dovarganes/AP Photo
A pedestrian walks past a banner promoting vaccinations in the Pico-Union district of Los Angeles, July 26, 2021. The city’s ad reads in Spanish: “Protect and Respect, Let’s End the Pandemic.”
Something interesting is happening at the nation’s COVID vaccination clinics: People are showing up. The three-month slide in daily vaccination rates that began in early April has stopped, and doses have nudged up throughout July. On Monday, the seven-day average of first-time doses was up 24 percent over a week earlier.
The likely explanation is the explosion of case counts from the delta variant, reminding those yet to be vaccinated that COVID remains a threat to their well-being. But the shift also tells us something important. For all the focus on the rigidity of the anti-vaccine movement—which certainly exists as a social phenomenon, as the peer pressure on display at this summer lakeside resort in the Ozarks demonstrates—too much is made of its reach into the general population.
The unvaccinated contain multitudes: They are concerned about side effects, fearful of losing their jobs if they have to miss work, wary of hidden health care costs and vaccines without formal authorization, aware that their previous contraction of COVID might give them enough immunity to avoid the hassle of the vaccine, lacking in access to preventive services and therefore untrained about where or even how to get a shot, and even embarrassed and reflexively obstinate about being lumped in with hard-core anti-vaxxers. The resumption of vaccinations within this population, however modest, suggests that many are in fact reachable.
The question, of course, is how to reach them. Letting a deadly virus loose in the hopes of triggering a rush to the vaccine clinics may be an option, but it’s not a solution.
The options always get funneled into a binary of carrot or stick. Do we offer sweepstakes with a million-dollar jackpot and a Starbucks gift card, or do we shut down spaces to the unvaccinated? This analysis gets too tied to pop psychology to be truly effective. In fact, many things can help at the margins to give people on-ramps to vaccination; there’s no need to distinguish between the “best” options. And even the sticks could be seen as carrots.
For all the focus on the rigidity of the anti-vaccine movement, too much is made of its reach into the general population.
Unfortunately, anything requiring legislation is probably off the list at this point. We should have established multiple sick days so a workforce at constant risk of firing could get vaccinated and take a couple of days off if needed to deal with subsequent, fleeting symptoms. We could have built stimulus checks into vaccinations, with a bonus for a full course of shots. It’s unlikely those benefits will be revisited, and that’s sad; America is being victimized by poor public-health policies that unnecessarily hassle people into complying with things we generally want them to do.
The Biden administration’s latest effort is an untargeted mandate that doesn’t interfere with personal privacy. The CDC on Tuesday updated its guidance to recommend mask-wearing for everyone in communities with “substantial or high transmission” of COVID-19. The guidance will include a mask recommendation in all K-12 schools, since children under 12 cannot be vaccinated yet.
This follows some local mask mandates, which inevitably get issued in areas with large Democratic populations, not cities with large outbreaks. I personally don’t see mask-wearing as much of a burden, and such mandates buy time for the delicate work of encouraging people to get vaccinated. But since a CDC recommendation is unenforceable and would have its greatest impact among those least at risk of severe illness (i.e., those already vaccinated), it’s unclear what this order is trying to accomplish. Mostly, it frustrates a lot of people, and while maybe that’s a bank shot to have them pressure friends to vaccinate, it seems less than optimal.
Empirically, the best way to ensure safety in indoor environments is to only have the vaccinated enter them. In April, as the first strains of the delta variant were starting to hit Europe, I made a case for vaccine passports as a freedom-enhancing intervention. We dwell more on the freedom of the minority of Americans who resist getting a shot and who would be barred from certain activities under a passport regime than the freedom of the majority who are vaccinated and want to go about their lives, and the businesses that want to cater to them.
Over the past several days, we’ve finally seen a recognition of this. The Department of Veterans Affairs will require vaccines for its 115,000 health care personnel; so will large chains like Trinity Health and Banner Health, academic hospitals like New York-Presbyterian and Yale, nursing home groups like CareOne, and more. All health care workers and government employees in California must show proof of vaccination or submit to regular testing and indoor masking, along with city workers in Pasadena and New York City. Five hundred bars in San Francisco won’t just card patrons for their age but their vaccine status.
Given the potential economic damage from delta variant fears, there’s almost an economic imperative for businesses that realize the popularity of a vaccine requirement.
The University of California and California State university systems have a vaccine mandate, as do several other colleges and universities; a federal judge turned back a lawsuit against Indiana University and allowed them to move forward with this requirement. That lawsuit just reinforced the constitutionality of requiring vaccinations for accommodations or employment.
But these requirements, just like the mask mandate, will mostly hit populations receptive to a public-health message. Many Republican governors, likening vaccine requirements to historic civil rights violations, have preemptively blocked this approach. Without a national scope like in France and Italy, it’ll be hard to truly generate impact. (Incidentally, while both European countries triggered protests for their vaccine requirement policies, they’ve also led to millions of appointments for vaccines.)
One option that President Biden will announce today is a vaccine mandate for all federal employees, including contractors. That comprises millions of people and would hit all areas of the country.
I see the vaccine requirement for entry as more carrot than stick. If you want access to regular life, you can get stuck and benefit. Selfishness being what it is, that signal could work. And the public does seem to agree. One poll regarding vaccine passports and travel showed a remarkable 81 percent support, and large pluralities would be more likely to take a plane trip, visit a restaurant, or attend a concert under that regime. Given the potential economic damage from delta variant fears, there’s almost an economic imperative for businesses that realize the popularity of a vaccine requirement. If they won’t allow service without shoes and a shirt, they can certainly do so for a vaccine, and promote a safe environment.
But too much attention has gone to mandates and not enough to persuasion. Some believe that trusted sources or peers are the best messengers for vaccination; if it takes calling it the “Trump vaccine,” that’s perfectly fine. But the audience for these messages should be actual persuadables, not those who have built the vaccine into their impenetrable blue team/red team worldview. Tens of millions of other Americans would be interested in protecting themselves from respiratory failure but haven’t been reached by the current messages or the current level of vaccine access. Whether it’s mobile clinics (vaccines “within five miles” hardly matters if you don’t have a car or access to transportation), “Souls to the Shots” partnerships with church groups, a campaign of direct outreach from doctors, or answering questions about the vaccines in a real and respectful way, there do seem to be options to encourage more take-up.
We are ridiculously lucky to be living in a country where vaccines are available at all. There’s no single way to take maximum advantage of this gift. We shouldn’t get locked into thinking there’s a magic bullet to prevent clearly preventable deaths. The situation is more complicated than that, and will require some real creativity. Maybe we’re turning the corner toward that.
