Getting a COVID-19 vaccine in summer 2021 could have given you a shot at a million dollars. Soon, not getting one could cost you your job.
Health officials and politicians have tried to stay positive in recent months as vaccination rates plummet, turning to ad campaigns touting giveaways and lottery drawings. And then the ultra-contagious delta variant arrived.
Now health officials say the nation's lagging vaccine rates are creating a spiraling public health crisis as the unvaccinated rapidly get sick and the protective power of vaccines is given a "stress test." A growing chorus of voices say people who resist vaccinations should face pressure – and consequences.
On Thursday President Joe Biden announced the biggest U.S. mandate yet: Civilian federal employees and onsite contractors must be vaccinated or undergo once or twice a week COVID-19 testing, he said. Google and Facebook are also now among employers who say vaccines will be required for employees who work in offices.
The consequences for resisting similar rules have already proven real. Vaccine mandates in health care settings have already resulted in some people who refused to get vaccinated being fired or quitting in New Jersey and Texas.
“Getting the vaccine (should be) the easy choice,” Dr. Leana Wen, a proponent of vaccine mandates, told USA TODAY. “Opting out has to be the hard choice.”
Wen, an emergency physician and public professor at George Washington University, said unvaccinated people aren't just risking their own health. They have a high likelihood of transmitting the virus, which endangers vulnerable people – including children who can't yet get vaccinated – and the immunocompromised.
Multiple experts told USA TODAY that a virus circulating at high rates among unvaccinated people tests the effectiveness of vaccines. It also increases the chance that even worse variants of the virus will arise.
Wen is among experts who say vaccine requirements should be seen as akin to laws against drunken driving and other reckless behavior.
A USA TODAY opinion piece on Friday said the Biden administration should embrace "targeted vaccine mandates," with a vaccine requirement for air travel as the most urgent. A Los Angeles Times editorial argued the "carrots" of lotteries and giveaways haven't been enough to persuade millions of Americans to get vaccinated, so "it’s time to break out the sticks."
But in the U.S., about 100 million people who are eligible for the vaccine still haven't gotten their first dose. According to a new poll by The Associated Press-NORC Center for Public Affairs Research, only a small percentage of people who remain unvaccinated plan to get the shot.
“We need something a lot more dramatic,” Wen said. She once was Baltimore's health commissioner, and in her experience, she said, “mandates work.”
Hospitals are first battleground for vaccine mandates
COVID-19 vaccine mandates have long been discussed in the U.S. and are widely considered legal, but the "vaccine passports" that would help facilitate them have faltered without a federal framework.
So the future of mandates in the U.S. probably will be driven by employers – not federal or state governments, according to Dr. Ashish Jha, dean of Brown University's School of Public Health.
Employers will be increasingly motivated to make sure their workforce isn't sickened en masse and that infected workers don't endanger customers, Jha said. That's especially true in health care, he said.
Hospitals have already been a legal battleground for vaccine mandates. In a notable legal victory for mandates in mid-June, a federal judge said that if employees of the Houston Methodist hospital system didn't want to get vaccinated, they could go work elsewhere.
Vaccine requirements in health care settings have gained steam in recent days, with the American Hospital Association saying it supports them.
Full approval will pave way for more mandates
A cloud of legal ambiguity has hovered over vaccine mandates for months because no COVID-19 vaccine has yet been fully approved by the Food and Drug Administration.
The vaccines have been distributed under an emergency use authorization status, and an April analysis from the Kaiser Family Foundation found it was "unclear whether COVID-19 vaccination could be legally mandated while the FDA’s (emergency use authorization) is in place."
But Jha said recent court rulings show the vaccines' status is not a significant legal barrier that would prevent mandates. He said the distinction is more "psychological" than legal.
For now, many employers, especially ones outside health care, are likely to remain hesitant to require vaccines until full approval comes, Jay Wolfson, a public health expert at the University of South Florida, told USA TODAY. Wolfson also holds a law degree from Stetson University College of Law.
That approval could diminish the threat of employees fighting the mandates in court, Wolfson said. But such approval could be months away.
Pfizer recently announced that the FDA declared its application eligible for “priority review” and would decide no later than January. But the agency is widely expected to finish its work far sooner.
Full approval carries the FDA’s strongest endorsement of a product, and, among other steps, it usually requires six months of safety follow-up.
Vaccine rules don't need to require vaccination
Rules aimed at increasing vaccination rates don't necessarily need to be blanket mandates, Wolfson said.
New York City's order for public health care workers to be vaccinated or regularly tested as a way of sidestepping potential legal trouble, he said: “You can fire people for not getting tested."
Wolfson expects to see such approaches become more common, especially if the delta variant continues sickening Americans at a high rate.
Jha said the move toward mandates and vaccine rules isn't surprising: “We always kind of knew this day was coming.” Forcing people to get vaccinated "is not some new thing,” he said.
The rules will likely be effective at targeting a huge swath of the unvaccinated population: people who aren't “fundamentally opposed” to getting vaccinated but "don’t think they need one," Jha said.
Wen is aware many Americans believe such rules infringe on their liberties. She agrees they have the right to remain unvaccinated – as long as they stay isolated and don't put others at risk.
“If you want to engage in public spaces where there are other people, you need to get vaccinated.” she said. The choice to get a vaccine is “not just about you.”
Contributing: Mabinty Quarshie USA TODAY; Lindy Washburn, NorthJersey.com; The Associated Press
This article originally appeared on USA TODAY: Calls for COVID vaccine mandates, requirements grow as cases surge