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Make COVID-19 vaccines mandatory

Jim Son, a Stony Brook University Hospital pharmacist,

Jim Son, a Stony Brook University Hospital pharmacist, prepares to administer a COVID vaccine in Melville in March. Credit: Howard Schnapp

Lawmakers in more than 40 states have proposed legislation to prohibit mandates requiring employees to be vaccinated against COVID-19. Sponsors of such measures argue that vaccination should be a choice. They object to any requirement that a person be vaccinated in order to work, enter sports arenas, restaurants, houses of worship or nursing homes. When mandates have been instituted by a tiny number of health systems, state colleges and employers, lawsuits and outraged gubernatorial news conferences have ensued.

Many states and employers are jumping on the incentive bandwagon to try to boost vaccination rates. Some public health experts are going along, despite the fact that they know if we don’t mandate vaccines, and incentives fail, then huge numbers of Americans are likely to become sick, find themselves masked and quarantined again, or die.

Gimmicks to encourage vaccination include special lotteries, dinners with governors, cash and free drinks, fishing licenses, passes to state parks, and tickets to shows and sporting events. Will they work? No one seems to know.

The harsh truth is that our nation is still in the middle of a public health emergency. So is the world. This means we remain under threat of a barrage of reinfection, including potentially more dangerous variants. The only proven tool for effectively controlling infectious diseases like COVID is vaccination. The only way to ensure vaccines work is to get them into as many arms as possible, and fast.

Americans say they want to go back to work and to social gatherings. They want to resume travel, recreation and in-school learning. Vaccination is a crucial tool to make this much-desired freedom happen.

There are also millions of our fellow citizens who have immune diseases, cancer, transplants and other maladies or who are newborns whom we very much do not want to die of COVID. Even as many politicians prattle on about personal choice, the vulnerable need a fully vaccinated nation and world to protect them so they can enjoy choices, too.

So why is the public health community not fighting for mandatory vaccination? Where are those warning that if entire states in the South and West don’t get to much higher levels of vaccination soon they will almost certainly be introducing more virulent strains of COVID to the entire nation? The sad answer: We are letting unchallenged, mistaken ideology and bullying drive our public health response, leaving the nation and the world almost certain to face a recurrence of lockdowns, quarantines, closures, deaths and hospitalizations.

Some say current vaccines are not fully approved, so mandates are premature. This is absurd. The data on vaccines under emergency use authorization in the U.S. is huge and positive. Facing an ongoing pandemic that could worsen is surely sufficient to justify mandates with the data now accumulated. Pfizer is applying for full licensing for its vaccine and, while that process is still likely months away, it is also a strong "go" signal for mandates now.

The road to real, meaningful liberty, choice and freedom runs right through mass vaccination. The fastest way to get there is mandates, not free drink giveaways. When you are locked in isolation, on a ventilator or in the morgue, freedom and choice mean little. Mandates, not gimmicks, are the best, evidence-based strategy to normalcy.

Arthur Caplan is director of medical ethics at NYU Grossman School of Medicine.

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