As the CDC announces its third change in masking guidance in as many months, the United States is approaching a perilous plateau in vaccination rates, with just over 48 percent of Americans fully vaccinated and nearly half of unvaccinated Americans saying that they won’t get the jab.
Some states in the South and Midwest have vaccinated barely a third of their populations. Yet Americans, vaccinated or not, are now tossing away their masks, and going to restaurants, bars, ballgames, movies, concerts, and theme parks in startling numbers.
The highly transmissible Delta variant is now the dominant strain, COVID-19 cases have doubled during the last three weeks, and deaths are again on the rise. Small wonder that the CDC on Tuesday revised its guidance to once more recommend that Americans don masks when indoors.
Will people listen again, or is this like the proverbial case of the boy who cried wolf once too often? One can sympathize with CDC’s decision to revisit mask guidance. If everyone used a mask—both the vaccinated and unvaccinated—it would slow the spread of the Delta variant. But that isn’t going to happen. It’s very unlikely unvaccinated people will listen and mask up.
Consequently, this new guidance will only penalize vaccinated Americans when the vast preponderance of the new wave of hospitalizations and deaths have occurred among the unvaccinated—many if not most of whom have decided to forsake a life-saving responsibility and remain unvaccinated as an ideological choice.
Vaccine refusal poses a major threat not just to oneself but to others, especially vulnerable individuals who have weak immune systems or children who cannot be vaccinated. It also prevents our country from achieving the level of herd immunity that will free us all from the shackles of COVID-19 and protect us particularly from the new variants that are currently rampaging across the country and the globe.
Even our military has become vulnerable. The Pentagon emphasizes that they encourage military personnel and their families to get vaccinated. Yet at Fort Benning, one of the Army’s largest training facilities, a growing number of young trainees are in the intensive care unit after arriving on duty and testing positive for COVID-19.
The new CDC mask guidance may be right on the science, but it is an extraneous distraction. The government instead must focus its energy primarily on vaccine mandates, political third-rail though those may be.
There is strong evidence that mandates boost and maintain vaccine coverage. From smallpox to childhood immunizations, history has shown that vaccine rates rise and stay high after mandates are enacted. According to the CDC, influenza vaccination coverage is highest (94.4 percent) among health workers where vaccination is required. Colleges and universities already have a history of mandating certain jabs such as Hepatitis B and meningococcal vaccine. These mandates keep students safe, especially in high-risk settings like dormitories and classrooms. Currently, more than 500 colleges and universities have announced COVID-19 vaccine requirements. Requiring vaccinations in post-secondary education can help reach young adults who are among the most resistant to COVID-19 vaccinations.
The Equal Employment Opportunity Commission has ruled that businesses can require COVID-19 vaccines as a condition of returning to work but must grant medical and religious exemptions. And the Department of Justice just this week released an Office of Legal Counsel opinion affirming that businesses, universities, and other entities can mandate COVID-19 vaccines even under the current emergency use authorization for them. In fact, many surveys demonstrate an overwhelming majority of Americans support employer requirements for vaccination as a condition to return to work.
This week, the United States will celebrate the 73rd anniversary of an act of great political courage in another contentious realm. On July 26, 1948, President Harry Truman—the man at whose desk the buck stopped—issued a sweeping Executive Order to desegregate the entire U.S. military establishment. The law and the resurgence of COVID-19 suggest that President Joe Biden should take an equally bold step to require vaccination of both the U.S. military and its civil service. That act alone would vastly boost vaccinations, while encouraging states and businesses to do the same.
Meanwhile, the FDA could do the right thing—and give the president political cover—by fully licensing mRNA vaccines. The case for full approval is overwhelming and many businesses and individuals say they want the FDA to act.
Further technical and logistical support for COVID-19 vaccinations is needed, as well. The CDC should be funding and offering technical guidance to states, localities, schools, and businesses to develop reliable and secure “proof of vaccination” systems. The CDC can also encourage vaccine mandates for the states and make recommendations on how to implement them equitably. When COVID-19 vaccines are fully approved for use in children, the CDC should include them in its recommendations of childhood vaccinations as a condition of school attendance.
Vaccine mandates alone will not address the access barriers that some still face, such as individuals who cannot travel to a vaccination site, workers in the “gig” economy who fear they will lose their income if they spend time getting vaccinated and dealing with normal transient reactions to the shot or undocumented immigrants who may fear consequences to their immigration status.
We are not advocating compulsory vaccination for everyone, but we strongly believe that those who seek exemptions should be required to receive counseling or vaccine education and to file a legal declaration explaining why they won’t get vaccinated. And those who still refuse to vaccinate should undergo frequent testing and indoor masking. Data suggest clearly that states that have a more onerous exemption process achieve significantly higher rates of childhood vaccinations.
Political and philosophical arguments against vaccine mandates don’t hold water. Everyone has the right to make decisions about their own health and welfare, but no one has the right to go unvaccinated in crowded public places. We need to make being vaccinated the easier, “default” choice. If we do that, we predict that America will quickly achieve, and far exceed, President Biden’s goal of 70 percent of our adult population getting at least one dose. Then we can really celebrate freedom from the coronavirus.
