Research About Vaccine COVID 19 Mandates

Vaccine mandates have worked in the
past. Can they overcome modern

hurdles?
The public health directives are older than the U.S. itself. But it's unclear
whether they will be effective at driving up COVID-19 vaccination among the
nation's 80 million resistant adults.
BYJILLIAN KRAMER
PUBLISHED SEPTEMBER 16, 2021
• 7 MIN READ
As vaccinations lag across the U.S. and COVID-19 cases continue to rise ,

new federal mandates will attempt to stymie the spread of the virus by
requiring millions of workers to be vaccinated or face weekly testing.
President Joe Biden on September 9 announced the new mandates,

which apply to workers at companies with more than 100 employees,
federal workers and contractors, and health-care workers at institutions
that receive federal funding. Together, the various orders affect about
100 million American workers.
These mandates, although sweeping, follow a precedent of U.S. vaccine

directives that date to the days of the Revolutionary War. “Mandates are
American, and resistance to them is American,” says Elena Conis, a
historian of medicine at the University of California, Berkeley.
Some companies have already mandated COVID-19 vaccines—including

Disney, Uber, Facebook, Google, Netflix and Delta Air Lines—and many
celebrated those announcements, but the backlash against the new
requirements has been thunderous: Several Republican
governors declared them unconstitutional , and the Republican National
Committee threatened to sue .
Experts say that this opposition, along with other hurdles, makes it
tough to predict how much the mandates will contribute to slowing the
spread of the virus, and ultimately, bringing the pandemic to an end.
While history is on the side of the vaccine mandates, “no one knows
how effective this will be,” says Eric Toner, a senior scholar and
emergency medicine expert with the Johns Hopkins Center for Health
Security. “[But] I think more people will be vaccinated with these
measures than would be vaccinated otherwise.”
The historical precedent for vaccine mandates

While some politicians have touted the new mandates as “un-
American,” vaccine mandates are older than the United States itself.
“General [George] Washington mandated smallpox inoculation —the
precursor to the vaccine, and a more dangerous procedure—for the
Revolutionary Army,” says Dorit Reiss, a law professor who specializes
in vaccine policy at the University of California, Hastings College of the
Law. “And I don't think it’s fair to describe Washington as un-
American.”
In 1809, Massachusetts enacted a law that gave the state’s municipal

boards of health the authority to require smallpox vaccinations for
people older than 21. “Throughout the 19th century, individual
employers would sometimes insist on proof of smallpox vaccination or
infection before hiring someone who might work in their shop or
home,” Conis says. That proof was usually just the bodily scar that
remained on the arm or leg after vaccination.
The Supreme Court upheld the law when it was challenged, setting a

precedent that such mandates are constitutional. In 1922, the court
again backed vaccine mandates , supporting the authority of states to
make them a condition of school attendance.
Today, armed services personnel face a long list of vaccine mandates ,

and health-care workers may be required to have certain vaccines —such
as those for influenza, as well as measles, mumps, and rubella—as a
condition of employment. But most vaccine mandates affect school
children: All 50 states have vaccination requirements as a condition for
admittance. (And some states, such as Mississippi and Maine, do not
allow religious or philosophical exemptions.)
Vaccine mandates must work in two ways to be most effective, says
Reiss: They must increase vaccination rates and prevent outbreaks.
Multiple studies show that school mandates have increased childhood
vaccination rates across all 50 states and tamped down the spread of
preventable diseases.
In one example, measles outbreaks in 1976 and 1977 led Alaskan health
officials to more strictly enforce the state’s measles, mumps, and rubella
vaccine mandate. According to the Centers for Disease Control and
Prevention, 7,418 of the state’s 89,109 students were unable to provide
proof of vaccination on the day of the announced enforcement. They
were forced to leave school. One month later, however, fewer than 51
students were still excluded, the CDC reported, and no further cases of
measles occurred.
Hospitals with mandatory influenza vaccinations have achieved higher

vaccination coverage than those that make it voluntary. And the
agencies that mandated COVID-19 vaccines before Biden’s
announcement have already seen some success: For example, the
number of active-duty military personnel who are vaccinated increased
from 76 percent to 83 percent in the weeks after the Pentagon issued its
mandate.
The mandates still face hurdles

But the new mandates are not an instantaneous fix to the pandemic, nor
are they guaranteed to work. The mandates will face legal challenges
from Republicans and employers. It’s also unclear how many of the 100
million American workers affected by the mandates are already
vaccinated, leaving some experts to question how many new
inoculations will occur.
“Undoubtedly, [the vaccine mandates] are very effective tools if fully

implemented and properly enforced, but that is fraught with
challenges,” says Rossi Hassad, an epidemiologist at Mercy College in
New York. “So, there will be many cracks in the system that
unfortunately may prolong this pandemic.”
What’s more, getting a COVID-19 vaccine does not offer instantaneous
protection; it takes time for immunity to build, and with the highly
transmissible Delta variant now the dominant strain in the U.S., non-
medical measures—like hand washing, mask wearing, and social
distancing—will continue to be important tools to stop the spread of
COVID-19, Hassad says.
And while an August AP-NORC poll showed that more than half of

Americans support employer vaccine mandates, 87 percent of
unvaccinated respondents to a later CNBC poll said they would not get a
COVID-19 vaccine even if their employers required them to do so.
“Polls are really important to get a temperature” for how people are
feeling and as guidance for policy efforts, says Angela Shen, vaccine
policy expert and visiting research scientist at the Vaccine Education
Center at Children’s Hospital of Philadelphia. But people don’t always
stick with their decision not to get vaccinated when faced with the
consequences of their choices, she adds.

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Vaccine mandates have worked in the

past. Can they overcome modern

As vaccinations lag across the U.S. and COVID-19 cases continue to rise ,

President Joe Biden on September 9 announced the new mandates,

These mandates, although sweeping, follow a precedent of U.S. vaccine

Some companies have already mandated COVID-19 vaccines—including

The historical precedent for vaccine mandates

In 1809, Massachusetts enacted a law that gave the state’s municipal

The Supreme Court upheld the law when it was challenged, setting a

Today, armed services personnel face a long list of vaccine mandates ,

Hospitals with mandatory influenza vaccinations have achieved higher

The mandates still face hurdles

“Undoubtedly, [the vaccine mandates] are very effective tools if fully

And while an August AP-NORC poll showed that more than half of

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