Vaccine Mandates: Critical or Counterproductive?
Did COVID shot mandates damage public trust?
September 1, 2023 4 minutes read
“As COVID-19 vaccines became available, the federal government instituted requirements for certain populations to be vaccinated, including healthcare personnel,” said Lynch, testifying for the Infectious Diseases Society of America. “Requirements have long been in place for other vaccines and have been effective at increasing vaccine uptake.”
Lynch spoke at a July 27, 2023, hearing of the Select Subcommittee on the Coronavirus Pandemic of the U.S. House of Representatives Committee on Oversight and Accountability.
Misinformation on the COVID-19 vaccine has undermined uptake of the current bivalent booster, although the Food and Drug Administration plans to release another reformulated SARS-CoV-2 vaccine this fall.
“Misinformation weakens vaccine confidence and causes more people not to be vaccinated,” Lynch said. “Not enough people are getting COVID-19 boosters, which means they are not as protected from hospitalizations and deaths. Declining vaccine rates for diseases like measles, pertussis, and polio can cause outbreaks that are not only dangerous from a public health perspective, but can have profound consequences for our society and the families involved.”
Prior to the pandemic, seasonal flu shots for healthcare personnel as a condition of employment had been in place for many years at some facilities.
“In hospitals with a requirement, including my own system, vaccination coverage rates of healthcare personnel have consistently been greater than 95%,” he said.1 “Influenza vaccine requirements for healthcare workers in hospitals and long-term care facilities also decrease patient influenza diagnoses and reduce influenza mortality for long-term care residents.”2,3
In addition, school immunization mandates have greatly reduced outbreaks of vaccine-preventable diseases.
When COVID-19 vaccines first were distributed, there were compelling reasons to boost vaccination rates quickly, and mandates made sense, particularly for healthcare workers, Lynch said.
“We wanted to ensure that any employee providing direct patient care would be vaccinated in order to minimize the risk of that essential healthcare worker being unable to work due to COVID-19 illness or transmitting COVID-19 to a patient,” he said. “Our health system decided to require the COVID-19 vaccine as a condition of employment so that we could best protect our employees and the patients that we serve.”
While COVID-19 vaccines still are effective in preventing hospitalization and death, breakthrough infections and transmission are possible, but much of the population has some form of hybrid immunity from natural infection and/or immunization.
“We also now have safe and effective COVID-19 therapeutics available to help prevent serious illness and death,” Lynch said. “Policies should evolve based upon the latest data, and the data do not support federal COVID-19 vaccination requirements at this time. “
The Centers for Medicare and Medicaid Services lifted the requirement for COVID-19 vaccination of healthcare personnel, and it now is largely left to states and individual medical facilities to set immunization policies.
Kevin Bardosh, PhD, a medical anthropologist and implementation scientist at the University of Washington School of Public Health, described a paper he wrote with colleagues that showed that vaccine mandates largely are counterproductive.
“[We] outlined a set of 12 reasons why the coercive approach to COVID vaccination policy would ultimately be both counterproductive and damaging to public health and society,” Bardosh testified. “We based these ideas on the existing literature at the time, with nearly 150 citations.”
The 12 reasons were divided into the following four categories:4
• Behavioral psychology: reactance and entrenchment, cognitive dissonance, stigma and scapegoating, distrust and conspiracy theories;
• Politics and law: erosion of civil liberties, social polarization, global governance;
• Socioeconomics: disparities and inequalities, reduced health system capacity, exclusion from work and social life;
• Integrity of science and public health: erosion of key principles of public health ethics and the erosion of trust in regulatory vaccine oversight.
“Our analysis strongly suggests that mandatory COVID-19 vaccine policies have had damaging effects on public trust, vaccine confidence, political polarization, human rights, inequities, and social well-being,” Bardosh read from the article. “We question the effectiveness and consequences of coercive vaccination policy in pandemic response and urge the public health community and policymakers to return to nondiscriminatory, trust-based public health approaches.”
Also testifying at the hearing was Danielle Runyan, JD, senior counsel with First Liberty Institute, a legal organization dedicated to defending religious liberty in the United States.
The institute challenged a U.S. Navy policy that required certain Navy personnel to be vaccinated for COVID-19 to be deployed for duty. According to Runyan, medical accommodations were granted but those who cited religious exemptions were denied and not deployed.
First Liberty legally challenged this policy and ultimately was vindicated when a court determined that the government had not justified the “the substantial burden imposed on the plaintiffs’ religious beliefs,” she said. “In short, the court granted the plaintiffs the relief they requested, which allowed them to remain employed without being vaccinated.”
REFERENCES
- Greene MT, Fowler KE, Ratz D, et al. Changes in influenza vaccination requirements for health care personnel in US hospitals. JAMA Netw Open 2018;1:e180143.
- Carrera M, Lawler EC, White C. Population mortality and laws encouraging influenza vaccination for hospital workers. Ann Intern Med 2021;174:444-452.
- Lindley MC, Mu Y, Hoss A, et al. Association of state laws with influenza vaccination of hospital personnel. Am J Prev Med 2019;56: e177-e183.
- Bardosh K, de Figueiredo A, Gur-Arie R, et al. The unintended consequences of COVID-19 vaccine policy: Why mandates, passports and restrictions may cause more harm than good. BMJ Glob Health 2022;7:e008684.
Testifying before a recent congressional committee on vaccine mandates, John Lynch, MD, MPH, FIDSA, medical director of infection prevention and control at Harborview Medical Center in Seattle, extolled the many benefits of COVID-19 immunization compared to the risks of morbidity, mortality, and the lingering chronic effects of SARS-CoV-2 infection.
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