Against: Mandate a new form of ‘institutional segregation’

Increasingly, vaccination is no longer a matter of choice. Hundreds, perhaps thousands, of workplaces and schools are instituting COVID-19 vaccine mandates, with more expected following formal FDA licensure of the vaccines.

But mandating people and their children who have consciously chosen not to get vaccinated — a group that tends to be younger, less educated, Republican, non-white and uninsured — is a recipe for creating new and deeper fractures within our society, the kind of fractures we may profoundly regret in hindsight.

Let’s not sugarcoat it: This is a new form of institutionalized segregation. Yes, some unvaccinated adults may swallow this bitter pill and comply as a way of doing their part in making America safer.

But many will see it — along with requirements that the unvaccinated wear masks or undergo regular COVID testing — as a thinly veiled attempt at public shaming. After all, if the goal is to maximize the interruption of spread, then surely all people should be masked irrespective of vaccination status. Forced compliance will come with future consequences. The ensuing anger, resentment and loss of trust forms a ticking time bomb waiting to go off. Are we ready to add this mandate to the list of issues helping erode the fabric of our society?

These practices diverge substantially from the historical norm of equal opportunity. For all other required vaccines, religious and philosophical exemptions allow unvaccinated children to enjoy the same educational experience as the vaccinated.

This is because exemptions reflect a social value that in the United States, there are valid reasons for refusing treatments or vaccines, and these reasons will be respected.

Once exempt, there are no sanctions experienced in everyday life. But with COVID vaccine mandates, even those with exemptions are being sanctioned, sending another clear message: We really don’t care about your reasons.

And in schools, where a child’s experience will be shaped by their parents’ decisions and those of policymakers, the situation could become tragic. If schools invite vaccinated children to lose their masks, what was once an act of social responsibility could morph into a mark of disease.

What should we anticipate? Children of different ages being barred from mingling. Children being bullied, ridiculed and mocked, with taunts using terms like “covidiot.” Differential treatment toward unvaccinated children by some teachers (who are, just like everyone else, individuals with their own views about COVID vaccines).

And families deciding to withdraw from formal education, choosing instead to home-school. Vaccinate-or-mask policies will drive a wedge between children and parents, cause daily psychological harm, carrying long lasting consequences for future generations.

Some might see mandate resistance as a symptom of vaccine misinformation. But considering most of these individuals have complied with mandates for routine vaccines such as mumps and measles, diseases of far less societal consequence than COVID, is it not worth listening to their objections against COVID vaccine mandates?

For some, there’s little value in a vaccine against a disease they have already recovered from, even as new variants develop.

The Centers for Disease Control and Prevention estimates that by May, 120 million Americans of all ages (35% of the population) had already been infected with SARS-CoV-2. New data shows natural immunity is six to 13 times more protective against emerging variants than vaccines.

For many, it is a product safety issue. The vaccines were developed and tested in months, not years, before rollout, and they were initially authorized by regulators in the context of an emergency. These people want greater assurances of safety and efficacy — something that requires additional time and data.

Yet in response, some public commentators are calling for the FDA to speed its review process and approve all of the coronavirus vaccines. Thus far, only one COVID-19 vaccine has received full approval. While such an approval might convince a slice of the unvaccinated, many will remain skeptical. Considering that the pivotal safety and efficacy trials were designed as two-year trials to finish in mid-2022, an approval this year can be seen as premature.

Despite hundreds of millions of doses already in bodies, we are still in the learning phase regarding vaccine safety and efficacy, as can be witnessed in the data about “breakthrough infections” and previously unknown side effects like myocarditis and blood clots. Most people may accept this uncertainty and conclude that whatever the risks, they are outweighed by the benefits. But for the minority who desire greater scientific certainty, we should respect these reasons, not respond with mandates.

We already know this country has deep divisions. We simply cannot allow coercive policies that will result in the creation of a society that is less just and more fractured than it already is.

Peter Doshi (pdoshi@rx.umaryland.edu) is an associate professor of Pharmaceutical Health Services Research at the University of Maryland School of Pharmacy. Aditi Bhargava (aditi.bhargava@ucsf.edu) is a professor in the Department of ObGyn and Reproductive Sciences at University of California San Francisco. The views expressed are those of the authors and do not represent their home institutions or any office they hold.