State vaccine mandate is needed
The first COVID-19 vaccine shots in arms did not occur until December 2020, when a winter surge was already well under way. Although developed at warp speed in response to pandemic, the vaccine’s arrival was too late to spare tremendous suffering. Hundreds of thousands died.
Nine months later, despite universal access to the vaccine in the U.S., our current vaccination rate remains below the threshold to prevent future surges, even in California. The current delta wave not only quashed our brief moment of optimism as we retired the state’s tier system and lifted the state mask mandate, it was also fundamentally different in that it was fully preventable. And while public officials reached back into their pre-vaccination toolkits to keep Californians safe, reinstating mask mandates and counseling against travel, the single most effective policy for preventing COVID spread was quietly ignored.
That, of course, was a broad vaccine mandate.
In recent days, public officials have finally begun to lean into vaccination as the essential tool for moving beyond this pandemic. In August, Culver City in Los Angeles County became the first school district in California to mandate teacher and eligible student vaccinations. The city of Los Angeles, with the second largest school district in the country, just followed suit. San Francisco and Berkeley recently implemented limited vaccine mandates, requiring proof of vaccination for entry into restaurants and gyms. And on a national level, President Biden asked the Occupational Safety and Health Administration to craft a workplace vaccine mandate for private sector businesses that employ more than 100 people.
This patchwork of mandates is highly encouraging. But, here in California, we can improve on things in two key areas:
First, mandates are more likely to be effective in bringing dramatic reduction in COVID spread if an opt out for testing is removed. Weekly testing has only a modest effect on lowering transmission and is in no way equivalent to vaccination.
Second, we need a statewide mandate in California that requires vaccination for entrance into all public spaces, from schools and workplaces, to restaurants and bars. This will close loopholes and speed up our vaccination coverage, giving Californians the best shot at avoiding a winter surge.
If we want to return to the life we knew before COVID, within months rather than years, a state mandate for vaccination is the quickest path forward. Once a system of verification is in place and with more conclusive data, proof of natural immunity could substitute in some situations.
This may feel like a radical concept for some. Yet the alternative, continuing along our current path of masking, distancing and an ever-present fear of close human contact, represents a more profound infringement on our freedoms than a vaccine requirement.
Many of us long for the return of the simple freedoms of walking inside a store without a mask or attending a concert or wedding. But from our vantage point as emergency physicians, there are more consequential freedoms that never-ending COVID surges will continue to restrict, including family access to loved ones while hospitalized, the ability to wait in a warm waiting room, rather than sit outside in the cold, and allowing doctors and patients to see each other without masks, which can be crucial for conveying grave and urgent information when a patient is critically ill.
Inadequate population level immunity will also continue to impact the freedom of the severely immunocompromised, for whom vaccines may not offer full protection from deadly illness.
During the nine months it has taken our country to inch toward a national mandate, the COVID-19 pandemic has resulted in too much avoidable suffering and death. While our national leaders work to implement and enforce vaccination for federal workers, the military and businesses with 100 or more employees, our state leaders can move us further faster. As it has in the past, California should serve as a national model, requiring educators and students, small-company employees, patrons and employees of restaurants, bars, gyms and entertainment venues to be vaccinated or have proof of immunity in order to gain access or maintain employment.
With united action by the federal government and public and private decision-makers at the state level, a broad mandate would be enough to push vaccination rates well above 80%, likely stopping future surges when combined with high rates of natural immunity.
If we fail to achieve adequate levels of vaccination, however, we will continue to experience surges among the unvaccinated. And all of us will pay the price, especially young children, likely delaying their language development and interfering with their process of building natural immunity to other viruses by perpetual masking.
Additional preventable diseases born of social isolation and economic disruption, from depression to drug overdoses, will continue to spike while COVID continues to circulate and mutate.
This summer’s delta surge was fully preventable. And although serious illness from COVID was suffered almost exclusively by the unvaccinated, we all suffered collateral damage.
If mandating the COVID-19 vaccine or proof of immunity feels radical to you, ask yourself how radically different your life will continue to be if we don’t.