We need COVID-19 vaccine requirements now — not just recommendations

In the current phase of this ever-changing pandemic, we are witnessing the emergence of two Americas. One where fully-vaccinated Americans often remain highly reluctant to remove masks with examples of “mask shaming.” At the opposite pole, another country where large unmasked crowds gather in public, such as at sports events, unclear of who has or has not been vaccinated. What links both of these Americas? Neither one is following the CDC’s updated COVID-19 recommendations.

Recommendations are often complex and confusing. Trust in science and the CDC, damaged by politicization, has deteriorated. As an example of how acute these challenges are — four out of every 10 health care workers remain unvaccinated. Recommendations alone are not enough. New requirements for vaccinations and reporting are required to move the country forward that will “open” the country back up in ways that are practical and safe at the same time.

The country needs to implement vaccine requirements, especially in high-priority settings including hospitals, nursing homes and schools. Without vaccine requirements the country will face significant difficulties and delays in safely opening back up. In turn, public health will be compromised, and the economy will face avoidable burdens. These types of vaccination requirements aren’t new and are done routinely in hospitals and schools. There are several reasons why these measures are needed.

First and most important is the direct health consequences of unvaccinated individuals in critical settings. The lack of a vaccine requirement in health care settings has resulted in superspreader events and preventable deaths posing a health risk to patients. It is reasonable for many patients to assume that health care workers are all immunized. Additional critical settings where requirements should be considered are institutions of education or childcare, transportation, law enforcement and hospitality industries -all places where close contact indoors can pose risks, particularly to infants and children for whom there is currently no available Covid-19 vaccine. While some universities are moving ahead with mandates, a disturbing trend has erupted: Public colleges in red states are less likely to have a vaccine requirement compared to private universities in blue states. Law enforcement, including police officers were some of the earliest eligible essential works for vaccines, but in same large urban areas such as Columbus, Ohio only 28 percent of the employed police officer have received a vaccine to date.

Vaccination requirements will need to be augmented through mechanisms to demonstrate proof of vaccination and reporting requirements. Without this type of transparency, rebuilding the social trust needed to return to normalcy will continue to lag. We are in a transitional period where the number of immunized Americans is increasing but we are not yet at a level where mitigation measures can easily be lifted, if at all. Federal officials should work with state and local authorities to consider how best to establish fair and accurate reporting mechanisms — without overburdening already stressed businesses — to reflect actual levels of immunization. Employers, especially large ones, are already embracing vaccine requirements partly because they know that customers might choose to seek services elsewhere, which could have significant financial impact.

If we don’t shift from recommendations to requirements, new forms of inequalities will likely emerge. For example, the lack of a federal standard for immunization proof has led to a deluge of private market solutions, such as digital verification of immunization status in the workplace. These solutions can be very expensive. Employers and individuals with limited financial resources will be unlikely to be able to afford such solutions. In turn, we may see a society in which people with means and income to do so will pay to ensure their safety. For example, we may see market demand for access that are certified as vaccinated spaces. These could include more expensive vaccinated seats on airlines or hotel rooms. In short, America could become further divided by those who can have access to immunized places that carry lower risk and those that don’t.

Shifting from recommendations to requirements will itself require and different leadership and new phase of coordination and alignment between federal, state and local authorities, as well as between the public and private sectors. This transparency and consistency will better enable the country to return to normalcy.

We must do the hard work of addressing safety concerns while educating Americans around the role of broader immunity and the impact that one unvaccinated individual can have in a community. We have to do it in multiple settings and with multilingual approaches that humbly meet people where they are. That is no small task given how diverse peoples’ reasons are for delaying or rejecting vaccination. There should always be consideration for religious or valid medical exemptions and the ethics of mandating a vaccine that was approved under an emergency authorization — but that will be moot in a matter of weeks as Pfizer filed for a full approval recently with the rest of the manufacturers in line to do the same. The stakes could not be higher to shift our approach from recommendations to requirements, along with the need to foster the trust necessary to overcome hesitancy.

Kavita K. Patel is a physician at Mary’s Center, a federally qualified health center in Washington D.C. and a nonresident fellow at the Brookings Institution. She was a director of policy in the Obama administration.