The U.S. has hit a worrying plateau with its COVID-19 vaccination coverage. Only half of the country is fully vaccinated. This is due to pandemic fatigue (weak compliance with COVID-19 risk mitigation measures like masking and ditancing) and the highly infectious Delta variant which accounts for over 83 percent of all infections. The pandemic is at an important turning point, with coronavirus infection rates increasing by around 140 percent over the past two weeks.The Biden administration expressed deep concern about the lack of vaccinations and mandated immunizations for federal workers and contractors. This was in addition to regular testing and masking, while the Department of Veterans Affairs issued mandates to all frontline health workers within its facilities. The President Joe Biden ordered that the military move towards compulsory vaccinations.New York State, California and New York City are the first to require government workers to be vaccinated. New York City's Key to NYC Pass was just launched. It requires proof of vaccination to gain access to all indoor activities including restaurants, gyms, and performances. This is the first such policy in the United States. Following a joint statement by 100 nursing and medical groups, more hospitals and long-term care facilities have implemented mandates. Nearly 600 universities and colleges will be required to get vaccinated when they return from higher education in the fall. This is true for both the private sector and a growing tide of businesses like Uber, Google, Netflix, Delta Air Lines, which mandate vaccinations for their workers.These mandates are legal and ethical. The short answer to this question is yes. There is strong behavioral science to support mandates being highly effective.The Lawfulness and Legality of COVID-19 MandatesBusinesses: The Equal Employment Opportunity Commission (EEOC), as well as the Department of Justice, have ruled that employers may legally require employees to receive the COVID-19 vaccination before they are allowed to work. Businesses must allow legitimate religious or medical exemptions. Houston Methodist Hospitals' COVID-19 vaccine mandate was the only major court decision. Private sector can set conditions for employees and customers with great discretion, but businesses have an ethical and legal duty to ensure safety in the workplace.All COVID-19 vaccines currently are administered under an EUA (emergency use authorization) and are not fully licensed. According to the DOJ and EEOC, employer mandates can occur under any EUA. The U.S. is acting as though the vaccines are fully approved. Public health agencies recommend that everyone eligible get a shot. The Food and Drug Administration announced recently that it will expedite full licensure for the Pfizer vaccine. Other vaccines are likely to follow. More businesses will likely require vaccinations if the FDA approves COVID-19 vaccines.Federal and state governments: Since long, states have had the constitutional power to require vaccinations. The Supreme Court upheld this right twice, in 1905, and again in 1922. However, the federal government has limited authority to order vaccines. They can only be required to prevent the spread of dangerous infectious diseases across borders or state lines. The federal government has not sought to mandate nationwide vaccinations and the courts likely wouldn't allow it. All state mandates for vaccines have been approved by the government to date. It is possible that cities and states will wait until the vaccines are licensed before they mandate COVID-19. Governments acting as employers would be in the same legal position as businesses. Therefore, COVID-19 vaccine mandates for federal and state workers are legal even under the EUA.K12 schools: All states and Washington, D.C. require routine vaccinations, including measles, rubella, and mumps, to ensure school attendance. Although state mandates can vary in their content, they all follow the recommendations of the Centers for Disease Control and Prevention. The Supreme Court upheld school mandates in 1922. All courts have accepted the state's authority to require fully approved vaccines. Schools must provide medical exemptions to those who might be harmed by vaccines. However, they don't have to grant religious objections or conscientious objections. Six states do not offer religious or personal exemptions to school mandates. This is a decision that has been upheld by the courts. They will likely require FDA licensure because K12 COVID-19 mandates will be issued directly from the government. The FDAs EUA for the Pfizers COVID vaccination is only available to adults aged 12 and over. Current clinical trials are underway for children under 12 years of age, but results may not be available until later this year or early in 2022.Institutions of higher Education (IHEs: IHEs are, in most ways, similar to businesses. IHEs require students to be vaccinated against human papillomavirus and meningococcus. A federal court ruled that Indiana University's COVID-19 mandate was reasonable and scientifically based to protect student safety and health. The U.S. Court of Appeals, Seventh Circuit recently affirmed Indiana University's mandate as legal. IHEs are in loco parentis, and have a duty of care to ensure the safety and security on campus. Many IHE COVID-19 mandates are applicable to students. However, some also apply to faculty members and staff.Antivaccination LawsSome states want to limit vaccine mandates. Over a dozen states have passed laws that prohibit mandatory COVID-19 vaccines and even proof of vaccination (so called vaccine passports). There are many more bills in progress. Governors have issued executive orders that prohibit COVID-19 vaccine mandates and vaccine passports. These orders prohibit private businesses, schools, and IHEs asking for proof that they have been vaccinated. COVID-19 has been politicized as no other virus. AIDS, tuberculosis, Zika, influenza, and Ebola are just a few examples of states that have previously taken steps to improve public health. Many states are now doing the opposite, making it difficult for health officials to respond quickly and decisively during this pandemic. This will make it more difficult to combat COVID-19 and the next health crisis.States have broad powers to regulate business. This means that even though laws and executive orders may be harmful, they could still be legal. States may attempt to regulate businesses that are involved in international or interstate commerce. Florida's attempt to prohibit the cruise ship industry from asking passengers and crew to prove their vaccination status is currently under scrutiny. A federal court of appels voted unanimously against a CDC regulation of cruise ships. Florida had previously challenged the decision. This was an unusual case, as the appeals panel's earlier 2-1 decision, which temporarily blocked Floridas ban from being upheld, was reversed. The appeals court has yet not to explain why the change was made. It is clear from the Constitution that Congress has sole authority to regulate interstate commerce and international commerce.Are Vaccine Mandates Effective?There are a lot of behavioral science data to support the idea that vaccine mandates work. This includes both mandatory vaccinations required for school and workplace attendance, as well as soft mandates that allow people to choose whether or not they want to be vaccinated or tested regularly. Hospitals that require influenza vaccinations have maintained and achieved greater coverage than those who make it voluntary. The U.S. has high vaccination rates due to IHE and K12 school mandates.Many educational and business mandates fall under the hard category. This means that students or workers can't attend class or work if they have not been fully vaccinated. People are encouraged to get vaccinated by soft mandates. Most people choose to get vaccinated if it is easier or more convenient. When faced with the decision between getting a vaccine and having to go through one to two SARS CoV-2 testing per week and masking up, most people choose to get the jab. How can we be sure? A significant percentage of parents will opt out of vaccines if there are no exemptions. If a state makes it difficult to get an exemption, such as requiring a written statement, a doctor certificate, or attending vaccine literacy courses, vaccine hesitancy disappears. COVID-19 vaccines will be the same.Are COVID-19 Vaccine Mandates Ethical?Many people cite bodily integrity and personal liberty as their main reasons for refusing vaccinations. These arguments are not valid. Everyone has the right to refuse medical intervention. However, vaccines do not just protect the individual being vaccinated, but also their family members, friends, classmates, and co-workers. Nobody has the right not to be covered up and vaccinated in a classroom or work environment. Vaccine mandates don't unethically discriminate. Discrimination is not allowed if it is based upon irrational or animus reasons, such as discrimination on the basis of race, gender, or disability. However, vaccine mandates can only be used as a tool and are applicable to all. They don't seek to inflict blame on the unvaccinated. They are only intended to protect the population. A person's privacy is not at risk by being required to show proof that they have been vaccinated. Individuals can choose to not disclose whether they have received a shot. However, they should expect reasonable consequences in order to protect everyone's health. Federal privacy rules regarding health information are only applicable to individuals and not businesses or schools. Privacy rules are also applicable to public health.The American Revolutionary War began the tradition of requiring people to have a vaccine. General George Washington ordered troops to receive a smallpox variolation because it was necessary to protect soldiers and win the war. Not only is it legal to mandate vaccination, but it also comes with an ethical responsibility. Americans have been asking the question "What rights do I have as an American citizen?" For too long Americans have wondered: What rights do I have as a citizen with rights? It is crucial that we get a COVID-19 vaccination as we are facing a major health crisis. This will help us all to be better and to build mutual solidarity.
