COVID-19 vaccine mandates have come and mostly gone in the U.S. Why their messy rollout matters for trust in public … – Lewiston Sun Journal

Ending pandemics is asocial decision, not scientific. Governments and organizations rely onsocial, cultural and political considerationsto decide when to officially declare the end of a pandemic. Ideally, leaders try to minimize the social, economic and public health burden of removing emergency restrictions while maximizing potential benefits.

Vaccine policy is a particularly complicated part of pandemic decision-making, involving a variety of other complex and often contradicting interests and considerations. Although COVID-19 vaccines havesaved millions of livesin the U.S., vaccine policymaking throughout the pandemic was oftenreactiveandpoliticized.

A late November 2022 Kaiser Family Foundation poll found thatone-third of U.S. parentsbelieved they should be able to decide not to vaccinate their children at all. The World Health Organization and the United Nations Childrens Fund reported that between 2019 and 2021, global childhood vaccination experienced itslargest dropin the past 30 years.

The Biden administration formallyremoved federal COVID-19 vaccination requirementsfor federal employees and international travelers in May 2023. Soon after, the U.S. government officiallyended the COVID-19 public health emergency. But COVID-19s burden on health systemscontinues globally.

I am apublic health ethicistwho has spent most of my academic career thinking about the ethics of vaccine policies. For as long as theyve been around, vaccines have been a classic case study inpublic health and bioethics. Vaccines highlight the tensions betweenpersonal autonomy and public good, and they show how the decision of an individual can havepopulationwide consequences.

COVID-19 ishere to stay. Reflecting on the ethical considerations surrounding the rise and unfolding fall of COVID-19 vaccine mandates can help society better prepare for future disease outbreaks and pandemics.

Vaccine mandates are the most restrictive form of vaccine policy in terms of personal autonomy. Vaccine policies can be conceptualized as a spectrum, ranging from least restrictive, such as passive recommendations like informational advertisements, to most restrictive, such as a vaccine mandate that fines those who refuse to comply.

Each sort of vaccine policy also has different forms. Some recommendationsoffer incentives, perhaps in the form of a monetary benefit, while others are only averbal recommendation. Some vaccine mandates are mandatory in name only, withno practical consequences, while others may triggertermination of employmentupon noncompliance.

COVID-19 vaccine mandates took many forms throughout the pandemic, including but not limited toemployer mandates,school mandatesandvaccination certificates often referred to asvaccine passportsorimmunity passports required for travel and participation in public life.

Because of ethical considerations, vaccine mandates are typicallynot the first optionpolicymakers use to maximize vaccine uptake. Vaccine mandates arepaternalistic by naturebecause they limit freedom of choice and bodily autonomy. Additionally, because some people may see vaccine mandates as invasive, they could potentially create challenges in maintaining and garnering trust in public health. This is why mandates are usually the last resort.

However, vaccine mandatescan be justifiedfrom a public health perspective on multiple grounds. Theyre apowerful and effectivepublic health intervention.

Mandates can providelasting protectionagainst infectious diseases in various communities, including schools and health care settings. They can provide a public good by ensuring widespread vaccination to reduce the chance of outbreaks and disease transmission overall. Subsequently, an increase in community vaccine uptake due to mandates can protect immunocompromised and vulnerable people who are at higher risk of infection.

Early in the pandemic,arguments in favorof mandating COVID-19 vaccines for adults rested primarily on evidence that COVID-19 vaccination prevented disease transmission. In 2020 and 2021, COVID-19 vaccines seemed to have astrong effect on reducing transmission, therefore justifying vaccine mandates.

COVID-19 alsoposed a disproportionate threatto vulnerable people, including the immunocompromised, older adults, people with chronic conditions and poorer communities. As a result, these groups would havesignificantly benefitedfrom a reduction in COVID-19 outbreaks and hospitalization.

Many researchers foundpersonal liberty and religious objections insufficientto prevent mandating COVID-19 vaccines. Additionally, decision-makers in favor of mandates appealed to the COVID-19 vaccines ability toreduce disease severity and therefore hospitalization rates, alleviating the pressure on overwhelmed health care facilities.

However, the emergence ofeven more transmissible variantsof the virus dramatically changed the decision-making landscape surrounding COVID-19 vaccine mandates.

The public health intention (and ethicality) of original COVID-19 vaccine mandates became less relevant as the scientific community understood that achieving herd immunity against COVID-19 wasprobably impossiblebecause of uneven vaccine uptake, andbreakthrough infectionsamong the vaccinated became more common. Many countries likeEnglandandvarious states in the U.S.started to roll back COVID-19 vaccine mandates.

With the rollback and removal of vaccine mandates, decision-makers are still left with important policy questions: Should vaccine mandates be dismissed, or is there still sufficient ethical and scientific justification to keep them in place?

Vaccines are lifesaving medicines that can help everyone eligible to receive them. But vaccine mandates are context-dependent tools that require considering the time, place and population they are deployed in.

Though COVID-19 vaccine mandates are less of a publicly pressing issue today, many other vaccine mandates,particularly in schools, are currently being challenged. I believe this is a reflection of decreased trust in public health authorities, institutions and researchers resulting in part fromtumultuous decision-makingduring the COVID-19 pandemic.

Engaging in transparent and honest conversations surrounding vaccine mandates and other health policies can help rebuild and foster trust in public health institutions and interventions.

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COVID-19 vaccine mandates have come and mostly gone in the U.S. Why their messy rollout matters for trust in public ... - Lewiston Sun Journal