The power of mandates

I really enjoy Chotiner’s interviews with the Ashish Jha, dean of the School of Public Health at Brown — not as entertaining as his give-’em-enough-rope jobs but more informative. This is a good way of explaining why vaccine mandates are a good idea where they’re viable:

Do you have any thoughts about more coercive ways of getting people to take the vaccine? It seems pretty clear we’re not going to have a law telling people they have to get vaccinated, but you could have certain nudges or rules, whether you’re paying people to take it or whether you’re telling people that they cannot come to public or private spaces unless they prove that they’ve been vaccinated.

This comes back to a conversation I had with our university president, a few months ago. Chris Paxson, the president of Brown, asked, What if we don’t have a vaccine mandate? My assumption was that, if seventy, maybe seventy-five per cent of people will get vaccinated, we’re going to probably continue to have everybody masking up, and we’re going to continue doing some amount of social distancing. And this would probably be for a very long time, not just for a few months. And then she asked, What if we do a vaccine mandate? And the answer was, we don’t have to have indoor masks, classes can go back to normal, dorms can go back to normal. Life can go back pretty close to what life was pre-pandemic.

My sense is that this was a no-brainer. And that’s what companies are starting to do. I’m talking to businesses that said, I just want my employees back. How do I do it? And my answer is, if you don’t require vaccinations, then you have to put in a whole bunch of mitigation measures and you have to be doing ongoing testing and you need to make sure people are wearing masks. And you’re not going to have a dozen people crowded around a table in a conference room. Then they say, For how long? And I’m like, Probably for years. Then it dawns on them that this is untenable. I think businesses, universities are going to jump off the fence and start mandating. A lot of them are just waiting for the F.D.A. I really think people are underestimating the power of F.D.A. approval. I think when it happens you’re going to see a large number of organizations require it for returning back to work, partly because their senior leadership is older people who don’t want a breakthrough infection.

And FWIW, Jha on FDA approval:

Nearly all public-health authorities in the country are urging people to get vaccines. We see the incredible results that the vaccines have had and how many lives they’re saving, and still the F.D.A. has not offered full, permanent approval of the vaccine. President Biden suggested it might take several more months. How do you understand that, or how can that be defended, if it can be?

I find it incredibly puzzling what exactly the F.D.A. is doing. The F.D.A. says that it typically takes them six months or sometimes as much as a year to fully approve a new product. And, generally, we appreciate that. There are two components to that. One is that they want to see a large amount of data, and they want to go through that carefully, and I think that’s essential. Then the second is that there’s a process, which can take a while. This is a global emergency, and while all of us want to make sure that the F.D.A. does its job, most of us also feel that just operating on standard procedures may not be the right thing to do here, and that there are things that can be sped up. Just as with the development of vaccines, we didn’t cut any corners. We did all the steps, but we did it much, much faster. The F.D.A. has to go much, much faster.

The other thing about the data—the amount of data that the vaccines have generated, the number of people who’ve been vaccinated, and the scrutiny that the data has received. I mean, my goodness, this data has been scrutinized and looked over more than—

I’d imagine it’s more than any data in modern history, right?

Any therapy, any vaccine ever. These are the most highly scrutinized medical products we have ever had, and I don’t understand what the F.D.A. is doing.

I also think this is an excellent point about how way too much coverage has focused solely on mortality rates from the virus, and not enough on how you really don’t want to get this infection, especially if you’re unvaccinated, even if it’s not fatal:

I think there are a couple of things. One is that young people always feel invincible, right? If you remember back to the conversations about the Affordable Care Act, they always talked about the young invincibles—the people who think, I don’t need health insurance. I’m going to be fine. A vaccine is a little bit like insurance, right? It’s insurance against encountering the virus and not wanting to get sick from it. And young people tend not to buy insurance for health stuff because they tend to think they’re invincible. I think that’s a broader societal issue. But there’s a second problem here, which is that, for a year and a half, they have been bombarded with misinformation that says that, for them, the coronavirus is no worse than a bad cold. And when you’ve been hearing for a year and a half that there’s a cold going round, and then someone shows up with a vaccine, you won’t be surprised that lots of people aren’t going to necessarily avail themselves because they already think they’re pretty invincible, and now you’re asking them to get vaccinated against what they perceive to be a mild disease. The truth, of course, is that, while young people do better than old people, this is probably the most significant infection that any of us can get right now in America. And, even for people who do just fine and get better, there are a lot of people who end up getting really quite sick. And I think the misinformation really has made it hard for people to believe that.

This message isn’t just coming from the Tucker/Berenson crowd, and it’s a major barrier to getting vaccination rates where they need to be. As the high rates of vaccination among the elderly make clear, even most hardcore Trump supporters will get vaccinated if they think they’re at serious risk.