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Experts say a COVID-19 vaccine mandate might be difficult to enforce, so public education or a limited mandate might be better solutions. Getty Images
  • Experts say it appears government agencies and even employers can require people to get a COVID-19 vaccine once it’s available.
  • However, they say such a mandate might be difficult to enforce, so public education might be a better option.
  • Another alternative would be to mandate that healthcare workers and people in high-risk groups get vaccinated.

It’s still a long ways away, but the debate over COVID-19 vaccinations has already begun.

And if recent experiences with measles vaccines and face masks are any indication, all those months of waiting might be needed to have enough time to build public support.

Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, told Congress on Friday that he’s cautiously optimistic that we’ll have a vaccine by the end of this year and as we go into 2021.

But as researchers race to develop and test potential vaccines, groups have shown up at rallies against lockdown orders or face mask requirements. And there’s skepticism in even the less-extreme segments of the population as well.

A May survey found that less than two-thirds of U.S. adults were “very” or “somewhat” interested in getting a COVID-19 vaccine.

In a different survey, nearly a quarter said they wouldn’t be willing to get a COVID-19 vaccine, including nearly two-thirds of those who were skeptical of vaccines in general.

And a June survey found about 27 percent of adults would “probably” or “definitely” not get a COVID-19 vaccine.

“One group will start running and rolling up their sleeves, and one group is not so sure and will wait to see if anything bad happens and then consider it,” Dr. William Schaffner, an infectious disease expert at Vanderbilt University in Tennessee, told Healthline.

Skepticism about an as-yet unproven and nonexistent medication that promises to return the world to “normal” life may seem understandable for now.

But the open, albeit still hypothetical, question is whether that skepticism will remain if a vaccine has been proven safe and effective.

If so, can governments or employers mandate that people get vaccinated? And will they?

The answer to the first question appears to be yes. There are already vaccine requirements for diseases, such as measles or tuberculosis, to attend or work at many schools.

And there are requirements for diseases such as polio to travel to most countries.

Certain exemptions to those requirements have been tightened up in many states as high-profile outbreaks of measles in places like Disneyland revealed the extent of the anti-vaccination movement in some communities.

But while voluntary compliance in the name of protecting yourself and others is ideal, the anti-vaccination movement underlines why the nation might need requirements in an emergency, such as the current pandemic.

“What concerns me is when I see the types of fights over wearing a mask. I can’t even imagine what would happen over vaccines,” said Debbie Kaminer, a law professor at Baruch College in New York who has written about the legal questions around vaccination laws and exemptions.

Kaminer recently wrote about the legality of states and employers requiring people to get a COVID-19 vaccine.

In her column, she writes, “People are often surprised to learn that states would likely have the legal right to enforce such a rule.”

Still, the ideal scenario would be compliance through public education. To Kaminer, though, that public education needs to have already begun by now — not once a vaccine is available.

“At the very least, there should be an enormous public education campaign going on right now, and that really hasn’t been happening the way it should,” she told Healthline.

Kaminer says a big part of that should be relying on people who can get the attention of particular communities.

She notes how polio vaccine rates surged after a young Elvis Presley got the vaccine on “The Ed Sullivan Show” in 1956, and how the Orthodox Jewish Nurses Association played a key role in convincing some people in Orthodox Jewish neighborhoods to get the measles vaccine amid an outbreak in New York last year.

“Find the people who communities listen to and start that campaign now,” Kaminer said.

The catch could be that the opposite may be true in communities skeptical of a vaccine.

An April study found Americans who voted for President Donald Trump are more concerned about potential harms of vaccines than other voters, and that the president’s tweets can firm up their opposition.

But it can also work both ways.

In one of the earlier surveys about attitudes toward a potential COVID-19 vaccine, more than a third of respondents said they would be less — not more — willing to get a vaccine if President Trump said it was safe.

Only 14 percent said Trump saying it was safe would make them more willing to get it.

“We have both anti-vaxxers and those who don’t trust Trump, who think he just wants to say he has a vaccine,” Kaminer noted. “So there’s people on both sides.”

That makes this a unique situation, she says, adding that the name of the current White House vaccine project doesn’t help.

“I could not think of a worse name than Operation Warp Speed,” Kaminer said.

That’s because the title implies the vaccine is being rushed through.

So, with education an ideal but tricky option in the current scenario, requiring certain high-risk groups could be an important tool.

This would include before the vaccine becomes plentiful and widely available.

“When vaccines first become available, they won’t be available in a sufficient quantities to vaccine everyone on day one,” Schaffner said.

As in past emergencies, such as 2009’s H1N1 outbreak and 2014’s Ebola outbreak, a Centers for Disease Control and Prevention (CDC) advisory committee is going through a “very rigorous process… to figure out, to put it colloquially, who should go to the front of the line, who should go to the middle of the line, and who should wait a little bit,” Schaffner said.

He notes that education has an important role to play here, too, and that it would be important to be transparent about who’s getting the vaccine and why.

But, Schaffner says, there appears to be a “rather a uniform opinion in surveys that the first folks should be healthcare workers in contact with COVID, because we need to keep them as healthy as possible so they can take care of people with COVID and not get sick themselves.”

The CDC committee’s emerging thinking appears to follow that idea, with a preliminary five-tier sketch of the plan placing those workers in the top tier, followed by others working in healthcare and essential jobs, as well as those deemed high-risk of severe COVID-19 complications.

Schaffner says attention is being paid to focus equity and make sure all segments of the population are considered as any prioritization scheme is set up.

But as for requiring certain segments to get it once it’s available to everyone, the picture is less clear.

As for employers being able to require a COVID-19 vaccine, Kaminer notes in her article that while most employers would likely be hesitant to try it, they likely could, especially given the “significant cost to having an unimmunized workforce” amid the pandemic.

Schaffner says it’s possible that healthcare institutions could require workers get the COVID-19 vaccine, as some states already require they get flu shots.

Or maybe people in the armed forces would be required to get it.

But it’s just speculation for now, and Schaffner sees it’s probably unlikely.

“If you come on our property at Vanderbilt Medical Center and want to enter a building, you’re going to have your temperature taken, but that’s very different than obliging people to get a vaccine, and I don’t think that will happen,” he said.

“There may be some subpopulations where there is a requirement, but I would be hugely surprised if there’s a broader requirement,” he added.

That broader requirement — while likely legal — would be a last resort and unlikely option, experts say.

The U.S. Supreme Court has rejected multiple lawsuits stating that vaccine mandates infringed on people’s liberties.

But in addition to the potential outcry and conspiracy theories, enforcing a broad requirement may just be too difficult to enforce.

“I don’t think anybody is going to compel people to get a vaccine,” Schaffner said.

So, to avoid that, education may be key.

There may be a ways yet to go. After her article about the legal underpinnings for vaccine requirements was posted, Kaminer says “almost all” the comments were from people who were anti-vaccine.

But there’s still plenty of time.

A safe, effective vaccine is — at least — many months away.

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