But I suspect all of this will change a depressingly modest number of minds. There are no speeches more powerful than the fear of disease and the grief of loss. That’s evident in the vaccination data now. Delta does appear to be driving a surge in vaccinations. But is this really our strategy? More death will lead to more shots in arms? One of the most heartbreaking stories I’ve read lately came from a Facebook post by Brytney Cobia, a doctor in Alabama. She wrote:
I’ve made a LOT of progress encouraging people to get vaccinated lately!!! Do you want to know how? I’m admitting young healthy people to the hospital with very serious Covid infections. One of the last things they do before they’re intubated is beg me for the vaccine. I hold their hand and tell them that I’m sorry, but it’s too late. A few days later when I call time of death, I hug their family members and I tell them the best way to honor their loved one is to go get vaccinated and encourage everyone they know to do the same. They cry. And they tell me they didn’t know. They thought it was a hoax. They thought it was political. They thought because they had a certain blood type or a certain skin color they wouldn’t get as sick. They thought it was “just the flu.” But they were wrong. And they wish they could go back. But they can’t. So they thank me and they go get the vaccine.
Phil Valentine, a conservative radio host in Nashville who said he wouldn’t get vaccinated and made parody songs about “the Vaxman,” caught the virus, and his condition quickly turned critical. He’s now in the hospital, on a ventilator. “He regrets not being more vehemently ‘pro-vaccine,’ and looks forward to being able to more vigorously advocate that position as soon as he is back on the air,” his radio station said in a statement.
This is one problem with trusting our rationality: The choice we make now, before we catch the virus, may not be the choice we will wish we had made once we get sick. Then there’s the stubborn fact that individual decisions have collective consequences. It may indeed be the case that a healthy 19-year-old American has little to fear from the coronavirus. But his immunosuppressed grandfather has much to fear from him. Whether it is a more severe imposition on liberty to ask someone to get vaccinated or regularly tested than to ask all immunosuppressed people in the country to effectively shelter in place for the rest of their lives is a collective question that demands a collective answer.
Other countries are offering that answer, and seeing results. Emmanuel Macron, the president of France, proposed a law requiring either proof of vaccination or a negative test result for many indoor activities. The mere prospect of a vaccine mandate set off mass protests. It also led to a surge in vaccinations. On July 1, 50.8 percent of the French population had gotten at least one shot — putting France 3.5 points behind America. By Sunday, 59.1 percent of France had been at least partially vaccinated, putting it 2.7 points ahead of us.
A number of American employers are following suit. On Thursday, the Biden administration is expected to announce a directive requiring all civilian federal workers to get vaccinated or face routine testing and restrictions. California and New York will require proof of vaccination or routine negative test results for all state employees. New York City is imposing the same requirement for its public employees. Around 600 college campuses have announced that they’ll require vaccinations for students returning in the fall. There’s no hard count of how many businesses are requiring vaccinations or test results to come back to work, but the anecdotal answer appears to be “a lot.”
There is nothing new about this. We do not solely rely on argumentation to persuade people to wear seatbelts. A majority of states do not leave it to individual debaters to hash out whether you can smoke in indoor workplaces. Polio and measles were murderous, but their near elimination required vaccine mandates, not just public education. When George Washington wanted to protect his soldiers from smallpox, he made inoculations mandatory. It worked. “No revolutionary regiments were incapacitated by the disease during the southern campaign, and the mandate arguably helped win the yearslong war,” wrote Aaron Carroll.
The objection I find most convincing to any kind of vaccine mandate is that we have not built the infrastructure to make it work. What if someone who received a vaccine has lost her card, or her information was wrongly recorded when she got her shot? If we try to carry this out through smartphones, what if you don’t have a smartphone, or you lose it? If you want to choose frequent testing, how do you get access to those tests, and who pays for it, and how are the results recorded? If you have a problem, who do you call to solve it? How long are the wait times when you call? What if you need an answer quickly?
I covered both the debacle of the HealthCare.gov launch and the now-multidecade failure to transition to electronic medical records. We just watched state unemployment insurance systems nearly collapse under the demands of the pandemic. Perhaps we don’t have the capacity to do this well. But with so many public and private employers mandating vaccination for their workforces, we’ll know soon enough. Either they’ll build models that can scale or they will fail spectacularly enough to settle the question. And either way, this suggests a step the government could take right now: Funding, building and deploying an excellent vaccination passport infrastructure — backed up by ubiquitous rapid-testing options, for those cases when the passport fails — that private and public employers can use to implement their own policies.