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'Enough is enough': Frustration fuels new push for vaccine passports

A proof of vaccination sign is posted at a bar in San Francisco on Thursday, July 29, 2021. Until now, many employers had taken a passive approach to their unvaccinated workers, relying outreach and incentives. But that has been shifting, with vaccine mandates gaining momentum. (AP Photo/Haven Daley)
A proof of vaccination sign is posted at a bar in San Francisco on Thursday, July 29, 2021. Until now, many employers had taken a passive approach to their unvaccinated workers, relying outreach and incentives. But that has been shifting, with vaccine mandates gaining momentum. (AP Photo/Haven Daley)
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As other cities weigh following New York’s lead in requiring proof of COVID-19 vaccination for certain activities, critics on the right and left are questioning the fairness and efficacy of such policies as a way to overcome entrenched vaccine hesitancy in some segments of the population.

The rapid spread of the delta variant across the United States has lent urgency to the push to convince reluctant Americans to get vaccinated. New data suggests those who are vaccinated might transmit the delta variant easily if infected, but the vaccines still greatly reduce the risk of contracting the virus or suffering serious symptoms.

New York City Mayor Bill de Blasio unveiled the “Key to NYC Pass” earlier this week, mandating proof of vaccination for indoor dining, gyms, and entertainment venues beginning Aug. 16, and enforcement of the mandate will start Sept. 13. The city is also offering a $100 cash incentive for those who get inoculated.

“If you’re unvaccinated, you will not be able to participate in many things,” de Blasio said Tuesday. “It’s time for people to see vaccination as necessary to living a good, full, and healthy life."

New Yorkers will be able to verify their immunization through the city’s new NYC COVID Safe app, the state’s Excelsior Pass app, their paper vaccination card, or a copy of their official vaccination record. All vaccines approved for emergency use by the World Health Organization will be accepted.

Children under 12 who are not yet eligible for vaccination will be allowed to enter establishments with vaccinated adults if they are masked. It is not yet clear how the city will deal with adults who have legitimate medical or religious reasons for not getting a shot.

“I think this approach might be successful for some people who don’t want to lose these everyday privileges we take for granted,” said Amber Reinhart, an expert on health communication at the University of Missouri-St. Louis.

De Blasio compared the policy to “health passes” implemented in France last month, which appeared to increase vaccination rates but also sparked a wave of fierce anti-vaccine protests. Several U.S. cities have instituted vaccine mandates for government workers, but New York is the first to impose social costs on the unvaccinated in the general population.

It might not be the last, though. San Francisco health director Dr. Grant Colfax said Tuesday the city is “exploring” a similar vaccine requirement and is encouraging private businesses to institute their own mandates. The Los Angeles City Council is considering a proposal to require proof of vaccination for a variety of indoor entertainment activities.

"Enough is enough already," said Los Angeles City Council President Nury Martinez in a statement. "Hospital workers are exhausted, moms who have put aside their careers are tired, and our kids cannot afford the loss of another school year. We have three vaccines that work and are readily available, so what’s it going to take?”

The White House has so far ruled out any sort of federal vaccine mandate, but President Joe Biden welcomed de Blasio’s announcement. Although vaccination rates are beginning to accelerate nationwide, he suggested other communities should consider more aggressive measures to compel inoculation.

“There are steps that are going to be taken by localities,” White House press secretary Jen Psaki said Wednesday. “There will be steps taken by businesses. The president supports local efforts to keep communities safe. They’re going to be different from community to community.”

Resistance to more coercive measures remains strong in many areas, particularly those where vaccination rates are low. Several Republican governors and legislatures have prohibited the use of vaccine passports in their states.

“We can either have a free society or we can have a biomedical security state," Republican Florida Gov. Ron DeSantis said Wednesday.

Some public health experts frustrated by the resurgence of the virus and the slowdown in vaccinations say the time for mandates has come. Incentives like lotteries and free beer had limited impact, so a more punitive approach could work.

“The public has not responded to health educational messages or incentives,” said Lawrence Gostin, director of the O’Neill Institute for National & Global Health Law at Georgetown University. “We need to get serious about raising vaccination coverage. Vaccine passports and mandates are proven methods to increase vaccination coverage.”

However, Republicans are not alone in voicing concerns. Democrat Kim Janey, the acting mayor of Boston, lashed out at the concept of vaccine passports Tuesday, raising the specter of Jim Crow laws and demands for former President Barack Obama to release his birth certificate. She stressed there are still many impediments to vaccination for people of color and low-income families, and requiring proof of inoculation could disadvantage them.

"There’s a long history in this country of people needing to show their papers — whether we are talking about this from the standpoint of, you know, as a way to, after — during slavery, post-slavery, as recent as, you know, what the immigrant population has to go through," Janey said.

In New York City, about 60% of white and Latino adults have gotten at least one COVID-19 shot, compared to only 43% of Black adults. That means a significant portion of the city’s population could be barred from engaging in typical social activities once vaccine requirements are in place, and that group would be disproportionately Black.

Vaccine hesitancy among Black Americans, rooted in a long history of mistreatment by the government and the medical community, has been a challenge from the start, and some progress has been made in countering it. Unless more outreach is done to communities of color, experts say vaccine mandates could inadvertently foster discrimination.

“This type of unintended consequence is definitely something that public health officials need to be watching out for and setting up measures to protect against this happening,” Reinhart said.

Convincing people the vaccines are safe and effective is only part of the solution. Access is less of a concern now than it was in the spring when supplies were scarce, but some low-income workers might still have trouble finding child care or transportation or getting time off from work.

“Saying you have to be vaccinated but not ensuring everyone has access to it is extremely problematic,” said Michael Ulrich, an assistant professor of health law, ethics, and human rights at Boston University.

There are logistical and technological obstacles to requiring proof of vaccination, as well. Experts have warned any sort of digital verification system could lead to increased surveillance, tracking, and sharing of personal health data because existing privacy laws do not contemplate a situation like this.

“People are going with something that is completely unproven and potentially harmful,” Albert Fox Cahn, executive director of the Surveillance Technology Oversight Project, told NBC News.

After the difficulties and customer hostility some restaurants and stores encountered with mask mandates, enforcement of vaccine mandates could place uncomfortable burdens on employees. New York City’s uncertainty about facilitating religious and medical exemptions signals additional complications too.

Sen. Rand Paul, R-Ky., called vaccine requirements “obscene” in an appearance on Fox News Thursday. He noted Centers for Disease Control and Prevention guidance that those who have been infected with COVID-19 wait at least three months after recovery before getting vaccinated, and he questioned whether someone merely complying with that recommendation should be penalized.

A CNBC survey released Wednesday found the American public nearly evenly split on vaccine mandates in general, with 49% in favor and 46% opposed. Most Americans back targeted mandates for hospitals, cruise ships, and airplanes, but fewer than 40% support them for restaurants, hotels, and stores.

Getting 70% of U.S. adults to roll up their sleeves for at least one shot of a new vaccine in less than nine months represents an enormously successful rollout, but it is still far short of what experts believe is necessary to halt the spread of COVID-19. The delta variant is far more contagious than the original strain, and additional mutations could emerge that are more resistant to vaccines if the virus continues to circulate.

“The concern is that if we don’t get enough people vaccinated as soon as possible, the delta variant will keep spreading... but also, the more people get infected, the longer the time span, more variants could pop up,” Ulrich said.

The renewed debate over vaccine passports comes amid growing tensions between the vaccinated and unvaccinated. Eighteen months into the pandemic, a return to normal is looking further away than it did in the spring, despite the ready availability of vaccines that could prevent most transmission.

An Axios/Ipsos survey showed nearly 80% of people who are vaccinated blame the recent increase in infections and spread of new variants on the unvaccinated, and more than one-third blame former President Donald Trump and conservative media. Those who are not vaccinated are more likely to say foreign travelers and the mainstream media are responsible.

Scorning and shaming the unvaccinated might not be the most effective way to change their minds. In a recent poll of likely voters conducted by the Trafalgar Group for Convention of States Action, 60% of respondents said public figures criticizing the unvaccinated is an inappropriate way to address vaccine hesitancy.

“Name-calling citizens who choose not to be vaccinated is immoral and dangerous,” said Mark Meckler, president of Convention of States Action. “Once again, Washington D.C. and its allies in big business and big media are hugely out-of-step with the overwhelming sentiments of the American people across all political parties and perspectives.”

That could be true, but identifying another strategy that works better has proven difficult. Polls show about 20% of Americans say they are unlikely to get vaccinated under any circumstances, but some holdouts might be swayed if they were required to do so for work, school, or other activities.

“Requiring vaccination as a condition of enjoying the things we love like dining or watching a movie is an effective method to increase vaccination rates,” Gostin said. “It could become controversial, but most people will just get the jab.”

(If you are viewing on a mobile app, click here to take the poll.)

Reinhart cautioned some of the unvaccinated could have the opposite reaction to vaccine passports, growing even more strident in their opposition to immunization because they feel the government is trying to force it on them. A similar backlash occurred over mask mandates, but that is not necessarily a reason not to try it if officials believe they have no other options.

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“Think of telling a child, ‘Don’t touch this hot plate’ – immediately all the child wants to do is touch the plate, even if past experience tells them the hot plate can hurt their hand...,” Reinhart said. “There is a definite risk here, but again, I think public health officials would say they were backed into making these types of decisions because previous methods haven’t worked.”

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