Making — and confusing — the case for mask and vaccine mandates


Public health mandates have three distinct roles: to increase the availability of accurate information; protect people from each other; and establish collective action that benefits society in ways that individual actions cannot. Mandates reflect and ideally reinforce the understanding that we are connected: individuals affect and are affected by the actions of others.

Public attitudes towards mandates have changed as understanding of how the behavior can harm others has increased – for example, with laws against drunk driving or the creation of smoke-free public places. These changes did not require drastic changes in society but were a natural evolution as we better understood these threats and the interventions to counter them.

Omicron muddled the Covid mandates file. If vaccination essentially eliminates the risk of spreading the disease – as with two doses of measles vaccine – the case for a mandate is clear. If the burden of a mandate, like handwashing for restaurant workers, is minimal, then the controversy is minimal. And if the risk to others is significant, as in someone with infectious multidrug-resistant tuberculosis, then compulsory isolation is generally accepted. Omicron is an intermediate case. It is much less likely to cause hospitalization and death than previous variants, and breakthrough infections among vaccinated people are much more common. But Omicron is so highly infectious that even a lower risk of serious illness still means hospitalizations and deaths have increased. A disease that is both less severe and kills more people complicates policy-making and public understanding.

What is the rationale for Covid vaccination mandates? Vaccination mandates are about both protection from others and collective action for the benefit of society. Vaccinated people and vulnerable people are better protected. Society benefits from a lower risk of cases, epidemics, and disruptions to health care, education, and economic activity. The risk from mRNA vaccination is extremely low and these vaccines are highly effective in reducing the risk of serious illness and death.

The case for vaccination mandates for healthcare workers is clear, as has been the case for many years for influenza vaccination. Health workers look after the most vulnerable people in our society. Anyone who visits a health care facility has a reasonable expectation that the facility will take all reasonable steps to avoid causing harm. And healthcare workers have the right to be protected, and to have their families protected, from preventable infections. “Less serious” does not mean “harmless”, especially for vulnerable populations seeking health services.

When pediatric vaccinations are fully authorized, there will be a case for vaccination mandates for school attendance, as has been the case for many vaccines for decades. If Delta returns – or a new variant as lethal or deadlier than Delta emerges – the case for warrants would be much stronger.

The case for vaccination mandates beyond health care and school settings is less clear. What about people who work or live in correctional facilities? Homeless shelters? In the workplace, protecting co-workers, preventing disruptions, reducing healthcare costs, and creating an environment in which people with medical vulnerabilities are better protected are reasonable considerations that support mandates employers.

We must recognize the complexity, the values ​​and the importance of an open discussion on the mandates. Does a warrant serve the interests of society so much that it justifies compelling individuals or organizations (including private companies) to do something? Mandates will be effective if there is widespread understanding and acceptance of their necessity.

What about mask mandates? On the one hand, requiring someone to wear a mask is much less intrusive than asking them to be injected with a vaccine. On the other hand, masking has drawbacks, including discomfort, loss of social connections, and cost.

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A philosophical underpinning of warrants is the simple concept that your right to swing your fist ends in someone else’s face. When a deadly variant of Covid is spreading widely, mask mandates in public places are clearly justifiable. The burden of masking is small compared to the burden of serious illness or death from Covid. When the lethality of Covid decreases – as with the Omicron variant – and the infection rate decreases – decreasing the risk that hospitals will be stressed and the care of patients with Covid and other conditions will suffer – the case of mask mandates is much lower. In schools, mask mandates when Covid spreads widely can be an effective way to keep children in school, teachers healthy and schools open for in-person instruction.

The goal is to strike a balance: When is a demand on certain people justified in order to protect others?

Short of warrants, society can do a lot to protect people. Better insights with up-to-date data dashboards and maps that display the equivalent of how hard it is Covid raining in a community lets individuals know when they might want to voluntarily increase or decrease their exposures, hide or switch to an N95 mask. Employers can choose to offer N95 masks to employees who want to use them and can promote a culture where there is no stigma in wearing a mask at all times. Organizations can make plans for what they will do when there are cases or clusters. Insurers and employers may decide to charge less for health coverage to people who are up to date on their vaccines so that those who are vaccinated do not have the burden of paying for the care of those who choose not to be vaccinated.

Some mandates are clearly stated, but when and which one is a societal decision, best made with open discussion, weighing scientific facts – including on the effectiveness and safety of vaccines and masks – with societal values. Different communities may make different decisions when faced with similar scientific information. At a minimum, governments should ensure that factual information is timely, widely available and reliable; clearly communicate the science and rationale for the recommendations; and facilitate open and respectful discourse. Recommendations for mandates should be explicit and realistic about both the benefits of any mandate and the burden on those mandated to change their behavior.


cnn

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