State governments, private businesses and even part of the federal government are suddenly embracing mandatory coronavirus vaccinations for their employees.
Why it matters:Vaccine mandates have been relatively uncommon in the U.S. But with vaccination rates stagnating and the Delta variant driving yet another wave of cases, there’s been a new groundswell of support for such requirements.
Driving the news: Monday was a turning point.
The VA became the first federal agency to require its employees to be vaccinated.
More than 50 medical groups called for mandatory vaccinations of all health care workers, WaPo first reported.
California announced that state employees and health care workers must show proof of vaccination or get tested regularly.
New York City brought all municipal workers — including teachers and police officers — under a vaccine requirement that had previously only applied to health workers.
Even the SF Bar Owner Alliance hopped onboard, announcing that the 500 San Francisco bars it represents will require indoor customers to show proof of vaccination or a negative test.
The big picture: Vaccine requirements are also gaining steam internationally.
France has required health workers to get vaccinated. Members of the public must also have a vaccine or a negative test to enter most indoor venues.
Although the measure has sparked protests, it’s also encouraged millions of people to get vaccinated, per the NYT.
The bottom line:Vaccine mandates have been unpopular in part because they’ll inevitably create a backlash.
But the vaccination effort seems to have run out of carrots to incentivize more people to get a shot, and with rates remaining as low as they are in light of a worsening domestic situation, resorting to sticks has clearly become a more attractive option.
Experts are warning that the greatest threat to the pandemic recovery in the United States are the large swaths of Americans who remain unvaccinated.
Over the past few weeks, the U.S. has seen a surge of coronavirus cases across the country in the wake of the highly infectious delta variant. The new strain has particularly wreaked havoc in states with low vaccination rates.
The state of Missouri has recently become a U.S. hot spot, averaging more than 2,100 cases per day over the last seven-day period, according to data from The New York Times. About 41 percent of the state population is fully vaccinated.
Florida, Arkansas, Louisiana and Nevada have also seen an increase in coronavirus cases.
The nationwide vaccination rate has also dropped following the mad dash for the vaccine earlier in the year. Health experts warn that unvaccinated individuals pose a risk to the country, and could spread the disease until other, vaccine-resistant strains arise.
Some say the U.S. has missed its chance at outrunning the delta strain.
“I think we probably could have done that here in the U.S., if we hadn’t slowed our vaccination rates so much,” Andy Pekosz, professor of molecular microbiology and immunology at Johns Hopkins University, told The Hill.
“But I think it’s important also to emphasize that variants will emerge anywhere the virus is replicating in people to a great degree. And globally, there are so many places where this virus is just freely infecting people and replicating and it’s those situations that are going to be generating variants at a higher frequency.”
The delta variant isn’t even the only variant to worry about.
The lambda strain, first detected in Peru, is now present in the U.S. The World Health Organization (WHO) has designated this strain as a “variant of interest,” the designation beneath that of a “variant of concern,” like that of the delta variant.
Jen Kates, director of global health and HIV policy for the Kaiser Family Foundation, and Pekosz told The Hill that data on the lambda variant is limited at the moment, but what information is available suggests that it is similar to delta in that it is more transmissible than previously dominant strains like the alpha and beta variants. They added that vaccines should still offer protection against it.
At the same time, the lambda variant is not spreading as quickly as the delta variant.
“There’s a lot that we do not yet know about the lambda variants, including compared to the delta,” said Leana Wen, an emergency physician and public health professor at George Washington University.
“Is it more contagious? This is a really important question, because when there is a new variant, and it’s more contagious, it displaces the previous variant. But if there is already a very contagious variant and you have other variants that are appearing as they are all the time, they probably are not going to take over,” Wen said.
Wen, who previously served as Baltimore’s health commissioner, expressed frustration that vaccinations have not been properly incentivized even when she warned earlier in May that the window for intervention was quickly narrowing.
“If we had tied vaccinations to reopening policy, we had a much higher chance of achieving the kinds of immunity that we needed,” Wen said.
Pekosz opined that if the U.S. had reached a 90 percent vaccination rate earlier this year, the nation could have avoided the current situation.
“We stalled at a place where essentially half the population has immunity and half doesn’t and that’s a really awful place to be from a vaccine perspective,” Pekosz said.
According to the most recent data from the Centers for Disease Control and Prevention, around 69 percent of adults in the U.S. have received at least one dose. The country has still yet to reach President Biden‘s 70 percent vaccination goal, weeks after his initial July 4 deadline.
All health experts who spoke with The Hill agreed that the biggest challenge that the U.S. faces to overcome the pandemic is vaccine hesitancy.
The large groups of people holding out from vaccinations pose a significant threat because they are not immune, and are still capable of spreading COVID-19 and new variants. They added another major issue is that unvaccinated people are behaving as though they were vaccinated, going without masks in public and attending large indoor and outdoor gatherings that they should avoid.
However, Pekosz added that the progress that has been made is substantial.
“I always want to emphasize the positive, which is right now the vaccine seems to be working well against the delta variant. And that should be something that people are using to get motivated to get the vaccine,” he said. “I think that’s the critical thing to get across to everybody.”
Here’s our personal bellwether for how the Delta variant is impacting health systems:we’ve had three different, in-person leadership retreats cancel across the course of the past week, due to COVID concerns. Three very different parts of the country, on both coasts and in the heartland.
Case counts are up, hospitalizations are up, and clinical leaders are (rightly) becoming more skittish about large, in-person meetings. As many have noted, this latest wave of infections is unevenly distributed across the country, primarily affecting the unvaccinated but also putting vaccinated people at risk of transmitting the virus or becoming ill.
As frequent business travelers who thrive on meeting face-to-face with our members, we had just begun to get comfortable being back out “on the road”—but now that’s changing, too. The recent cancellations are a good reminder that we’re still in a fluid situation in this pandemic, and that being flexible and adaptable will continue to be critical for the foreseeable future. (Thank goodness we’re not in the conference business—that’s got to be a nightmare right now.)
Just as we always check the weather forecast for places we’re traveling to, we’ve started checking the number of cases per 100,000 and the test positivity rate as well—over 10 per 100,000, or over 5 percent, and we’ll think twice about visiting.
And our masks have gone back on. We’ll hope to see you out there soon, but in the meantime—stay safe and get vaccinated!
We’ve been hearing a growing number of stories from patients about difficulties scheduling appointments for specialist consults.
A friend’s 8-year-old son experienced a new-onset seizure and was told that the earliest she could schedule a new patient appointment with a pediatric neurologist at the local children’s hospital was the end of November. Concerned about a five-month wait time after the scary episode, she asked what she should do in the meantime: “They told me if I want him to be seen sooner, bring him to the ED at the hospital if it happens again.”
A colleague shared his frustration after his PCP advised him to see a gastroenterologist. Calling six practices on the recommended referral list, the earliest appointment he could find was nine weeks out; the scheduler at one practice noted that with everyone now scheduling colonoscopies and other procedures postponed during the pandemic, they are busier than they’ve been in years. Recent conversations with medical group leaders confirm a specialist access crunch.
Patients who delayed care last year are reemerging, and ones who were seen by telemedicine now want to come in person. “We are booked solid in almost every specialty, with wait times double what they were before COVID,” one medical group president shared. The spike in demand is compounded by staffing challenges: “I pray every day that another one of our nurses doesn’t quit, because it will take us months to replace them.”
Doctors and hospitals are now seeing a rise in acuity—cancers diagnosed at a more advanced stage, chronic disease patients presenting with more severe complications—due to care delayed by the pandemic. If patients can’t schedule needed appointments and procedures, this spike in severity could be prolonged, or even made worse.
For medical groups who can find ways to open additional access, it’s also an opportunity to capture new business and engender greater patient loyalty.
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HENRY KOTULA 