Opinion | Vaccine Mandates Are Needed in the U.S.

Some states, including neighboring Ohio, have engaged in lotteries or prize giveaways in an attempt to entice people to get vaccinated. Those are carrots, or positive behavioral nudges. When it comes to incentives, most people like carrots. Sometimes, though, people need sticks.

When the United States was fighting smallpox long ago, it took mandates to get enough people vaccinated. To eradicate polio, the same was true. Nearly all major infectious diseases in the country — measles, mumps, rubella, pertussis, diphtheria and more — have been managed through vaccine mandates by schools. The result is that the vast majority of children are vaccinated, and in time, they grow into adults who are vaccinated. That’s how the country achieves real herd immunity.

But this process can take decades. Covid-19 is an emergency, and we don’t have that much time.

The mRNA vaccines, made by Moderna and Pfizer-BioNTech, will likely get full approval for use from the Food and Drug Administration soon, which may be necessary for broader vaccine mandates. Although the vaccines are already known to be safe and effective, after being given to hundreds of millions of people, with full approval, more groups will begin mandating that their employees get vaccinated. It’s unlikely the United States can overcome the pandemic without such actions.

The U.S. experience with diseases for which vaccination isn’t mandated is also instructional: In those cases, vaccination rates have remained much lower than desired. The human papillomavirus vaccine approved in the United States, for example, protects against an extremely widespread and often asymptomatic sexually transmitted disease that can lead to cancer. Despite calls to mandate HPV vaccination, it is required for school only in a few states; Washington, D.C.; and Puerto Rico and has never been mandated outside the school environment, where it would do more good.

Although the vaccine was approved in 2006, only about half of teens are currently covered. What’s worse, only 22 percent of 18- to 26-year-olds, who are most at risk for infection, are fully vaccinated. Influenza vaccination is another that has rarely been mandated, and the United States has never achieved anywhere near the rates of protection that health experts would like, even during pandemics.