research on vaccine mandates

August 5, 2021

Vaccine Mandates Are Lawful, Effective and Based on Rock-Solid Science

Clear legal pathways exist to move the U.S. closer to herd immunity

By Lawrence O. Gostin

President Joe Biden spoke at the White House on July 29 about his administration’s efforts to get more Americans vaccinated and to combat the spread of the Delta variant.

Anna Moneymaker Getty Images

The U.S. has reached a worrying plateau in its COVID-19 vaccination coverage, with just half of the population fully vaccinated. This coincides with pandemic fatigue, or weak compliance with COVID-19 risk-mitigation measures such as masking and distancing, and the highly infectious Delta variant, which accounts for more than 83 percent of infections . We’re at an inflection point in the pandemic, with coronavirus infections soaring by about 140 percent in the past two weeks.

Reflecting deep concern over lagging vaccinations, the Biden administration recently mandated vaccinations for all federal workers and contractors (with masking and regular testing as an alternative option), while the Department of Veterans Affairs issued mandates for all frontline health workers at its facilities. President Joe Biden also ordered the military to move toward compulsory vaccinations .

California, New York City and New York State are leading the way in requiring that government workers get vaccinated or else submit to weekly testing . And New York City just announced its “Key to NYC Pass,” requiring proof of vaccination for access to most indoor activities, including gyms, restaurants and performances, beginning on September 13—the first policy of its kind in the U.S. Meanwhile more hospitals and long-term care facilities are implementing mandates following a joint statement from 100 medical and nursing groups urging compulsory vaccinations. And when schools of higher education return in the fall, nearly 600 colleges and universities will require vaccination. That’s true in the private sector as well as a rising tide of businesses—including Uber, Facebook, Google, Netflix and Delta Air Lines— mandate vaccinations for workers .

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Are these mandates lawful and ethical? The short answer is emphatically yes. And there is strong behavioral science evidence that mandates will be highly effective.

The Lawfulness of COVID-19 Mandates

Businesses: Both the Department of Justice and the Equal Employment Opportunity Commission (EEOC) have ruled that businesses may lawfully require workers to get a COVID-19 vaccine as a condition of coming to the workplace. However, businesses must grant legitimate medical or religious exemptions. The only major court ruling to date upheld Houston Methodist Hospital’s COVID-19 vaccine mandate. The private sector has wide discretion in setting conditions for workers and customers, and businesses have a legal and ethical duty to keep the workplace safe.

Currently all COVID-19 vaccines are administered under an emergency use authorization (EUA) and are not fully licensed. The DOJ and EEOC specifically stated that employer mandates may occur even under an EUA. The U.S. is already acting as if the vaccines were fully approved, with public health agencies recommending that all eligible Americans get a shot. In any event, the Food and Drug Administration recently announced it is expediting full licensure of the Pfizer vaccine, which is likely to occur by September, with other vaccines not far behind. When the FDA does approve COVID-19 vaccines, more businesses are likely to require immunizations.

Federal and state governments : States have long had the constitutional authority to mandate vaccinations, which the Supreme Court has upheld twice, first in 1905 and then in 1922 . The federal government, however, has limited power to mandate vaccines. It can only require them to prevent transmission of a dangerous infectious disease across state lines or international borders. The federal government has never sought to require nationwide vaccinations, and the courts probably would not allow it. To date, all state government mandates have been for fully approved vaccines. Thus, it is likely cities and states would wait to mandate COVID-19 vaccines until they are fully licensed. But when governments act as employers, they would be in a similar legal position as businesses. Thus, federal and state worker COVID-19 vaccine mandates are fully lawful even under an EUA.

K–12 schools : Every state and Washington, D.C., require routine vaccinations, such as for measles, mumps and rubella , as a condition of school attendance. While state mandates vary, all are based on a long list of childhood vaccinations recommended by the Centers for Disease Control and Prevention . In 1922 the Supreme Court upheld school mandates, and all courts have recognized the states’ authority to mandate fully approved vaccines. Schools must offer medical exemptions for those who may be harmed by vaccines, but they do not have to grant religious or conscientious objections. Six states offer neither personal nor religious exemptions for school mandates, a move that the courts have upheld. Because K–12 COVID-19 mandates would be issued directly by the government, they are likely to require full FDA licensure. Further, the FDA’s EUA for Pfizer’s COVID vaccine currently applies only to people aged 12 years and older, and the other two COVID vaccine EUAs are only for adults. Clinical trials for children younger than 12 years old are currently underway but may not report full results until late this year or early 2022.

Institutions of higher education (IHEs) : In most respects, IHEs are in a similar position to businesses. IHEs have long required vaccinations of students—for human papillomavirus, meningococcus and influenza, for example. A federal court has already ruled that Indiana University’s COVID-19 mandate is a reasonable, science-based measure to ensure student health and safety. And the  U.S. Court of Appeals for the Seventh Circuit just affirmed that Indiana University’s mandate was lawful. IHEs act in loco parentis and thus have a duty to care for the safety and security of students on campus. While most IHE COVID-19 mandates apply to students, many also apply to faculty and staff.

Antivaccination Laws

While there is a rising tide of governments, businesses and IHEs mandating COVID-19 vaccines, some states are actually seeking to restrict vaccine mandates . More than a dozen states have enacted laws prohibiting mandatory COVID-19 vaccinations or even “proof of vaccination” (so-called vaccine passports). Many more have bills pending. A number of governors have issued executive orders prohibiting COVID-19 vaccine mandates or vaccine passports. These edicts restrict private businesses, schools and IHEs from asking for proof of vaccination. COVID-19 has been politicized like no virus before. From AIDS and tuberculosis to Zika, influenza and Ebola, states previously acted to enhance public health powers. A multitude of states are doing the opposite during this pandemic, tying the hands of health officials to act quickly and decisively. That will not only make it harder to fight COVID-19 but also the next health crisis.

States have wide powers to regulate businesses, so even if these laws and executive orders are harmful, they still may be lawful. The exception may be states’ attempts to regulate businesses that operate in interstate or international commerce. There is litigation regarding Florida’s attempt to ban the cruise ship industry from requiring passengers and crew to show their vaccination status. Recently a federal court of appeals unanimously voted against a CDC order regulating cruise ships, which Florida had challenged. It was a bizarre case because the decision reversed the appeals panel’s earlier 2-1 ruling, which temporarily blocked a lower court’s decision to uphold Florida’s ban, and the appeals court has yet to give its reasoning for the change. The Constitution is quite clear that Congress holds the sole power to regulate interstate and international commerce.

Are Vaccine Mandates Effective?

There is considerable behavioral scientific data that vaccine mandates are effective . That includes both “hard” mandates (required vaccinations for school or workplace attendance) and “soft” mandates (the choice to vaccinate or undergo regular testing and indoor masking). Hospitals that have required influenza vaccinations have achieved and maintained far higher coverage than those that make it voluntary. At the same time, K–12 school and IHE mandates have given the U.S. high vaccination rates.

Many business and educational mandates fall into the “hard” category—that is, students or workers cannot attend classes or the workplace unless they are fully vaccinated. “Soft” mandates “nudge” people to get vaccinated. When getting a vaccine is the “easier” or “default” option, most opt for the jab. Thus, when given the choice between getting a vaccine or having to undergo one to two SARS-CoV-2 tests weekly and masking up, most people will eventually roll up their sleeves. How do we know? Well, in states that have wide and easy exemptions for childhood vaccines, a significant number of parents opt out . But if a state makes getting the exemption hard, such as requiring a written declaration, a doctor’s certificate or attending vaccine literacy classes, vaccine hesitancy melts away. The same will happen for COVID-19 vaccinations.

Are COVID-19 Vaccine Mandates Ethical?

People cite bodily integrity, personal liberty and freedom as the most common justifications for refusing vaccines. But these arguments don’t hold water. It’s true that everyone has the right to refuse a medical intervention for their own good. But vaccines not only protect the person vaccinated but also that person’s family, neighbors, and classmates or co-workers. No one has the right to go into a crowded classroom or workplace unmasked and unvaccinated. Vaccine mandates do not unethically discriminate. Discrimination is wrong when it is based on irrational reasons or animus, such as discrimination based on race, gender or disability. But vaccine mandates are simply a tool, and they apply equally to everyone. They don’t impute blame or seek to shame the unvaccinated. They are intended only to keep the entire population safe. Finally, requiring proof of vaccination does not violate a person’s privacy. Individuals are free to decline to give information about whether they received a shot, but if they do decline, they must expect reasonable consequences to ensure everyone’s health. Additionally, federal health information privacy rules apply principally to health care providers and not to businesses or schools. There is also a public health exception to privacy rules.

Requiring people to get a vaccine is part of the fabric of American history going back to the Revolutionary War. General George Washington compelled troops to get a smallpox variolation, saying it was necessary to safeguard soldiers and to win the war. And not only is mandating vaccination lawful, but it is also an ethical responsibility. For far too long, Americans have asked the question, “What entitlements do I have as a rights-bearing citizen?” It’s now time to ask, “What duties do I owe to my neighbors, my community and my country?” Getting a COVID-19 vaccine as the nation and the world are undergoing a historic health crisis is badly needed for the common good and mutual solidarity.

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• 06 July 2022
• Correction 13 July 2022

Did COVID vaccine mandates work? What the data say

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For four weekends across July and August last year, around 200,000 protesters took to the streets and squares of France, united in opposition to President Emmanuel Macron’s pass sanitaire . Soon, to enter cinemas, museums, cafés, trains and other shared public venues, people in France would have to present evidence that they were fully vaccinated, had tested negative for a COVID-19 infection or had recovered from an infection within the previous four months. In Paris, protesters chanted “Freedom!” and “Macron, we don’t want your pass!”

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Updates & Corrections

Correction 13 July 2022 : An earlier version of this story incorrectly reported the percentage of respondents to a series of German surveys who were opposed to mandatory vaccination. The figures have been updated.

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Federal Research Bolsters the Case for Vaccine Mandates

Scientists believe the administration’s new measures may tamp down the pandemic, although the effects will not immediately be obvious.

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By Apoorva Mandavilli and Roni Caryn Rabin

Just a day after President Biden issued broad mandates aimed at encouraging American workers to get vaccinated against the coronavirus, federal health officials released new data showing that unvaccinated Americans are 11 times as likely as vaccinated people to die of Covid-19.

Three large studies, published on Friday by the Centers for Disease Control and Prevention, also highlighted the effectiveness of the shots at preventing infection and hospitalizations with the virus.

The research underscored a deep conviction among scientists that vaccine hesitancy and refusal have prolonged the pandemic. The administration’s new plan should stem the flood of infections and return the country to some semblance of normalcy in the long term, several experts said in interviews.

“It’s going to fundamentally shift the arc of the current surge,” said Dr. Ashish Jha, dean of Brown University School of Public Health. “It’s exactly what’s needed at this moment.”

The new data also may help bolster confidence in the nation’s vaccines, which has eroded amid unexpected reports of breakthrough infections.

One of the studies looked at more than 600,000 virus infections in 13 states, representing about one quarter of the U.S. population, between April and July. The researchers concluded that Americans who were not fully vaccinated were far more susceptible to infections, illness and death from the virus.

Even after the Delta variant became dominant in the United States over the summer, the vaccines’ protections remained strong: Compared with vaccinated adults, those who were not fully vaccinated were 4.5 times as likely to become infected, 10 times as likely to be hospitalized and 11 times as likely to die of Covid.

The cumulative data have made it clear that the nation cannot hope to end the pandemic with some 37 percent of Americans not having received a single dose of Covid vaccine, researchers said. Cases and hospitalizations are only expected to rise as Americans move indoors into homes, schools and offices in the fall.

That is why scientists generally welcomed the Biden administration ’s vigorous vaccination push. Mandatory vaccinations will be crucial for keeping the virus in check as it becomes endemic in the United States, said Natalie Dean, a biostatistician at Emory University in Atlanta: “It’s part of the shift from short-term reactions to long-term solutions.”

Still, some experts cautioned that results from the administration’s plan would take many weeks to unfold. It is not clear when the new requirements will be finalized or how the promised legal challenges from Republicans will play out in courtrooms. Moreover, while the administration said the mandates would cover 100 million American workers, no one knows how many of them have already been vaccinated.

In any event, immunization is not an instant process — at least six weeks for a two-dose vaccine. The administration did not emphasize measures that work more quickly to stop the virus: masking and widespread rapid testing, for example.

The nation will need every tool at its disposal to fend off the Delta variant, a far more formidable foe than the original version of the virus. The variant became the dominant version of the virus in the United States only in mid-July, and the consequences have been beyond anything experts predicted.

Reassuringly low numbers of cases and hospitalizations in June have risen inexorably for weeks to nearly 10 times their previous levels. About 1,500 Americans, the vast majority of them unvaccinated, are dying each day.

Much of the misery could be prevented, the new C.D.C. research found. An analysis of 32,867 patient visits in nine states found that even as the Delta variant predominated, the vaccines had an overall effectiveness rate of 86 percent at preventing hospitalizations, though they were less protective for adults aged 75 and over.

Moderna vaccines had the highest efficacy rate, at 95 percent, compared with 80 percent for Pfizer-BioNTech and 60 percent for the Johnson & Johnson vaccine.

The shots’ effectiveness at preventing infection declined somewhat, from 91 percent to 78 percent, as the variant spread. The Moderna vaccine had an effectiveness rate of 92 percent against infection, compared with 77 percent for the Pfizer-BioNTech shot and 65 percent for Johnson & Johnson.

“There are more breakthrough infections happening than there were before — that’s a real phenomenon,” said Heather Scobie, an epidemiologist at the C.D.C. and lead author of the largest of the studies. “But for the most part, people are not going to hospitals if they’ve been vaccinated.”

The new data show that vaccine mandates will protect millions more people, particularly against severe disease, and will relieve pressure on the health care system, Dr. Dean said. “It also sets a precedent for other organizations to make similar decisions” about mandates, she added.

The administration’s new mandates include health care workers, requiring that any provider receiving Medicaid or Medicare funding impose a vaccination requirement on staff members. This is the measure mostly likely to have an immediate impact, experts said, because health care facilities are high-risk settings for transmission.

There is ample historical precedent for the decision to hold hospitals to certain standards — notably, the historical directive to desegregate patients by race, Dr. Jha said.

“We have a real dearth of leadership from health care systems that have not mandated within their own organizations, and it is imperative that the president require that patients be protected,” he added.

The requirement may drive some health care and nursing home workers, particularly many who are close to retirement age, to leave the profession, and exacerbate staffing shortages. Even so, there is more to be gained than lost by the mandates, said Dr. Nahid Bhadelia, founding director of the Center for Emerging Infectious Diseases Policy and Research at Boston University.

“This is an important step to get us out of the pandemic,” she said. “The very people who are taking care of the vulnerable coming into the hospital need to be our first line of defense.”

The Labor Department will order all private-sector businesses with more than 100 employees to require that their work forces be fully vaccinated or be tested at least once a week. Employers will be required to give paid time off to employees to get vaccinated.

That move alone will affect 80 million Americans. But Bill Hanage, an epidemiologist at Harvard University, was skeptical that the mandates would be successful in inoculating millions more people than have already opted for the vaccine.

Some of the people who most urgently need to be protected are older adults who will not be affected by workplace requirements, he noted. The new C.D.C. research on Friday confirmed that this population was particularly vulnerable.

One study, conducted at five Veterans Affairs medical centers, where patients tend to be burdened by chronic illnesses that contribute to severe Covid disease, found that the vaccines’ protection against hospitalization declined with age, to 80 percent for those aged 65 and older, down from 95 percent for adults aged 18 to 64. A second study found vaccine effectiveness dropped off at age 75.

And mandates already are drawing criticism from conservative Americans. Republican governors in several states have decried the mandates as unconstitutional and say they plan to file suits to stop them.

“My question would be whether this actually makes people get vaccinated, or just increases the political heat around it,” Dr. Hanage said.

Vaccine mandates for active-duty military personnel , frontline health care workers , and employees of nursing homes and hospitals in Maryland have bumped vaccination rates up by a few percentage points.

More than half of Americans favor vaccine mandates for workplaces, but in a recent poll, 87 percent of those who were unvaccinated said they would not get the shots even if their employers required them.

By insisting that vaccination is the way out of the pandemic, officials in both the Trump and Biden administrations have de-emphasized the importance of masks, testing and ventilation when so many are likely to remain unvaccinated, several experts said.

“There are many measures that were left on the table, such as an indoor mask mandate tied to community transmission rates, or minimum ventilation standards for schools and workplaces,” said Dr. Gavin Yamey, a global health expert at Duke University.

Recently, Dr. Yamey was unable to locate a single Binax rapid test within a 100-mile radius of Durham, N.C. — “which is pathetic,” he said. “I was in England recently, where home antigen tests are free and plentiful.”

Simple and inexpensive tests are crucial for monitoring the rise and fall of the virus, Dr. Bhadelia noted: “If you don’t have eyes on the ground, if you don’t have the lay of the land, you really can’t do any other planning.”

The Occupational and Safety and Health Administration, which regulates workplace safety, will require private businesses to mandate that their employees either be vaccinated or provide weekly proof of a negative test.

But weekly tests are unlikely to be helpful against the Delta variant, because the virus replicates quickly in the airways and an infection swiftly becomes contagious. Businesses in hard-hit areas, at least, should consider testing twice a week, Dr. Bhadelia said.

Many public health experts felt “uneasy” when Americans, urged by the administration, prematurely celebrated a summer of freedom from the virus, she said. But with much of the world still unprotected from the virus, new variants may again surge in the nation.

“We need an honest conversation about the goals of what it means to be on the other side of the pandemic phase of this crisis,” she said. “This is a once-in-a-century pandemic, and we have to course correct — and it’s OK to do that.”

Apoorva Mandavilli is a reporter focusing on science and global health. She is the 2019 winner of the Victor Cohn Prize for Excellence in Medical Science Reporting. More about Apoorva Mandavilli

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COVID-19 and Vaccine Mandates

Two experts discuss what makes mandates necessary, effective, and ethical.

The summer arrival of the COVID-19’s highly infectious Delta variant triggered a wave of hospitalizations and deaths, primarily among the unvaccinated.

In response, President Biden on September 9 ordered broad mandates aimed at tamping down the spread of the virus. The measures require businesses with more than 100 employees to be vaccinated or tested weekly. The mandates also apply to health care workers and federal contractors.

Predictably, the move has generated strong opposition from groups who argue that the government does not have the power to compel vaccination and equally strong responses from public health officials who say that the time has come for mandates to be put in place.

In a Q&A, Nancy Kass , ScD ’89, a professor in Health Policy and Management and Phoebe R. Berman Professor of Bioethics and Public Health; and Saad Omer , MBBS, PhD ’07, MPH ’03, director of the Yale Institute for Global Health, discuss when public health mandates should be considered and what makes an effective—and ethical—mandate.   

When in a public health crisis is it time to consider mandates?

Nancy Kass: Public health rarely starts with a mandate as Plan A. In general, public health will do exactly what happened with COVID vaccines, which is try to help the public understand why a vaccine is effective, how a vaccine is safe, and execute its responsibility for making it accessible in all senses of the word—cost, location, language. If it turns out that doing all of those things leads to sufficient coverage, mandates aren't needed. You’re able to maximize this ethical goal of respecting people's autonomy and freedoms—and maximize the benefits that we need from a public health perspective.

If it turns out that that doesn’t happen, that’s when mandates come into play. It’s the same thing that happened with wearing seatbelts, with smoking in restaurants: Plan A was education. It was only when that didn’t influence sufficient [numbers of] people, and it was important enough from a public health perspective, that mandates become an important tool.

Mandates in general depend on there being a really large and consequential public health threat and that less intrusive measures have not been sufficiently effective. All of these things are essentially justifying why it’s OK to overrule the wishes of some people who didn’t want to get vaccinated.

Can you talk about the criteria you proposed last year for a vaccine mandate?

Saad Omer: In June 2020, colleagues and I published a paper with six criteria for a COVID-19 mandate based on science and ethics, including that mandates should be implemented only if the COVID-19 containment is not adequate and that evidence of the safety and efficacy of the vaccine has been transparently communicated. We now have met those triggers for sub-populations, like certain employers and universities, but not for the general population.

When is it not appropriate to turn to mandates?

SO: Implementing too early could drown out the voluntary response. And there are ethical reasons as well; you do the least intrusive intervention at a given time to get the same effect. And if you don’t have [vaccine] access covered, you could also exacerbate inequities.

What makes an effective mandate?

SO: I take a middle-of-the-road approach to vaccine mandates. Some people think that the only way to implement a mandate is a draconian approach of picking up people from their homes and jabbing them with a shot. That’s not how modern mandates work. They are tied to a benefit, a privilege, or a service, and getting vaccinated becomes a condition of availing yourself of that opportunity.

If you have a mandate that’s too easy to opt out of, you don’t get that much response. In the case of a mandate for childhood vaccines, [for example,] if you can go to your health department’s website, print an exemption form, and just check a box, you don’t get that high-end effect of your mandate.

In a different scenario, in 2011 Washington state added a requirement where if you are opting out of the vaccine for non-medical reasons you have to go to a health care provider, you have to have counseling, and you have to sign what’s called an informed declination form. When they did that, they had a more than 40% drop in their exemption rates.

So the bottom line is, don’t make it too easy but don’t make it impossible to opt out. A Goldilocks approach is the optimal approach.

From an ethical perspective, how would you respond to someone who is adamantly opposed to getting vaccinated?

NK: People who are opposed to mandatory vaccination will often say, “I ought to have the freedom to decide what to do with my body.” Very often in public health there is a view that agrees with that, that says, Let’s inform people and allow them to make the choices that they feel are right for them.

Where vaccination for something like COVID becomes different is that when someone chooses not to be vaccinated out of, for example, freedom to make that choice, it impacts the freedoms for everyone else. We’re seeing right now that a lot of places that had opened up and eliminated mask mandates are now going back to mask mandates. So the choices that people make to not be vaccinated—while genuinely they may really feel like it’s a personal choice—end up impacting the freedoms of others.

SO: I grew up in a country where when I was young there was a dictatorship, so I don’t take questions of personal liberty lightly. But here’s the problem with infectious diseases: They are just that—infectious. So your choice of staying unvaccinated impacts me and my loved ones.

Therefore, even if you have the most libertarian perspective on life, vaccines and infectious diseases can be, and should be, and must be an exception. Because you’re taking away the liberty for me to exist. And in the life, liberty, and happiness cadence, I think a smartly designed mandate threads the needle very appropriately.

Looking ahead, do you think resistance to vaccine mandates will wane?

NK: My hypothesis is that the more it becomes normal for big national employers and little local employers to say, “To work here, to keep our customers and clients safe, we’ve decided we’re going to do this,” the more I believe it really will be normalized. It’s not simply that people will have fewer options to get out of it. I genuinely believe that fewer people will insist that they need to have an option to get out of it.

In watching what’s going on in different states right now with the Delta variant, it seems like some of that is [already] happening. But there’s also something else going on: Governors or other elected representatives in states where there has been more opposition to vaccines and vaccine mandates are faced with hospitals that have no more bed capacity, and [they] are starting to advocate for vaccination in order to help save the state.

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Promoting Public Health with Blunt Instruments: Evidence from Vaccine Mandates

We study the effect of mandates requiring COVID-19 vaccination among healthcare industry workers adopted in 2021 in the United States. There are long-standing worker shortages in the U.S. healthcare industry, pre-dating the COVID-19 pandemic. The impact of COVID-19 vaccine mandates on shortages is ex ante ambiguous. If mandates increase perceived safety of the healthcare industry, marginal workers may be drawn to healthcare, relaxing shortages. On the other hand, if marginal workers are vaccine hesitant or averse, then mandates may push workers away from the industry and exacerbate shortages. We combine monthly data from the Current Population Survey 2021 to 2022 with difference-in-differences methods to study the effects of state vaccine mandates on the probability of working in healthcare, and of employment transitions into and out of the industry. Our findings suggest that vaccine mandates may have worsened healthcare workforce shortages: following adoption of a state-level mandate, the probability of working in the healthcare industry declines by 6%. Effects are larger among workers in healthcare-specific occupations, who leave the industry at higher rates in response to mandates and are slower to be replaced than workers in non-healthcare occupations. Findings suggest trade-offs faced by health policymakers seeking to achieve multiple health objectives.

Research reported in this publication was supported by the National Institute on Mental Health of the National Institutes of Health under Award Number 1R01MH132552 (PI: Johanna Catherine Maclean). John Earle also acknowledges support from the Russell Sage Foundation. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Institutes of Health or the National Bureau of Economic Research.

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Republicans who support childhood vaccine mandates often stay silent, research suggests

by Tatyana Woodall, The Ohio State University

Most Republican voters support childhood vaccine mandates, yet may be discouraged from publicly expressing these views, a new study suggests.

To determine the source of this disconnect, researchers conducted a survey that revealed differences between Republican voters who support childhood vaccine mandates and those who do not.

According to the study, most Republicans surveyed supported immunization requirements for children and held favorable attitudes toward vaccine safety, while those who said they opposed vaccine mandates did not acknowledge this support exists—and expressed a greater willingness to share their vaccine views to others.

In contrast, the Republicans who supported vaccine mandates were largely aware that their views were in the majority, but tended to be less outspoken.

This phenomenon, called the false consensus effect, describes a misperception by people about how widespread their views are and a belief that their opinions are shared by others—when they are not.

These results suggest that conservative supporters of childhood vaccination are not discouraged from speaking out because they assume that they are in the minority, but because external information environments, like social media, are sometimes dominated by minority views, said Graham Dixon, lead author of the study and an associate professor of communication at The Ohio State University.

"Those in the majority may simply sit out of the conversation because they see online environments as being dominated by extreme views and don't want to engage in uncivil discourse," said Dixon. "What's significant is that those in the majority may self-silence even when they are aware of their majority status."

The study was recently published in the journal Human Communication Research .

The work is especially notable because it corroborates recent research showing that much of social media content is driven by a minority of users who express more opinionated and politicized views than the typical user, said Dixon.

"Social media has become the new public square, so it's concerning that the overrepresentation of atypical and sometimes extreme views may discourage people from participating in the conversation," he said.

This overrepresentation, notes the study, can discourage those in the majority from speaking out because they fear that they may experience social conflict from doing so.

For example, when participants who supported immunization requirements were frequently exposed to anti-vaccine content on social media, they were more likely to believe that they would encounter conflict if they publicly voiced their support for vaccines.

This is likely a larger consequence of the online social environment, as social media can be used to amplify misleading information that represents the views of only a small subset of the population, said Dixon. In this case, such large-scale self-censorship could play a role in hindering public mobilization of important public health policies.

Researchers also found that the study's results reveal more about majority misconceptions about a number of other issues, including how much support there is for climate change mitigation policies. For society to combat these issues, Dixon suggests that helping individuals build more self-confidence when engaging in online discourse and encouraging them to gain greater media literacy to navigate society's fluctuating information environment could be better tools for overcoming self-silencing.

"We need to figure out ways of motivating people to engage in online discourse and to have the self-confidence necessary to be able to present their views," he said. "Instead of telling them that their views are in the majority, efforts should be made to empower people's self-confidence to participate in online discourse in civil and constructive ways."

Journal information: Human Communication Research

Provided by The Ohio State University

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How americans view the coronavirus, covid-19 vaccines amid declining levels of concern.

Just 20% of the public views the coronavirus as a major threat to the health of the U.S. population and only 10% are very concerned about getting a serious case themselves. In addition, a relatively small share of U.S. adults (28%) say they’ve received an updated COVID-19 vaccine since last fall.

Americans’ Largely Positive Views of Childhood Vaccines Hold Steady

About half of recent online daters in u.s. say it’s important to see covid-19 vaccination status on profiles, sign up for our internet, science, and tech newsletter.

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Just 20% of the public views the coronavirus as a major threat to the health of the U.S. population and only 10% are very concerned about getting a serious case themselves. In addition, a relatively small share of U.S. adults (28%) say they've received an updated COVID-19 vaccine since last fall.

About nine-in-ten (88%) Americans say, overall, the benefits of childhood vaccines for measles, mumps and rubella outweigh the risks, identical to the share who said this before the coronavirus outbreak. U.S. adults are less confident in COVID-19 vaccines: Fewer than half rate them as having high health benefits and a low risk of side effects.

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How effective are vaccine mandates? Furman research shows: meh.

Did COVID-19 vaccine mandates work?

That’s a question Adam Richards,  associate professor of communication studies at Furman University, sought to answer.

Richards and his co-author, Professor Stephen Rains of the University of Arizona, are intrigued by the process of persuasion and resistance to it.

They study psychological reactance theory, a concept that explains how people react when they perceive that their autonomy is threatened, Richards said. Sometimes, he added, it can motivate people to do things that aren’t in their best interest so they can feel free again.

“We have studied this … in a variety of health concepts, for example, telling someone to drink more responsibly and other vaccination behaviors,” he said. “And it occurred to us that state (COVID-19 vaccine) mandates might be one mechanism that people might feel their freedoms are threatened by.”

Using data from the U.S. Centers for Disease Control and Prevention, Richards and Rains analyzed the trends of vaccine uptake in states before and after mandates.

Their findings suggest that the mandates had “no discernible influence” on vaccination rates, but reduced uptake of COVID-19 boosters and flu vaccines, he said.

“When we compared states that had mandates with states that banned vaccine (mandates), after controlling for the proportion who got the COVID-19 vaccine, proportionally fewer people were getting the (COVID-19) booster in the mandate states,” he said. “And flu vaccine as well.”

Richards said the take-away from the research is that promoting public health through vaccination is a complex issue.

“The government had the best intentions of trying to facilitate vaccination, but it’s a difficult thing,” he said. “These data suggest that vaccine mandates might have unintended consequences in the form of affected vaccination behavior.”

Richards cautioned, however, that there could be other explanations for the findings, noting that the study didn’t control for partisanship, for example, adding that states that banned vaccine mandates were more conservative and vice versa.

“When mandates of any sort are instituted, people feel like their freedom is more threatened if they start out resistant to that,” he said. “So, vaccination became a political issue instead of a public health issue.”

Not all 50 states were included in the research, Richards said, adding that five or six had neither a mandate nor a ban and so were excluded.

The research, published in the Proceedings of the National Academy of Sciences , covered the period from November 2021, when the first booster was available, to May 2022, and people who had already gotten the initial two rounds of vaccine, he said.

Richards said that some earlier studies have also shown that mandates can have negative consequences while other research shows they encourage vaccine uptake.

“This paper is one bit in a larger conversation,” he said, “and we advance one explanation: psychological reactance.”

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Exploring the Silence: Survey Reveals Republican Support for Childhood Vaccine Mandates

D espite being in the majority, Republican voters who support childhood vaccine mandates often choose to keep their opinions to themselves, a new survey unveils. The study, recently published in the journal Human Communication Research, showcases a peculiar phenomenon where those with favorable views on vaccine safety and mandates for children self-censor their stance due to perceptions of online discourse being controlled by more extreme, vocal minorities.

Lead author Graham Dixon, an associate professor of communication at The Ohio State University, sheds light on this silent majority, “Those in the majority may simply sit out of the conversation because they see online environments as being dominated by extreme views and don’t want to engage in uncivil discourse.” This suggests that Republicans who support vaccine mandates are not reticent because they believe they are outnumbered but because they anticipate social conflict from vocal opponents online.

The survey reveals that most Republicans acknowledged the safety of vaccines and supported immunization requirements for children. However, those opposed to the mandates often do not recognize this majority support and demonstrate a greater readiness to broadcast their views publicly.

Such self-silencing among conservatives who back vaccination could have significant public health implications. Dixon notes that the false consensus effect, where people overestimate how widespread their views are, may not be the driving factor here. Instead, it is the overrepresentation of fringe opinions on social media that intimidates the majority into silence. He elaborates, “Social media has become the new public square, so it’s concerning that the overrepresentation of atypical and sometimes extreme views may discourage people from participating in the conversation.”

Interestingly, this pattern of self-censorship is not limited to vaccine mandates. The research also suggests similar trends in other politically charged topics, such as climate change mitigation policies.

To counteract this reluctance to engage in online discourse, the study advocates for strategies to empower individuals’ self-confidence and enhance their media literacy. As Dixon puts it, “We need to figure out ways of motivating people to engage in online discourse and to have the self-confidence necessary to be able to present their views.”

Relevant articles:

– Republicans who support childhood vaccine mandates often stay silent. Research found those in the majority may simply sit out of the conversation because they see online environments as being dominated by extreme views and don’t want to engage in uncivil discourse

– Republicans who support childhood vaccine mandates often stay silent, research suggests , Phys.org, Tue, 09 Apr 2024 19:00:50 GMT

– RFK Jr. voters span the political spectrum. But they agree on disliking Biden and Trump. , The Washington Post, Wed, 03 Apr 2024 13:00:00 GMT

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Republicans who support childhood vaccine mandates often stay silent

Study suggests social media is key contributor to self-censorship.

Most Republican voters support childhood vaccine mandates, yet may be discouraged from publicly expressing these views, a new study suggests.  

To determine the source of this disconnect, researchers conducted a survey that revealed differences between Republican voters who support childhood vaccine mandates and those who do not.

According to the study, most Republicans surveyed supported immunization requirements for children and held favorable attitudes toward vaccine safety, while those who said they opposed vaccine mandates did not acknowledge this support exists – and expressed a greater willingness to share their vaccine views to others. 

In contrast, the Republicans who supported vaccine mandates were largely aware that their views were in the majority, but tended to be less outspoken.

These results suggest that conservative supporters of childhood vaccination are not discouraged from speaking out because they assume that they are in the minority, but because external information environments, like social media, are sometimes dominated by minority views, said Graham Dixon , lead author of the study and an associate professor of communication at The Ohio State University.

“Those in the majority may simply sit out of the conversation because they see online environments as being dominated by extreme views and don’t want to engage in uncivil discourse,” said Dixon. “What’s significant is that those in the majority may self-silence even when they are aware of their majority status.”

The study was recently published in the journal Human Communication Research .

The work is especially notable because it corroborates recent research showing that much of social media content is driven by a minority of users who express more opinionated and politicized views than the typical user, said Dixon. 

“Social media has become the new public square, so it’s concerning that the overrepresentation of atypical and sometimes extreme views may discourage people from participating in the conversation,” he said. 

This overrepresentation, notes the study, can discourage those in the majority from speaking out because they fear that they may experience social conflict from doing so. 

For example, when participants who supported immunization requirements were frequently exposed to anti-vaccine content on social media, they were more likely to believe that they would encounter conflict if they publicly voiced their support for vaccines. 

This is likely a larger consequence of the online social environment, as social media can be used to amplify misleading information that represents the views of only a small subset of the population, said Dixon. In this case, such large-scale self-censorship could play a role in hindering public mobilization of important public health policies.

Researchers also found that the study’s results reveal more about majority misconceptions about a number of other issues, including how much support there is for climate change mitigation policies. For society to combat these issues, Dixon suggests that helping individuals build more self-confidence when engaging in online discourse and encouraging them to gain greater media literacy to navigate society’s fluctuating information environment could be better tools for overcoming self-silencing.

“We need to figure out ways of motivating people to engage in online discourse and to have the self-confidence necessary to be able to present their views,” he said. “Instead of telling them that their views are in the majority, efforts should be made to empower people’s self-confidence to participate in online discourse in civil and constructive ways.” 

Other Ohio State co-authors include Blue Lerner and Samuel Bashian. 

More Ohio State News

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Posted on 04/09/2024 3:20:50 PM PDT by nickcarraway

Journal information: Human Communication Research

Defund the CDC, FDA, end all medical licensing. Deregulate all drugs.

informed consent is no longer required for medical studies.

the civil contract has been voided.

https://www.jonesday.com/en/insights/2024/01/fda-final-rule-irb-waiver-of-informed-consent-for-minimalrisk-investigations#:~:text=On%20December%2021%2C%202023%2C%20FDA,and%20welfare%20of%20human%20subjects .

“Most Republican voters support childhood vaccine mandates, yet may be discouraged from publicly expressing these views, a new study suggests”.

Every illegal migrant crossing the border should get every vaccine immediately or catapulted back over the border. Small pox, measles, mumps, yellow fever, flu, Covid, TB and anything else that there is a vaccine or shot for.

The author doesn’t understand the libertarian underpinnings of most conservative thought.

For example, if a conservative was an atheist, he couldn’t care less if I am Jewish or you are Christian or whatever.

Whilst a liberal that is an atheist demands you must also be an atheist.

It has nothing to do with “false consensus”. It has to do with not pushing your beliefs on others.

Leftists don’t comprehend this.

Multiple rounds of antibiotics for STDs, too.

Most Republicans don’t publicly express their views on anything.

The spike in autism since the 18 pages of vaxxes were mandated is not a coincidence.

That’s right.

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Mandatory COVID-19 vaccination and human rights

a Faculty of Laws, University College London, London WC1H 0EG, UK

Octávio Luiz Motta Ferraz

b The Dickson Poon School of Law, London, UK

Andrew Jones

On Dec 9, 2021 the Austrian Government laid a bill before parliament that would impose a mandatory COVID-19 vaccination requirement for all its residents. 1 This move followed the Greek Prime Minister's announcement to impose fines on residents aged 60 years and older who do not take up COVID-19 vaccination. 2 Many other nations are contemplating similar mandates or have adopted mandates in certain workplace settings, such as Australia, Brazil, Canada, France, Indonesia, Italy, and the UK. 3 Some people resist vaccine mandates on pragmatic grounds, for example, that such mandates could decrease health-care staffing levels or morale. 4 , 5 However, mandatory vaccination is also often opposed in principle. The UK Secretary of State for Health and Social Care, Sajid Javid, for instance, told the BBC on Dec 10, 2021 that he thought mandatory vaccination is “unethical”. 6 Many others presume mandatory vaccination violates human rights. 7 We believe that this view is mistaken, at least as a matter of international and comparative constitutional law.

Our opinion is based on extensive discussion and analysis held as part of the Lex-Atlas: Covid-19 (LAC19) project, a worldwide network of jurists that is producing and curating the open-access Oxford Compendium of National Legal Responses to Covid-19 . 8 50 jurists in the network adopted principles concerning the legality and constitutionality of mandatory vaccination in October, 2021 (the LAC19 Principles). 9 We concluded that mandatory vaccination and human rights law are compatible in principle and that there is a compelling rights-based case for a state duty to consider adopting mandatory vaccination, defined as any law that makes vaccination compulsory, or any public or private vaccination requirement for accessing a venue or service that cannot be avoided without undue burden. 9 This definition recognises mandates adopted by public and private bodies and, crucially, that requirements avoidable through affordable testing are not mandatory.

Even on the most libertarian understanding of liberty, philosophers and jurists agree that restrictions on liberty can be justified if they prevent harm to others. The European Convention on Human Rights recognises this by considering the right to physical integrity under article 8 to be a “qualified right” that can be limited “for the protection of health”. 10 If a mandatory vaccination scheme aims in part or whole to reduce harm to others, it is not paternalistic.

But liberty is not the only value relevant to human rights law. Economic and social rights to health, work, and education have been recognised in international law since 1948, most comprehensively in the UN International Covenant on Economic, Social and Cultural Rights (ICESCR), 11 an international treaty ratified by 171 states, including all those in Europe and the UK. In its 2013 Global Vaccine Action Plan, WHO reinforced the view that ”immunization is, and should be recognized as a core component of the human right to health and an individual, community and governmental responsibility”. 12 A similar view was recognised in article 12(c) of the ICESCR, which lists “the prevention, treatment and control of epidemic… diseases” as among the obligations entailed by the right to health. 11

Mandatory vaccination is not a knee-jerk response to COVID-19. In more than 100 countries there already exist some version of mandatory vaccination of school children for a range of diseases, including measles, mumps, rubella, tetanus, and polio. 13 In April, 2021 Chile, Germany, Israel, Mexico, Norway, Serbia, Spain, and a number of states in the USA had pre-pandemic laws that gave legal authority to impose vaccination mandates against COVID-19 in particular. 14

As far as we know, no major constitutional or international court has found that a mandatory vaccination policy violates any general right to liberty. Many such policies have been upheld when challenged. In April, 2021 in relation to a pre-COVID-19 law, the Grand Chamber of the European Court of Human Rights found that a Czech law requiring compulsory vaccination of children against nine diseases did not violate the article 8 right to physical integrity because the scheme was a proportionate means of protecting public health. 15 In several other jurisdictions, courts have reached the same or similar conclusions, including the US Supreme Court's ruling in Jacobson v Massachusetts (1904), 16 recent pre-COVID-19 judgments that uphold mandatory vaccination schemes in France, 17 Italy, 18 , 19 and Chile, 20 , 21 and COVID-19-specific decisions for programmes in New York, USA, 22 and Brazil. 23 In most of these decisions, the courts found the schemes gave effect to the right to health.

Nevertheless, the in-principle compatibility of mandatory vaccination and human rights does not mean that governments, employers, or schools should be cavalier about their adoption. They certainly interfere with fundamental rights, so careful design is required to ensure that vaccine mandates do not violate rights. The LAC19 Principles thus aim to provide guidance on how to enact rights-compliant schemes. 9

The LAC19 Principles recommend that mandatory vaccination schemes must be prescribed by law that is clear and preferably adopted after consultation. Ideally, mandatory vaccination should be regulated by statute, rather than executive rules (ie, regulations). The making of mandatory vaccination laws should undergo a period of consultation of at least 4–6 weeks and involve subnational governments, opposition parties, trade unions, experts, the public, and others. These consultations, and the government's response, should be published before the passage of any bill, to allow for debates and amendments. Consistently with widely accepted constitutional principles that relate to the non-delegation of core legislative functions, mandatory vaccination laws should not leave major policy questions for governments, private businesses, or employers. They should be addressed in the bill going through the legislature, allowing for debate and amendments.

Mandatory vaccination schemes must also meet the legal principle of proportionality. As detailed in the LAC19 Principles, the scheme must have a legitimate aim—eg, the reduction of virus transmission or protection of health services. The means chosen must be rationally connected to that aim. In practice, proportionality will be satisfied if the mandatory vaccination scheme is based clearly on sound public health advice. The scheme must also be necessary in the sense that there is no other less-impairing means of achieving that aim. Here there will be much debate about vaccine efficacy and probable social responses to mandatory vaccination. Public law principles counsel judicial restraint on a question as complex as the epidemiological necessity of a nationwide vaccine mandate. Finally, fines and punishments for not complying with the mandate should be effective but not be too onerous. The more severe the penalty, the more vulnerable is the policy to a legal finding of disproportionality.

The LAC19 Principles also call for constructive engagement with reasonable vaccine hesitancy. The political philosopher John Rawls famously distinguished what is rational from what is reasonable. 24 Vaccine hesitancy may be reasonable (understandable and respect-worthy) for some groups who are suspicious of vaccine mandates—eg, communities who have been subject to state-complicit persecution, discrimination, marginalisation, or neglect. 9 , 25 In such cases, the state and other actors should adopt constructive engagement interventions with these groups, such as community-led education or delayed commencement periods. Blunt termination notices on their own are insufficient. However, constructive engagement falls short of offering full exemptions. Medical exemptions should be considered, but exemptions for religious beliefs or freedom of conscience are not generally required by human rights law. 25

Although mandatory vaccination requirements must be designed with great care, there is no reason to think they are inherently incompatible with human rights law.

Acknowledgments

The Lex-Atlas project is funded by the Faculty of Laws, University College London, UK, the Dickson Poon School of Law, King's College London, UK, and the Max Planck Institute of Comparative Public Law and International Law in Heidelberg, Germany. JK and OLMF are principal investigators and AJ is a research fellow of the LAC19 project, which is supported more widely by the UK's Arts and Humanities Research Council, the Leverhulme Trust, and UK Research and Innovation (UKRI). The funding sources had no role in this Comment. We declare no other competing interests.