Vaccine mandate backlash sparks concerns of other health crises

Explosive disputes over COVID-19 vaccine mandates are prompting concerns in the public health community that previously low-level opposition to other required vaccines could quickly gain traction.

Health experts say that rejecting routine vaccines might spark preventable public health crises, including the reemergence of outbreaks of diseases such as measles and mumps.

In addition, rising criticism of President Biden’s vaccine mandate from GOP governors is seen by some as giving more legitimacy and momentum to the anti-vaccine movement and its resistance to requiring shots of any kind, even for children and members of the military.

If more parents decide to refrain from getting routine vaccinations for their kids, experts warn, it could cause the childhood immunity rate for certain diseases such as measles to fall below the herd immunity threshold, allowing them to spread more easily. 

“Now we could potentially reenter an era where we have endemic transmission of these diseases that we’re no longer transmitting in the population,” said Jonathan Berman, an assistant professor in the department of basic sciences at the New York Institute of Technology (NYIT).

The anti-vaccine movement started long before COVID-19 took hold, but the pandemic presented activists with the opportunity to bolster their ranks by taking advantage of people’s anxieties and uncertainties amid the evolving nature of the coronavirus and the government’s response.

The Center for Countering Digital Hate’s Anti-Vaxx Playbook, published last year, said vaccine opponents have promoted three key messages to circulate COVID-19 vaccine skepticism: that the virus is not dangerous, that vaccines are unsafe and that people shouldn’t trust vaccine advocates.

The debate over vaccines has intensified over the past 10 days after Biden announced that all private employers with 100 or more employees would be required to mandate vaccines or weekly testing, a move that will impact millions of workers. The announcement faced immediate backlash from many Republicans who have slammed the policy as government overreach.

Rep. Tom McClintock (R-Calif.) commented directly on mandating other vaccines during a House Judiciary Committee markup last week.

“So, in this brave new world of Big Brother Biden, what is to stop the government from forcing every American from getting a flu shot or a tetanus shot or a hepatitis shot or a shingles shot?” he asked. “The president warns his patience is wearing thin. Mr. Biden, our patience as Americans is wearing thin.”

Such arguments are seen by some experts as casting vaccine mandates of any kind as government overreach.

That position also plays into the conservative narrative of “left-wing authoritarianism,” which Berman of NYIT said he expects “will be exploited” by anti-vaccine proponents “to great effect.”

The Supreme Court held up vaccine mandates more than a century ago, in 1905, for a Massachusetts smallpox immunization requirement, meaning any legislation outlawing the practice would clash with the long-held precedent.

Dan Salmon, director of the Institute for Vaccine Safety at the Johns Hopkins Bloomberg School of Public Health, said it’s difficult to predict what’s going to happen in response to Biden’s mandate because the U.S. doesn’t “have precedent in mandating a vaccine that a quarter of the population doesn’t want.”

“Having worked in this area for decades, I do have concerns that it could create backlash, and it could spill over beyond COVID vaccines to other vaccines and other laws such as those for routinely childhood required vaccines,” he said.

A majority of Americans have voiced approval for vaccine mandates in workplaces, schools and sporting events; 52 percent of respondents in a recent Economist-YouGov poll said they supported Biden’s requirement.

Months after the vaccine became widely available, almost three-quarters of the eligible population has received at least one dose, and 63.6 percent is fully vaccinated, according to the Centers for Disease Control and Prevention (CDC).

But more than 70 million of those aged 12 and older have not yet gotten a shot, and those younger than 12 are still ineligible, leaving much of the population at risk of serious illness from COVID-19.

Meanwhile, the CDC said routine child and adolescent vaccinations fell significantly in the early months of the pandemic as people stayed at home. The rate picked up in the summer and fall of 2020 but not to high enough levels to offset the earlier drop-off, according to a study released in June.

Timothy Callaghan, an assistant professor of health policy at the Texas A&M School of Public Health, said it’s unclear at this point whether the decrease is attributable to vaccine hesitancy or to more people avoiding doctors’ offices during the pandemic.

But it’s “certainly possible” those who view Biden’s mandate as overreach could question the government’s ability to require vaccines in general, he said.

“I think it’s too soon to tell whether or not that specific pattern will take hold, but it is certainly a concern,” Callaghan said. “That said, the benefits of these mandates likely largely outweigh the risks, given the need to get as much of the population vaccinated against COVID-19 as possible to get us past the pandemic.”