Vaccine carrots only got us so far — now, it’s time for sticks

This week, the dam broke. With COVID-19 surging around the United States and vaccination rates stagnating, federal agencies and state governments started announcing vaccine mandates for their workers. The Department of Veterans Affairs was the first federal agency to introduce a mandate, and Thursday, President Joe Biden announced that all federal employees would have to be vaccinated or face testing and other protocols. New York City and Los Angeles will also require city workers to get vaccinated.

Private companies are doing the same. Google said Wednesday that employees would have to be vaccinated to come to the office, and Facebook and Lyft followed with their own announcements hours later. Some New York City restaurants are requiring that employees get vaccinated and are asking diners to show proof of vaccination.

For months, states and organizations have been using incentives to encourage people to get vaccinated — lottery entries, free baseball tickets, free beer. Those can work, and can spur people who were dragging their heels to make an appointment for a shot.

“Those are carrots, or positive behavioral nudges,” Aaron Carroll, chief health officer for Indiana University, wrote in The New York Times. “When it comes to incentives, most people like carrots.” Carrots are continuing — the Biden administration said yesterday it wants state and local governments to give $100 to the newly vaccinated. But carrots can only go so far. It’s clear that they’re not going to push enough people to get vaccinated to drive back the pandemic. “Sometimes, though, people need sticks,” Carroll said.

The US has been tiptoeing around the issue of vaccine mandates since the COVID-19 shots were first authorized. Lawmakers across the country have tried to introduce legislation banning mandates. But now, with major players stepping up to require vaccinations, other, smaller organizations have cover to introduce more — they won’t be in the lonely position of being the first to do so and can point to those bigger precedents to back up their decisions.

Vaccine mandates have always been key to stopping pandemics, Carroll said in The New York Times. It took mandates to eradicate smallpox and eliminate polio. We control measles, diphtheria, and other infectious diseases by requiring kids get their shots before going to school. When vaccines aren’t required, uptake tends to stay low — it’s one reason rates of HPV vaccination aren’t as high as health experts would like, even though the shots can prevent cancer.

The politicization and backlash around the COVID-19 vaccines means that, like the rest of the pandemic, mandates will be patchwork. They’re far more likely to be in place in states with higher vaccination rates and liberal leadership than in places like Florida, where Governor Ron DeSantis is vocally against mandates and has new powers to cancel local emergency orders.

But in the places where they’re implemented, mandates will get more shots in more arms. It may have been preferable to get to high vaccine rates without requirements. In the US, though, it’s unrealistic — vaccine hesitancy and misinformation is too entrenched, and too many people don’t think COVID-19 is a serious enough problem to make it worth their time. Mandates won’t fix that problem on their own, but they’re one more strategy that could help. At this point, we need all the help we can get.

Here’s what else happened this week.

Research

Your Vaccinated Immune System Is Ready for Breakthroughs
Breakthrough infections are uncommon in people fully vaccinated against COVID-19. For the rare cases when people do get sick, the body’s immune system is prepared to take on the virus. (Katherine J. Wu / The Atlantic)

Why are fully vaccinated people testing positive for Covid?
Data out of England shows that the vaccines are still working as expected. They’ve made the disease far less lethal — a fully vaccinated 80-year-old has the same risk of death from COVID-19 as an unvaccinated 50-year-old. (Oliver Barnes and John Burn-Murdoch / Financial Times)

CDC reversal on indoor masking prompts experts to ask, ‘Where’s the data?’
The CDC released new recommendations that even people who are fully vaccinated against COVID-19 wear masks indoors in some situations. The agency hasn’t released the data that prompted that change but says it’s concerning. (Joel Achenbach, Yasmeen Abutaleb, Ben Guarino and Carolyn Y. Johnson / Washington Post)

COVID Symptoms May Linger In Some Vaccinated People Who Get Infected, Study Finds
A small study in Israeli healthcare workers found that some vaccinated people who had breakthrough cases of COVID-19 had symptoms that lasted up to six weeks. Breakthrough cases were still rare. (Rob Stein / NPR)

Development

At the FDA’s urging, Pfizer-BioNTech and Moderna are expanding their studies of children 5 to 11
Pfizer / BioNTech and Moderna are increasing the size of their COVID-19 vaccine trials in children to better understand any rare side effects. (Sheryl Gay Stolberg, Sharon LaFraniere, and Noah Weiland / The New York Times)

Pfizer COVID-19 vaccine’s protection against severe disease holds steady over six months
Data released by Pfizer shows the protection against symptomatic disease drops over time, but the vaccines stay highly effective against severe cases. The data raises more questions about the potential for boosters, which United States regulators are still considering. (Nicole Wetsman / The Verge)

New Vaccinations Are Rebounding in the U.S.’s Covid Hot Spots
Places where COVID-19 is surging are also seeing increases in vaccinations. States that have the lowest vaccination rates are now giving shots faster than the rest of the country. (Drew Armstrong / Bloomberg)

Perspectives

Most of the cats and the great apes—the gorillas and orangutans—are trained for voluntary vaccination, so they will be easy to vaccinate. And then the smaller animals are trained to go into a little mesh box, so those will be fairly easy. The trickier ones are going to be some of the mid-sized primates that maybe aren’t so interested in voluntarily being injected and are also super smart.

— Keith Hinshaw, the director of animal health at the Philadelphia Zoo, told Slate about the process for vaccinating animals with an experimental COVID-19 vaccine.

More than numbers

To the people who have received the 3.9 billion vaccine doses distributed so far — thank you.

To the more than 196,280,506 people worldwide who have tested positive, may your road to recovery be smooth.

To the families and friends of the more than 4,192,702 people who have died worldwide — 611,904 of those in the US — your loved ones are not forgotten.

Stay safe, everyone.