My work as an emergency medicine physician has taken me to urban and rural areas on both coasts and in the middle of the country. No matter where I see patients, I hear excuses like these for not getting immunized against influenza:

  • “Flu shots don’t work.”
  • “I got the vaccination once and it made me sick.”
  • “We don’t believe in vaccination.”
  • “Vaccination is dangerous.”

It puzzles me, then, that they’ve come to the emergency department because they are feeling awful with fever, chills, cough, body aches, and fatigue — in other words, with the flu — expecting a fix for something that could have been easily prevented.

Indeed, 43% of Americans forgo getting vaccinated against influenza. That doesn’t bode well for the highly anticipated vaccine against coronavirus, something that President Donald Trump has said we might have by the end of the year, though others say it will take longer.

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To achieve herd immunity, which makes it more difficult for an infectious disease to spread through a population, 80% or more of us need to be immune to Covid-19, either because we’ve been infected with the virus that causes it or we’ve gotten the vaccine against it.

I fear that many Americans will resist getting vaccinated against the SARS-CoV-2 coronavirus even after having been bombarded by news reports of the number of cases (more than 1.3 million in the U.S. as I write this) and the number of deaths (more than 80,000), or having seen images of refrigerated trucks in New York City storing the bodies of people who died of Covid-19.

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To put this scourge behind us, I believe that our nation should, for the first time ever, require all Americans — or at least schoolchildren and workers in direct-contact jobs — to be vaccinated against this coronavirus.

Scientists are moving at “Warp Speed” to develop a coronavirus vaccine. Researchers at the University of Oxford intend to try one on 6,000 people by the end of May. The NIH has created a partnership with 16 pharmaceutical companies to speed vaccine development.

That means we need to develop vaccination policies and programs now, since they will take time to enact.

Here’s what I think we should do:

Create a federally mandated vaccination policy. No federal laws require vaccination, and states have a smorgasbord of policies.

state laws school vaccine
State laws establish exemptions for school vaccination requirements as well as the requirements regarding the exemption application process and the implications of an exemption in the event of an outbreak. Centers for Disease Control and Prevention

A 1905 Supreme Court decision established the constitutionality of compulsory state vaccination laws to protect the public health. Although all 50 states and the District of Columbia now require diphtheria, tetanus, pertussis, polio, measles, rubella, and varicella vaccinations before attending public school, all also offer a variety of vaccine exemptions for medical, religious, and philosophical reasons. Only 11 states can override these exemptions in an outbreak. Court decisions, including from the Supreme Court, have upheld both state-imposed fines for refusing to be vaccinated and the exclusion of unvaccinated children from schools.

Because people often travel across state lines, we need a unified national approach, perhaps something like the military’s Army Medicine 2020 initiative, which requires vaccination but also allows for rigorously controlled exemptions that are medical (such as pregnancy), religious (in consultation with a chaplain), and administrative (such as plans to leave the military).

Test, test, test. The only way that individuals should be allowed not to get the vaccine against SARS-CoV-2 is to prove they’ve been infected with it. Testing for the presence of the virus, the antibodies to it, or both, will need to be proven, accurate, and available to everyone.

Make influenza and coronavirus vaccinations mandatory for public school children. Only five states — New York, California, Maine, Mississippi, and West Virginia — have eliminated religious and philosophical vaccination exemptions for children entering public kindergarten. This applies to the standard childhood immunizations only and does not include influenza. In fact, only one state, Connecticut, requires influenza vaccination for public school attendance. Only a few states require flu vaccination for day care and pre-K attendance. While I respect individual health care choices and acknowledge that some citizens will not avail themselves of the protection afforded by a vaccine, the enormity of the Covid-19 pandemic demands that the welfare of the community take precedence and all children be vaccinated against the virus that causes this disease.

Require vaccination for workers in direct-contact jobs. Health care workers are the only adults in the U.S. required either by state law or individual employers to be vaccinated against the flu, though they can file an exemption and instead wear a mask at work from October through March. (For coronavirus, that might mean wearing one year-round.) Requiring immunization for a broader range of people with direct-contact jobs, like those working in restaurants and food stores, flight attendants, hair stylists and barbers, nail salon workers, teachers, and others, would decrease the spread of infection and the resulting hospitalizations and deaths.

This is especially important for the coronavirus because it has a higher viral load in the nose, mouth and throat, making transmission more likely via a simple conversation or a sneeze. In one recent study, 71% of individuals who tested positive for Covid-19 but who had no symptoms had detectable levels of SARS-CoV-2 up to six days before becoming ill.

Make the vaccine easier to get. One key to widespread uptake of vaccination against SARS-CoV-2 is making it as easy as possible for people to get it, like buying groceries or filling up a gas tank. Here are a few ways to do that:

  • Combine the coronavirus vaccine with another one (like influenza) and package them in a form that patients can take on their own.
  • Allow it to be administered to individuals with low-grade symptoms. Tetanus immunization has been wildly successful in part because we administer the vaccination when someone is being seen for a wound, not weeks later when it has healed.
  • Make coronavirus vaccination available in all health care facilities, physicians’ offices (no matter what the specialty), local health departments, and emergency or urgent care facilities. Make it clear that any physician or advanced practice provider can administer a vaccine.
  • Offer vaccinations in workplaces, schools, pharmacies, and community organizations. That could mean visits from mobile teams (perhaps run by medical school students as part of their public health training) to provide immunizations.
  • Make vaccinations inexpensive. Instead of costing as much as $70, the price tag for a high-dose influenza vaccination for seniors, the cost of a coronavirus vaccine should be affordable for all. Stores like Walmart, with its $4 medication list, could add immunizations and offer them as people come in to pick up their prescriptions.

To add one more incentive, health insurers should require either a test result showing immunity to influenza and coronavirus or proof of vaccination in exchange for full coverage. We all pay for those who eschew prevention but who then seek medical care when they become ill.

Finally, we should do a better job of teaching kids about the value of vaccination so they can make good choices. Misinformation is the enemy of good public health.

We can’t afford another pandemic with millions sick or dying, a health care system stretched beyond its limits, and a devastated economy. Immunization for all is a simple way to prevent that from happening.

Lauren S. Grossman is a physician, assistant professor of emergency medicine at the University of Colorado School of Medicine, and medical director of the university’s Integrative Medicine Center. The opinions expressed here are her own and do not necessarily represent those of the University of Colorado or UCHealth.

  • I laugh when i hear to make it mandatory that all Americans need to be vaccinated from this

  • I am sorry, but I have a problem with rushed into place vaccines being mandated. We have all too often seen that drugs and in some cases vaccines intended to do good things have had issues discovered in later years or perhaps were contaminated. I am not saying that I would not take it, but I am saying that I would not be the first in line. This virus has been surprising us from day one. The current disease affecting children that seems to be tied to Covid in a great example. Rushing a vaccine and then forcing it on people? Not a smart idea…..I am not a medical professional.. This is just my $.02 on this topic….

  • Also, think about if everyone deserves to live, at the expense of loosing freedoms and the damage to the economy? I say someone who eats healthy whole and organic foods, who maintains their immune system with herbs and exercise, who keeps their mind healthy as well as their spirit, will be just fine and may not even show symptoms, after having contracted the virus. Look at all the crap humans ingest worldwide. All the medications that erode the body over time. Kind of Iike… if you haven’t been taking care of yourself the way nature intended, then why should I sacrifice so that you can keep living and ingesting crap, not contributing to the positive evolution of the species? Various agendas are using this to see what they can get away with. That’s not conspiracy theory, it’s been verified by intelligent minds, mostly polymaths, who can ascertain a clear picture of the entire scenario, and who work with information for a living. Wake up please.

  • I agree with your comments.
    There are so many people who are suffering (economically and/or physically) now due to this pandemic. We must take aggressive steps to relieve and prevent this suffering for so many folks.

  • The survival rate is greater than 99%. Whoever wrote this is an imbicile. Reality is there was chatter about the virus a year ago. It was planned and the hysteria is absurd. How would you like to be dragged from your home someday? The feeling of helplessness and lack of control is enough to shake sense into most reasonably intelligent thinkers. We don’t need more vaccines, people need to upgrade their health, lower their fear levels and realize peolple get sick, people die, and what we are seeing is not out of the norm. This is self evident when the reported numbers are analyzed with an objective and open mind. How about you get put on a list as someone willing to support the loss of personal freedom in America, according to false propaganda and an obviously planned pandemic? I say your words are dangerous and a threat tonbard earner freedoms.

  • Really..keep your opinions to yourself and learn the Word of God…Free country…our choice….smh..sound like a beast image

    • Robert – In case you did not know, vaccines are mandatory in many places, she is not suggesting anything far out, you have to get your kids their shots to send them to public school. I think your statistics on the fatality rate are way, way off. If it is really under 1%, we do not need mandatory vaccines, but what if it is 5% or more? That is the crucial thing. The people in power are trying to do what is best for us all, at least in the case of this epidemic.

  • I agree with the premise and thank you for the thoughtful piece. Please note that the image of state law is old, published in 2017 and CDC website says it accurately reflects 2015 laws. These may not have changed much, but the image should not be reproduced with the date.

  • ID2020 – vaccine with digital tattoo and you will not be able to buy or sell without it. Revelations 13 – 16 – mark of the beast.

  • Our bodies, our choice. The vaccine shouldn’t be mandated. Those who agree to get it, should go ahead by any means. But it shouldn’t be forced on those who do not want it.

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