Defeat COVID-19 by requiring vaccination for all. It's not un-American, it's patriotic

To win the war against the novel coronavirus that has killed nearly 163,000 people in this country, the only answer is compulsory vaccination — for all of us.

And while the measures that will be necessary to defeat the coronavirus will seem draconian, even anti-American to some, we believe that there is no alternative. Simply put, getting vaccinated is going to be our patriotic duty.

The reason: When an effective vaccine is available for COVID-19, it will only defeat the pandemic if it is widely used, creating “herd immunity.” It is important to note that during an epidemic, there is no threshold above which the protection conferred by herd immunity cannot be improved. Thus, the more people who are immunized, the lower the risk for all of us, including those who are not vaccinated. 

Nor is there an alternative to vaccine-induced herd immunity in a pandemic. Relying on enough people becoming infected and then immune is dangerous, as exemplified by the Swedish experience where the COVID-19 mortality rate exceeds that of its more cautious neighbors. Broad induction of immunity in the population by immunization will be necessary to end this pandemic. In simple terms, a refusal to be vaccinated threatens the lives of others.

Disincentives for noncompliance

Here's what America must do when a vaccine is ready:

►Make vaccinations free and easily accessible.

►Exempt only those with medical contraindications to immunization. It is likely that more than one vaccine platform will prove effective (as was the case for polio vaccines) and, as a result, medical conditions that prohibit all COVID-19 vaccines will be rare.

►Do not honor religious objections. The major religions do not officially oppose vaccinations.

►Do not allow objections for personal preference, which violate the social contract.

How can government and society ensure compliance with protective vaccines?

Vaccine refusers could lose tax credits or be denied nonessential government benefits. Health insurers could levy higher premiums for those who by refusing immunization place themselves and others at risk, as is the case for smokers. Private businesses could refuse to employ or serve unvaccinated individuals. Schools could refuse to allow unimmunized children to attend classes. Public and commercial transit companies — airlines, trains and buses — could exclude refusers. Public and private auditoriums could require evidence of immunization for entry.

Unnerving toll: Sweden hoped herd immunity would curb COVID-19. Don't do what we did. It's not working.

The only legal limitation on government or private action is that it not be discriminatory, and it’s hard to see how discrimination would occur if vaccinations were free and accessible to all.

Immunization certification cards 

How then should immunizations be documented? A registry of immunization will be needed with names entered after immunization is completed. Adequate immunization may require more than a single vaccination, and the durability of protection by different vaccines may vary and may require periodic booster immunizations. Thus, immunized persons will need to receive expiration date-stamped certification cards, which should be issued to all who are immunized in the country, whether here legally or not.

These measures might seem draconian and would be costly, but ensuring universal vaccination is a negligible sacrifice compared with the costs, deaths and social upheaval that a sustained pandemic is having on our country.  

Q&A with epidemiologist: Coronavirus future in America will be like whack-a-mole 

We acknowledge that the refusal to obey rules one considers unjust is an American tradition. But another cornerstone of the American tradition is that we come together when it’s necessary. The best example of this was during the two world wars. Everyone contributed, no one was allowed to opt out merely because it conflicted with a sense of autonomy, and draft dodgers who refused to serve were subject to penalties.

True, conscientious objectors could refuse to use weapons for religious reasons, but they were obligated to help out in other ways, serving in noncombatant roles. There are no such alternatives for vaccination.

Dr. Michael Lederman is professor of medicine at the Case Western Reserve University School of Medicine. Maxwell J. Mehlman is professor of law at the Case Western Reserve University School of Law. Dr. Stuart Youngner is professor of bioethics at the Case Western Reserve University School of Medicine.

• Dr. Michael Lederman, Maxwell J. Mehlman and Dr. Stuart Youngner Opinion contributors
• Published 12:28 AM EDT Aug 10, 2020

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