On Friday, US President Joe Biden announced a sweeping new vaccine mandate for employers covering around 100 million adults.
Given the urgent need to increase Australia’s vaccination rate, it may be tempting to think we need our own mass mandates.
That would be a mistake. The US mandate responds to problems which aren’t major barriers to vaccine uptake in Australia.
State and federal governments here should pursue other avenues first.
Why did Biden announce a mandate?
Biden has mandated vaccination for federal workers and contractors, and employees at hospitals and health centres that receive federal government funding. This covers around 17 million people.
Biden will also instruct his Department of Labor to issue an emergency ruling to require vaccination (or weekly testing) for workers at companies that have 100 or more employees. This should cover around 80 million people.
This big step has already courted backlash in Republican-led states. Why was it necessary?
Despite setting a good early pace, the US has fallen behind many other wealthy nations. The country hit 40% of its total population fully vaccinated in May, but is now only at just over 53%. Canada began June with just 6% of its population vaccinated, but is now at almost 70%.
The US also faces large regional disparities. In the northeast, some states have vaccination rates comparable to Canada. In the south, rates are much lower. Despite administering more than 380 million vaccine doses, the country is currently recording over 140,000 COVID cases and 1,600 deaths per day.
The causes are complex. However, under-resourced and/or unwilling state governments, a fragmented and inequitable health-care system, a deficit of social trust, and the viral spread of misinformation undoubtedly contribute.
Biden’s announcement arises out of well-known problems with political action in the United States. Passing legislation would require agreement from a Congress already at loggerheads over other key planks of the Democrats’ domestic agenda. Therefore, the mandate will be implemented via Biden’s unilateral powers as president.
It may provoke backlash against vaccination among some people, which could impact existing vaccinations for children, as well as COVID vaccines. However, it’s difficult to see what other options are available.
Australia has other ways to increase uptake
Fortunately, the circumstances are different in Australia. We would therefore advise a more circumspect approach.
Some states have already announced mandates for frontline health-care workers and police, and the Australian Medical Association has backed mandates for all of those who work in a health-care setting.
Companies have introduced their own private mandates for workers, the public, or both, with Crown Resorts this week announcing it’s looking to introduce such a policy. State governments will be adding vaccine passports to their toolkits for venues in New South Wales and Victoria.
But there are additional important pathways to increasing vaccination rates that can foster trust in the health-care system. These have proved difficult in the US, but are available in Australia.
Targeted outreach in the form of clinics and bespoke persuasive communications are needed for poorly reached communities. Culturally and linguistically diverse populations and Aboriginal communities need culturally safe vaccination sites and interventions to address specific concerns.
The Biden administration can do little to work with states with low vaccination rates. Even as cases soar in Kentucky and Tennessee, Republican state governments have been largely unwilling to take additional steps to stop the spread and speed up vaccination.
In Australia, with supply issues soon to dissipate, the states and territories can work together with the federal government on improving communications and addressing access issues. The current significant disagreements in our National Cabinet nevertheless pale in comparison to the ceaseless battlefield of US federalism throughout the pandemic.
While there has been some gnashing of teeth regarding additional supplies of vaccines to NSW, western Sydney has demonstrated how effective targeted local campaigns can be.
As recently as late July, there were concerns raised about hesitancy in western Sydney. Blacktown now has one of the highest vaccination rates in the country: 89.5% of those over 15 years old have had at least a single dose.
A US-style mandate is a blunt instrument. It’s potentially effective if all else fails, but not without costs.
We should continue to build a rollout that strengthens trust in health systems and vaccinations. This will not only help us reach the high vaccination coverage rates we need, but will also prepare us for the next crisis.
Adam Hannah receives funding from the WA Department of Health.
Katie Attwell receives funding from the Australian Research Council and the WA Department of Health. She is currently funded by ARC Discovery Early Career Researcher Award DE1901000158. She is a member of a government advisory committee, the Australian Technical Advisory Group on Immunisation (ATAGI) COVID-19 Working Group 2. She is a specialist advisor to the Therapeutic Goods Administration. All views presented in this article are her own and not representative of any other organisation.
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