Tornado Alley (PROG)

[fuagf]

They sure did. Still many mandates got more vaccinated and that is inarguably a good thing for all of us ..

""Supreme Court vaccine mandate ruling won’t bar companies
from demanding Covid shots for workers"
"B-bu-but but mah freedumms...", they all cried!"

Did COVID vaccine mandates work? What the data say

A measure of last resort got a major workout during the pandemic. Scientists are now trying to determine whether the benefits outweighed the potential damage to public trust.
[...]
In Canada, Lu and colleagues looked at certificate-based policies implemented across nine provinces from July to September of 2021, as the number of daily vaccines being administered was falling2. Lu used a technique, regularly deployed in economics, called differences in differences. “It exploited the fact that different provinces introduced the policy at different times”, he says, meaning that for each implementation, data from the other eight provinces served as counterfactual controls.

To varying extents, announcing a mandate caused an increase in the number of people receiving a first vaccination in all provinces. “The average effect that we estimate is a 66% increase in the pace of vaccination,” says Lu, although the effect varied between 34% and 326%.

Starker increases were seen when the gap between announcement and implementation was shorter and when pre-policy vaccination rates were lower. Lu wonders whether this suggests that mandates overcome people’s vaccine hesitancy or their complacency about COVID, which had previously been reinforced by social norms.

In total, Lu and his colleagues estimated that the certificates accounted for an extra 979,000 people, roughly 2.9% of the eligible Canadian population, becoming vaccinated. “Just looking at the graphs of daily new vaccinations, you can see very big spikes,” he says.
[...]
Consistent with Lu’s observations in Canada, across these European countries, the more unvaccinated people there were when the policy was introduced, the greater its effect. [it's what one wold expect] Oliu-Barton also stresses that in France and Italy, there was clear, strong communication about the introduction of certificates, compared with less clear initial messaging in Germany (see ‘Mandates measured’).
[...]
Another notable and consistent finding was that health passes most effectively lifted vaccination rates in younger groups. Oliu-Barton suspects that the type of venues that COVID certificates granted access to was important. Pointing to a previous survey of incentives for getting vaccinated, he says the data showed “if you can go to a bar, that’s freedom. And liberties were much more influential for young people”.
[...]
In the United States, James Lee, an epidemiologist at the Centers for Disease Control and Prevention in Atlanta, Georgia, led a national phone survey of 12,875 health-care professionals who self-reported their vaccination status and the presence or absence of a workplace mandate5. Where mandates existed, 90.5% of respondents were vaccinated; where they did not, only 73.3% were.

The finding is consistent with mandates increasing vaccination rates, although Lee says, “our study is a cross-sectional survey, so we are not able to determine causality”. He notes that mandates are more likely to be implemented in regions where vaccine acceptance is higher.

When it comes to private-sector mandates, there are mainly isolated reports from the companies themselves. “You have lots and lots of cases,” says Ezekiel Emanuel, an ethicist at the University of Pennsylvania in Philadelphia, and a former member of US President Joe Biden’s COVID-19 Transition Advisory Board.

Emanuel cites United Airlines and New York City’s police, fire and sanitation departments as examples of mandates leading to high vaccination rates. United reported that it vaccinated more than 99% of its 67,000-strong workforce. “I think we’ve got a lot of evidence that when you put the mandate in, people will choose either working or not working,” says Emanuel. “They end up saying, ‘Alright, you know, a shot’s not that bad a deal’.”

MacDonald stresses that a probable factor in these widely heralded successes was that the companies “also made it really easy for people to get the vaccine”.

Improving access might be significant in accounting for a key observation made by Lee: in health-care settings where mandates existed, there was greater parity in vaccination rates between socio-economic groups. Where mandates were absent, there was a 26.7% gap (79.6% versus 52.9%) between the vaccination rate of staff earning more than US$75,000 (for example, doctors and senior managers) versus staff earning below the federal poverty line (for example, cleaners and other manual labour workers). In mandated settings that gap fell to 11.9% — 92.7% versus 80.8%. This suggests mandates can help foster equity, Lee says.

But such mandates were not a success everywhere. In the United Kingdom, the Department of Health and Social Care first mandated that care-home workers must be vaccinated, then announced the same policy for National Health Service (NHS) employees.

Ahead of the policies’ implementation, William Palmer, an analyst at the Nuffield Trust, an independent UK health-care think tank, advised that the government should prioritize clear and sympathetic communication with the two workforces, which had borne the brunt of the pandemic. “If you’re going to do it, you need to do it right,” he says.

But this never materialized, Palmer says. Instead, the government’s impact assessments and the rationale for the policies were buried in documents published at the last minute. A spokesperson for the Department of Health says, “There was full public consultation and engagement on the proposals at every point, which clearly set out the rationale and purpose.”

Between the policy’s announcement in June and its implementation in November 2021, the number of directly employed care-home staff fell by 26,000, roughly 5%. And the NHS policy was withdrawn before taking effect after sustained protests.

Employer mandates and their implementation warrant further analysis, although Lee warns, “as employer requirements are not collected systematically and enforcement varies, I anticipate this will be hard to study”.

At what cost?

Vaccine mandates do risk overly politicizing health policy, says MacDonald. But it is hard to accurately quantify the consequences such as social exclusion, loss of public trust or inequitable outcomes. Numerous other factors are at play, such as the way a government handled the pandemic overall, wider political campaigns against vaccination or mandates, or frustrations with the way that a mandate was implemented. Another crucial aspect of whether mandates are successful is the political skill and messaging used to introduce them.

Opposition to vaccines — and mandates — can also be a way of expressing displeasure with other aspects of civil society, says Heidi Larson, an anthropologist and founding director of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine. “All of a sudden everyone who had an issue with government has an issue with vaccines,” she says. Oliu-Barton says that some mandates seem like a referendum: “Do you like the government? You can say, ’no’, by not getting a shot.”

Ward has tried to gauge how the French public reacted to vaccination policies by using questionnaires. When asked if they felt relief, anger or regret when they got vaccinated, respondents who were vaccinated in early 2021 said they mostly felt relief. But most of those vaccinated later, especially after the government imposed health-pass requirements, reported anger or regret6. In a later poll conducted in March this year, more than 60% of respondents said they had felt at least somewhat ‘constrained’ to get vaccinated. Ward’s future work will further dissect why and how.

The case for mandatory vaccination

In Germany, Katrin Schmelz, a psychologist at the University of Konstanz, has led a unique series of surveys that tracked the evolving views of nearly 2,000 German residents over the course of the pandemic7.

Across all surveys, the questionnaire showed that only around 3% of the population consistently opposed vaccination if it was voluntary. By contrast, 16.5% of people consistently opposed mandatory vaccination. Roughly half of all respondents changed their minds over time — and the shifting variables most closely tied to support for mandates were trust in government and belief in vaccine effectiveness.

“Mandates are an essential part of public health policies,” says Schmelz, but her work also suggests that it was a good decision to make vaccination a personal choice initially. Polling before vaccines were available showed that 73% of German adults were OK with getting vaccinated voluntarily8 — which corresponded almost exactly to the fraction who were vaccinated before mandates were introduced. Schmelz says she believes that a sense of moral autonomy motivated these people to help battle the virus, and that mandating vaccination earlier would probably have reduced this motivation. “People respond to feeling distrusted by lowering their effort,” she says.

A major concern is that if a substantial proportion of society has lost trust in public institutions, this will make public-health policies harder to implement — in particular, other ongoing vaccine programmes. “Sentiments around vaccines are hugely tied to trust in government,” says Larson. “What’s the knock-on effect of this COVID experience on routine vaccination?”

Deciphering those longer trends might take time. Larson is awaiting the results of the Vaccine Confidence Project’s latest survey of overall attitudes to vaccines, which she thinks will be an indicator of how views have shifted.

Like so many aspects of the pandemic, decisions about mandates and their implementation have occurred at speed — amid a constantly shifting crisis. The legal requirements now being studied were introduced in the summer of 2021, when anxieties about the pandemic still ran deep, and such measures were more palatable. Available vaccines also offered protection against infection, not just against serious illness. With people becoming less afraid of COVID-19 and vaccines offering less protection against infection by Omicron variants, plans this spring to introduce new nationwide mandates in Austria and Germany, for example, were rejected or never enforced.

As concerns about the pandemic wane in many countries, researchers fear that research fatigue is setting in, too, not least when it comes to analysing the complex behavioural responses of people to the virus and mitigation strategies. Yet behavioural science is an essential part of the response to this pandemic and future ones. “People are tired,” MacDonald says, “I think everybody wants this done.” But what she’s more tired of is seeing governments not learning the lessons of previous public-health emergencies. “We need this analysis done.”

Nature 607, 22-25 (2022)

doi: https://doi.org/10.1038/d41586-022-01827-4

Updates & Corrections

https://www.nature.com/articles/d41586-022-01827-4