The Daily - The Vaccine Mandate Conundrum

Episode Date: July 27, 2021

In the effort to raise America’s vaccination rate, some agencies and private organizations have turned to the last, and most controversial, weapon in the public health arsenal: vaccine mandates.How have the federal government and the White House approached the issue?Guest: Jennifer Steinhauer, a Washington reporter for The New York Times. Sign up here to get The Daily in your inbox each morning. And for an exclusive look at how the biggest stories on our show come together, subscribe to our newsletter. Background reading: California and New York City will require vaccinations or tests for their employees, while the Department of Veterans Affairs said frontline health care workers must get vaccinated or face possible termination.With some health care workers still refusing to be immunized, medical centers around the country are requiring shots as cases climb once again.For more information on today’s episode, visit nytimes.com/thedaily. Transcripts of each episode will be made available by the next workday. 

From The New York Times, I'm Michael Barbaro. This is The Daily. Today. For the first time, a federal agency is requiring that its workers receive a vaccine against COVID-19. I spoke with my colleague, Jennifer Steinhauer, about whether it's a sign of things to come. It's Tuesday, July 27th.

Jennifer, why is it that we are now suddenly talking about vaccine mandates? So Michael, I think you have to look at the vaccine as sort of three phases, right? First, there was the phase of, okay, we have a vaccine, but nobody can get it, right? Lines, people waiting all night to get a vaccine. Right. And then we moved pretty quickly into the phase of, we have a lot of vaccine, and we're having slow uptake among certain people to take the vaccine, right? And now we're in the next phase of it, which is you had this Delta

variant of the coronavirus raging through the world, including the United States. And it's no longer seen so much of a choice of who wants a vaccine and who doesn't want the vaccine as it is a border on a public health crisis again. So at this point, government, the private sector, the White House have done kind of what they can do to move the needle. They've begged, they've cajoled, and pretty much it seems that we've hit a ceiling. And so you're starting to hear increasing calls from experts on this illness that in order to get this in check and not have another giant wave in this country, possibly the best way to do that would be mandates. Right. The thinking being, after all these efforts and experiments that haven't quite done the job, that a mandate is kind of our last weapon in the public health arsenal to get people to get the shot. That's the thinking. And so they're looking to

both the private sector and the government, including the federal government, to do that. Mandates mean you need to get a vaccine or you can't do something. It can be you can't stay employed here. It could be you can't come into a restaurant. It could be you can't fly in an airplane. Right. But mandates remain very rare. So remind us, what has been the story of vaccine mandates up to this point? Well, vaccine mandates are not a new concept. I mean, most of your listeners who went to school probably had to have vaccines to go to school. In the military, pretty much any vaccine that's required in school and sometimes beyond, especially for foreign deployments, are required. In fact, George

Washington ordered all of the Continental Army forces vaccinated in 1777 because they were getting wiped out by smallpox. So vaccine mandates have long been a public health tool, both to get large groups vaccinated and to prevent, obviously, the spread of the disease, especially among more vulnerable groups. And what about during this pandemic? What has been the role of vaccine mandates so far? So among those first out of the gate on vaccine mandates were colleges and universities. Anyone planning on attending Rutgers University for in-person learning this fall will need to be vaccinated against COVID-19. Who quickly said that they were going to require vaccine of students who wanted to attend classes or live on campus. Currently, more than 500 colleges and universities nationwide

have imposed COVID-19 vaccine mandates. And shortly thereafter, we started to see hospitals and healthcare systems also compel employees to get vaccines. A major legal ruling in the battle over whether companies can mandate COVID vaccines in the workplace. And recent court decisions have upheld those rights for them to do that. Back in March, Houston Methodist Hospital

made its policy very clear. All employees must be vaccinated by June 7th or risk termination. For example, in June, a federal judge in Texas dismissed a lawsuit that was brought by the employees of Houston Methodist Hospital, who had challenged the hospital's coronavirus vaccine requirement.

In the ruling, the judge wrote, "'The vaccine mandate is a choice made to keep safe patients and their families.'" And a lot of hospitals and other medical facilities looked to that and began to create mandates of their own. Individuals' choice not to get vaccinated is now impacting the rest of us. And most recently, we're starting to see cities and states also follow that. You're putting other people's, innocent people's lives at risk.

And on Monday, we saw Governor Gavin Newsom of California and Mayor Bill de Blasio of New York City. This is about our recovery. This is about what we need to do to bring back New York City. Order hundreds of thousands of government employees mandate vaccines. So right now, it's all very piecemeal. A city here, a state there, a different company, a handful of hospitals. But the one person who could really impose a broad mandate is the one who won't do it. And that's President Biden. And what could he do in terms of a vaccine mandate as president? Well, certainly as it pertains to the military, with a stroke of a pen, he can authorize a vaccine, even though it's in the emergency use authorization stage. And he could probably also order federal workers, at least in some agencies, to have vaccines as well.

But so far, not only has he resisted. Hi, everyone. Hello. The White House has been pretty upfront that they have no interest in that. One, that's not the role of the federal government. That is the role that institutions, private sector entities, and others may take. That certainly is appropriate. But that's the role of state and local governments and the private sector

and institutions like colleges and universities. Also, local communities are going to take steps they need to take in order to protect people in their communities. And it's not as if they've shied away from this opinion. They've been quite vocal and quite open when asked that this is their point of view. And they're almost irritated at the suggestion that they could or should be imposing mandates on federal workers, even as the White House and President Biden have offered and suggested and sort of almost begged states, local governments and employers to do it. So it's a bit of a it's a bit of a conundrum. And it's pretty clear that Biden is walking a pretty thin rope here in terms of the politics of vaccines, which have dogged this whole effort from the very beginning. Just the fact that the federal government had an effort to go door to door to offer

vaccine information and the shots themselves had people go bananas. You know, a lot of folks were accusing the federal government of overreach and worse, and he doesn't want to be seen as forcing people to do something. So there's the message on the one hand of, please do this, we beg you to do this. On the other hand, but we're not going to force anybody. And it's purely political, because if you were focused from a public health standpoint on outcome, obviously a mandate is a tool in your toolbox. And right now, politically, the White House has made the calculation that it's not one they want to use. Explain that. What is the political calculation? What is the fear that a vaccine mandate inspires in this White House?

mandate inspires in this White House? I think the fear is that the already fairly toxic environment around the vaccine, that is to say, people who are resistant to the vaccine and not just saying they're worried that it's not safe or they want to wait until other people get it so they can kind of measure how it works out, but people who are proclaiming that the vaccine is a tool to federal government to harm them. Having a mandate reinforces all of that in a very visible way. It's saying, if you won't do something to your body, we're going to force you to. The idea of mandating a vaccine, of mandating putting a shot in your body somehow strikes people not just as unpalatable, but pernicious. And I think that's the politics that they're trying to avoid. So what you're describing is a fear from the Biden White House that this would either backfire and perhaps make those who are resistant more resistant

and potentially become politically very dangerous for them. Yes, that is true. And that's what made it so interesting on Monday when the Department of Veteran Affairs announced that it was going to have vaccine mandates for a segment of its employees, which seemed to fly right in the face of what the administration emphasized on Friday it was not going to do, federal mandates. We'll be right back. So Jennifer, tell us about this vaccine mandate from the Department of Veterans Affairs, because it would seem, as you said, to be quite out of line with the Biden administration's approach

to this. So how did it come to be? So the Secretary of Veteran Affairs, Dennis McDonough, has been very concerned a couple of months now about the ceiling that he's hit at some VA centers with vaccines. Overall, VA employees are about 70 percent fully vaccinated, which, as you know, is better than the national average, but not good enough in his view and his clinicians view for health care workers. And in some places, it's much lower, you know, lingering in the 50% rate. So he started to feel it was really inappropriate, frankly, for people giving direct care to veterans who tend to be older and more vulnerable to illness to not have the vaccine. So he saw the VA as at unique risk because it serves veterans, obviously a group that the United States government cares a great deal about.

I think that from his standpoint, all that Desmond Dunn had to worry about was the VA. He didn't really need to think through the politics of how it fit into Joe Biden's proclamation that he wasn't going to have a federal mandate. He looked at this as how is this affecting the VA? And I think what he did was he looked at the VA not as much as a federal agency in the context of a vaccine mandate, but as a healthcare provider. The Department of Veteran Affairs is actually the nation's largest integrated healthcare system, period. It provides care for tens of thousands of veterans and their families. It has hospitals, for tens of thousands of veterans and their families. It has hospitals, it has nursing homes,

it has long-term care facilities, it has clinics. So he's looking around the country and he's saying, what are other hospitals and medical settings doing? And what's the legal test? And he very carefully consulted their legal department and the VA constructed a mandate that is a slice of employees. It's 115,000 of, you know, roughly 300,000 who work directly with patients, doctors, registered nurses and specialists, folks like that, who he and his clinical staff believed really needed to be vaccinated to be working with veteran patients. Got it. So it's very much a health care, and in that sense, a logical place to experiment

with a federal vaccine mandate. Right. But obviously he had to do that in coordination with the White House, right? He's not going to blindside them. He needed to let them know this was his plan, and they obviously had to bless it. And they did that by using the same logic, clearly.

This is not a federal employee mandate. This is a mandate on a federally functioning healthcare system. Hmm. What more do we know about the White House's reaction to this mandate? Well, President Biden, when the story broke, was asked about it. And he quickly sort of brushed it off. Yes, this is happening at the VA. And kind of reemphasized, we're not doing big federal mandates.

So they're definitely trying to keep this in the health care box. And time will tell whether they get away with that or whether we immediately see the sort of protests that we've seen around vaccine mandates in other countries, mask mandates here. I have to imagine that for families of those being cared at the VA, they will be pretty supportive of this. I don't know about the workers themselves, how they're going to feel. Obviously, those who have been resisting it, I can't imagine that a mandate is going to make them excited. Well, to that point, how is this secretary of the VA messaging this mandate to the VA workforce, knowing how sensitive this all is? Well, it's kind of interesting. When Dennis McDonough talks about vaccines and a mandate for health care workers in the VA, he talks about it specifically for protecting veterans. You don't want to be the one who is passing the virus unknowingly to somebody, including

one of our great heroes, our vets. And there are not too many groups in this country besides veterans and those actively serving the military now who remain on sort of a cultural pedestal, right, the way they are. This is not a state or a federal issue. This is not a Republican or a Democratic issue. This is an American issue. And so when he talks about it that way, and he specifically and pointedly repeats that, that's clearly how he's

trying to message this. Got it. So from everything you're describing, this is a very narrow mandate in a corner of the government that very much resembles a healthcare system. And so I wonder if we should think of this as any kind of test case for how the Biden administration is thinking about vaccine mandates, or if we should be thinking about it as kind of a one-off that is unlikely to be replicated. I think it's somewhere in between, Michael. I'm not sure that I think this is a test case for the federal government. First of all, one has to take President Biden at his word since he's been so emphatic that he's not seeking a widespread mandate for federal workers. I would look at it more as the continuation of testing mandates in healthcare settings, where obviously vaccines are

probably most vital to protecting other people's health, and perhaps to other private sector employers. I think that I would look to the private sector more, and of course local governments like we saw in New York City, to be doing mandates before I would look for the federal government to be doing it. That's my spidey sense. But don't we expect private companies will have to navigate these same pretty tricky political waters and cultural war questions as the federal government. And potentially, if they impose vaccine mandates, risk losing customers if they end up on the wrong side of this issue in the minds of those customers. Yes, I think vaccine mandates are politically tricky for everybody, private and public sector.

But what's been interesting is you haven't seen so far, and it's obviously a small test, of pushback that seems to be hurting anyone's bottom line. You know, I haven't read any stories about people dropping out of college because they don't want to get a vaccine or deciding to live at home rather than live in a dorm because they don't want to get vaccines. Governor DeSantis in Florida really pushed back against the cruise industry because they were requiring vaccines for passengers. And the cruise industry said, you know, take a hike and seemed to be victorious in that. It sounds like you're saying that the stick that private companies or colleges wield, whether it's access to classes

or to a vacation on a cruise ship or to employment itself at a company, is pretty powerful. Correct. If the idea that you might make others sick doesn't compel you to take a vaccine, that's kind of that. But once you start to lose your rights,

that becomes a different kettle of fish. People don't like to be told they can't do something that they want to do. I saw someone tweet the other day that if they required vaccines for college football season, you'd see, you know, people lining up tomorrow. People don't necessarily make decisions based on abstract concepts of what might happen to them, but they don't like to have things taken away from them. Right. But it seems like so far, the majority of those mandates, the majority of those attempts to require vaccines are coming from private organizations. And I guess the question becomes, is it an abdication of the federal government's very unique responsibility to safeguard public health to foist such mandates off on the private sector or even on local

governments if the federal government has the power to impose it itself on federal workers, given the symbolism that that would create? It's an interesting question. And I would point out to you that there's not even a vaccine mandate to work in this White House. So that just goes to show you how far away they are politically from wanting to have to do that and whether they think that political cost

is higher than the benefit of having specifically federal workers vaccinated. Because you raised the question of symbolism. And when it comes to public health outcomes, symbolism usually is less interesting of having specifically federal workers vaccinated? Because you raised the question of symbolism. And when it comes to public health outcomes, symbolism usually is less interesting to people than actual data outcomes, right? How are you going to keep the largest group of people from getting sick?

And is it through the federal workforce? Maybe, maybe not so much. So why would President Biden in some ways want to insert the federal government into what you're sort of describing as a political calculation when they can just continue to talk about it as a public health policy issue that everyone needs to play a role in and not have to sort of wear that burden of yet another piece of perception that the Biden administration is just forcing people to do things that they don't want to do with their own bodies. But Jennifer, what if the answer is as simple as it could save lives, a federal worker mandate to be vaccinated from the White House? Well, it's interesting because while it certainly probably would save lives of those who are not vaccinated, who are part of the federal workforce,

the question is, would that also cost lives for people who don't get vaccinated, almost as a pushback to what they see as more federal intrusion? And the White House has decided very clearly, because they're articulate and open about it, that pushing federal workers that cause having a mandate come from the White House is a bridge too far in the fight against vaccine hesitancy. Well, Jennifer, thank you very much. We appreciate it. Thanks for having me, Michael. On Monday afternoon, a group of nearly 60 major medical organizations, including the American Medical Association and the American Nurses Association, called for the mandatory vaccination of all U.S. health care workers.

In a statement, the groups called vaccination the ethical obligation of health care workers. We'll be right back. Here's what else you need to know today. I'm honored to welcome the prime minister. We've known each other for some time. And welcome to the White House. Welcome to the Oval Office, Mr. Prime Minister. On Monday, during a meeting with the leader of Iraq,

President Biden said that by the end of 2021, the United States' mission there would switch from combat to advising and training Iraq's government. We are not going to be by the end of the year in a combat mission. The United States currently maintains about 2,500 soldiers in Iraq, and it's unclear how many will be removed. many will be removed. But the shift in Iraq mirrors Biden's efforts to reduce the long-term role of the U.S. military in Afghanistan. And the remains of the final victim of the building collapse in Surfside, Florida, has been identified. The authorities identified her as 54-year-old Estelle Hedaya, who lived on the building's sixth floor. The discovery brings the final death toll at the building to 98 people. Today's episode was produced by Rachel Quester, Nina Potok, and Rob Zipko, with help from Chelsea Daniel.

It was edited by M.J. Davis-Lynn, engineered by Chris Wood, and contains original music by Dan Powell. That's it for The Daily. I'm Michael Barbaro. See you tomorrow.