Would COVID-19 Vaccine Mandates Improve Vaccine Access?

April 20, 2021 - More than 50 percent of Americans view COVID-19 vaccine mandates in educational settings favorably, giving credence to what could be an effective policy lever for supporting COVID-19 vaccine access and ultimately herd immunity, researchers said.

The study, published in the journal Vaccine, showed that most people view general vaccine mandates in daycare settings, K-12 schools, and colleges and universities favorably. Approval of mandates specific to the COVID-19 vaccine was lower than for other vaccines, but still significant, the researchers from Pennsylvania State University found.

These findings come as the medical industry grapples with how it can achieve herd immunity from the novel coronavirus. Herd immunity typically comes when between 70 and 90 percent of a population has been vaccinated against or otherwise become immune from a certain pathogen. Currently, scientists do not know how many people need to be vaccinated against COVID-19 in order to achieve herd immunity.

According to Simon Haeder, an assistant professor of public policy at Penn State and a researcher on the study, creating vaccine mandates in educational settings can be an effective way to achieve herd immunity and reduce disease spread. Mandating vaccination simply leads to more vaccinations, Haeder wrote in the study, and can ultimately quell community spread.

"Even if children are less likely to get severely ill, vaccination of students has been shown to have benefits such as lower numbers of community deaths, particularly among the elderly," Haeder explained in a press release. "Mandates may serve as a crucial policy tool to help reign in COVID-19 and reach herd immunity, which we otherwise might not reach any time soon."

In a survey of just more than 2,400 adults in the US, Haeder found general acceptance of vaccine mandates in daycares, K-12 school settings, and university of college settings. Respondents were receptive of a vaccine mandate for both students and teachers in each of those settings.

A total of 68 percent of respondents approved of general vaccine student mandates in K-12 schools, a number that fell to just over 50 percent when the mandate was specific to COVID-19. A little under 60 percent of respondents agreed with COVID-19 vaccine mandates for teachers in K-12 schools.

Support was generally higher in the college and university setting, but not by much. Sixty-five percent agreed with a general vaccine mandate for college students, while 55 percent supported a student mandate for the COVID-19 vaccine. Fifty-eight percent of respondents approved of a COVID-19 vaccine mandate for college and university teachers.

In the daycare setting, 70 percent of respondents said they definitely or probably supported general vaccine mandates for children. Just over 50 percent agreed with COVID-19 vaccine requirements for children, while 60 percent support COVID-19 vaccine requirements for teachers.

Vaccine mandate acceptance wasn’t universal across all populations, the survey revealed. Partisanship, gender, race, rural versus urban residence, and views about how schools should deliver public health or healthcare all influenced findings. For example, Republican voters were less likely to support vaccine mandates, a finding that was more pronounced for mandates specific to the COVID-19 vaccine.

"Partisanship has permeated everything related to COVID-19 and lots of misinformation has been spread, including from individuals in leadership positions," Haeder pointed out. "Additionally, there's a general growing distrust of science and its elites, which when combined with the novelty of the illness and vaccines, could contribute to this lack of support for vaccine mandates in certain groups."

People with more political education and people with children living in their households were more likely to say they approve of vaccine mandates in school settings, as are White respondents and older respondents. People who believe schools should play a role in public health also agreed with vaccine mandates, including COVID-19 vaccine mandates.

Women were more responsive to general vaccine mandates, but their support wavered for COVID-19 vaccine mandates in school settings.

Nevertheless, these findings could have positive policy and public health implications, Haeder said. Previous vaccine mandates offer further evidence.

"Massachusetts mandated smallpox vaccinations in the early 1800s, Alaska and California used mandates in the 1970s to control measles, and in more modern times, there are often certain vaccine mandates for living in the dorms on some college campuses," Haeder said.

But Haeder remarked that these policies are also often met with fierce opposition from vaccine-hesitant people, something that could spell the need for strong public health education.

"Efforts to provide Americans with more information about the safety and effectiveness of the vaccines should be undertaken to help alleviate fears around the COVID-19 vaccines," Haeder said. "Also, efforts could be made to reduce potential barriers for vaccinations, including providing the vaccine free of charge, making scheduling appointments easier, avoiding long travel times, and offering convenient opening hours."

COVID-19 vaccine mandates could be important for compelling vaccine access, separate data has shown. In January 2021, a Kaiser Family Foundation survey showed that one in five people would hold out on getting the vaccine unless it was a requirement for returning to work or school.

That figure may have fallen as general vaccine hesitancy rates have gone down since this winter. Nevertheless, as more colleges and universities announce COVID-19 vaccine mandates, it will be imperative for other institutions to consider their role. Additionally, healthcare may consider how these institutions can impact vaccine acceptance and access rates.