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Is It Time For a Citywide Vaccine Mandate?

This image accompanies a story about the need for Philadelphia to institute a vaccine mandate like they did in Boston and New York

Header photo is from a Rite-Aid host vaccination clinic at Kelley School in Philadelphia. Photo courtesy Philadelphia City Council / Flickr

We follow the science. Usually. Sort of.

That’s essentially the Kenney administration’s approach to Philly’s own infection with long Covid, our endless fever dream now moving into its third year. Following the science implies coherence, rationality, and a lack of politics. That is not what we have here.

Nationwide, new infections are exploding everywhere with the emergence of the even more contagious, if not as deadly, omicron variant. Locally, the City’s Health Department just reported that our Covid-19 positivity rate, the share of tests coming back positive, was 38 percent. Typically, this figure is in the single digits, sometimes a fraction of a percent.

It’s precisely the omicron variant’s comparatively benign effects fueling the strain on the nation’s healthcare system. People have heard it’s not as serious, so they’re shrugging at getting it. But if it infects 70 times more people, as researchers believe, we’re still looking at a huge increase in total hospitalizations over a few months ago. Indeed, last week, Covid hospitalizations were up in Philly by 50 to 60 percent over the week prior.

Going for two years straight now, nurses, and others are now dealing with burgeoning admissions affecting quality and availability of care, including here in Philadelphia.

Following the science implies coherence, rationality, and a lack of politics. That is not what we have here.

In part to grapple with this anticipated reality, last month Mayor Kenney announced a vaccine mandate for all diners at any venues serving food. It started this week on January 3. The key is on-site consumption: if a shoe store sold hot dogs, that area must be cordoned off and people’s vaccine status must be verified, I’m told.

Philly’s glaring omission of gyms, where people are forcefully expelling air and where, anecdotally in my experience, people are as committed to maintaining proper masking as they are on the El, seems bizarre. (The City has had a mask mandate for gyms since the summer.)

And in November, the City issued a requirement for all government workers and contractors to be fully vaccinated by mid-January or lose their jobs.

But is that enough? Is the City really doing everything it can on its end?

A look around at what other cities are doing makes the answer clear: Nah.

RELATED: As we prepare for approval of the Covid vaccine for children, what have we learned so far about efforts to get shots in arms?

In Boston, newly-elected Mayor Michelle Wu took a harder stance, ordering that people must be vaccinated to enter almost all indoor businesses, including “bars, restaurants, gyms, theaters, and sports venues,” according to the Boston Herald. Yes, there were hecklers. But many business owners were thrilled, saying it takes the burden off them to keep people safe.

In New York, new Mayor Eric Adams is enforcing his predecessor Mayor Bill Di Blasio’s rule that all employees of the city’s 184,000 private businesses must be vaccinated to keep their jobs.

Now that’s a mandate.

Chicago, likewise, has more stringent requirements also covering gyms.

It seems many cities are doing something bold and letting the legal challenges and political chips fall where they may. This sets them apart from Philadelphia’s meek, incremental, at times frenetic approach as of late.

To wit: The School District barreled ahead with in-person learning then disrupted the lives of families by just days later abruptly switching nearly 100 schools to remote learning due to Covid spreading like wildfire after the holidays. Maybe we should, for the time being, anticipate surges around times people get together?

Whether the mayor doesn’t have the stomach to fight for more draconian and effective approaches or can’t handle the shrill criticism of people online who never supported him in the first place, or whether he genuinely believes his decisions are rooted entirely in science, isn’t clear. (I haven’t even brought up the Philly Fighting Covid debacle. I won’t, either, beyond saying it’s entirely appropriate to question the basis of Health Department actions and guidance.)

RELATED: Those Nerdy Girls of Dear Pandemic have spent the last 15 months sharing science-backed info with their 100,000 followers. They have some advice for how to get us through this next wave.

Consider the Mayor’s restrained response to the local Fraternal Order of Police’s demented anti-vaccine kamikaze mission that’s sure to infect both the maximum number of officers and vulnerable Philadelphians calling 911. When the police union objected to the City worker vaccine mandate, the case went to arbitration as outlined in the contract with the FOP, where the City lost.

Meanwhile, the union posted on Instagram cheering their win and then four days later, rather ghoulishly and unironically, posted a memorial remembrance to an officer who was one of the first locally to die of Covid-19 in November 2020 before vaccines were available. The City is quick to point out that the FOP was celebrating a non-win and that nothing was lost as this event only suspended the city worker rules from applying to police while the process continues to play out.

But it is worth noting that usually people call 911 on a bad day amid a dangerous situation. What is public service minded about endangering, in their hour of need, South Philly nanas and people in West Philly with compromised immune systems or children in Fox Chase with asthma?

Whether the mayor doesn’t have the stomach to fight for more draconian and effective approaches or can’t handle the shrill criticism of people online who never supported him in the first place, or whether he genuinely believes his decisions are rooted entirely in science, isn’t clear.

Where is the public condemnation or daily expressed disapproval from the mayor toward the FOP’s erratic selfishness? This isn’t a gray area, it’s a clear double standard that quite literally endangers lives.

Then again, we could just go straight to what we keep tap dancing around: Just require everyone to be vaccinated. There’s a good reason for this: Vaccines nearly entirely eliminate risk of death from Covid-19. Almost all deaths from Covid-19 today occur in unvaccinated people.

Under law and Supreme Court precedent, including Jacobson v. Massachusetts (1905), Kenney appears to be within his authority to require everyone living in Philadelphia eligible for vaccination to get their shots. That decision was about smallpox and is 116 years old, but it’s the established law of the land that local Health departments can compel residents to vaccinate.

RELATED: Since New York required vaccines for city employees, shots surged 40 percent. Is it time for the same here, too?

The attention we’d get would be massive, locally and nationally. Sure it would be controversial, but so was Obamacare, global warming, and pasteurized milk. A residential mandate would indeed get howls from some people. So do taxes. Yet, we have no problem getting people to pay. And our City solicitor is happy to fight anyone in court who claims they’re a sovereign citizen and the wage tax doesn’t apply to them.

But what of civil liberties, you say? The radicals over at the ACLU will provide anti-vaxxers no comfort. “At the ACLU,” write experts David Cole and Daniel Mach in the New York Times, “we see no civil liberties problem with requiring Covid-19 vaccines in most circumstances.”

They explain that Covid is “highly transmissible, serious and often lethal; the vaccines are safe and effective; and crucially there is no equally effective alternative available to protect public health.” That protection is key to their rationale: vaccine mandates protect “the most vulnerable among us, including people with disabilities and fragile immune systems, children too young to be vaccinated and communities of color hit hard by the disease.”

They identify the real threat to civil liberties are prohibitions against vaccine mandates themselves, like in Florida, forcing people to choose between never participating in society or being put in danger of acquiring Covid by simply leaving the house – just like the braggadocious FOP’s dispensation from vaccination does here.

I reached out to a couple lawyers about it. They weren’t sure how a residential mandate would work out in court, but one mentioned that Jacobson already plays a role in discussions about vaccines and travel.

RELATED: Is a vaccine collaboration between Penn and West Philly faith leaders a roadmap to more equitable healthcare?

Kenney spokesperson Kevin Lessard told me that the City hasn’t even considered such a measure. “The City’s approach has always been aimed at instituting the least restrictive rules that allow us to keep people safe from Covid-19,” he added.

Least restrictive is fine. I like the free movement of society. But how free is it for people with compromised immune systems to be under threat for riding the bus, or for a doctor or nurse to never see their kids? How long must we continue to suffer these unvaccinated fools?

To me, the solution is simple. Stop the incremental, hopeful approach. We’ve seen time and time again this extraordinary virus only responds to extraordinary measures. Go big or go home (and quarantine).

To be clear, I’m not suggesting steep criminal penalties or for paramilitary squads of nurses to descend upon every zip code and forcibly jab people. But we’re not even doing a mandate without enforcement beyond pretty please, like we currently do with masks. And that pretty please, combined with other social distancing measures, nearly eliminated flu deaths last year.

Our current “least restrictive” approach to vaccine requirements now excludes so many public spaces. What about coworking spaces, transit, accounting firms, grocery stores, everywhere? Why not every employer like New York City does? Why not gyms like Boston? We can ticket people for not recycling, we can’t manage this?

We could require library cardholders to be vaccinated to maintain their library cards. We could distribute N95s together with food from hunger relief organizations. We could offer a temporary discount on water bills if you’re vaccinated.

RELATED: As citywide vaccination rates drop, a veteran political consultant reflects on the absurdity of the city’s failed attempts at vaccine equity

We should do more than just responding to events, rather than controlling them. As former Secretary of Homeland Secretary Jeh Johnson has observed, “You don’t prepare for the attack that happened, you prepare for the attack that hasn’t happened yet.”

I want us to do something more both for the public good and also because if we don’t, what happened to me will keep happening.

I came back Covid-19 positive on Christmas Day despite doing everything to prevent it. Thanks to my vaccinations, I survived. People who aren’t vaccinated are getting much sicker—or dying. They also provide a host for the virus to continue to mutate, possibly one day evading the protection of our vaccine technology or becoming more virulent and deadly.

This will continue forever because natural immunity to Covid-19 isn’t as effective as the vaccines at preventing adverse outcomes and about one third of people who get Covid never develop any immunity.

To me, the solution is simple. Stop the incremental, hopeful approach. We’ve seen time and time again this extraordinary virus only responds to extraordinary measures. Go big or go home (and quarantine).

Take the political hit from predictable foes, and save more lives. The downside is criticism, maybe, and probably a legal case. Big whoop.

The upside? Fewer lives lost. And maybe this thing finally ends.

Clarification: This article has been updated to note that the arbitration process to decide on the FOP’s objection to the vaccine mandate has not yet concluded. 

MORE ON VACCINES IN PHILADELPHIA FROM THE CITIZEN

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The Answer To Our Vaccine Debacle

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Guest Commentary: Med Students To The Rescue!

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Ideas We Should Steal: Vax to Win

 

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