Amid challenges to Biden's vaccine mandate, study shows they work

In early November, the Biden administration announced that large companies with 100 or more employees would have until Jan. 4, 2022, to ensure their workers are fully vaccinated against COVID-19 or to require unvaccinated workers to undergo weekly testing. Companies that fail to comply with this ruling may be fined by the Occupational Safety and Health Administration (OSHA). Twenty-four states and several governors have threatened to challenge the ruling in court, and a federal appeals court has temporarily blocked the mandate.

Some business owners also have expressed fear that mandating the vaccine could intensify existing staffing shortages. Many politicians have shied away from mandates, worrying that the approach would be unpopular. But the key public health question is whether the evidence suggests that a mandate will increase or decrease vaccination. Now, Americans have the evidence coming from the implementation of mandates in companies and the government of New York City. In addition, a series of scientific experiments published recently show that the mandates can cause an increase in intentions to vaccinate.

Although many public health experts support vaccine mandates, others caution that requiring vaccination can stir anger and opposition to the vaccine. According to one psychological theory, forceful measures may trigger negative emotions and weaken intentions to vaccinate. A key question about COVID-19 vaccination is: Will expanding vaccination mandates backfire by reducing vaccine acceptance instead of increasing it?

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In a paper published recently in the journal Scientific Reports, we present evidence that strongly supports the use of vaccine mandates. In four studies conducted between January and April 2021, we assessed whether requiring a vaccine, encouraging free choice in vaccination, or even suggesting that the vaccine will make recipients feel freer, strengthens or weakens vaccination intentions. In all studies, compared to free choice, the requirements strengthened vaccination intentions. Requirements worked better across racial and ethnic groups and across different political ideologies. Also, requirements did better even when we told people that vaccine mandates have low levels of support within a population, and when participants expressed a negative psychological reaction to any mandates (we measured this by asking them if they agree with statements such as “When someone forces me to do something, I feel like doing the opposite”). 

The public health rationale of vaccine mandates and whether they are legal, constitutional and ethical have been thoroughly discussed. Regulations can promote behaviors that benefit society and, in so doing, also may instill social norms to do the right thing. Mandates, or safety laws, are part of the fabric of American life. As Americans, we are used to wearing car seat belts, submitting to security scans at airports, and stopping at red lights when we drive. In work settings, health care workers and military personnel must get required vaccines to serve in those roles, and some people who initially resent workplace vaccine mandates eventually come around

To be sure, not all Americans are enthusiastic about having COVID-19 vaccination as a condition for their employment, and in polls a sizable minority (29 percent) strongly oppose workplace mandates. As many as half of workers say that they are willing to quit their jobs if their employers require the vaccine. However, few employees are actually leaving their jobs because of mandates. Rather, the overwhelming majority of government, airline and health care workers have chosen to vaccinate when mandated. 

In New York City, for example, only 34 police officers out of about 35,000 remain unvaccinated when the city’s Nov. 1 vaccine mandate deadline passed, despite warnings from union leaders that there would be thousands of police officers who would not comply. Possibly, vaccine mandates provide an important face-saving way for many unvaccinated people to get the motivation they need and even reduce their cognitive dissonance by thinking that there is a clear need to vaccinate. People’s fear of job losses and wanting to conform to social norms may be additional reasons why vaccine mandates work well.

Taken together, the experimental research evidence and success of vaccine mandates in rapidly increasing uptake of COVID-19 vaccinations among workers across the United States suggest that the mandates do work; the scientific experiments may be conservative, if anything. Fears of a backlash against vaccine mandates appear to be largely unfounded. 

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What remains unknown is how best to implement and tailor the vaccine mandates to different contexts in which they are introduced, including how politicized the mandate is locally. We propose that more research is needed on the impact of media and political polarization surrounding mandates. 

Dolores Albarracin, PhD, is a senior fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania, the Alexandra Heyman Nash Penn Integrates Knowledge Professor and director of the Science of Science Communication Division at the Annenberg Public Policy Center.  

Jessica Fishman, PhD, is a fellow at Penn’s Leonard Davis Institute of Health Economics and the director of the Message Effects Lab at the Annenberg School for Communication and Perelman School of Medicine.

Andy Tan, PhD, MBBS, MPH, MBA, is a senior fellow at Penn’s Leonard Davis Institute of Health Economics and an associate professor at the Annenberg School for Communication.