The plan President Joe Biden announced Thursday to defeat Covid-19 will likely stand out as one of the most significant actions of his administration. It is an outlier in many ways in that it is the boldest move we’ve seen to raise the vaccination rate in the United States, setting up a domino effect across the country to expand mandates in local settings.
We’ve already seen from other countries that strong and unwavering leadership makes a difference.
Thursday was also the first time the president has drawn a line in the sand and identified some of the largest threats in this pandemic: governors who have prioritized future presidential bids and misinformation over the health of their state and misinformation.
In an obvious reference to Florida Gov. Ron DeSantis, who has waged war with local school officials who have mandated face masks, Biden said, “Right now, local school officials are trying to keep children safe in a pandemic while their governor picks a fight with them and even threatens their salaries or their jobs. Talk about bullying in schools. If they’ll not help — if these governors won’t help us beat the pandemic, I’ll use my power as president to get them out of the way.”
Biden clearly recognizes the stakes and has taken an unequivocal stance. However, his drawing that line in the sand is the very thing that will unify his detractors and set up a frenzied race for members of the Republican Party to argue — wrongly, of course — that vaccine requirements are worse for the country than millions of Americans being infected with Covid-19 and many hundreds of thousands dying from it.
The path out of the pandemic has been clear for months: We have not just one, but three highly effective vaccines with more real-world safety data than any effort in public health history. Yet we continue to see a proliferation of lies and misinformation and, even worse, a growing sense of pride among those who now have chosen to remain unvaccinated.
Such a straightforward path became instantly riddled with manmade peaks and valleys. Lines in pharmacies were soon replaced with protests and parents threatening violence at school board meetings. Half of the country remained unvaccinated, in time for an opportunistic variant which managed to reverse the summer of freedom.
Arriving at a decision to mandate vaccination in most workplaces in the country could not have been easy for Biden. There will be legal challenges and disruptions to workplace culture and camaraderie as employees who do not get vaccinated face the risk of being ostracized. Hospital and health systems already running on fumes will lose health care workers over mandates, which will increase the burden on their remaining colleagues and potentially put some patients in a deeper crisis. Unions have already been divided over their competing desires to promote public health and hold onto potential bargaining rights.
We continue to see a proliferation of lies and misinformation and, even worse, a growing sense of pride among those who now have chosen to remain unvaccinated.
But the alternative to such a mass mandate has already been on display: record-breaking infections in schools and death and devastation across the country.
We’ve already seen from other countries that strong and unwavering leadership makes a difference. In France, President Emanuel Macron implemented a vaccine passport for French citizens to enjoy many leisure activities. Crowds protested in the streets, but over time the protests gave way to growing public support for vaccine requirements. Greece and Italy quickly followed with similar requirements. Biden’s actions are being watched by an international audience which could serve to overcome growing vaccine skepticism in other countries. Mandates can have negative and unintended consequences if they are not accompanied with strong and clear communication around science and public health. Mandates can cause some to overly focus on side effects or the criteria for the policies in the first place. Parents who have fears of long-term risks if their children are vaccinated can dominate the discussion and drown out parents speaking of the benefits of the vaccine. Then, as cases of Covid-19 begin to drop around the country, some will characterize the mandates as overly punitive despite the fact that the mandates themselves would have led to decreased cases of Covid-19. The president finally articulated Thursday what so much of the country has felt: Enough is enough. His challenge now is to implement his bold policy initiatives through the inevitable avalanche of noise and distractions. The process of rule-making and creating regulatory actions is not swift, which leaves a narrow window for fear to fight immunization efforts. Scientists, public health officials, clinicians, and other members of the vaccinated public will need to put aside differences of opinion around boosters, the role of tests and masks and unite in support of what we know to be true: The path to the end of the pandemic is before us. But we’ve got to stick to that path and not let fear, misinformation or anybody’s desire to win the White House steer us off of it.
Dr. Kavita Patel
Dr. Kavita Patel is a teaching professor of medicine, Division of Hospital Medicine, at Stanford University and a board-certified internal medicine physician. She served in the Obama administration as director of policy for the Office of Intergovernmental Affairs and Public Engagement in the White House. Her area of expertise is around the intersection of health policy, clinical medicine and innovation. She also spends time advising venture capital and is a medical contributor for NBC News. 
