A Brief History of Vaccine Mandates (and How to Do it Right)

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Let’s talk about this hot new idea, “vaccine mandates.” Conservatives across the US are up in arms (and I mean that literally, because this is America, so of course the people scared of needles own assault rifles and carry them with them to Panera) about the idea that they could be fired, kicked out of public school, escorted off airplanes, or not allowed to travel internationally because they refuse to get the safe, effective, and free COVID-19 vaccine. I mean, they could also die like all these people did, but they might also lose their job.

They’re so worked up because this is AMERICA, home of the FREE, and a vaccine mandate clearly goes against Joey’s FREEDOM to refuse the vaccine, post antivax memes that also manage to be racist, and then die of COVID.

Except…vaccine mandates aren’t new. They’ve been in place pretty much since the advent of vaccines, starting with smallpox in the 19th century. And since states and countries began instituting vaccine mandates, there have been people like Joey doing whatever the 19th century equivalent of posting racist memes and then dying is. Probably standing on a milk crate in the town square ringing a bell and shouting “SMALLPOX IS A LIE SPREAD BY RUTHERFORD B HAYES AND THE VACCINE CAUSES ONE TO TURN INTO AN IRISHMAN!”

So sure enough, soon after California passed a smallpox vaccine mandate in 1889, anti-vaxxers lobbied them into adding an exemption for those who are “conscientiously opposed” in 1911, and in 1929 they repealed the mandate entirely. And what was their specific conscientious objection? Nothing religious — it was freedom. They really just thought exactly what Joey thought before he died: it’s his bodily autonomy and he should be allowed to catch and spread whatever disease he wants.

Fifty years later, polio was ravaging the US and a vaccine was developed to completely eliminate it. Again there were mandates, and again in state after state Joeys popped up to lobby for exemptions — in 1959 Ohio it was Democrats who held up legislation on mandates due to anti-vaccination rhetoric. And again there were exemptions but they also started specifically including “religious” exemptions, thanks in part to the dedicated lobbying of another group — the Christian Scientists. That’s capital C capital S, not to be confused with the generic Christian scientist, that is a scientist who happens to be Christian like, say, Francis Collins.

To broaden the exemptions to more than just Christian Scientists, though, “religious” belief was often changed to “personal” belief. Here in California, they just went and made the exemption so broad that pretty much anyone could opt out for whatever reason they want. That’s not a huge deal if the number of people opting out is low, or all tucked away on their compound where they treat their cancer with homeopathy and accusing each other of malicious animal magnetism or whatever. It’s fine, the vaccinated public still reaches herd immunity, and the anti-vaxxers don’t riot in the streets.

But once the number of anti-vaxxers grows, as it did starting in the 1990s thanks to Andrew Wakefield (and then Jenny McCarthy, and then your new Jeopardy host Mayim Bialik), it becomes a problem. California had so many people opting out of vaccines that they started having serious outbreaks of measles, and finally by 2015 they had had enough and finally got rid of the vaccine exemption completely. No more religious exemption, no more “personal belief” exemption, no more “but my freedoms” exemption.

New York, Maine, Connecticut, West Virginia, and Mississippi (!) all followed suit and are currently the only states that don’t let anti-vaxxers off the hook.

That’s a good trend, right? Close the loopholes, get everyone vaccinated, no more measles outbreaks. And yet! In 2019, public health researchers published a paper looking at the rate of vaccination in California before and after they eliminated the exemptions. They found that the number of vaccinations didn’t increase — the people who used the loophole just found another loophole. Specifically, they went with the one loophole we can’t really close, which is medical exemptions.

There will always be people who are immunocompromised, or for some reason cannot get vaccinated, which is why it’s so important for the rest of us to get vaccinated — we can protect them. So those people shouldn’t be prohibited from public life just because they actually cannot get a vaccination without dying or being hurt.

So a lot of the people who were exempted from the vaccine for “personal beliefs” prior to 2015 just went out and found a less-than-ethical doctor to give them a medical exemption. Study co-author Saad Omer told WBEZ Chicago:

“What happened was there was a cottage industry of people giving medical exemptions that sprouted, but that was a small fraction. A bigger group just found other loopholes, like quasi-homeschooling. And so if you look at that trajectory, in two to three years there was an exact replacement proportionally for all the people who were getting religious exemptions.”

Omer and other experts think the answer to this is to allow mandate exemptions but make them super annoying to get. For instance, you could allow people to get an exemption only after they take, say, a semester of classes on basic epidemiology. Or make them watch slideshows of babies with whooping cough. Not only is it extra hoops they may not feel like jumping through, but there’s a chance that after jumping through the hoops they MIGHT realize why they shouldn’t opt out after all.

Omer points out that it’s a bit of a balancing act to get an effective mandate — not too strict, not too easy to avoid. But there are already people testing this. Take, for example, these absolute maniacs over at Conway Regional Health Services in Arkansas, where the CEO got sick of seeing a bunch of staff members say they couldn’t get the COVID vaccine specifically because of their religious beliefs, as the vaccines were developed using cells from aborted fetuses.

First, a brief fact check: the MRNA vaccines (from Moderna and Pfizer) were not developed using fetal cell lines. Here in the US, the only vaccine available that was developed that way is Johnson and Johnson

Fetal cell lines DO come from aborted fetuses, but those fetuses were aborted back in the ‘70s and ‘80s. Researchers took cells from them and multiplied them repeatedly — having the same cells used across multiple labs allows scientists to compare their data with as little differentiation as possible, leading to more robust results. It just makes sense!

That’s why these cell lines aren’t just used for (some) vaccines. So the Conway Regional CEO heard his employees’ religious concerns and agreed that they had every right to avoid products that in some way relied upon fetal cell lines. With that in mind, he says

“we provided a religious attestation form for those individuals requesting a religious exemption.” The form includes a list of 30 commonly used medicines that “fall into the same category as the COVID-19 vaccine in their use of fetal cell lines,” Conway Regional said.

“The list includes Tylenol, Pepto Bismol, aspirin, Tums, Lipitor, Senokot, Motrin, ibuprofen, Maalox, Ex-Lax, Benadryl, Sudafed, albuterol, Preparation H, MMR vaccine, Claritin, Zoloft, Prilosec OTC, and azithromycin.”

Ahhhhhhhhahahahaha, KING SHIT!

“Employees are asked to attest that they “truthfully acknowledge and affirm that my sincerely held religious belief is consistent and true” and that they do not and will not use the medications and any others like them.

“The intent of the form is twofold, Troup says. First, the hospital wants to ensure that staff members are sincere in their stated beliefs, he said, and second, it wants to “educate staff who might have requested an exemption without understanding the full scope of how fetal cells are used in testing and development in common medicines.”

I absolutely LOVE it. Because they recognize that this isn’t a religious issue — these people are ignorant, completely infested with brainworms thanks to Fox News and Facebook memes, and they’re reaching for any option they can find to opt out of the vaccine. This approach does exactly what Dr. Omer suggested: give them hoops to jump through, and along the way give them the chance to actually learn a thing or two. I love it.

I guess we’ll see what happens in this impromptu social experiment, and in the meanwhile I hope lawmakers and other employers are taking all of this into account as they figure out the best way to get people vaccinated and keep people safe even if they can’t get vaccinated.

Rebecca Watson

Rebecca is a writer, speaker, YouTube personality, and unrepentant science nerd. In addition to founding and continuing to run Skepchick, she hosts Quiz-o-Tron, a monthly science-themed quiz show and podcast that pits comedians against nerds. There is an asteroid named in her honor. Twitter @rebeccawatson Mastodon Instagram @actuallyrebeccawatson TikTok @actuallyrebeccawatson YouTube @rebeccawatson BlueSky

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  1. Nice approach there, what a shame that acetaminophen (Panadol) is not on the list too – cos then rip all headache meds for those guys.

    Here in Australia the government is leading the way with vaccine mandates for specific groups e.g. in the State of Victoria all building trades must be vaccinated due to widespread noncompliance with mitigation protocols on building sites. Cue violent demos led by motherfuckers who kick dogs

    This is bound to gather public sympathy (snark) amongst a population that is already very strongly pro vaccination.

    There is nothing the antivaxxers can do because there IS no freeedom here, we are all subjects of Her Majesty and when the Governor General signs a State of Emergency there are draconian powers enshrined in law. God Save Good Queen Bess! (tongue firmly in cheek here)

    There are also mandates by Qantas and all the other airlines, all the private old folks homes and so on. Attendance at many events will depend on vaccination too. This is seen as the only possible way out of the current lockdowns.

  2. If this is a “virtual reality world egg” (born without language and computer knowledge, die/move-on with language and computer knowledge) you’re promoting non-consensual penetration. e.g. if all doctors are “NPCs,” you’re not a doctor, so you’re not qualified to make assertions regarding vaccine efficacy, an NPC can’t be guilty of a crime, but sentient human can.

    1. Sorry if that’s a bit out of the blue. I’m looking for a possible “VR World Egg Sister.” There’s a King James Version of the Bible, you were friends with James Randi, I am James Harbour (puns with “Baywatch”). We’re about the same age and have had similar intellectual “dawn of the digital age” journeys, though I don’t think you were raised religiously: but I was. I majored in English and Religious Studies, you majored in Communications. I spent 2005-2016 stating I’m an atheist. We are both “in each others league” as far as attractiveness goes – not repulsive in our college years – but you probably don’t have flocks of guys as I have never had my pick of women.

      And of serious note: you have a mild resemblance to Amy Acker who plays “Fred”/”Illyria” in Angel – a character that could easily reference “my VR World Egg Sister.” Anyway, my Twitter is @EuclideanOrigin if any of this sounds important to you.

        1. Yeah, I’m aware of that. “Until death do us part.” I’m talking about a “virtual reality world egg” (e.g. elevator gate, fear of an enclosed place with one person) which is a question of fact and nothing else.

        2. For example, Rebecca Watson thought a man in an elevator came onto her because of her looks. I am suggesting her and I may be locked in a “virtual reality world egg” with the “world overmind” and its “puppets” and I am only suggesting this because I believe she may be “sentient” rather than “NPC.”

    2. e.g. the guy who commented above me mentioned the “absolute power of the monarch against antivaxxers” and I’m using “Pharaoh’s Username.”

  3. Antivaxxers here plan to book fake consults to “educate” doctors about the “dangers” of vaccines. A list of questions is on their website. The RACGP says GPs should tell fake patients to leave immediately and call the police.
    Some doctors plan to say that they are already educated to the professional standard required by law, that they will not give a vaccine to the person as the doctor will probably be unable to persuade them of its merits, and pay to at the door. Private fees with no medicare refund.

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