As President Donald Trump and former Vice President Joe Biden accepted their respective party’s presidential nomination last month, each candidate vowed to the American people that he would not rest until the discovery, production, and distribution of a safe, effective vaccine for the novel coronavirus that has tanked the national economy and claimed more than 180,000 lives in just five months.
“We are marshalling America's scientific genius to produce a vaccine in record time,” said Trump on Thursday night. “Hundreds of millions of doses will be quickly available. We will have a safe and effective vaccine this year, and together we will crush the virus.”
“If I’m your president, on Day One we’ll implement the national strategy I’ve been laying out since March,” Biden said the week before. “We’ll develop and deploy rapid tests for the results available immediately, we’ll make the medical supplies and protective equipment that our country needs, and we’ll make them here in America, so we will never again be at the mercy of China or other foreign countries in order to protect our own people.”
But one question remains conspicuously unanswered about the discovery of the vaccine that could finally return America to a state of normalcy: How do you actually get people to take it?
Both Biden and Trump have put forward proposals about the production and delivery of the estimated 300 million doses—600 million if multiple treatments are required to attain immunity—to the American people, but neither has addressed how they plan to solve the most consistent issue raised by vaccinations in the United States: the fact that a lot of people don’t trust them, and many who don’t trust them refuse to be inoculated.
A poll released by NPR-PBS NewsHour-Marist earlier this month found that more than one in three Americans said that they would not choose to get a vaccine for the novel coronavirus once it becomes available for public use—which would leave a massive portion of the American population vulnerable to infection, and would make it functionally impossible to eliminate the virus for good.
One solution that might seem obvious—a national vaccine mandate—is without precedent, and, medical and legal experts told The Daily Beast, may actually exacerbate mistrust in the government’s vaccine implementation plan.
“For adult vaccination, which this is mainly going to be, we have little or no experience with mandating vaccination,” said Dr. Arnold Monto, a professor of epidemiology at the University of Michigan School of Public Health. “There’s very little precedent that I know to mandate vaccines for adults, and my concern is this kind of mandate, if there is lack of public confidence in the approval process, may backfire.”
“The president has no constitutional power to compel vaccinations,” said Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University Law Center. “President Trump's power is even more tenuous acting without Congress. Vaccination laws are all at the state level.”
Even with the power devolved to the states, the president does have some potential authority to encourage vaccinations among adults, but that scenario would require the cooperation of Congress to make it effective, as well as state governments. Given the wide disparity in public health response to the pandemic by different state governors—Gov. Gretchen Whitmer of Michigan faced armed protesters when she closed public golf courses, while Gov. Ron DeSantis of Florida has lagged behind on mask orders and shutdowns for the entirety of the state’s outbreak—that may be too tall an order to be effective.
“States have the right to compel vaccinations to protect the public’s health, but they are not required to exercise this authority,” said Dr. Timothy Brewer, a professor of epidemiology at the University of California, Los Angeles Fielding School of Public Health, and a member of the Division of Infectious Diseases at the David Geffen School of Medicine at UCLA. “This right has been held up in several Supreme Court decisions going back decades.”
Every public health expert interviewed told The Daily Beast that outside of attempting to incentivize states into making vaccinations mandatory by conditioning federal emergency funding to the enactment of a statewide mandate, similar to how the federal government encourages seat belt laws, the most important role that a president can play in ensuring vaccine compliance is by instilling confidence in the vaccine itself.
“Thus the best strategy for ensuring high vaccine coverage for COVID is a well-funded federal vaccine education campaign, targeted to communities and localities,” said Gostin.
“Rather than rely on forcing individuals to do something they do not want to do, I would focus efforts on educating individuals to take positive steps to protect their health and that of others in their community,” said Brewer. “In my experience, most individuals do not want to become sick if they can avoid it. However, they may need information and guidance to help understand trade-offs in protecting their health and those around them.”
But both Trump and Biden have recently made remarks that could weaken public confidence in the safety or efficacy of a vaccine—the president by publicly insisting on the effectiveness of would-be “miracle” cures that have since proved decidedly un-miraculous, and the former vice president by cautioning that Trump could be attempting to fast-track a vaccine without proper safeguards.
“Who believes them? Who is willing to take their word for it?” Biden asked rhetorically in an appearance with Andrea Mitchell on MSNBC on Thursday, saying that he prayed to God that “we have some credibility when we do have a vaccine, [and] that people are willing to take it.”
“How much credibility are we gonna have telling people to take it after going through all this stuff?” Biden said.
Trump, for his part, is a longstanding vaccine skeptic who has publicly endorsed the discredited theory that childhood vaccines are responsible for autism. After his election, Trump attempted to create a vaccine safety panel under the leadership of Robert F. Kennedy Jr., one of the most visible anti-vaccine activists in the country who has since floated COVID-19 conspiracy theories.
The appointment of Dr. Scott Atlas, a neuroradiologist and fellow at Stanford University’s conservative Hoover Institute, to the White House’s coronavirus advisory team has further increased the anxieties of some public health experts. Atlas, who has no background in epidemiology or infectious diseases, has been a public proponent of the so-called Swedish model, which has entailed allowing Swedes to continue living their lives without lockdown procedures or business closures in the hopes of achieving herd immunity without annihilating the nation’s economy.
That model has resulted in Sweden’s death rate from the pandemic being among the world’s highest, while failing to spare it from resultant economic damage.
“When younger, healthier people get the disease, they don’t have a problem with the disease. I’m not sure why that’s so difficult for everyone to acknowledge,” Atlas told Fox News’s Brian Kilmeade during a radio interview in July, inaccurately. “These people getting the infection is not really a problem and in fact, as we said months ago, when you isolate everyone, including all the healthy people, you’re prolonging the problem because you’re preventing population immunity. Low-risk groups getting the infection is not a problem.”
“That, to me, is frankly terrifying to contemplate,” said one infectious disease expert, who discussed Atlas on background because they are currently working with the Food and Drug Administration on the agency’s vaccine plan. “It should terrify anybody with an understanding of infectious disease management.”
Biden, though he has not publicly endorsed mandatory vaccines for schoolchildren like some of his rivals for the Democratic presidential nomination, has publicly endorsed vaccines in the past, particularly as part of the Biden Cancer Initiative he led in the final year of the Obama administration.
“I look forward to the day when your grandchildren and my grandchildren and their children show up at the office to get their physical to start school and get a shot for measles and they get a vaccine that affects significant causes of cancer,” Biden said in 2016.
The Biden campaign told The Daily Beast that part of the former vice president understands that a nationwide vaccine rollout represents “a broad-scale coordination and implementation challenge,” but one that Biden is prepared to meet.
“Since June, Biden has been calling on the Trump administration to proactively build a nationwide vaccination campaign,” said campaign spokesperson Rosemary Boeglin. “As President, Biden will finally enact the comprehensive, coordinated national response we've needed all along, and ensure the effective and equitable distribution of a safe vaccine.”
The Trump campaign did not respond to requests for comments about how to encourage or mandate vaccinations, but the president’s past statements on vaccinations have raised concerns that he may sow doubts about a potential coronavirus vaccine, particularly if some state governors aim to make inoculation mandatory.
“We’ve had so many instances... a child went to have the vaccine, got very, very sick, and now is autistic,” Trump said at a Republican primary debate debate on Sept. 16, 2015, repeating a baseless theory that vaccines cause autism. “Autism has become an epidemic. It has gotten totally out of control.”
The most important aspect of any effective vaccine strategy, Monto told The Daily Beast, is that the next administration move in lockstep with the medical community’s consensus.
“Short of a mandate which, for which there is no practical precedent, if we were living in the best of all possible worlds, we would have a uniform message coming from the White House, medical societies about gaining traction, but in the current world, I’m not sure that’s feasible.”