A growing number of people trickling into Philadelphia-area vaccine clinics this month very much don’t want to be there.
What cut through reluctance, anxiety, or the cacophony of misinformation on social media, they said, and got them to roll up their sleeves, were the restrictions and mandates that are becoming increasingly common in the city and across the nation.
“Basically I got boxed in a corner, I guess,” said Kittrell Norman, 33, who has side jobs that now require vaccination. “Until this started messing with my money no one could tell me any different.”
The Pfizer vaccine’s winning full approval from the Food and Drug Administration on Monday is likely to make vaccine requirements and mandates even more common.
This is a new phase of vaccination: Get tough.
Restaurants, cruise lines, colleges, and a growing number of employers — hospitals, municipal governments, Amtrak, Citigroup — are telling workers and customers to prove they’ve been vaccinated or go elsewhere.
And all that was before Monday’s full authorization of the Pfizer-BioNTech vaccine.
Anthony Fauci, the government’s infectious-disease adviser, has predicted that step would lead to a “flood” of employers and institutions requiring vaccination.
“Organizations, enterprises, universities, colleges that have been reluctant to mandate at the local level will feel much more confident,” he said in an interview with the USA Today editorial board earlier this month.
On Monday, President Joe Biden said employers and policymakers mulling vaccine requirements should see the FDA approval as a green light to move forward.
“If you’re a business leader, a nonprofit leader, a state or local leader, or has been waiting for full FDA approval to require vaccinations,” he said, “I call on you now to do that, require that.”
Almost two weeks after Philadelphia reintroduced an indoor mask mandate that included an opt-out for businesses that confirmed all workers and customers were vaccinated, and implemented vaccination requirements for some classes of workers, there are early signs of an impact. Last week, Philadelphia reported 20,000 vaccinations, a number the city hasn’t reached in some time. Before the mandates and restrictions, Philadelphia was averaging this summer about 15,000 to 18,000 vaccinations weekly.
James Garrow, spokesperson for the Philadelphia Department of Public Health, said the city, seeing increasing COVID-19 cases due to the delta variant, and, more recently, rising hospitalizations, needed to use “the proverbial stick, as opposed to a carrot.”
But that stick has to be used judiciously.
“We firmly believe that having folks make their own decision to be vaccinated leads to a more committed public,” he said in an email that also acknowledged mandates seem to work. “We believe that the recently announced mandates may be contributing to the small rise in vaccinations in the last couple of weeks.”
Fear of the delta variant and the availability of booster shots to people with serious conditions that weaken their immune systems also may have played a role in those increases, health officials said.
Officials and experts disagree about the wisdom of getting tough.
University of Pennsylvania physician and bioethicist Ezekiel J. Emanuel has been advocating since April for mandatory vaccination of health-care workers. Now he says mandates for all workers are overdue.
“Especially if they’re working in an office,” he said.
Many who have not yet been vaccinated aren’t opposed to getting a shot, health experts have said. They simply hadn’t prioritized it. The possibility of being denied access to, for example, indoor dining, was the catalyst they needed.
“I don’t really go out that much,” said Vernon Foat, 58, a retired police officer who said indoor dining and travel restrictions caused him to finally get his shot. “I knew eventually I was going to get it.”
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The city is requiring vaccinations of all new employees, and any current employees not vaccinated by Sept. 1 will have to double-mask at work. The city also required all heath-care workers and higher-education workers and students, except those with religious or medical exemptions, to be vaccinated by Oct. 15.
Statewide, there are fewer vaccine requirements, but Pennsylvania insisted on vaccinations, or weekly testing, for all workers in state health care and congregant care facilities by Sept. 7. New Jersey introduced a vaccine requirement, or regular testing, for health-care workers at the beginning of August, and on Monday expanded the requirement to teachers and state employees.
The desire for self-protection and protection of loved ones drove the early vaccine uptake. Persuasion, education, door-to-door pleading, and incentives ranging from time off work to cash lotteries have slowly helped push just over half of the country to get fully vaccinated. Still, many people in large swaths of the country have refused to roll up their sleeves. That has allowed the highly transmissible delta variant to undo some of the progress made in the early spring, when rising vaccination rates curbed infections, hospitalizations, and deaths. Hesitance and outright refusal have kept most of the country, including Philadelphia and its surrounding counties, from reaching vaccination rates that would provide herd immunity, estimated at 80% full vaccination.
Almost 65% of Philadelphians 18 and older and 54% of all Pennsylvania’s population are fully vaccinated, according to city and state data. In New Jersey, almost 62% of all people are fully vaccinated.
The Black Doctors COVID-19 Consortium, which has hosted clinics aimed at the city’s undervaccinated communities since the beginning of the year, saw vaccinations triple, at its clinics between Aug. 16 and 17, though those numbers were still relatively small, said Ala Stanford, the physician who founded the organization.
Stanford predicted for months that restrictions would boost vaccinations.
“What it really forced them to do is look at the true reason as to why they weren’t getting it in the first place,” she said in an interview Friday.
Clarence Gland, 55, who called vaccines a necessary evil at a Thursday clinic at Deliverance Evangelistic Church, believed the technology was too new, despite decades of research into mRNA vaccines and rigorous trials of COVID-19 vaccines involving tens of thousands of people before they were made available to the public. But he wants to get on planes, he said, to see family and potentially go overseas for his real estate business.
“I don’t want to get it, but if I want to do what I do in life I have to,” Gland said.
His friend Sheree Drennon, 50, who works at Holy Redeemer’s nursing facility and was also vaccinated Thursday at the Lehigh Avenue church, said she became more convinced of the vaccine’s safety over time but still was reluctant.
“I got it because the job made me get it,” she said.
She had held off on vaccination because of her fear of reactions, but also because she felt she was already protected, and protected patients, with the PPE she wears at work.
“I felt like I waited this long, and I was cautious and protecting myself and I’ve been doing fine,” she said.
Pharmacist Mark Adler, owner of Adler’s Pharmacy in Cherry Hill, said most people coming in to be vaccinated now cite fear of losing jobs, though fear of the delta variant is a close second.
”We were down to a handful of people getting vaccines” in a week, he said, just a few days ago. “Now, it’s six times that amount.”
Some public health experts worry that get-tough measures will backfire. A group of women scientists who call themselves “nerdy girls” have built a following of tens of thousands of people with their “Dear Pandemic” website, where questions are answered based on science, but with a “Dear Abby” kind of levelheadedness and compassion.
”We don’t believe that taking a hard line will work in the long run,” said Aparna Kumar, a psychiatric nurse-practitioner, educator, and researcher at Thomas Jefferson University. “Our general nerdy approach is one based on trust, honest communication, and openness. Pressure and forcefulness do not always achieve this.”
Stanford, despite predicting that requirements would boost vaccination rates, also is ambivalent about mandates.
“The people who feel like ‘the government is ruling my life,’ this reinforces that for them,” she said.
She wished governments and employers had given far more notice about mandates, she said, to allow time for more compassionate conversations to let workers know they are valued but vaccination improves safety for them and everyone else. She is particularly empathetic with people in low-paying jobs, who must now decide between a vaccine they’re frightened of and their livelihoods.
“It’s multiple conversations you need to be having with folks,” she said. “People think they’re going to be zombies. They think they’re going to die in their sleep.”
For Norman, vaccination was a deeply stressful experience. He cradled his head in his hand as he spoke with the nurse giving him his dose.
“I was just nervous and kind of scared,” he said after receiving a Johnson & Johnson shot. “I just don’t want to die from this [vaccine], but if I don’t take it I might die.”