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Vaccine incentives are giving way to mandates. Will Connecticut embrace the shift?

The season of zany vaccine incentives, from free drinks to million-dollar rewards, is giving way to vaccine mandates among private employers — largely in health care — as coronavirus vaccination rates stagnate and infections driven by the delta variant increase nationwide.

And while some states have also taken more aggressive steps to increase vaccination rates among state workers, Connecticut officials say they aren't currently planning to go that route.

Hospitals and higher education institutions have led the mandate charge, but "it's hard to know how widespread that will become," said Deidre Gifford, acting commissioner of the Department of Public Health. "A lot of it will depend on the level of transmission that people see in the community and also the level of uptake that exists without a mandate as to whether or not other employers want to follow a similar path."

Connecticut has one of the highest vaccination rates in the country, which initially slowed the spread of the delta variant in the state, Gifford said. Nevertheless, the variant is now the dominant strain here and has been proven to be considerably more transmissible than the original virus.

In southeastern Connecticut on Wednesday, Lawrence + Memorial Hospital in New London reported it had nine COVID-19 patients, while Westerly Hospital said it had two.

Chris DePentima, chief executive officer of the Connecticut Business and Industry Association, said most employers represented by the group are not considering mandates. "Most businesses that I talked to, somewhere between 80% and 100% of their workforce has been vaccinated."

In response to a report of 14 patients and several staffers testing positive for COVID-19 at a rehabilitation facility, Gov. Ned Lamont was asked Tuesday if nursing homes should consider emulating the hospitals that are mandating vaccinations for their employees.

"I do," Lamont said. "I haven't gotten into mandating to a private enterprise, 'This is what you got to do.' But if I see this ramping up, maybe we step in, and meantime, I hope they're doing the right thing."

As of last week, there were "no active discussions" about mandating vaccines for state employees, Gifford said. DPH is not keeping track of the number of state employees who have been vaccinated.

California and New York have taken more aggressive stances this week. New York City announced that city employees would be required to get vaccinated or tested weekly, though that now faces pushback from unions. The Department of Veterans Affairs was the first federal agency to issue a mandate to its health care workers earlier this week.

Connecticut State Colleges and Universities, which mandated vaccinations for students last month, has not extended that requirement to staff and faculty.

"Evaluations are ongoing to determine whether this course of action will be necessary," wrote Leigh Appleby, CSCU director of communications. Some private colleges in the state, by contrast, have set out universal vaccination requirements.

"Why should you have the risk of academic disruption for a state university? Why should that be higher than a private university?" said Saad Omer, a Yale epidemiologist. As the pressure on employers to create safe working conditions builds, "federal and state governments can take the lead by putting in place sensible immunization mandates for government employees," he tweeted.

Is it time to mandate vaccines broadly?

California and New York City are in the minority; most mandates are being driven by the private sector. Typically "mandates" refer to requirements for school entry, as opposed to "conditional benefits schemes," such as access to a job or a social event, said Michelle Mello, professor of law at Stanford University. "I know people who are opposed to vaccination really like to frame this as like yet another government mandate, but that's just not where things are right now," she said.

In the fall last year, Omer and Mello outlined six criteria for states to consider when imposing a vaccination mandate:

  • COVID-19 is not adequately contained in the state.
  • The Advisory Committee on Immunization Practices has recommended vaccination for the groups for which a mandate is being considered.
  • The supply of vaccine is sufficient to cover the population groups for which a mandate is being considered.
  • Available evidence about the safety and efficacy of the vaccine has been transparently communicated.
  • The state has created infrastructure to provide access to vaccination without financial or logistic barriers, compensation to workers who have adverse effects from a required vaccine, and real-time surveillance of vaccine side effects.
  • In a time-limited evaluation, voluntary uptake of the vaccine among high-priority groups has fallen short of the level required to prevent epidemic spread.

"I don't think it should be done now. But I think the state should start preparing for that," Omer said last week. "That would be a decision that will take political courage."

Three COVID-19 vaccines — Moderna, Pfizer/BioNTech and Johnson & Johnson — are authorized for emergency use by the Food and Drug Administration. Pfizer has applied for full authorization, and the FDA is expected to rule on the application after August, according to the Department of Public Health.

There is some disagreement among legal experts about whether the emergency use authorization standard poses a barrier to mandating vaccination, but the "better analysis of the law" suggests it does not, Mello said. "Obviously, there's a clock running as well. Even if it is a barrier now, it is not likely to remain so for very much longer as the FDA moves towards full approval."

How are mandates being enforced?

Employees at most Connecticut hospitals have until the end of September to comply with the vaccination requirement or risk termination of their employment. At Hartford HealthCare, employees who get their shot outside the hospital system are being encouraged to show proof of vaccination through vaccination cards, according to an email sent to staff systemwide.

The Biden administration will not be implementing a nationwide digital vaccination verification system — or "passport" — unlike counterparts like the European Union. Those who receive a shot in the United States also receive a paper vaccination card, which has raised concern about forgery. As an Atlantic article put it, "America is on a COVID-19 vaccine honor system."

Vaccination fraud "is a concern," Gifford said. "We've read about instances of it. I don't know of any widespread problems in Connecticut at this point."

The budget implementation bill included provisions for residents to request replacement cards from vaccine providers. The Department of Public Health also can issue a proof of immunization record on request, Gifford said.

Employers may also ask workers to self-attest regarding their vaccination status, which would be subject to laws concerning perjury, Mello said.

California's Occupational Safety and Health Administration Board voted last month to require employers who allow vaccinated employees to go maskless to track the vaccination status of all workers, though they are not required to keep copies of vaccination cards. The federal OSHA COVID emergency standard does not include such a requirement.

Four states — New York, California, Hawaii and Louisiana — have invested in vaccination verification apps for vaccination, according to a database maintained by the MIT Technology Review. New York's Excelsior pass, an IBM product, was the first out of the gate in March and has been downloaded by over 2 million state residents, according to data from last month. The pass has been used by residents to gain entry to baseball games and comedy nights; New York State has said that paper cards must also be accepted as vaccination proof if presented.

In Connecticut, "So far we haven't heard a lot of requests for additional resources in this area," said Josh Geballe, the state's chief operating officer.

The Electronic Frontier Foundation, a civil liberties group based in California, has come out against digital verification due to concerns about privacy and surveillance, said Jon Callas, EFF's Technology Projects Director. "We don't want to have any database or authority who knows where you've been and what you've been doing," he said.

CT Mirror staff writer Mark Pazniokas and Day Staff Writer Brian Hallenbeck contributed to this report.

Kasturi Pananjady is a reporter for The Connecticut Mirror (www.ctmirror.org). Copyright 2021 © The Connecticut Mirror.

kpananjady@ctmirror.org

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