As coronavirus cases mount and vaccine mandates spread, holdouts plague police and fire departments

Washington Post
Mark Berman October 2, 2021, at 9:00 a.m. EDT


When the coronavirus vaccines were first rolled out, the national Fraternal Order of Police went to the federal government, pleading for law enforcement officers to have “expedited access” to the shots. Police, the group wrote, needed the vaccines “to keep them, and the public with whom they interact, safe from infection.”

But to the group’s surprise, officers did not rush to get the shot. And months later, with the vaccines widely available across the country, scores remain unvaccinated.

“We worked very hard, along with others, to ensure that police officers had early availability on a premise that they’d all want it,” said James Pasco, FOP executive director.

Nearly a quarter of Americans age 18 and older remain unvaccinated, according to a Washington Post analysis of federal data, frustrating officials and fueling bitter debates. Yet the continued resistance among the first responders included in those tens of millions is particularly troubling and creates a different kind of threat, experts say.

Foxboro Police Officer Brendan Fayles checks in at the Putnam Clubhouse at Gillette Stadium in Foxboro, Mass. to receive his coronavirus vaccination on Jan. 15. (Mark Stockwell/AP)

Due to the nature of their jobs, first responders regularly have close contact with the public, which increases their risk of contracting and spreading the coronavirus among themselves, their families, and the people they are sworn to protect, experts in public health and policing said.

“They’re going to get infected because they have more contact with people than most,” said Vincent Racaniello, a professor of microbiology and immunology at Columbia University. “It doesn’t work any other way.”

Changing recommendations for boosters leads to confusion for the vaccinated and their doctors

The resistance to vaccination is surprising, some said, given how the virus has battered law enforcement’s ranks since the beginning of the pandemic and continued to do so as the delta variant has taken hold.

Covid was the leading cause of line-of-duty deaths last year, killing at least 182 officers, according to the National Law Enforcement Memorial Fund, which tracks such deaths. That’s nearly double the number killed by gun violence and vehicle crashes combined. At least 133 officers have died of covid so far this year, according to the organization.

But despite the toll the pandemic has taken, tensions over vaccinations have only increased as unions and individual officers and firefighters have railed against mandates, filing lawsuits and threatening to quit if the shots are required.

Pfizer, partnering with BioNTech, and Moderna has created effective coronavirus vaccines that scientists hope will lead to medical breakthroughs using mRNA. (Joshua Carroll, Brian Monroe/The Washington Post)

When Chicago Mayor Lori Lightfoot (D) announced that all city employees would have to be vaccinated by Oct. 15, the head of the city’s largest police union compared it to the Holocaust.

“We’re in America, G------n it. We don’t want to be forced to do anything. Period,” FOP President John Catanzara told the Chicago Sun-Times. “This ain’t Nazi f---ing Germany, [where they say], ‘Step into the f---ing showers. The pills won’t hurt you.’” he said.

Catanzara later posted a video apologizing for the comments, which were condemned by the mayor and Jewish leaders.

The Los Angeles County Health Department identified hundreds of coronavirus outbreaks at police and fire agencies across the county, according to records obtained by the Los Angeles Times. The outbreaks accounted for more than 2,500 cases — more than half of which were in the Los Angeles Police Department and Los Angeles Fire Department, the paper reported. The fire department said recently that more than half its sworn members have been fully vaccinated, while police chief Michel Moore reported this week that more than 60 percent of his agency’s 12,000 employees — sworn officers and civilians — are fully vaccinated.

Yet employees of both departments have been fierce critics of vaccine requirements and have filed lawsuits in response to a mandate that all municipal employees be vaccinated by Oct. 5, unless they have a medical or religious exemption. Thousands of police employees have indicated they will seek such exemptions.

While there has been much national debate over vaccine mandates in the workplace, experts say first responders are a special case because of the unique position they hold in American life.

Officers wield significant authority, and many of the public’s interactions with police are initiated by officers or by 911 calls summoning them, with people having no choice about whether to engage.

“Somebody gets stopped at a traffic light for a traffic violation, the window goes down, the officer leans toward the person … if they go to a house where there’s been a complaint, they go into the house,” said Jack Greene, professor emeritus of criminology and criminal justice at Northeastern University. “They’re always going into public spaces.”

When police knock on someone’s door, “more often than not, people accede to that request,” said Greene, who has consulted for police departments. “And if they don’t, the door might get broken down. It really boggles the imagination” that any first responder could respond to a call and potentially expose someone else to the virus, he said.

“At the risk of sounding a little bit snide, maybe we should take protect and serve off the sides of patrol cars and put down show up and infect,” he said.

They’re called mild cases. But people with breakthrough covid can still feel pretty sick.

Experts were split about the reasons behind so many officers remaining resistant to vaccination. Some point to the same misinformation and fear impacting the decisions of other Americans.

“Police officers are no different than other people in their community,” said Pasco, with the FOP. He said his initial surprise that police did not flock to the vaccines in larger numbers faded as he saw how fractured the general public was on the topic.

“I’m better informed today as to the depths of divisions on this issue than I was when vaccines first became available,” Pasco said. “The country has not embraced vaccines to the degree that most people anticipated.”

West Virginia was an early leader in covid-19 vaccinations, but health officials say they have hit a wall of vaccine resistance and misinformation. (Jorge Ribas/The Washington Post)

In a recent policy statement, Pasco’s group reiterated its support for vaccinations and said “whether or not to accept the vaccine is a personal decision” up to individual members.

Chuck Wexler, executive director of the Police Executive Research Forum, who frequently speaks to police chiefs, said it appeared to be “predominantly younger officers who do not want to get vaccinated.”

Wexler called the trend “puzzling,” saying he couldn’t explain it.

Charleston police Lt. Robert Gamard reported that some of his department’s officers have said they were still “meaning to do it,” while others remain adamantly opposed. There is no vaccine mandate, he said, but the department has been pushing information to its officers and is exploring making vaccinations available during roll call.

“We’re going to keep trying,” said Gamard, who oversees training for the force.

David J. Thomas, a professor at Florida Gulf Coast University and a retired police officer, described policing as “very conservative in nature.” He noted that in the past, officers have resisted other measures meant to protect them, such as body armor, and are hesitant to adapt to changes.

Officers have the “belief that it’s just not going to happen to them,” he said. Thomas said one police chief told him, “We’ve done everything we can to get them vaccinated, and they won’t listen.”

Thomas said he also believed some officers are vaccinated but not admitting it, comparing it to the work he does with law enforcement on mental health issues. Some officers are hesitant to admit they need help, fearful of seeming weak, and admitting they are vaccinated might be similar, he said.

But as the delta variant-fueled virus surge continues to sweep the country, the prospect of significant numbers of first responders falling ill raises other issues.

“I’m going to use a term the Pentagon would use: It’s a matter of force readiness,” said Sandra C. Quinn, a professor at the University of Maryland School of Public Health. “Will they have a healthy workforce that’s vital for protecting public safety and well-being?”

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Miami police chief Art Acevedo said he found officers’ resistance to vaccination “very surprising” and “disappointing.”

Acevedo has been an outspoken advocate for vaccinations, and when he signaled support for a mandate last month, local and national police groups lashed out. Pasco called it “management by tantrum,” while the local police union’s president in a letter called the chief’s comments “flat out demoralizing.”

After the pushback, Acevedo, who was chief in Houston before becoming the Miami department’s leader in April, was undeterred, saying unions arguing against mandates were practicing “labor leadership by hypocrisy” after demanding more protective equipment for officers early in the pandemic.

“We need to do everything we can to keep each other alive,” Acevedo said in an interview. “And the one thing when it comes to covid that we know, that the data shows, that’ll help you stay alive … is being vaccinated.”

However, Charlotte-Mecklenburg police chief Johnny Jennings said while he believes in vaccination, he does not support a mandate. Jennings said he preferred to “continue to educate and get cooperation from people to go and voluntarily get vaccinated.”

He noted that the pandemic has “been devastating” for police.

“We don't have the luxury of putting … Plexiglass between us and the people we come in contact with,” Jennings said. He said police “have to be responsible to protect ourselves.”

Yolian Y. Ortiz, a spokeswoman for the FOP lodge representing officers in Charlotte, similarly backed vaccinations while pushing against any requirement.

“We are asking everybody to get vaccinated,” she said. “But we believe it’s a personal choice and should not be mandated.”

Officers, she said, are going through the same thought process as others who have not gotten the shots.

“You want your employees to be able to exercise that personal choice, like religion or your freedom of speech. You don’t want that to be infringed upon,” Ortiz said.

Some departments have been able to obtain high compliance without mandates. Ian Adams, a former police officer in Utah who is a doctoral candidate at the University of Utah, studied police vaccination rates in Salt Lake City and found that most of the department’s officers were vaccinated in a matter of days. Adams said the department’s leadership helped fuel the outcome. (A spokesman for the department said the police chief was not available for an interview.)

“My question for people talking about mandates, is there an alternative to consider? It requires a lot of leadership and hard work and transparency, but none of that’s impossible,” said Adams, who also is also executive director of the Utah State Fraternal Order of Police. “And I think that’s what this case demonstrated.”

Exactly how many officers nationwide are vaccinated is unknown. There are more than 15,000 local police departments in the United States, each with its own policies, and no government agency tracking the information.

The Washington Post requested vaccination rates and policies from dozens of police, fire and city officials. Several said they did not keep track of vaccination rates or had incomplete statistics, while some departments reported numbers suggesting thousands of their employees remained unvaccinated.

Police officials in Atlanta, Austin, Dallas and San Antonio — cities that are home to some of the country’s largest departments — said they have not kept records of vaccinations among their forces, nor were mandates in place. In Chicago, home to the country’s second-largest local police force, officials have not kept track of how many officers are vaccinated although a mandate for city employees goes into effect later this month.

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Of the major departments that are keeping track, Las Vegas officials said more than half of that city’s force is fully vaccinated. The department also said that vaccinations are required for newly-hired police employees.

There is no mandate for New York City police, the country’s largest local department, which said about 62 percent of its workforce — which includes 36,000 officers as well as 19,000 civilian personnel — had gotten vaccinated as of Sept. 23. By comparison, 74 percent of adults in New York are fully vaccinated, according to city data.

Data reported by fire departments also varied. In Austin, vaccinations are not mandated, but fire officials said that 4 in 5 personnel were vaccinated. Both New York and Los Angeles departments reported that more than half of employees are vaccinated.

In Denver, a vaccine mandate covering government workers — including police, fire and sheriff’s department employees — went into effect at the end of September, and those who refuse risk losing their jobs.

Even without mandates, experts said, first responders have an obligation to get vaccinated to protect the public.

They are in “very public-facing positions, and they really have a responsibility to keep the public safe,” said Racaniello, the Columbia professor.

COVID-19 Vaccine Mandates—A Wider Freedom

Lawrence O. Gostin, JD
Author Affiliations Article Information
JAMA Health Forum. 2021;2(10):e213852. doi:10.1001/jamahealthforum.2021.3852
COVID-19 Resource Center

President Biden has required COVID-19 vaccinations across much of the US workforce, reaching nearly 100 million workers. Opponents call it unconstitutional, a violation of personal freedom, and even “un-American.” The truth is that vaccine mandates are lawful and deeply entrenched in US history and values. They constitute a “wider freedom” so that everyone in society can feel safer where they work, learn, worship, and live.

Vaccine Mandates Integral to US Culture and Tradition

Vaccine mandates are very much part of US culture and tradition dating back to the colonial era, even before Edward Jenner’s 1796 discovery of cowpox vaccinia. George Washington required smallpox inoculations for the Continental Army in 1777, writing that “we should have more to dread from [smallpox], than from the sword of the enemy.” He condemned a Virginia law restricting inoculations, saying he would rather move for a law to compel inoculation of all children “under severe penalties.” Massachusetts enacted the first law mandating immunization in 1809, and by the time the US Supreme Court upheld its constitutionality in Jacobson v Massachusetts (1905), municipal and state smallpox vaccination mandates were prevalent across the US.

States began requiring childhood vaccinations as a condition of school entry by the mid-19th century and by 1963, 20 states had school vaccine mandates. Although the US Centers for Disease Control and Prevention (CDC) has a recommended schedule for child and adolescent immunization, it does not set vaccination requirements for schools. The CDC points out that each state makes its own decisions about which vaccines are required for school attendance in that state. All school immunization laws grant medical exemptions, 44 states grant religious exemptions, and 15 states allow philosophical exemptions. Although vaccines are not routinely required for adults in most settings, they are often mandated for military service members, new immigrants seeking permanent US residence, college and university students, and health care workers. Previous epidemics like the 2018-2019 measles outbreak in New York City were quashed by emergency vaccine mandates for adults in affected zones. Even before President Biden’s COVID-19 vaccine mandate announcement, several cities and states, businesses, and institutions of higher education had issued their own COVID-19 vaccine mandates.1

COVID-19 vaccine mandates, therefore, should not be viewed as an aberration but as the continuation of a long tradition in the US to prevent or mitigate infectious disease outbreaks and epidemics. The CDC recognizes vaccinations as among the top public health achievements of the 20th century.

Vaccine Mandates Lawful

Cities and states have broad “police powers” to require vaccinations, upheld twice by the US Supreme Court in 1905 and 1922. The Pfizer-BioNTech COVID-19 vaccine is fully licensed for individuals aged 16 years or older and has received Emergency Use Authorization for children aged 12 to 15 years. (It is likely that vaccines will soon be authorized for children aged ≥5 years.) The police powers of cities and states enable them to require eligible individuals to be vaccinated against SARS-CoV-2 for school attendance, as the Los Angeles Unified School District recently did covering more than 600 000 students. New York City’s “Key to NYC” program requires proof of COVID-19 vaccination for indoor activities such as dining, fitness, and entertainment. The courts have upheld Jacobson v Massachusetts for more than a century, affording municipalities and states wide discretion in exercising public health powers, including mandatory vaccinations.2

Unlike cities and states, the federal government does not have broad public health powers. The president has only limited public health powers and could not, for example, issue a nationwide vaccine mandate. President Biden’s 3 vaccine requirements, however, have strong legal support. First, President Biden ordered all federal workers and contractors to be vaccinated. There is no option to be tested for COVID-19 instead of being vaccinated. As head of the federal workforce, Biden has the power to set evidence-based safety standards, including mandating masks and vaccines. The Equal Employment Opportunity Commission and the Department of Justice both advised that governments and businesses can require COVID-19 vaccines as a condition of employment, so long as they provide religious and medical exemptions. Courts also have upheld COVID-19 vaccine mandates for employees as well as college students.

Second, President Biden ordered all health care facilities to require COVID-19 vaccinations as a condition of receiving certain Medicaid or Medicare funding. The Supreme Court has ruled that the federal government can set reasonable conditions for the receipt of federal funds. In South Dakota v Dole (1987), the Supreme Court upheld a law requiring states to adopt a minimum drinking age of 21 years as a condition of receiving certain federal highway funds. So-called conditional spending must be reasonable. For example, the Supreme Court struck down a requirement in the Affordable Care Act for states to expand Medicaid as a condition of receiving all Medicaid funding, ruling that the amount of funding at stake made the contingency unduly coercive.

President Biden’s third, and most controversial, vaccine mandate requires businesses with 100 or more employees to either mandate COVID-19 vaccinations or institute weekly testing and other risk mitigation measures. Opponents have called it an “overreach” and unconstitutional, but President Biden is acting at the height of his presidential powers. He is not making a unilateral executive decision but is rather acting through specific congressional authorization. In 1970, Congress enacted the Occupational Safety and Health Act precisely because of a weak patchwork of state worker safety regulations. It empowered the Department of Labor to set uniform national workplace safety standards, including emergency temporary standards in response to workplace hazards. Exposure to SARS-CoV-2 can be just as hazardous as workplace injury risks. The Occupational Safety and Health Administration (OSHA) has already set emergency temporary standards for COVID-19 exposures in health care settings. Previously, OSHA set bloodborne pathogen standards that included hepatitis B vaccinations. OSHA is currently devising emergency temporary standards for COVID-19 vaccination or weekly testing, which is expected to be issued soon.


Two Freedoms

Freedom holds deep ethical and legal value in the US. There are at least 2 types of freedom—freedom from personal restraint and a wider freedom to engage in daily life without significant risk of exposure to safety hazards. Vaccine mandates are justified under both notions of freedom. Certainly, competent adults have the right to bodily integrity and to make their own health care decisions. Yet, the right of informed consent has clear limits. No one has the right to expose others to a potentially serious infectious disease. Even though breakthrough SARS-CoV-2 infections after vaccination do occur, vaccinated individuals pose transmission risks for much shorter periods compared with unvaccinated individuals. Thus, a fully vaccinated workforce, especially if layered with other risk mitigation measures such as wearing a mask and improved ventilation, creates a far safer environment for everyone.

In his annual address to Congress in 1941, Franklin D. Roosevelt identified “Four Freedoms”—for speech and worship, as well as freedom from want and from fear. By freedom from fear, he meant that the public has the right to engage in daily social and economic life without fear of avoidable harms. It is unknown how much COVID-19 vaccination coverage is needed to contain SARS-CoV-2, but it probably requires rates exceeding 80% of the population. It is important to remember that everyone in society is interconnected. Our individual choice to not get vaccinated poses avoidable risks to the people we interact with and those with whom they interact. The higher the vaccination coverage, the safer we all are.

Highly vaccinated populations create a wider freedom to return more safely to the ordinary activities people value—such as going to work, school, cafés or restaurants, the theater, or sporting events, as well as traveling. COVID-19 vaccines are a remarkable scientific tool that enables society to live in greater freedom and with less fear. Using every tool—including mandates—to achieve high vaccination coverage enhances freedom.
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Article Information

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Gostin LO. JAMA Health Forum.

Corresponding Author: Lawrence O. Gostin, JD, Georgetown University Law Center, 600 New Jersey Ave NW, Washington, DC 20001 (gostin@georgetown.edu).

Conflict of Interest Disclosures: None reported.
References
1.
Gostin LO, Shaw J, Salmon DA. Mandatory SARS-CoV-2 vaccinations in K-12 schools, colleges/universities, and businesses.  JAMA. 2021;326(1):25-26. doi:10.1001/jama.2021.9342
ArticlePubMedGoogle ScholarCrossref
2.
Gostin LO. Jacobson v Massachusetts at 100 years: police power and civil liberties in tension.  Am J Public Health. 2005;95(4):576-581. doi:10.2105/AJPH.2004.055152PubMedGoogle ScholarCrossref

The Right Answer and the Effective Answer

The comment below was written by an orthopedic surgeon in response to this article

October 8, 2021

Steven Zeitzew, M.D. | West Los Angeles VA Healthcare Center
There is a large difference between being correct and being effective. As an orthopaedic surgeon I learned long ago that telling patients what to do is less effective than informing them effectively about the consequences of the choices before them, and gently guiding them so they can make the correct choice willingly. Sometimes mandates are effective and necessary, such as vaccines for schoolchildren or for healthcare workers in at least some circumstances. What we are learning is that telling people we are forcing them to do the right thing is sometimes not an effective technique for getting them to actually do the right thing. Sometimes telling a "biker dude" that he cannot put weight on his leg after fracture surgery won't work, because he won't do something just because he is instructed to, and is in fact more likely to do the opposite. That same patient is smart enough to make a good decision if he is informed of the poor prognosis associated with excessive premature weight-bearing before fracture healing. That is human nature. We don't like being told what to do. We do like making well-informed decisions on our own. Even a well-intended mandate based on the best evidence will sometimes be a less effective technique for getting people to make the right choice.

It might be more effective to provide reliable information and allow patients to decide about vaccination on their own in many circumstances, even though some will make the poor choice of declining vaccination, in spite of the overwhelming and persuasive evidence supporting COVID vaccination. Liberty and freedom are important to human beings, and threatening to take it away will have consequences. We will find we cannot force all people to do the right thing. We will also find that most people will make the choice to do the right thing when they are allowed to give informed consent, the same standard we use for other medical interventions, even when they face a life and death choice that affects them and those around them. Yes, sometimes we must impose a choice in order to protect others. Forcing our choice may not be the most effective technique in this instance.

In case you're in Irving and or headed here....

Captain Jeff Wright secured the funding and filed the mandatory Certificate of Insurance (COI), the course for event number 518 was set up and ready to go. 

Then the DFW fire marshals descended with the grim news. The event cannot be held on an empty parking lot that can accommodate a 747. They delivered the news after the close of business sending us into General Quarters status with an after-hours search for Plan B.

As we packed up under the dark sky, we secured an alternative location: The Irving Mall. 

So, we'll take the tower down first thing tomorrow and the show will go on at 4p CDT. 6.7 miles away

See you there: 

Opinion: Covid-19 is sticking around. Time to stop pretending it’s not your problem.

Eugene Robinson

Washington Post, Oct 1, 2021

It is mystifying to me, and to many others, that such a divide could possibly exist. Yet an estimated 70 million Americans who are eligible to protect themselves against being hospitalized or dying from covid-19 have not done so. To be as generous as possible, some of those people may still worry about losing days off work to side effects or fear that getting a shot could reveal their undocumented status. But the selfishness and foolishness of people who don’t face those obstacles endanger not only their own health but everyone else’s as well.

Not getting vaccinated is indeed a decision, at this point, given the practically universal access to safe and effective vaccines that the entire nation enjoys. Guaranteeing protection from this highly infectious and deadly disease is no more difficult or complicated than dropping by your neighborhood pharmacy once or twice and rolling up your sleeve. Serious side effects are astonishingly rare, and more routine ones are manageable and often, as was true for me, nonexistent. And the benefits are massive, both for individuals and society.

Are you a lover of freedom? Do you hate all those covid-19 restrictions? Have you been impatient for life to get back to the old normal? Then get yourself vaccinated immediately and do everything you can to make sure your family and friends do the same. Aim your torch-and-pitchfork anger at the covid-19 virus — not at the experts and officials who are trying to save your life even as circumstances and available evidence shift around them.

The willfully unvaccinated are covid-19’s enablers. They are giving the virus an enormous supply of potential hosts, allowing it to thrive and evolve — perhaps someday in a way that evades the vaccines. They are filling intensive-care hospital beds and keeping beleaguered doctors and nurses under constant, and unnecessary, siege. They are prolonging a crisis that we have the resources to get under control.

Incredibly, cynical politicians are actively boosting the death toll. Florida, where Gov. Ron DeSantis (R) has sought to further his presidential hopes by pandering to the anti-vaccination crowd, suffered 14,334 covid-19 deaths this summer, according to figures compiled by Johns Hopkins University.

Sen. Ted Cruz (R-Tex.) earned membership in the Pandemic Hall of Shame on Wednesday by tweeting that “I stand with” the handful of National Basketball Association players who have publicly refused to be vaccinated. Similarly enshrined are Texas Gov. Greg Abbott, Missouri Sen. Josh Hawley, and a host of other ambitious Republicans who seek to curry favor with the party’s populist base by painting vaccination as a question of free choice rather than an imperative of public health.

Ultimately, however, there comes a point where this crisis is not about unscrupulous presidential wannabes. Yes, they may be persuading some of the tens of millions of holdouts, but they’re also doing it to win the approval of those who have decided not to protect themselves and others. Given the negative impact these free-riders are having on the rest of us, we have every right to be ticked off.

Fortunately, there is an intervention that works to eliminate vaccine hesitancy: employer mandates. If workers are told they must be vaccinated as a condition of keeping their jobs, it turns out that the vast majority comply.

In early August, United Airlines announced that all of its roughly 67,000 U.S. employees would be required to show proof of vaccination or be fired. On Thursday, the airline announced that 99 percent of its workers had complied — and that 320 workers who had neither gotten their shots nor filed for exemptions would be terminated, and are perfectly free to work somewhere else.

It’s clear now that we will be living with covid-19 for some time, though hopefully as an endemic disease like the flu rather than in a state of pandemic urgency. The keyword there is “living” — the vaccines give this country the chance to reduce covid-19 to more of a nuisance than a plague.

Millions of Americans who received the Pfizer vaccine at least six months ago are now eligible to get a booster shot, which experts hope will offer additional protection against covid-19. Boosters for those who got the Moderna or Johnson & Johnson shots will likely soon be offered as well. Those additional shots will make us safer — but if the unvaccinated did their duty, we would all be safer still.

And yes, it is a duty. If you refuse to get vaccinated — without a medical reason — you are failing your family, your community, and your nation. Just get the shot. Today.