Whatever the arguments in favor of COVID-19 mandates, MMR doesn’t make for a very good parallel, for a number of reasons.
The FDA has finally given formal approval to the Pfizer vaccine, and this will likely pave the way for more widespread adoption of mandates, as there was more legal gray area about mandating vaccines that were only authorized for emergency use. The news comes as New York City announced vaccine requirements for all public school teachers and staff. As the debate over mandating vaccines has come up, one analogy I keep hearing is to the mandates that schools have for the MMR vaccine. Mandates for MMR virtually eradicated measles, with pockets of outbreaks connected to anti-vaxxers. So that has led a segment of the population to argue that similar tactics should be employed to get COVID-19 under control. However, whatever the arguments in favor of COVID-19 mandates, MMR doesn’t make for a very good parallel, for a number of reasons.
For one thing, widespread mandates for measles shots did not begin until 1977, well after the release of the first measles vaccine in 1963. In contrast, COVID-19 vaccines have been with us for less than a year. While there is good reason to believe they are safe given that billions of people have now taken them, trepidation is more understandable for a vaccine that is less than a year old (and for which long-term effects aren’t yet knowable) than for one that has been around for decades.
For another thing, MMR vaccines generally apply to schoolchildren. But those discussing COVID-19 passports are discussing a system in which people are excluded from a wide range of activities based on whether or not they get vaccinated. Nobody is asked to show proof of MMR vaccination before going to a restaurant or the gym. (There is, to be clear, a distinction between private businesses demanding their customers demonstrate their vaccination status, and what is happening in New York City, where proof of vaccination is a government requirement for a variety of indoor activities.)
But from an administration perspective, the biggest difference is that people have to receive only two doses of the MMR vaccine in their lifetimes. Current CDC recommendations are that children receive their first dose between twelve months and 15 months of age, and their second dose between ages four and six. That essentially means that by the time children enter elementary school, they are done with MMR vaccinations.
In contrast, there is a growing body of real-world evidence that the efficacy of COVID-19 vaccines has waned over time. Israel, which was an early leader in vaccination, has been forced to counter a huge surge in cases by starting to deliver booster shots — an initiative that has now been opened up to all those 40 and over. If it turns out that people need to be getting boosters every six months — either for variants or just because vaccines lose power over time — it will be a lot more difficult to administer a mass vaccine mandate or passport program.
It’s one thing to say to people, as is the case with MMR, that they get two shots and they are done for life. It’s another thing if they have to get a shot every six months for the rest of their lives. If this is the case, how does government institute a mandate or passport system? Will people have to show not only that they have received at least one dose, but that their most recent dose was within six months? Doing so would not only be impractical, but would require a level of surveillance that would be without precedent in the U.S.
Additionally, it’s hard to see how we’d ever get the country into a position at which 85 percent of people are effectively vaccinated. We’re nine months into the vaccination campaign in the U.S., and just 60 percent of the eligible over-twelve population is fully vaccinated. If this has to be repeated twice a year, there is always going to be a sizeable chunk of the population that doesn’t have an up-to-date vaccine. There’s a reason why we don’t mandate flu vaccines every year, even though it would save lives if we had broader uptake. So MMR vaccines are not much of a relevant model for COVID-19.