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Former Biden COVID-19 Advisor: Voluntary Vaccination Can Only Get U.S. So Far


We're going to begin the program with a focus on this country's battle against COVID-19 and what could potentially be a turning point. We're talking about President Biden's decision last week to issue vaccine mandates for all federal employees and contractors, along with millions of health care workers. The president also issued a vaccine mandate for companies employing 100 or more workers. Also last week, the Los Angeles Unified School District, the second largest in the country, voted to require vaccines for students aged 12 and up.

We wanted to understand how significant these moves might be, so we've called Dr. Zeke Emanuel. He is the vice provost of global initiatives at the University of Pennsylvania and a former member of President Biden's Transition COVID-19 Advisory Board. Dr. Emanuel, thank you so much for joining us.

ZEKE EMANUEL: My great pleasure.

MARTIN: So up until this point, the Biden administration has tried a lot of different ways to get more Americans vaccinated, short of issuing a mandate, basically jawboning. Now the president has changed his tune. He's telling unvaccinated Americans last week that the country's patience is wearing thin. What's your reaction to that?

EMANUEL: Well, I think the president's done things very well here. He made the vaccine readily accessible. He made it free. He educated people. He then, as you point - you say jawboning. He tried to persuade people to get it. But we know voluntary efforts like this aren't going to get enough and that mandates are going to be necessary. Way back when, in - April 14, I began calling for a mandate, especially among health care workers, the Defense Department and others. And I think the president is slowly leading the country to accept the mandates.

MARTIN: I just want to point out that you helped organize a joint statement among nearly 60 medical groups, including the American Medical Association and the American Nurses Association, just encouraging every health care facility to require vaccinations for its employees. So you - when you say you know that voluntary efforts weren't going to be enough, how did you know? Was it because of that effort or something else?

EMANUEL: We know that if we need 80% of the population to do something, it won't happen voluntarily. Even in our most just wars that all the country is mobilized for, you still need a draft. Voluntary things will get you so far. And we've seen about 50% of the population - 54% of the population now - through a voluntary effort, has gotten vaccinated. And we're going up ever so slowly. You're going to need mandates, something more forceful to persuade all the people we needed to adopt the vaccine to actually get it. And I think the - President Biden has slowly led the country to realize that.

MARTIN: So the president's mandate potentially covers about 100 million Americans, so about a third of the country's total population. What impact do you think this will have on efforts to bring the pandemic under control?

EMANUEL: First of all, we do know that mandates work. When Houston Methodist Hospital mandated its 26,000 workers, there was a lot of pushback, a lot of noise about that. But in the end, only 127 or -37 of 26,000 employees decided they weren't going to get vaccinated and would prefer to quit. So mandates work. And that, I think, is going to make a big difference.

MARTIN: As we mentioned, the president's executive order also covers private sector employees. Now, as you - you know, some business organizations and trade groups have already been supportive of this mandate. But already, many Republicans are reacting furiously. They have called it a tyranny. And this includes even some people like Ohio Governor Mike DeWine, who is not among those who've downplayed the virus or resisted other measures. He's taken some strong measures. But even he's called this a mistake, saying people and business owners should make their own decisions about vaccination. So what do you say to that?

EMANUEL: Well, you know, our founders understood that if every individual made decisions, that would lead to - on something important, nationally important - that would lead to chaos. You couldn't have individual freedom on things that affected everyone. They believed in ordered liberty. And ordered liberty requires certain rules where your action impacts others. That's, in this country, why we have driver's license, why we say you can't go into a store without shoes and a shirt on - so that we actually protect each other.

This notion that freedom allows me to do whatever I want is something our Founding Fathers would totally reject. That is not their understanding of freedom. Freedom is ordered liberty. And part of ordered liberty is where we impact other people, like infectious diseases, we have to actually all act together. And they would think this is perfectly consistent with freedom.

And I think the president and most of the American population agrees with that. There's going to be a small group that doesn't. And that's the people who we actually need to abide by this mandate.

MARTIN: So before we let you go, as we are speaking now, cumulatively, U.S. COVID deaths are numbering more than 660,000 and - with about 1,500 people dying per day at...


MARTIN: ...The moment. Although the seven-day cumulative average seems to be going down, is that where you thought we'd be by now?

EMANUEL: No. I had - you know, way back in March 2020, I had said, you know, we'll probably get back to normalcy in November 2021. And I was considered a real bad pessimist then. And what I didn't anticipate was delta. I think it was hard for anyone to anticipate how infectious and deadly something like delta could be. And second, I didn't anticipate how resistant a portion of the public would be to vaccination. And now it looks like, you know, we're talking about spring 2022. And that assumes that we have more mandates.

I also might say, Michel, one of the things I'm very nervous about at the moment is looking forward to Thanksgiving and Christmas. We remember from 2020, we had a big surge around Thanksgiving. And that declined only a little bit and then a big surge around Christmas because of travel. I am very nervous that with people wanting to travel more, wanting to see family, if we don't get that vaccination rate up very rapidly in the very short period of time, we could have another double surge that would be, I think, quite, quite problematic for the country, with a very high death rate. And the only way to prevent that, I think, is mandating vaccination before any air travel, interstate trains, interstate buses. You know, frankly, you need six weeks before Thanksgiving to make that effective because you need two shots. And you need two weeks after the second shot to really be fully vaccinated. So we got to start now on travel mandates, too.

MARTIN: That was Dr. Zeke Emanuel. He is the vice provost for global initiatives at the University of Pennsylvania. Dr. Emanuel, thank you so much for joining us today. It was sobering but important. Thank you so much.

EMANUEL: Thank you. My pleasure for being here. Transcript provided by NPR, Copyright NPR.