California needs more than vaccine booster shots to prevent the next COVID surge

The incurable optimists among us might believe our national discourse about COVID-19 long ago progressed past mistaking cleaning products for medicine. But more than a year after a former president mused about ingesting bleach to combat the coronavirus, it turns out that a borax bath is among the “cures” social media quacks are recommending to mitigate the imaginary ills of the best available protection from the virus, vaccination.

The insight buried beneath this disturbing development is that the bad advice is being dispensed to people who got vaccinated despite misguided misgivings about the shots. They have done so in no small part thanks to the proliferation of public and private vaccine requirements. As California faces a fall resurgence of infections, officials should respond accordingly by strengthening existing vaccine requirements and introducing new ones to reduce the ranks of the unvaccinated.

With the statewide rate of positive coronavirus tests rising again in recent weeks as well as hospitalizations in some regions, led by far Northern California, the San Joaquin Valley and the Sacramento area, Gov. Gavin Newsom said last week that the rebounding contagion is his “biggest anxiety.” To that end, the governor extended emergency executive orders facilitating increased hospital, testing and vaccination capacity to answer the “possible beginning of a new surge in COVID-19 cases.”

Meanwhile, Dr. Mark Ghaly, the state’s health and human services secretary, broadly encouraged Californians who want booster shots to get them provided sufficient time has elapsed since their original vaccinations. The state’s public health officer, Dr. Tomás Aragón, joined Ghaly in that expansive stance, urging providers to “allow patients to self-determine their risk of exposure.” Based on research that the vaccines’ protection against infection and illness wanes over time, the Centers for Disease Control and Prevention recommend boosters somewhat more narrowly: among adults who got the Johnson & Johnson vaccine at least two months ago; and those who got the other vaccines at least six months ago if they are at elevated risk due to age, health conditions or living or working circumstances.

It certainly won’t hurt the state’s efforts to mitigate any nascent surge if the 62% of Californians who are fully vaccinated become even more so thanks to the state’s aggressive booster advice. But getting shots in the arms of the more than a third of Californians who aren’t fully vaccinated would be more to the point. The state’s vaccination coverage is about three percentage points better than the national average, but the latest statistics appear to show it’s not enough. The vaccination rate in Sacramento County, meanwhile, is worse, slightly below the national average.

The most effective means of increasing vaccination is requiring it as a condition of education, employment, entertainment and more. Private employers as different as United Airlines, Tyson Foods and the NBA have reported vaccination rates well over 90% as a result of mandates. San Francisco’s strict mandate for city employees yielded a vaccination rate of 98%. Los Angeles County recently found similarly high levels of compliance with rules requiring bars and nightclubs to verify vaccination. Such local mandates coincide with the highest vaccine penetration in California.

And yet neither the state nor most local governments in the Sacramento region have imposed any such requirements on high-risk places such as restaurants and gyms or on their own workforces. The Newsom administration’s rules for public employees such as teachers and prison guards allow regular testing in lieu of vaccination, with consequently diminished compliance. The city of Sacramento, which required employees to report their vaccination status but has yet to mandate the shots, recently reported that less than 80% were vaccinated.

While the dark arts of online conspiracy theory are fundamentally inscrutable, there’s no longer any mystery about the best official medicine for vaccine hesitancy. The question is why so many of our leaders still hesitate to write the prescription.