Dr. Dan Salmon on COVID-19 vaccine passports and mandates

My Vax Journey sat down with Dr. Dan Salmon of the Institute for Vaccine Safety in May 2021 to discuss vaccine passports and mandates. 


There’s been a lot of discussion about vaccine mandates. Where do you fall on this discussion? 


Largely the only place we've seen mandates put out there or announced that I'm aware of is for universities, and that's really coming in the fall. There's more and more data now showing that the COVID-19 vaccines not only prevent serious illness and death, but they also reduce transmission. And that's a really important point because it's of course great that the vaccine stops you from getting really sick or dying, or at least greatly reduces that, but we're getting more and more data showing that the COVID vaccines also reduce transmission, so that's great news. That means if I'm vaccinated, not only am I probably protected and probably I can't get other people sick. So if that's the case, then that allows me to go back to normal pretty easily. If it's walking into a restaurant or having a beer at a bar or going to a library or a movie theater or someone's home or an airplane, I'm probably fine. It's not a hundred percent—no vaccine is a hundred percent effective—but my risk has really been reduced. 


The issue really is how is it implemented? Because if it's based on the honor system, we may have a real problem. But if there's a way to implement it in a way that works reasonably well, not only will it produce a safe environment to help us economically, you can see kids going back to school and it'll also create an incentive for people to vaccinate. And I think it's great to create incentives to vaccinate. I'm a big fan of things like a vaccine passport documentation that shows that you've been fully vaccinated and there are apps that can do this. Some people raise concerns about equity issues, but you could also have paper records be allowed. So if you imagine, as you walk into a movie theater or a restaurant that there's a scanner at the door and somebody's sitting there and either you show that you've been vaccinated or you're wearing a mask, that's a pretty simple solution. I don't think it would be that hard to implement.


I think it would create fairly reasonably safe environments, and it would give people a real incentive to vaccinate. There's a time and a place for some mandates, and I think they need to be used carefully and they need to be used sparingly. And one needs to be really careful about when you start mandating vaccines. It's not that I'm against mandates altogether, I just think it really depends on the situation. And I certainly don't think we should start with a mandate. Right now, all of the vaccines are under emergency use authorization and I'd like to see them get approved through the regular process, which is a biological license application. I think until that happens, we shouldn't be talking about mandates, but even once that happens, I wouldn't immediately mandate every vaccine that's been approved through the normal channels.


Are there any unique considerations for certain populations?


There are special populations, for example, healthcare workers, where they are entering a field whose mission is to help people who are sick and ill. And I think therefore they have a special obligation. I still would like to see a regular license before requiring it. But I think that's a population where there's really good justification for requiring them to get vaccinated because not only are they at greater risk of getting COVID, but they're at greater risk of spreading it to sick and elderly people who they've been professionally hired to help.


When do you think a mandate should apply?


As a general principle, I think mandates should be the approach of last resort. In other words, if we can make the vaccine easily accessible and we can provide education and information and provide incentives for people to vaccinate, that may be enough. It may not get everybody vaccinated. They may not get a hundred percent vaccine coverage, but it might get us close enough that the pandemic is effectively controlled. And if we can accomplish that without a mandate, then that's exactly what we should do. 


Daniel A. Salmon, PhD, Director of the Institute for Vaccine Safety, has training, research and practice interests in epidemiology and health policy, and is a professor in the Department of International Health, where he also coordinates the PhD program in Global Disease Epidemiology and Control.