For Virginia Mason Franciscan Health, a medical center in the US state of Washington, 18 October 2021 was the day of reckoning. Ten weeks earlier, the center had declared that all of its staff would be required to be vaccinated against Covid-19 by that date in order to protect both those working at the medical center and their patients from the disease. It was a potentially risky requirement, given the shortages of medical staff and the resistance to vaccination rocking other parts of the US medical sector.
But when 18 October arrived, 95% of staff had met the requirement through vaccination or an approved exemption. (The other 5%, including partially vaccinated staff, are currently on administrative leave.)
Charlene Tachibana, an executive who has spent her entire career at Virginia Mason, believes that this high vaccination rate is partly because "we have a long history of [a] vaccination requirement… it's pretty well been normalized".
Back in 2004, Virginia Mason reportedly became the first medical center to require all of its staff to be vaccinated against influenza each year. The administration held focus groups and other activities, including quizzes and a party, to encourage discussion of the new requirement. The combined carrot-and-stick approach proved very successful, and the influenza vaccination rate of Virginia Mason staff shot up from 54% to 98% in two years.
The lessons learned from that experience informed the rollout of the coronavirus vaccine requirement. One aspect was ensuring that it was as convenient for staff to receive the jabs as possible. The other aspect was a heavy focus on communication around the new requirement, including information sessions and documents in multiple languages.
"We don’t take mandates lightly," says Tachibana. "When there's such clear science to this – when the vaccine has been proven to be safe and highly, highly effective – we’ve moved forward with these."
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As Virginia Mason's experience suggests, a vaccine mandate is a powerful tool for safeguarding public health. But it can also be a highly contested one. In some ways, attitudes towards the current Covid-19 vaccine requirements reflect the patterns of previous centuries, making it important to understand the historical lessons of compulsory vaccination.
Precedents for vaccine mandates
In the 17th Century, Chinese physicians found that when certain preparations of smallpox were blown up the nose, they could lead to a milder illness than a natural infection would, followed by immunity. Eventually, the technique spread to Europe and the Americas, where it generally involved rubbing infectious material into a puncture in the skin. As it spread around the globe, eventually some leaders mandated this kind of inoculation. For example, during the American Revolutionary War, in 1777, general George Washington required all troops to be inoculated against smallpox.
Vaccine passports have used for decades – with many countries insisting upon mandatory vaccinations for diseases such as yellow fever before travelers can enter.
Inoculation gave way to more sophisticated vaccination once the English doctor Edward Jenner developed a smallpox vaccine in 1796, based on the milder cowpox virus that infects cows. Mandatory vaccination began just a few years later. In 1806, Elisa Bonaparte, the ruler of Lucca and Plumbing in present-day Italy (and sister to Napoleon), mandated the vaccination of newborn babies and adults.
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