Joel Zinberg, M.D. Mandating Trouble Mayor de Blasio’s needlessly inflexible requirement that city workers be vaccinated will endanger New York.
Thanks to Mayor Bill de Blasio’s Covid-19 vaccine mandate for city workers, New York faces the prospect of slower ambulance- and fire-response times, fewer cops on the street to battle rising crime rates, and accumulations of uncollected trash. It didn’t have to be this way.
The mandate, imposed two weeks ago, excludes the alternative option of undergoing regular Covid-19 testing, putting unvaccinated city workers without religious or medical exemptions on unpaid leave as of November 1. A last-minute surge in vaccinations brought the rate for city employees up to 90 percent, but significant numbers of the essential workers remain unvaccinated. As of November 1, vaccination rates were 84 percent for the police, 82 percent for the Department of Sanitation, and 80 percent for the Fire Department (which includes 75 percent of firefighters and 87 percent of EMTs).
Nine thousand city workers, including as many as 2,500 NYPD employees and 1,000 firefighters, are now on unpaid leave. Another 12,000 city workers, including 1,000 FDNY members and 6,500 NYPD officers, have applied for religious or medical exemptions. If, as expected, most of these exemptions are denied, thousands more essential workers could end up on leave.
Workable alternatives exist to this assault on essential services.
Applicants for exemptions to the vaccine mandate will be permitted to work and be tested weekly while their requests are being processed. If it is safe for exemption-seekers to continue working with weekly tests, then why not offer this same accommodation to any worker who continues to refuse vaccination? This is the same alternative provided for in President Biden’s proposed OSHA vaccine mandate.
Another option would be to exempt from the mandate anyone who can provide proof of natural immunity, resulting from prior Covid-19 infection and recovery. Prior infection with SARS-CoV-2 can be readily documented with a previous positive PCR test or antigen test, a positive antibody test, or a T-cell test.
By May 31, 2020, during the first of several Covid-19 waves in the city, 40.7 percent of EMS responders and 34.5 percent of firefighters had already been on medical leave for suspected or confirmed Covid-19. Now, more than a year and a half later, even higher numbers of essential workers have likely been infected.
The CDC has long suggested that previously infected people get vaccinated to strengthen their immunity. This would amount to a booster, in the same way that fully vaccinated people can improve their immunity with an additional shot. But the relevant question is: Does natural immunity without vaccination protect as well as full vaccination without booster?
Experts generally say that natural infection almost always causes better immunity than vaccines. While the evidence is mixed, it seems clear that both natural and vaccine-provided Covid-19 immunity provide effective protection.
A new CDC review shows that infection with SARS-CoV-2 and vaccination each result in a low risk of subsequent infection for six months or more. This finding holds true for both the Delta and pre-Delta variants. In addition, both prior infection and vaccination confer high levels of protection against symptomatic Covid-19 illness.
Vaccination remains the best protection against Covid-19; everyone, especially essential workers, should be encouraged to get the shots. Nevertheless, heavy-handed mandates that reject workable accommodations risk endangering the public far more than unvaccinated workers.
Joel Zinberg, M.D., J.D., is a senior fellow at the Competitive Enterprise Institute and an associate clinical professor of surgery at the Icahn Mount Sinai School of Medicine in New York. He was general counsel and senior economist in 2017–19 at the Council of Economic Advisers, where he specialized in health policy.
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