LA has imposed one of the US’s strictest vaccine mandates. Will it prevent a Covid surge?

“The upside of mandates, they definitely work,” said Annette Regan, an expert in vaccine epidemiology at the University of California, Los Angeles. “The downside of the mandates is they can definitely polarize individuals.”

This winter is expected to be a precarious time for Los Angeles, which was pummeled by Covid-19 last winter. At one point last December, one person was dying of Covid every 20 minutes. The county’s public health director, Barbara Ferrer, broke down in tears at a briefing, over the “incalculable loss” of lives.

The region has been pushing strict Covid-19 prevention measures since then, and the new rules – combined with local, state, and federal rules requiring city employees, healthcare staff, and public schoolchildren to get vaccinated – means it will have some of the most stringent vaccine mandates in the nation.

Regan said that across the US, including north of LA in San Francisco, mandates have proven effective at pushing many who were unsure about the vaccine to get inoculated, and she expects that the mandates in LA, too, will help boost immunization rates. By 12 November, 73% of residents in LA county, which includes the city and surrounding areas, were fully vaccinated and 80% were partially vaccinated.

But the mandates won’t catch everyone.

The LA police union and a group of 500 local firefighters have already filed lawsuits over a mandate to be fully vaccinated by mid-December or submit to regular testing. So have aggrieved employees of the LA unified school district who oppose the requirement to get vaccinated by 15 November. And all the while, the city has been fielding for religious exemptions to the vaccine mandates, with residents pushing the already blurry lines that define “sincerely held” objections to the vaccine.

The LA police department has so far received 2,233 religious exemption requests . Police chief Michel Moore has vowed to crack down on those refusing vaccinations, but also said “to honor every exemption request, every request for accommodation possible”.

“I think in California, we’re not the wild west, but those are the origins of the state,” said Shira Shafir, an infectious disease epidemiologist at UCLA. “There is a little bit of this fierce individualistic streak and autonomy above all.”

In LA, and in many other cities across the US, that streak is running up against the realities of the pandemic, and a genuine desire to end it.

The opposition to the mandates is rearing as the region is bracing for what could be another winter surge. After low transmission rates throughout the summer, the number of infections has crept up again. Although hospitalization rates remain relatively low and flat, LA county has a case rate of about 98 per 100,000 residents, which the US Centers for Disease Control and Prevention (CDC) characterizes as a “substantial” level of community transmission.

For the vaccine-hesitant, powerful agents of disinformation and misinformation have prevailed over the reality of the horrors the region lived through last winter, said Shafir.

Until the Covid-19 pandemic hit, many epidemiologists hypothesized that the effectiveness of vaccines was precisely what fueled vaccine hesitancy. In the cases of measles, chickenpox or polio, “we no longer see the disease, just the risks of the vaccines” Shafir said. “So the risk-benefit calculation in people’s minds is skewed.” But that wasn’t the case for Covid-19’s impact in Los Angeles, she said. During the worst of the winter surge in January, the city brought in refrigerator trucks to hold dead bodies as morgues and funeral homes were overwhelmed.

“People have seen what the infection looks like and how devastating it can be,” she said.

Still, significant parts of the population are turning to religion and philosophy to shield themselves and their children from the requirements they distrust.

“This is certainly a misuse of the religious exemptions,” said Dorit Reiss, a law professor at ​​the University of California Hastings. “The religious exemption was not designed to give cover to people who are scared of vaccines. It was designed to ​​protect people from real discrimination.”

The new requirements for patrons of local shops, restaurants and other businesses include a religious exemption as well, though the city stipulates that it will be up to individual businesses to decide whether to honor such exemptions – turning restaurant servers, yoga instructors and bartenders into de-facto bouncers. “And that’s an issue because your local barista has been trained to make an outstanding cappuccino, but they have not been trained to verify vaccine compliance.” LA, like many cities across the US, has seen its share of angry customers violently opposing mask mandates.

Workers at restaurants, bars, shops and theaters are also the ones most at risk for contracting the virus and passing it onto their families, said Lorena Garcia, an associate professor of epidemiology at the UC Davis School of Medicine.

“Mandates like this are really about protecting these workers and their communities,” because one unvaccinated customer bringing the disease to a bartender would be all it took to not only infect that worker, but also their immunocompromised grandmother, their pregnant spouse or their young child. “Workers are shouldering a heavy burden,” she said.

City officials are holding off enforcement until the end of November, at which point businesses could be fined thousands of dollars for not complying. On Friday, the city council voted to soften the original mandate, removing malls and shopping centers from the vaccine directive, and requiring proof of vaccination only for those 12 and over.