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Over the last 18 miserable months, Americans have experienced great loss and hardship — and also, a miracle. With unprecedented speed, scientists invented not one but multiple safe and effective vaccines against COVID-19, the tools we desperately need to end this scourge that has killed more than 600,000 people, a toll that continues to mount by hundreds every day.

It can sometimes be hard to recognize the magnitude of events as they’re happening. But in all of human history, no infection that kills so many has been conquered so quickly. It’s a staggering achievement. We have, not even two years after the disease first emerged, the kind of preventive measure that those who suffered through thousands of years of plagues and pandemics wished for in vain.

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Now we just need to use it.

Since the initial approval of the first COVID-19 vaccines last winter, millions of people have been immunized, death rates have fallen, and some of the fear that dominated life last year has lifted like a storm passing. Yet the reluctance of tens of millions of Americans to take the vaccine has created an unbearable new reality: a pandemic that continues to fill hospitals and morgues, by choice.

The scientists have done their part. The question now is whether our political leaders, civic institutions, churches, and businesses can deliver on their end by leading a nationwide effort to overcome the apathy, fear, and misinformation that has prevented more widespread vaccination. Right now only about half the population of the United States is fully vaccinated, a number that masks just how badly some parts of the country lag. In Alabama, for instance, only 35 percent of the population is fully vaccinated. In Louisiana, the epicenter of the most recent surge, it’s only 38 percent.

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Even in the most successful states, like Massachusetts, the pace of new vaccinations has tapered off. Only 65 percent of the Commonwealth’s population is fully vaccinated. The fact that children under age 12 cannot receive the shot explains some of that number, but even among the eligible population the vaccination rate in Massachusetts is only 74 percent.

What that means is that the disease continues its remorseless spread — threatening not just those unvaccinated by choice, but also children who are now put at risk because of the unwillingness of some adults to help protect them. While the risk to children remains very low compared to adults, more kids are coming down with the newest coronavirus variant, Delta; the number of children hospitalized has hit record highs; and a handful of southern states have either run out of beds at children’s hospitals or are close to running out.

Continuing spread also gives the disease more space to mutate and for new variants to develop. So far, vaccines are effective against variants, including Delta, in terms of preventing severe illness and death — but the more the infection can spread, the greater the chance for a new variant to emerge that’s beyond the power of the vaccines.

Globe staff illustration; cgterminal/Adobe

While vaccine resistance sometimes seems like a consequence of our hyper-polarized political climate, it’s common in other countries too — and ours is hardly the first generation of Americans to confront this public health challenge. Vaccine hesitancy, and even violent opposition, is as old as vaccines themselves. Here in Massachusetts, someone bombed Cotton Mather’s house in Boston when he advocated smallpox inoculation. That was in 1721. In 1905, a vaccine opponent in Cambridge went all the way to the Supreme Court trying to overturn a smallpox vaccine mandate — an effort that led to the landmark decision upholding the right of states to impose vaccine requirements for public health.

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The best way to overcome hesitancy is for trusted figures like doctors to talk one-on-one to holdouts, explaining in an empathetic, respectful fashion the benefits of vaccination and debunking false rumors they may have heard. But simply waiting patiently for doctors to convince the unvaccinated to get shots, while people are dying every day, is not sufficient. Governments, employers, and other institutions must backstop those efforts:

  • Employers should institute — and then enforce — vaccination requirements for their employees, making a shot a condition of employment.
  • Labor unions should demand vaccination requirements at workplaces that do not institute them, since those policies will make their members safer.
  • Giving workers paid time off to get their shots — the Pfizer and Moderna vaccines require two shots — should be the norm for all businesses.
  • States should allow teenagers to receive vaccines without parental consent, so that kids who want the shot can’t be stopped by anti-vax parents.
  • Social media companies must remove or at a minimum label and demote vaccine misinformation — no excuses.
  • Restaurants, airlines, and gyms should require proof of vaccination for their patrons, whether or not they are required to.
  • The government and private sector should develop a secure, nationwide vaccine passport system to ease the implementation of vaccine requirements for entering restaurants, gyms, cruise ships, airplanes, and other settings.
  • As soon as the FDA issues final authorization for the vaccines, school districts should make it a condition for enrollment in school — as many already do for diseases like measles.
  • Employers should consider raising health insurance premiums for holdouts or assessing a surcharge to their paychecks, just as some do for smokers.
  • As a last resort, local governments can simply mandate vaccinations for everyone — just the kind of policy the Supreme Court allowed Cambridge to impose in the 1905 smallpox case.
Globe staff illustration; cgterminal/Adobe

The idea of mandating health choices, or making workers choose between their job and a vaccine, may seem Draconian. It may be Draconian. But the COVID-19 pandemic has been the worst infectious disease outbreak in the United States in a century, and all the powers of the state that we keep behind glass in case of emergency need to be used now.

Hundreds of thousands of Americans have died; millions have suffered job losses and economic insecurity; tens of millions are suffering psychologically from the impacts of closures and isolation. Nurses and doctors have stretched themselves to the breaking point to care for the sick and dying, and are now being asked to continue putting themselves at risk for people who choose to go unvaccinated. New variants will keep emerging until enough people are vaccinated or infected around the world, causing this cycle to repeat, endangering the lives of even those who chose to take the vaccine.

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All while we have a tool that the people who lived through past pandemics could only have dreamt of. The Plague of Justinian in the sixth century killed so many people in what is now Istanbul that the smell of rotting bodies pervaded the city. One contemporary observer described the efforts of overwhelmed Byzantine doctors to treat the victims, but lamented that none of them seemed to work: “no device was discovered by man to save himself.”

We now have such a device. It’s a vaccine. Unlike our ancestors, we can choose to end this misery. We just have to marshal the resolve to do it.


Editorials represent the views of the Boston Globe Editorial Board. Follow us on Twitter at @GlobeOpinion.