NASHVILLE, TN – Although more than half of Americans have been vaccinated, 93 million have not. The fast-spreading Delta variant has increased the number of infections, hospitalizations, and deaths in recent weeks.
The Center for Disease Control and Prevention (CDC) says that 99% of COVID-related deaths since January 2021 have been among unvaccinated Americans.
Alabama, Georgia, Arkansas, Louisiana, Mississippi, Tennessee. West Virginia and Wyoming have vaccinated less than 50 percent of their residents.
The CDC has not changed its main message: get the shot. Last week, Dr. Rachel  Walensky,  Director of the Centers for Disease Control and Prevention (CDC), recommended that people wear masks, even if they are vaccinated.
Fully vaccinated people account for almost 50% of new cases in Israel. It is not clear if their immunity waned or if they contracted the Delta variant before their full immunity kicked in. But they can spread it to others, prompting Israeli health officials to impose an indoor mask mandate last week.
Walensky stopped short of ordering a mask mandate and she didn’t order everyone over 12 years old to get vaccinated either. But she left no doubt that they should.

Dr. Rachel Walensky is Director of the Centers for Disease Control and Prevention (CDC). Last week she urged all eligible Americans to get vaccinated and recommended wearing masks indoors even if you are fully vaccinated. (Photo by Erin Clark)

Rather than shaming those who are most reluctant but also the most vulnerable, officials are offering carrots to persuade them. Last week, the U.S. Treasury Department urged states and cities to pay $100 to every newly vaccinated person with federal recovery money from the American Rescue Plan Act.
Columbus, Ohio is offering unvaccinated residents $100. In the first week, the city’s health department reported a 288.5% increase in vaccinations. Colorado is offering $100 Walmart gift cards. Illinois, Kentucky, Delaware, West Virginia, Alabama, New York are offering college scholarships. Maryland started a special lottery.
“The only way to get through this terrible virus is higher rates of vaccination,” said Dr. Monica Gandhi. She is a professor at UC San Francisco School of Medicine. Gandhi briefed minority press outlets last week.
Gandhi said health officials have been waiting for the U.S. Food and Drug Administration (FDA) to grant full approval of the vaccines before they issue any mandates. Vaccines have emergency authorization now and studies show they are safe and effective. But still, a lot of people, including nurses, are still reluctant to take the jab.
According to Gandhi, the Biden administration has employed six strategies to increase vaccination rates. One is community-based messaging. In San Francisco, the African American and Latinx communities have higher vaccination rates because Mayor London N. Breed promoted them and healthcare workers brought pop-up vaccine sites into the neighborhoods. Breed is an African American.
Gandhi said a second strategy is to bring vaccines to where the people are—“in their pharmacies, in their doctors’ offices, to their workplaces and giving them time off to get that vaccine”.
A third strategy is free transportation and childcare; the fourth is vaccine passports.
Dr. Monica Gandhi is Professor of Medicine at UCSF and Director of the its Center for AIDS Research.

“We didn’t want to use this “P” word before but it is important in our country to say that you can’t come in this restaurant if you are not vaccinated,” she said. Without a vaccination record, the only alternative is to require frequent testing. Some big tech companies are requiring their employees to do one of the other before coming back to work.
The fifth strategy is to combat misinformation with the truth and that includes using trusted community messengers to deliver it. In Nashville, Meharry Medical College President Dr. James Hildreth has been giving press briefings and answering questions about the virus for more than a year.
There is a Supreme Court precedent for issuing a vaccine mandate. In 1905 there was a smallpox epidemic in the U.S. and 30% of eligible people did not get vaccinated. Gandhi said that in Jacobson vs. Massachusetts the court “ruled it is legal and ethical to mandate vaccines for public health crises”.
“You are now seeing the effects of that ruling,” Gandhi said.
She said the dialogue about personal choice and public health has shifted in the last two weeks. California state workers have to get vaccinated and a number of cities have ordered their employees to get vaccinated, too. Healthcare and public safety workers are being told to get the shot.