As soon as the Food and Drug Administration issues a full approval for a COVID-19 vaccine, there will be "a flood" of vaccine mandates at businesses and schools across the nation, Dr. Anthony Fauci told USA TODAY's Editorial Board on Friday.
Mandates aren't going to happen at the federal level, but vaccine approval will embolden many groups, he predicted.
"Organizations, enterprises, universities, colleges that have been reluctant to mandate at the local level will feel much more confident," he said.
"They can say: 'If you want to come to this college or this university, you've got to get vaccinated. If you want to work in this plant, you have to get vaccinated. If you want to work in this enterprise, you've got to get vaccinated. If you want to work in this hospital, you've got to get vaccinated.'"
Fauci said he doesn't see more lockdowns coming. They were issued early in the pandemic to keep hospitals from being overwhelmed, known as "flattening the curve."
"The rationale for shutting down was that the hospital system would not be able to handle the surge of cases because everybody was getting sick," he said.
With more than 70% of adults having had at least one dose of vaccine, the epidemic has shifted to one of the unvaccinated, he said.
"When you walk into a hospital, what you're going to see is a lot of young people, some of whom are seriously ill, but you're not seeing an overwhelming outstripping of the capability of the hospitals throughout the country," he said.
Lies, mistruths and death
Though he's attacked online and in conservative media every day, Fauci said, he worries less about himself than for the nation as a whole.
"This is a dystopian world we're living in," he said. The public is awash in lies and misinformation about COVID-19 and the vaccines, he said, and "they are being misled."
With COVID-19 cases rising among the unvaccinated as the highly contagious delta variant spreads, Fauci hopes people's "better angels" will prevail over the sea of lies on social media.
Americans, he hopes, will say: "I'm not going to take any of this. I'm seeing everybody around me get sick and dying. Let me just go ahead and get vaccinated.'"
The delta variant has thrown the danger of COVID-19 to young children into sharp relief. In Tennessee, the Department of Health projects the state's children's hospitals are on pace to be full by the end of next week.
The state's health commissioner, Dr. Lisa Piercey, said the delta variant is rapidly spreading among children, who are quickly showing symptoms after possible exposure, possibly amounting to a much faster incubation time than previous versions of the virus.
Children under 12 are not yet eligible for the vaccine, so the adults around them must be their protection, Fauci said.
At schools, everyone needs to be vaccinated, he said, teachers, assistants, janitors, "anybody who is anywhere near a child in what should be a protected environment of a school."
Because in today's political environment that won't happen, Fauci said, masks are the next best thing. Schools are crucial for children's mental health and intellectual, physical and social development, so it's important they stay open.
"I would rather have a child be a little bit uncomfortable with a mask on and be healthy than a comfortable child without a mask in an ICU," he said. "It just doesn't make any sense to me why you would want to not protect the children."
A 'smoldering' future for US
The epidemic in the United States could be ended once and for all if everyone would get vaccinated, Fauci said. Barring that, he worries we're in it for the long term.
"You will get a smoldering level of infection that will just go right into the fall, get confused with influenza in the winter and then come back again in the spring," he said.
The unvaccinated will continue to get sick, and some will die. The young and healthy are statistically not likely to become seriously ill if infected, but they don't live in a vacuum, he said. The more people who are infected, the more chance the virus has to mutate into an even more dangerous variant.
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"All of the sudden, your decision not to get vaccinated goes beyond your own vacuum and influences society," he said.
That holds true for the world as well – unless the virus is stopped everywhere, it will continue to mutate and could come back in a form that can evade current vaccines.
That's different from many vaccine-preventable diseases such as measles, which doesn't mutate. And it's why getting vaccines to the rest of the world is crucial.
"If we're protected against measles here and there are a million cases of measles in Afghanistan or in India or in Uganda or in Kenya and somebody comes over here, it almost doesn't matter. But if we're protected against one group of (COVID-19) variants and a bizarre variant emerges somewhere in a low- or middle-income country, then we're vulnerable," he said.
Fauci ended by emphasizing that while the COVID-19 vaccines are not perfect, they do one thing extraordinarily well: keep people who get COVID-19 from becoming severely ill or dying.
"The reason to get vaccinated is not so that you can go around without wearing a mask," he said. The reason is "because we don't want you to wind up in the ICU. And I can guarantee you 99% that if you get vaccinated, you are not going to wind up in the ICU."
This article originally appeared on USA TODAY: Dr. Anthony Fauci: COVID vaccine mandates to follow FDA full approval