Covid-19 is more like influenza than smallpox. It kills 0.2% to 0.6% of those infected. Its severest effects are on populations that are smaller and more discrete than those at risk from either smallpox or influenza. The elderly and people with comorbidities account for most Covid-19 deaths and hospitalizations. Old age and comorbidities converge in residents of long-term care facilities, who account for 45% of Covid-19 deaths. Covid-19 merits a more targeted, less coercive response than smallpox.

Private industry will do better than 50 state governments in crafting narrow mandates. Private entities have financial and reputational incentives to protect their employees, patrons and residents, and are therefore well-positioned to determine what protective measures, including vaccination, need to be taken in specific circumstances. Vaccinated employees are less likely to become ill or infect their co-workers, thus reducing absenteeism. A vaccinated workforce will incur lower health-care costs, which could ultimately reduce premiums for employer-provided health insurance. A vaccine-protected enterprise will have a competitive advantage in attracting safety-conscious customers and employees. Finally, requiring vaccination could limit tort liability for failing to protect customers and other workers from infection and satisfy government requirements to keep workplaces safe.

Even before Covid-19, health-care facilities, including those providing long-term care, were increasingly requiring employees and residents to be vaccinated against vaccine-preventable diseases. Private mandates don’t violate statutory and constitutional constraints as long as reasonable accommodations are made for those with medical conditions that make vaccination risky and those with genuine religious objections.