Even with those numerical caveats, however, these reports from Ohio and California suggest a startlingly high rate of refusal among health-care workers. “I feel people think, ‘I can still make it until this ends without getting the vaccine,'” Lu said of her coworkers who are refusing without a reason like pregnancy. But the trouble is that the main way “this ends” is herd immunity, ideally achieved through widespread vaccination, not further years of wild viral spread and the death toll and social and economic misery that have come with it.

But … what can we really do? We can’t fire all the nurses who won’t get vaccinated when we’re still in the middle of a pandemic. Many hospitals already have a critical staff shortage, so it’s just not feasible to say only those who accept a vaccine can work. Sidelining 20 to 40 percent of available doctors and nurses would be catastrophic. An unvaccinated nurse is better than no nurse.

I’m also deeply wary of some proposed enforcement mechanisms. As I wrote in April, immunity certificates with attendant privileges have an obvious appeal, but the precedent of requiring special papers to appear in public is troubling, and the potential for abuse is real. Certificates would also immediately be forged, potentially giving medically vulnerable people a false sense of security.