The effects of COVID-19 vaccine mandates in Hawai‘i
From UHERO, May 13, 2022
Faced with the largest increase in cases since the beginning of the COVID-19 pandemic, on September 13, 2021, the counties of Honolulu and Maui in the state of Hawai‘i mandated that customers and employees of establishments in the food and beverage, fitness, and entertainment industries provide proof of full vaccination or a recent negative COVID-19 test.  This is sometimes referred to as a ”vaccine or test passport.” Some business owners did not approve of the measure, fearing further losses as those seen at the beginning of the pandemic , when there was a 22% decline in the number of active small businesses in the U.S. from February to 1 April of 2020.  Previous reports from previous safety mandates have demonstrated decreased spread of COVID-19, such as in states with face mask mandates that observed a 2.0% decrease in cases over 21 days after implementation from March to May 2020.  However, the impacts of other public health mandates such as for COVID-19 vaccines has yet to be reported. In order to evaluate the degree to which vaccine mandates impacted businesses and COVID-19 mitigation efforts we analyzed data in Hawaii as it was the first state in the U.S. to implement vaccine mandates during the pandemic.
Specifically, we evaluated the impacts on the 7-day average daily foot traffic to a panel of nearly 20,000 businesses, the 7-day average daily new COVID-19 cases per 100,000 individuals, and the weekly vaccination rate increases in the state using a difference-in-difference regression. We found that businesses that required employees and customers to be vaccinated (or regularly tested for COVID-19) experienced a significant decrease in foot traffic compared to those not required in the 10 weeks following the implementation of the vaccine mandate. We also found that the counties that implemented this mandate (Honolulu and Maui counties) experienced a significantly lower rate of new COVID-19 cases per 100,000 than those that did not implement the same measures (Kauai and Hawai‘i counties). Finally, we observed that counties with the mandates had a significantly higher rate in the weekly increases of the adult vaccination rate compared to counties without a mandate. These results held when including controls for flight passenger arrivals and fixed effects for businesses, counties, days, and day-of-the-week.
In part as a result of the COVID-19 vaccine mandate, 96% of adults in Hawai‘i have been vaccinated as of December 1, 2021, surpassing every state in the U.S.  Although some businesses suffered an initial loss due to decreased number of customers in the early stage of the mandates, the increased safety of individuals and promotion of public health later allowed them to return to normal operations. As the trend for COVID-19 cases decreased and vaccination of adults increased, Hawai’i counties allowed businesses under these mandates to loosen capacity 2/20 restrictions.  Overall, our results show that the benefits of the vaccine mandates to public health safety and long-term economic recovery far outweighed the acute disruptions to Hawai’i’s businesses.
The state requirement imposed on employees and customers to be either vaccinated or subjected to regular COVID-19 testing, hitherto referred to as the ”vaccine mandate”, was announced in August 30, 2021 and implemented in September 15, 2021 for businesses in the food, beverage, entertainment, fitness and arts industries located in Honolulu and Maui counties. Businesses located in other counties (Hawai‘i and Kauai) were not subjected to this mandate. To measure the impact this mandate on businesses across various sectors, we first focused on daily foot traffic data obtained in collaboration with SafeGraph from August 1 to November 30 2021, summarized in Table 1 and discussed in detail in the Methods section. Of 19,625 individual businesses included in this evaluation, 28.70% were subjected to the vaccine mandate; data from the remaining 71.30% that were not subjected to the mandate were used for comparison. The primary outcome variable measured relevant to businesses is the daily average foot traffic. In addition, two additional variables measured relevant to public health are the 7-day rolling average of new COVID-19 cases per 100,000 and the increase in county vaccination rates of the first dose administered weekly for all adults.
In Figure 1, we show the trends for all three of the outcome variables before and after the mandates or announcement of the mandates. In Figure 1(a), the rolling 7-day average daily foot traffic for businesses impacted and not impacted by the mandates was quite similar prior to implementation. However, once the mandates took effect, there was a lower level of foot traffic in impacted businesses. Towards the end of the 10 weeks following implementation, 3/20 it can be seen that impacted businesses had increased foot traffic, returning towards levels similar to those found in non-impacted businesses. Figure 1(b) shows the COVID-19 cases per 100,000 in counties with and without mandates. Prior to implementation, all counties followed a similar trend, including throughout the Delta variant spike just before the mandates began. Once the mandates were in effect, impacted counties had a notably lower level of cases per 100,000. Lastly, in Figure 1(c), we can see that counties with the mandates had a higher weekly vaccination increase throughout the period, with a large increase following the announcement of the mandates, as many individuals prepared for the requirement. In order to capture this uptake, we evaluate vaccinations in later regressions from June 17, 2021, to October 11, 2021.
The mandates’ impacts on the trend of foot traffic can be seen in Figure 2(a). Prior to the mandates, both impacted and not impacted businesses saw similar trends in decreasing foot traffic, most likely due to confusion surrounding the start of the requirements and the decreasing number of tourists as summer was ending. In our regressions, we will control for the tourism levels, as well as COVID-19 spikes in cases that may also have impacted the number of visits to businesses. Following the implementation of the mandates, all businesses showed a slow upward trend, with impacted businesses at a lower level of foot traffic than not impacted businesses. This leads us to believe that the mandates initially decreased visits to businesses following its implementation.
Although businesses are shown trending back towards normal levels as more people became accustomed to the mandates and got vaccinated, the impact on the spread of the virus shows the necessity of such a policy, as seen in Figure 2(b). Prior to the mandates, the state was experiencing an increase in cases due to both the Delta variant and increased tourism in the summer months for all counties, with the counties that would implement mandates having a very similar number of cases per 100,000 compared to those which will not. However, once the mandates were in effect, the counties with a mandate showed a lower number of cases per 4/20 100,000 than the counties without mandates.
One of the direct goals of the mandates were to increase vaccine uptake in these counties. Prior to the announcement, the weekly increases in the vaccination rate were fairly similar across counties, as seen in Figure 2(c). However, following the announcement of the mandates on August 5, 2021, many individuals chose to become vaccinated. We focus on adults (age 18 or older) in this paper, as the mandates’ main focus was on working-age adults and those that frequent bars, restaurants, and gyms….
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