As I write this, our country is in the midst of an exponential growth of COVID cases with hospitals bracing for an avalanche to follow.

Still, with well over a quarter of a million Americans already dead, our airports were filled with Thanksgiving travelers eager to spend time with their families, disregarding the urging of medical experts. Clearly, education and pleas have had a limited effect.

We now look forward to a savior in the form of a vaccine. Will it live up to expectations? The answer is probably yes in the long-run, but the level of success will, once again, depend upon the response of the American public.

The obstacles are formidable. According to the CDC, slightly less than half of people ages six months and older got a flu vaccine during flu season last year.

The history of public compliance to medical recommendations is poor. When advice is provided by experts but there are no immediate consequences, adherence is low. It’s no different than a parent telling a child to do their homework and not following up. No consequences result in a poor behavior.

Forty-two percent of Americans smoked in 1960. In the following decades, rates remained consistently high in spite of government and medical warnings.

Even when cigarette packaging, television and billboards showed direct cancer effects with gruesome pictures, smoking patterns were largely unchanged. It was not that they were useless, but it was only through high cigarette taxes and penalties to the tobacco companies that meaningful change was made.

Even so, almost 14 percent of our citizens continue to smoke.

The use of safety belts is another example where education had a limited effect. Not until state laws made it a requirement and enforcement was consistent and well-publicized did safety-belt use substantially increase. “Click it or ticket!”

The highest level of compliance occurs where consequences are consistent and consequential. A vaccination verification in order to enter public school kindergarten is an example. When such regulations are enforced compliance rises to nearly 100 percent.

We are a diverse country with strong roots in individualism and a higher than average resistance to authority. Politicization has been a strong headwind to mask wearing and limits to public gatherings. COVID-19’s lack of dire symptoms for many individuals, even when they are infected, is still another.

Given these considerations we need a stronger approach than education and persuasion. We need consequences whenever possible.

Perhaps the most powerful would be the influence of the president.

Upon taking office, President-elect Biden should invite CEO’s of the largest employers in the country, university presidents and other major executives to the White House and request they require their employees be vaccinated.

 If Walmart, Amazon, fast food and restaurant chains required vaccination as a condition of employment, the impact would be substantial.

The president could also issue a directive to federal employees.

While employers can require assent, employees have the right to request medical or religious exemptions under federal anti-discrimination laws. But even with these exceptions, rates of vaccinations would significantly rise under employer support.

Some of these requirements would undoubtedly be tested in the courts, but the conservative Supreme Court has already shown a tendency for employers to be granted their own wishes.

States should require institutions such as prisons, jails and nursing homes to implement 100 percent vaccination among its employees as a directive or loss of license, whatever possible. This approach, already implemented in some states, has been effective. Widespread expansion of this leverage should be instituted possibly to all state employees.

Education and pleas, even from grieving relatives and medical authorities, have achieved limited success. If we wish to substantially improve adherence levels we must attach consequences.

A prime opportunity is to turn to the presidential power of persuasion and pressure on our private sector to pull out all stops in achieving very high levels of vaccination against COVID-19.

Talk is good. Consequences are more powerful. Let’s do better with vaccinations than we have with mask wearing.

The lives of tens of thousands more Americans depend upon it.