'Patience is wearing thin': Biden rolls out vaccine requirements that will affect 100 million workers

WASHINGTON – Months after proclaiming the USA was on the verge of independence from the pandemic, President Joe Biden announced the most stringent federal vaccine requirements yet as the administration looks to combat the spread of a contagious variant of COVID-19 that's driving up daily new cases and once again overwhelming hospitals. 

The speech – which laid out a "six-pronged strategy" focused on sweeping vaccination requirements for federal workers and companies with more than 100 employees, increasing school safety protocols and making coronavirus testing more accessible – was a tacit acknowledgment that efforts have fallen short of Biden's campaign promise to bring the pandemic under control. 

"Many of us are frustrated with the nearly 80 million Americans who are still not vaccinated," Biden said. "This is not about freedom from personal choice, it's about protecting yourself and those around you."

A plan that would require businesses with more than 100 employees to ensure their workers are vaccinated or tested weekly could affect more than 80 million people. Biden announced vaccine requirements for health care providers that receive Medicare and Medicaid funding and for teachers and staff at federal programs such as Head Start and schools run by the Department of Defense and Bureau of Indian Education. 

The new plan is expected to affect about 100 million workers in the USA.

Before his remarks, Biden signed a pair of executive orders to require vaccination for federal workers in the executive branch and contractors, building on a policy announced in July that encouraged but didn't mandate vaccinations.  

At least 75% of adults in the USA have received at least one COVID-19 vaccine dose, a milestone that has helped prevent vaccinated Americans from hospitalization and death as the delta variant persists. But tens of millions of Americans remain unvaccinated, threatening to continue disrupting classrooms, vacations and plans for the holidays. The pandemic waned in the summer before a return to mask mandates and delays in return-to-office timelines. 

"We're in a tough stretch, and it could last for a while," Biden said.

The president's speech, public health experts said, comes at a critical point when the White House can refocus its strategy on restricting life for the unvaccinated and clearly lay out how it plans to bring the pandemic to an end after 18 months. While Biden has had to juggle a hyper-partisan pandemic response, resistance to a federal vaccine requirement and a focus on the return to normalcy set up unrealistic expectations, experts said.

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"Risk communication during a pandemic is extremely challenging, and the longer it goes on, the harder it gets," said Richard Besser, president and CEO of the Robert Wood Johnson Foundation and former acting director of the Centers for Disease Control and Prevention. "In this current climate, it's harder than ever." 

More Americans are unclear about the administration's path forward on COVID-19. A Gallup poll in July found that 41% of respondents disagree that the CDC has communicated a clear plan of action on COVID-19 compared with 32% who agree.

The same poll found Americans divided over whether Biden has communicated clearly on the pandemic: 40% say he has, and 42% disagree. The survey marks the first time Americans have not been more positive than negative about Biden's communication on the virus since he was a presidential candidate. 

Biden's six-point plan

Under Biden's new orders, executive branch employees and contractors will have about 75 days to be fully vaccinated, according to a senior administration official. The order includes limited exceptions for medical or religious reasons, but any federal worker who refuses to comply could face disciplinary action, the official said on condition of anonymity.

Some federal health workers, including those who work for Veterans Affairs, already must get vaccinated. Members of the U.S. military are also required to have a dose of COVID-19 vaccine.

Other civilian federal employees and contractors have only had to reveal their vaccination status and, if not inoculated, get tested regularly, socially distance, wear masks and be subject to restrictions on most work travel.

The Department of Labor's Occupational Safety and Health Administration will develop a rule requiring large businesses to mandate vaccinations or subject employees to weekly testing. Violation of the policy could result in penalties of up to $14,000 per violation, according to the official. The rule will ensure those businesses provide paid time off for workers to get vaccinated or to recover from the shot. 

"We have a tool to combat the virus if we can come together as a country and use those tools," Biden said

Biden called on all states to adopt vaccine requirements for all school employees and for large entertainment venues to require proof of vaccine or a negative test for events. 

He announced the Department of Education will provide additional funding to help school districts backfill salaries and other funding withheld by state leaders for implementing COVID-19 safety measures. 

Biden said it was "unacceptable" some elected officials are actively undermining the pandemic response and "keeping us from turning the corner." 

"Talk about bullying in schools," Biden said, referring to Republican governors who took action against schools that encourage vaccinations or defy anti-mask laws. "If these governors won’t help us beat the pandemic, I will use my powers as president to get them out of the way."

The strategy centers on boosting availability of testing by expanding the free pharmacy testing program to 10,000 pharmacies and sending 25 million free at-home rapid tests to community centers and food banks. Biden will use the Defense Production Act, a wartime authority that allows him to direct industry to produce critical equipment, to accelerate the production of rapid coronavirus tests and make at-home tests more affordable.

Biden will continue masking requirements on federal property, and the Transportation Security Administration will double fines for airline passengers who refuse to wear masks on flights.

The president announced other actions regarding support for small businesses affected by the pandemic, improving care for those with COVID-19 and providing relief for overburdened hospitals. 

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Juliette Kayyem, a former Obama administration homeland security official who's called for the Biden administration to restrict unvaccinated people from boarding flights, said vaccinated people should no longer carry the burden for those who resisting rolling up their sleeves. 

"Public health messaging undervalued the urgency in getting the unvaccinated two shots in favor of a process of trying to educate them and understand them," she said. "What I'd like to see from the White House is for it to pivot from begging and cajoling to demanding – because the vaccinated have feelings, too." 

The White House has resisted calls for more broadly mandating that Americans get vaccinated, arguing the president does not have the legal authority. Kayyem pointed to polling from the Kaiser Family Foundation that found a majority of people who said they would "only get vaccinated if required" remain unvaccinated, underscoring the argument for a mandate, even if it leads to legal challenges. 

She said polling shows the majority of Americans favor requiring people to show proof of vaccination for air travel, dining in a restaurant or  going to their office, according to Gallup. An AP/NORC poll found that the majority of American adults want vaccination mandates for sports, concerts, movies and other crowded events.

"The polling suggests that the American public is not only getting impatient with the unvaccinated but is getting impatient with the failure to simply move on from the unvaccinated," she said. 

Roughly 2 in 3 Americans – parents and non-parents alike – are in favor of schools or states implementing mask mandates for teachers and students, according to a USA TODAY/Ipsos poll. Respondents are similarly in favor of requiring teachers and other school employees to be vaccinated against COVID-19: 65% of all participants – and 56% of parents – say they support such mandates, the poll found. 

That frustration is felt by public health officials, according to Besser, who struggle to overcome the politicization of the pandemic and vaccines, as well as the misinformation and mistrust of government. 

"Meeting people where they are is part of it," he said, "but then I think also restricting what people can do – if they're not vaccinated – is also a legitimate strategy." 

An early declaration?

The president used his Fourth of July speech to declare the USA had lived through some of its darkest days but was "about to see our brightest future." That prospect has dimmed as the summer draws to a close and the country has notched more than 40 million COVID-19 cases since the pandemic began. More than 650,000 people have died in the USA, and daily infections and deaths are much higher than they were a year ago. Reports of more children falling ill are raising alarm as students return to in-person learning. 

"I think one of the big communication challenges from the administration was premature declaration of independence from the virus," Besser said. "Because in reality, we don't get to say when we're free of the virus, the virus will show us when we're free of that."

Marcus Plescia, chief medical officer at the Association of State and Territorial Health Officials, said although the country is much better off than a year ago, public health officials probably made missteps around preparation for the delta variant, which tore through other countries as U.S. officials told vaccinated Americans they could return to some semblance of normalcy and attend large gatherings unmasked. 

"We all probably should have realized that the delta variant is coming and we're going to have to get through that," he said. 

Asked whether Biden was too overconfident about his handling of the virus on July 4, White House press secretary Jen Psaki said, "The reason we're here is because people have not gotten vaccinated."

In the months since, the delta variant has fueled a spike that's led to roughly 150,000 cases and nearly 1,500 deaths per day – even though vaccines are widely available. 

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Part of that problem, according to Michael Mina, an epidemiologist at the Harvard T.H. Chan School of Public Health, is the Biden administration's "continual optimism."

"The best thing that we could have possibly done in a pandemic from a messaging perspective – without creating panic – is plan for the worst and hope for the best," he said. "Unfortunately, we keep planning for the best and finding what actually happens is worse than what people and what our officials are saying or expecting." 

Mina said the Biden administration should set better expectations about what to expect from vaccines and be clear that they do not limit the spread. Mandates that require either vaccination or routine testing incorrectly equate the two. 

Julie Morita, a pediatrician and member of Biden's transition COVID-19 advisory board, contended it was appropriate to hone in on vaccines as evidence shows the majority of those who are hospitalized or dying are unvaccinated. 

"We knew heading into this, and I think everyone anticipated there would be some people who would either choose not to get vaccinated or have challenges getting vaccinated," she said. "And yet to reach those groups requires a strong public health infrastructure, which we did not have prior to the pandemic."

Morita, executive vice president of RWJF and a former commissioner for the Chicago Department of Public Health, said a gutted health system was part of Biden's challenge in blunting the spread of the virus. 

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"The scaffolding was very weak to begin with – and the infusion of funding right now will help strengthen it – but it won't be as strong as it needs to be or should be in the long term," she said. 

One of the most difficult challenges, experts said, is the messaging as the colder months ahead drive more Americans indoors and raise the threat of delta thriving.

The Biden administration is moving forward with plans to offer booster shots for vaccinated Americans, a senior administration official said.  The president announced Sept. 20 as the target date, but Pfizer will probably remain the only vaccine that has federal approval by then. The U.S. Food and Drug Administration is scheduled to meet Sept. 17 to review booster shot data. 

"Our patience is wearing thin, and the refusal has cost all of us," Biden said.

Contributing: Maureen Groppe, Joey Garrison