President Biden’s new coronavirus vaccine mandates will have sweeping ramifications for businesses, schools and the political discourse in the United States. But for many scientists, the question is a simpler one: Will these measures turn back a surging pandemic?
The answer: Yes, in the longer term.
It has become clear that the nation cannot hope to end the pandemic with some 37 percent of Americans not having received a single dose of Covid vaccine, several experts said in interviews. Cases and hospitalizations are only expected to rise as Americans move indoors in homes, schools and offices in the cooling weather.
The administration’s new plan should stem the flood of infections and return the country to some semblance of normalcy over the longer term, the researchers said.
“It’s going to fundamentally shift the arc of the current surge,” said Dr. Ashish Jha, dean of Brown University School of Public Health. “It’s exactly what’s needed at this moment.”
The vaccine mandates will protect millions more people, particularly against severe disease, and relieve pressure on the health care system, said Natalie Dean, a biostatistician at Emory University. “It also sets a precedent for other organizations to make similar decisions” about mandates, she said.
But some experts cautioned that the results from the aggressive plan would take many weeks to unfold. Immunization is not an instant process — at least six weeks for a two-dose vaccine — and the administration did not emphasize the measures that work more quickly: masking and widespread rapid testing, for example.
The nation has been overtaken by the contagious Delta variant, a far more formidable foe than the original version of the virus. The optimism of the spring and early summer gave way to dread as experts observed the variant’s march across Asia and Europe, sending rates soaring even in Britain, which had successfully protected most of its older adults.
The variant became the dominant version of the virus in the United States only in mid-July, and the consequences have been beyond anything experts predicted. Reassuringly low numbers of cases and hospitalizations in June have risen inexorably for weeks to nearly 10-fold their levels. About 1,500 Americans, the vast majority of them unvaccinated, are dying each day.
The mandates arrived on Thursday after weeks of arguments from public health experts that the federal government must do much more to raise vaccination rates.
The administration’s mandates will affect nearly 100 million Americans. Among them are health care workers. The administration will require that any provider receiving Medicaid or Medicare funding impose a vaccination requirement on staff.
This is the measure mostly likely to have an immediate impact, experts said, because health care facilities are high-risk settings for transmission. And there is ample historical precedent for the decision to hold hospitals to certain standards — notably, the historical directive to desegregate patients by race, said Dr. Jha.
“We have a real dearth of leadership from health care systems that have not mandated within their own organizations, and it is imperative that the president require that patients be protected,” he added.
The requirement may drive some health care and nursing home workers, particularly many who are close to retirement age, to leave the profession. Even so, there is more to be gained than lost by the mandates, said Dr. Nahid Bhadelia, founding director of Boston University’s Center for Emerging Infectious Diseases Policy and Research.
“This is an important step to get us out of the pandemic,” she said. “The very people who are taking care of the vulnerable coming into the hospital need to be our first line of defense.”
The Labor Department will require all private-sector businesses with more than 100 employees to require that their workforces be fully vaccinated or be tested at least once a week. Employers will be required to give paid time off to employees to get vaccinated.
That move alone will affect 80 million Americans; it’s not clear how many are already vaccinated. In any event, the effects will not be immediately evident.
Given the time required between the first two doses of the vaccine, and then for immunity to build up, the effect of all these mandates is unlikely to be felt for many weeks, said Bill Hanage, an epidemiologist at Harvard University.
And Dr. Hanage was skeptical that the mandates would be successful in inoculating millions more people than have already opted for the vaccine. Some of the people who most urgently need to be protected are older adults who will not be affected by workplace requirements.
“I’m sure that the anti-vaxxers are already prepared to be up in arms about this,” he said. (Republican governors in several states have decried the mandates as unconstitutional and say they plan to file suits to stop them.)
By insisting that vaccination is the way out of the pandemic, officials in both the Trump and Biden administrations have de-emphasized the importance of masks and testing in controlling the pandemic, several experts said.
“It’s a lot quicker to put on a mask than it is to get a bunch of people vaccinated,” Dr. Hanage said.
President Biden, in his first remarks since unveiling an extensive plan to push two-thirds of American workers to be vaccinated against the coronavirus, said Friday that his sweeping mandates would withstand challenges by Republicans who said they plan to defy them.
“Have at it,” said Mr. Biden, who was delivering remarks at a middle school in Washington, D.C. “I am so disappointed, particularly that some of the Republican governors have been so cavalier with the health of these kids, so cavalier with the health of their communities.”
A day earlier, the president unveiled a series of sweeping actions through a combination of executive orders and new federal rules. His administration moved to mandate shots for health care workers, federal contractors and the vast majority of federal workers, who could face disciplinary measures if they refuse.
“I do not know of any scientist out there in this field that does not think it makes considerable sense to do the six things I have suggested,” Mr. Biden added.
Republicans quickly moved to call the Biden administration’s plan unconstitutional, and a handful of Republican governors, including Brian Kemp of Georgia, have threatened to challenge the mandates in court. Ronna McDaniel, the chairwoman of the Republican National Committee, said on Twitter that her organization would sue the Biden administration.
Legal experts say that broad provisions given to the federal government and the public health emergency caused by the coronavirus could ultimately protect against legal challenges. Jennifer Shinall, a law professor at Vanderbilt University, said in an interview that the mandate for federal workers is almost certain to encounter lawsuits, but these are likely to fail.
“As long as there are provisions for workers not healthy enough to get the vaccine and probably to some extent religious accommodations,” Ms. Shinall said, “I think that the legal challenges fail.”
Initially reluctant to enact mandates, Mr. Biden is now moving more aggressively than any other president in modern history to require vaccination. There is substantial focus on keeping schools safely reopened for in-person learning: The slate of new requirements would apply to those who teach in Head Start programs, Department of Defense Schools, and schools operated by the Bureau of Indian Education. Collectively, those schools serve more than 1 million children and employ nearly 300,000 staff, according to the plan released by administration officials.
The president traveled to Brookland Middle School on Friday with Jill Biden, the first lady, a college professor who returned to teaching this week. Her return to the classroom will give one of the most influential people in the White House the ability to speak firsthand about the challenges administrators, teachers and students are facing.
“We cannot always know what the future holds, but we do know what we owe our children,” Dr. Biden said on Friday. “We owe them a promise to keep their schools open as safe as possible. We owe them a commitment to follow the science.”
Republican governors across the country assailed President Biden’s aggressive moves to require vaccinations as an unconstitutional attack on personal freedoms and vowed to sue the administration to block the requirements.
The vaccine mandates Mr. Biden announced on Thursday, affecting tens of millions of private sector employees, health care workers, federal contractors and most federal workers, quickly poured gasoline on a political battle between the administration and Republican governors who have spent months fighting against mask rules and other pandemic restrictions even as infections and deaths surged in their states this summer.
Now, they are arguing that Mr. Biden’s plan is a big-government attack on states’ rights, private business and personal choice, and promise swift legal action to challenge it, setting up a high-stakes constitutional showdown over the president’s powers to curb the pandemic.
“@JoeBiden see you in court,” Gov. Kristi Noem of South Dakota wrote on Twitter. Gov. Mark Gordon of Wyoming said the new rule “has no place in America,” and said he had asked the state’s attorney general to be ready to take legal action.
South Dakota will stand up to defend freedom. @JoeBiden see you in court.
— Governor Kristi Noem (@govkristinoem) September 9, 2021
In Texas, Attorney General Ken Paxton questioned President Biden’s authority to require vaccinations or weekly testing at private businesses with more than 100 workers.
“I don’t believe he has the authority to just dictate again from the presidency that every worker in America that works for a large company or a small company has to get a vaccine,” Mr. Paxton said, speaking on a radio show hosted by Steve Bannon, who served as a strategist for Donald J. Trump during part of his presidency. “That is outside the role of the president to dictate.”
Mr. Paxton, a vigorous supporter of the sweeping new antiabortion law in Texas, promised to “fight back” in a message on Twitter: “Not on my watch in Texas.”
The Federal Gov’t is trying to dictate everything. You have my word, I will fight back on every one of his unconstitutional mandates. Not on my watch in Texas. https://t.co/TGAjXsbYba
— Attorney General Ken Paxton (@KenPaxtonTX) September 10, 2021
Mr. Biden had anticipated the attacks. In announcing his plan on Thursday, he said that he would do what he could to “require more Americans to be vaccinated to combat those blocking public health,” adding “If those governors won’t help us beat the pandemic, I will use my power as president to get them out of the way.”
On Friday, Mr. Biden said that his mandates would withstand Republican challenges.
“Have at it,” said Mr. Biden, who was delivering remarks at a middle school in Washington. “I am so disappointed, particularly that some of the Republican governors have been so cavalier with the health of these kids, so cavalier with the health of their communities.”
Gov. Greg Abbott of Texas called the actions an “assault on private businesses” in a statement on Twitter. He said he issued an executive order protecting Texans’ right to choose whether or not they would be vaccinated. “Texas is already working to halt this power grab,” he wrote.
Gov. Doug Ducey of Arizona wrote on Twitter: “The Biden-Harris administration is hammering down on private businesses and individual freedoms in an unprecedented and dangerous way.” He questioned how many workers would be displaced, businesses fined, and children kept out of the classroom because of the mandates, and he vowed to push back.
Mr. Biden’s vaccination requirements will be imposed by the Department of Labor and its Occupational Safety and Health Administration, which is drafting an emergency temporary standard to carry out the mandate, according to the White House.
OSHA oversees workplace safety, which the agency is likely to contend extends to vaccine mandates. The agency has issued other guidelines for pandemic precautions, such as a rule in June requiring health care employers to provide protective equipment, provide adequate ventilation and ensure social distancing, among other measures.
The vaccine requirements, drew praise from doctors and scientists who have for months stressed the urgency of increasing vaccination rates to contain the spread of the highly contagious Delta variant, which has raised the national caseload to heights last seen in January, overwhelmed hospitals in hard-hit areas and contributed to the deaths, on average, of more than 1,575 people a day.
However, the nation is so deeply polarized politically that even experts seemed split on how effective Mr. Biden’s plan would be.
Dr. Georges C. Benjamin, executive director of the American Public Health Association, said the actions might be “too little, too late,” and warned that Americans opposed to vaccination might dig in and bristle at being told what to do. The American Hospital Association was cautious, warning that of the possibility of “exacerbating the severe work force shortage problems that currently exist.”
But Dr. William Schaffner, an infectious disease expert at Vanderbilt University, likened the vaccination requirements to military service in a time of war.
“To date, we have relied on a volunteer army,” Dr. Schaffner said. “But particularly with the Delta variant, the enemy has been reinforced, and now a volunteer army is not sufficient. We need to institute a draft.”
After a giant Hindu pilgrimage contributed to a catastrophic coronavirus surge this spring, some states in India are preparing for a new season of religious festivals by imposing crowd limits, as experts warn of the threat of a third wave of infections.
Several festivals taking place in September and October typically draw large crowds to temples, processions and markets. In the past, the authorities have struggled to get devotees to follow health protocols. The Kumbh Mela, which drew millions of pilgrims to the banks of the Ganges River in the spring with hardly any testing or social distancing, was widely blamed for spreading the virus, as pilgrims carried infections back to their villages and towns.
Prime Minister Narendra Modi’s Hindu nationalist government faced criticism for allowing the Kumbh Mela to take place despite warnings that it would become a super-spreading event. Last month, Mr. Modi’s government asked states to take “suitable measures to avoid large gatherings during the coming festive season,” and to impose local restrictions if needed.
At a news conference last week, Dr. V.K. Paul, head of the national Covid-19 task force, reinforced the warning, saying: “We shall celebrate the festivals within the family — we should not have big gatherings.”
States have responded with varying measures in the days before a festival celebrating Ganesh, the Hindu elephant god. In the southwestern state of Karnataka, the government said that gatherings should be capped at 20 people, and imposed a 9 p.m. curfew. In the southern state of Tamil Nadu, officials announced a ban on large celebrations, and offered payments to idol-making potters whose businesses would be badly affected.
The western state of Maharashtra, among the worst hit by the spring Covid wave, draws some of the biggest crowds for the festival, known as Ganesh Chaturthi. In Mumbai, the state capital, the authorities issued guidelines limiting processions to 10 people, all of whom must be fully vaccinated and masked, news media reported.
Although India’s outbreak has eased, the country continues to report nearly 40,000 new cases and nearly 400 deaths daily. With Covid fatigue kicking in and the economy still flailing, many states are reluctant to impose strict restrictions. Prime Minister Narendra Modi’s government has bet that a ramped-up vaccination drive can boost immunity and keep another wave from being as deadly as the last.
With localized virus surges taking place in a handful of states, Dr. Lahariya said that continued restrictions could help prevent a nationwide third wave as India’s vaccination rates remain relatively low.
After a slow start to vaccinations, India has administered more than eight million doses per day over the past week. More than 700 million doses have been given nationwide, but less than one-fifth of the country’s roughly 900 million adults are fully vaccinated, according to official statistics.
While parts of the United States and Europe have recently tightened pandemic restrictions, and New Zealand sticks to its goal of zero coronavirus cases, a growing number of places in the Asia-Pacific region are moving in a different direction: preparing for a life with some level of Covid infections.
Leaders in Singapore, South Korea, Australia, Japan, Indonesia, Malaysia, Vietnam and Hong Kong recently announced they will begin easing restrictions in the coming months, even as cases have risen in some areas.
Singapore opened its borders to more countries and loosened quarantine rules for some inbound travelers on Friday. Its daily case count on Thursday surged to over 400 for the first time since August 2020, but the number of severe cases has leveled off at an average of 23 per day this week, according to data released by Singapore’s Ministry of Health.
Hong Kong, which has maintained some of the strictest rules in the world, began allowing residents from mainland China to enter the city without the need to quarantine starting Wednesday.
In Vietnam, officials in Ho Chi Minh City, the epicenter of the country’s outbreak, said they planned to allow economic activity to resume in the city next week.
“We cannot resort to quarantine and lockdown measures forever,” Prime Minister Pham Minh Chinh said last week, Reuters reported. “The Covid-19 pandemic is evolving in a complicated and unpredictable manner and may last for a long time.”
A large factor that has enabled these places to start reopening is the accelerating rollout of vaccines, which have reduced the risk of severe illness and death.
In South Korea, Son Young-rae, a health official, said the health ministry would begin incrementally reopening the country in November, when 70 percent of the population is expected to be fully vaccinated.
Officials in the Japanese government are also considering easing restrictions on travel and large gatherings in November, Kyodo News reported Wednesday. Prime Minister Yoshihide Suga said last month that nearly 60 percent of the Japanese population will likely be fully vaccinated by the end of September.
While officials remain alert in Indonesia, the country eased restrictions in the past few weeks as cases fell. Officials in Malaysia said they aim to vaccinate 80 percent of adults by the end of this month and loosen restrictions by the end of October.
And in Australia, Prime Minister Scott Morrison said that the country must abandon its zero-Covid strategy at some point. “Cases will not be the issue” once 70 percent of the population is vaccinated, he said last month. “Dealing with serious illness, hospitalization, ICU capabilities, our ability to respond in those circumstances, that will be our goal.”
Some places continued to struggle with increasing cases as vaccination drives remain slow.
Taiwan, for example, has recently seen clusters of the Delta variant grow near the capital, according to Dr. Ruby Huang of National Taiwan University. Earlier this week, the island received its first batch of Pfizer-BioNTech vaccines after months of trying to strike a deal.
The governments of Malaysia and the Philippines have also faced vaccine shortages and maintained their pandemic restrictions. Earlier this summer, President Rodrigo Duterte of the Philippines said that those refusing to take the vaccine should not be allowed to leave their homes. The country has fully vaccinated 15 percent of its population, according to Our World in Data, a data tracking project.
As Britain’s vaccine watchdog deliberates whether to introduce a booster program for healthy people vaccinated against the coronavirus, Prof. Sarah Gilbert of Oxford University, who led the development of the AstraZeneca vaccine, said on Thursday that a third dose was unnecessary for most.
Prof. Gilbert said in an interview with The Daily Telegraph that booster shots should be prioritized only for the immunocompromised and elderly, because in most people, the immunity from two doses is holding up. “We need to get vaccines to countries where few of the population have been vaccinated so far,” she said. “We have to do better in this regard. The first dose has the most impact.”
The comments came as Britain’s medicine regulator recommended on Wednesday that both the Pfizer and AstraZeneca vaccines could be used as “safe and effective” booster doses.
The regulator’s chief executive, Dr. June Raine, said in a statement that it would now be up to Britain’s vaccines watchdog, the Joint Committee on Vaccination and Immunization, “to advise on whether booster jabs will be given and if so, which vaccines should be used.”
Britain’s health secretary, Sajid Javid, announced this month that a third vaccine dose would be offered to those with severely compromised immune systems, aged 12 and over. The vaccination committee is deliberating whether to roll out boosters more widely, ahead of a winter season that may bring a rise in the number of coronavirus cases.
Several countries have already begun giving booster shots to healthy vaccinated people, or will start this month. But ethical questions about vaccine inequalities have been raised, as these programs are limited to wealthier nations.
The World Health Organization has called for a moratorium on booster shots for healthy people until the end of September to free up vaccine supplies so that low-income nations can vaccinate at least 10 percent of their populations. But several wealthy nations have said they would not wait that long.
Coronavirus infections are more than ten times higher than they need to be in order to end the pandemic, Dr. Anthony S. Fauci, the nation’s top infectious disease doctor, told the political news site Axios.
There are currently roughly 150,000 new infections a day in the United States. “That’s not even modestly good control,” Dr. Fauci told Axios.
He added, “In a country of our size, you can’t be hanging around and having 100,000 infections a day. You’ve got to get well below 10,000 before you start feeling comfortable.”
Case rates did fall to almost that level in June, when there were roughly 12,000 new infections per day, on average.
But that was before the highly infectious Delta variant spread widely throughout the country, causing a major surge in cases and hospitalizations, especially in areas of the country with low vaccination rates.
That surge has also impacted children, who are currently being hospitalized at the highest levels reported to date, with nearly 30,000 entering hospitals in August. No vaccine has been cleared for children younger than 12, who make up a sizable unvaccinated population in the United States.
In an interview with Apoorva Mandavilli, a New York Times reporter who covers science and global health, Dr. Fauci said that “we are still in the middle of a serious pandemic, and it is definitely involving children.”
“We’re seeing more children in the hospital now, because the Delta variant is more readily transmissible among everybody, adults and children,” Dr. Fauci said in the interview, which appeared on The Times’s website on Thursday.
Children still remain markedly less likely to be hospitalized or die from Covid-19 than adults, especially older adults. But experts say that the growing number of hospitalized children, however small compared with adults, should not be an afterthought, and should instead encourage communities to work harder to protect their youngest residents.
Although concerns have been growing about breakthrough infections, which officials acknowledge are not as rare as they once indicated, the vaccines continue to provide robust protection against the worst outcomes, including hospitalization and death.
Vaccination remains the best path out of the pandemic, experts and health officials have repeatedly said. “The endgame is to suppress the virus,” Dr. Fauci told Axios. “Right now, we’re still in pandemic mode.”
Emily Anthes and
The makers of the Pfizer-BioNTech vaccine will soon ask regulators to clearance its use in children 5 years and over, and are getting ready to make smaller doses of the vaccine for younger children, according to one of the founders of BioNTech, the German company that developed the vaccine in partnership with Pfizer.
“We will be presenting the results from our study on five- to 11-year-olds to authorities around the world in the coming weeks,” Ozlem Tureci, the co-founder of BioNTech and its chief medical officer, told Der Spiegel, a German news site, in an interview published on Friday. She added that the company would be applying for clearance of the use of the vaccine for that age group, including in Europe.
Both the European Union and the United States cleared the Pfizer vaccine for use in children 12 and over in May. They have not cleared any coronavirus vaccines for children younger than 12.
Dr. Tureci, who founded BioNTech with her husband, Ugur Sahin, said the companies were preparing to make smaller doses of the vaccine in anticipation of cleareance by authorities.
Dr. Sahin, who is BioNTech’s chief executive, urged anyone who is eligible for vaccination to get their doses before an anticipated wave of infections this fall.
“There are still about 60 days left for us as a society to avoid a tough winter,” he said.
On Monday, as New York City students fully return to public schools, the city’s entire municipal labor force, the largest in the nation, will return to work.
Mayor Bill de Blasio has ordered the city’s more than 300,000 employees to report to work five days a week, with no general hybrid or remote option. The move will be closely watched in cities around the nation, as the mayor navigates a thicket of safety procedures.
Office workers will have to be vaccinated or submit to weekly testing, and masks will be required in most indoor communal settings. Social distancing will not be required, except where workers are interacting with the public.
The move has been met by significant resistance from unionized workers. But Mr. de Blasio has been determined to restore the city to some semblance of its prepandemic existence, and he believes that returning to work will greatly help efforts to revive the city’s economy.
The New York Times interviewed roughly a dozen city employees, and all but one disapproved of the mayor’s plan. Many worried about working in cramped, open work spaces with unvaccinated colleagues; others wondered how they would balance their child-care responsibilities, should their children have to quarantine following an in-school exposure. Several workers interviewed, who sought anonymity because they were not authorized to speak publicly, said that they or their colleagues would be likely to start looking for other jobs with more flexible work-from-home policies.
“To me, this is crazy,” Henry Garrido, executive director of the city’s largest public union, District Council 37, said in an interview. “Because at this point, there’s a new reality.”
Jeffery C. Mays contributed reporting.
As disease and death reigned around them, some Americans declared that they would never get vaccinated and raged at government efforts to compel them. Anti-vaccination groups spread propaganda about terrible side effects and corrupt doctors. State officials tried to ban mandates, and people made fake vaccination certificates to evade inoculation rules already in place.
The years were 1898 to 1903, and the disease was smallpox. News articles and health board reports describe crowds of parents marching to schoolhouses to demand that their unvaccinated children be allowed in, said Michael Willrich, a professor of history at Brandeis University, with some even burning their own arms with nitric acid to mimic the characteristic scar left by the smallpox vaccine.
“People went to some pretty extraordinary lengths not to comply,” said Professor Willrich, who wrote a book about the civil liberties battles prompted by the epidemic.
If it all sounds familiar, well, there is nothing new under the sun: not years that feel like centuries, not the wailing and gnashing of teeth over masks, and not vaccine mandates either.
As the coronavirus overwhelms hospitals across the South and more than 650,000 Americans — an increasing number of them children — lie dead, the same pattern is emerging. On Thursday, President Biden announced that he would require most federal workers and contractors to be vaccinated and, more sweepingly, that all employers with 100 or more employees would have to mandate vaccines or weekly testing. Colleges, businesses and local governments have enacted mandates at a steady pace, and conservative anger has built accordingly.
On Monday, Representative Jim Jordan, Republican of Ohio, tweeted that vaccine mandates were “un-American.” In reality, they are a time-honored American tradition.
But to be fair, so is public fury over them.
“We’re really seeing a lot of echoes of the smallpox era,” said Elena Conis, an associate professor and historian of medicine at the University of California, Berkeley. “Mandates elicit resistance. They always have.”
None of it is new, but one thing distinguishes today’s anti-vaccination protesters from those of the past. The opposition was always political. It wasn’t always partisan.
When the first wave of coronavirus spread across the country in the spring of 2020, it ravaged the economy, pushing millions of low-income tenants to the brink of eviction. Over the next year, Congress responded with a series of relief packages that included a $46.5 billion fund for emergency rental assistance.
But the promise of that help has long since given way to confusion and desperation as national eviction protections lapse and the vast majority of that rental assistance sits unspent, precipitating the precise crisis Washington had hoped to avoid.
On Friday, the House Financial Services Committee will hold a hearing to examine the shortcomings of the fund, known as the Emergency Rental Assistance Program, which had only distributed a fraction of its total funding by Aug. 1, according to the Treasury Department.
The Supreme Court’s decision to strike down the national moratorium on evictions last month has transformed a vexing administrative problem into an acute human crisis, placing at least 2 million renters in immediate danger of eviction, according to one estimate.
Federal and local officials, housing experts, landlords and tenants cited an array of problems that slowed the flow of aid: bureaucratic missteps at all levels of government, onerous applications, resistance from landlords, the reluctance of local officials to ease eligibility requirements for the poor, difficulty raising awareness that rental aid even existed, and a steep rise in rents that increased the incentive for kicking out low-income tenants.
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