As COVID-19 infections climb, vaccine mandates follow

Public and private sector vaccine mandates are gaining steam amid the nationwide surge of COVID-19 infections, which is driven largely by the spread of the virus's delta variant among the unvaccinated.

After months spent trying to coax and cajole the reluctant into getting vaccinated with million-dollar lotteries, free beer or even college scholarships, local governments, businesses and universities are now looking to force the issue.

New York City this week became the first locality to require proof of at least one vaccine dose for anyone who wants to participate in indoor activities such as dining in restaurants, working out in gyms and attending theater performances.

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The policy from Mayor Bill de BlasioBill de BlasioThe Hill's Morning Report - Presented by Uber - Biden makes his pitch as tax questions mount Hochul gets early boost as NY gubernatorial race takes shape Overnight Health Care — Presented by Carequest — Boosters take a big step forward MORE (D) came just one day after he mandated that all city employees and contractors get vaccinated or face weekly testing and other restrictions.

Maryland and Virginia both announced on Thursday that shots will soon be mandatory for any state worker who doesn't want to undergo regular testing, while California will require all health care employees to be fully vaccinated by Sept. 30 without the option of submitting to weekly virus testing instead.

The Biden administration, which does not have the power to enact a national mandate, has wholeheartedly embraced the moves after months of encouragement from the sidelines.

"Our message is quite simple. We support these vaccination requirements to protect workers, communities and the country," White House coronavirus response coordinator Jeff ZientsJeff ZientsIndustry groups warn vaccine mandate could worsen holiday supply chain issues Walensky: CDC will 'not articulate a preference' for which booster to get White House details plans for vaccinating children ages 5 to 11 MORE said Thursday.

The administration is also moving forward with its own requirement that federal workers need to attest their vaccination status, under penalty of law. Those who are not fully vaccinated will be subject to mandatory mask wearing and social distancing requirements and will be ineligible for official travel.

Health experts hope the mandates represent a tipping point in the nation's fight against the coronavirus.

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New infections have been skyrocketing; according to the Centers for Disease Control and Prevention (CDC), the U.S. averaged nearly 90,000 new cases a day over the past week.

Vaccinations are the way out, and experts say sometimes the stick is more effective than the carrot.

"I've been working in public health for three decades. I've never seen the kinds of sweeping mandates in the city, state and private sector that we're seeing today," said Lawrence Gostin, a professor of global health law at Georgetown University Law Center. "Not for smallpox, not for polio, not for influenza. So this is unprecedented, and if there's a snowball effect, as I hope there will be, it could really get us very close to where we need to be to get back to a more normal life."

But Gostin and other experts are cautioning that the administration's long-standing hands-off approach could complicate the effort.

Federal officials had previously been reluctant to involve themselves in an issue such as vaccine requirements and have still not given any kind of guidance or support to businesses that want to require proof of vaccination for customers or employees.

The result is likely to be an inconsistent checkerboard of verification methods.

New York has two different electronic verification methods, along with the paper card given by the CDC. Individual colleges and universities have developed their own systems. The federal government is using an online "certificate of vaccination," and some restaurants in Washington, D.C., are now asking to see customers' physical vaccine cards.

In the corporate world, United Airlines on Friday said it would require all U.S.-based employees to get vaccinated and provide proof of their vaccination, becoming the first domestic airline to do so. 

Hospital systems and long-term care facilities are also implementing mandates, including the Mayo Clinic and Kaiser Permanente, and tech companies such as Facebook and Google will require employees to be vaccinated before returning to the office.

When asked during a press briefing whether there would be any technical support forthcoming for small businesses, Surgeon General Vivek MurthyVivek MurthyFauci says it's recommended to get same vaccine for COVID-19 boosters CDC director signs off on boosters of Johnson & Johnson, Moderna COVID-19 vaccines Overnight Health Care — Presented by Carequest — Boosters take a big step forward MORE merely praised the efforts of the private sector.

"We know this is not something that the federal government is leading, but we are happy to see the private sector leaning in, taking initiative on that, and I think this is going to be increasingly important because we know that more institutions are considering the vaccine requirements," Murthy said.

Public support for vaccine mandates has been mixed and broadly falls along political lines.

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"Not surprisingly, people who are vaccinated are in favor of them, and people who are unvaccinated are not in favor of them," said Liz Hamel, director of public opinion and survey research at the Kaiser Family Foundation (KFF).

According to KFF's most recent poll, 68 percent of vaccinated adults and 75 percent of Democrats said the federal government should issue a vaccine mandate, Meanwhile, 81 percent of unvaccinated adults and 67 percent of Republicans said it should not.

Polls also show that young adults in particular would be motivated to get vaccinated if it was required in certain instances, such as at sporting events or concerts, on an airplane, or for international travel.

According to Kaiser, the people who would get the vaccine only if it was required mainly say they don’t want or feel the need for the vaccine. They are not opposed to it — they just might not do it unless someone forced their hand.

Still, employer mandates and vaccine passports can help only if they are enforced, and there's a red line of Republican governors opposed to the idea. 

Many GOP governors preemptively banned mandates and passports in any form, including from private employers.

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“It’s not something I support,”  Florida Gov. Ron DeSantisRon DeSantisArizona attorney general asks for restraining order to block federal vaccine mandate The Hill's Morning Report - Presented by Uber - Manchin, Sanders in budget feud; Biden still upbeat Overnight Health Care — Presented by Carequest — Key CDC panel backs Moderna, J&J boosters MORE (R) said Thursday when asked about hospitals mandating employer vaccination.

There will also likely be legal challenges, although both the Department of Justice and the Equal Employment Opportunity Commission have ruled that businesses may lawfully require workers to get a COVID-19 vaccine as a condition of coming to the workplace. 

A federal judge last month tossed a lawsuit against Houston Methodist Hospital filed by a group of employees, ruling that making vaccinations a condition of employment was not coercion. 

An attorney for students suing Indiana University asked the Supreme Court on Friday to block the school's vaccine requirement for students after a series of lower courts all ruled in favor of the school — including an appeals panel of Republican-appointed judges.