Sweeping New Vaccine Mandates Will Impact Most US Workers

Brenda Goodman, MA

September 09, 2021

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

President Joe Biden on Thursday announced a host of new plans to rein in COVID-19's runaway transmission in the United States, including sweeping vaccine mandates that will affect 100 million American workers, nearly two thirds of the country's workforce.

"As your President, I'm announcing tonight a new plan to get more Americans vaccinated to combat those blocking public health," he said.

President Joe Biden

As part of a six-part plan unveiled in a speech from the State Dining Room of the White House, Biden said he would require vaccinations for nearly 4 million federal workers and the employees of companies that contract with the federal government.

He has also directed the Occupational Safety and Health Administration to develop a rule that will require larger employers — those with at least 100 employees — to ensure their workers are vaccinated or tested weekly. Nearly 17 million healthcare workers will face new vaccine mandates as part of the conditions of participation in the Medicare and Medicaid programs. 

Biden said the federal government will require staff at federally funded Head Start programs and schools to be vaccinated. He's also calling on all states to mandate vaccines for teachers.

"A distinct minority of Americans, supported by a distinct minority of elected officials, are keeping us from turning the corner," Biden said. "These pandemic politics, as I refer to them, are making people sick, causing unvaccinated people to die."

One public health official said he was glad to see the president's bold action.

"What I saw today was the federal government trying to use its powers to create greater safety in the American population," said Ashish K. Jha, MD, MPH, dean of the School of Public Health at Brown University, Providence, Rhode Island, in a call with reporters after the speech.

National Nurses United, the largest union of registered nurses in the US, issued a statement in support of Biden's new vaccination requirements, but pushed back on his language.

"…as advocates for public health, registered nurses want to be extremely clear: There is no such thing as a pandemic of only the unvaccinated. The science of epidemiology tells us there is just one deadly, global pandemic that has not yet ended, and we are all in it together. To get out of it, we must act together. All of us," the statement says.

A host of other professional groups, including the American Medical Association and the Association of State and Territorial Health Officials, also issued statements of support for Biden’s plan.

But the plan was not well received by all.

"I will pursue every legal option available to the state of Georgia to stop this blatantly unlawful overreach by the Biden Administration," said Georgia Governor Brian Kemp (R) in a tweet.


The National Council for Occupational Safety and Health called the plan "a missed opportunity" because it failed to include workplace protections for essential workers such as grocery, postal, and transit workers.

"Social distancing, improved ventilation, shift rotation, and protective equipment to reduce exposure are important components of an overall plan to reduce risk and stop the virus. These tools are missing from the new steps President Biden announced today," said Jessica Martinez, co-executive director of the group.

In addition to the new vaccination requirements, Biden said extra doses would be on the way starting September 20 for people who have already been fully vaccinated in order to protect against waning immunity. But he noted that those plans would be contingent on the US Food and Drug Administration's approval for third doses and the Centers for Disease Contol and Prevention's recommendation of the shots.

Biden pledged to use the Defense Production Act to ramp up production of at-home tests, which have been selling out across the nation as the Delta variant spreads.

He also announced plans to expand access to COVID testing, including offering testing for free at thousands of pharmacies nationwide and getting major retailers to sell at-home COVID tests at cost. 

The BinaxNow test kit, which currently retails for $23.99, will now cost about $15 for two tests at Kroger, Amazon, and Walmart, according to the White House. Food banks and community health centers will get free tests, too.

He called on states to set up COVID-19 testing programs at all schools.

Jha said that in his view, the game-changing news out of the president's speech was the expansion of testing.

"Our country has failed to deploy tests in a way that can really bring this pandemic under control," he said. "There are plenty of reasons, data, experience to indicate that if these were widely available, it would make a dramatic difference in reducing infection numbers across our country."

Jha said the private market had not worked effectively to make testing more widely available, so it was "absolutely a requirement of the federal government to step in and make testing more widely available," he said.

New Stimulus

Biden announced new economic stimulus programs, saying he's expanding loan programs to small businesses and streamlining the loan forgiveness process.

The president said he's boosting help for overburdened hospitals, doubling the number of federal surge response teams sent to hard-hit areas to reduce the strain on local healthcare workers. He said he would increase the pace of antibody treatments to states by 50%.

"We made so much progress during the past 7 months of this pandemic. Even so, we remain at a critical moment, a critical time," he said. "We have the tools. Now, we just have to finish the job with truth, with science, with confidence and together as one nation."

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