Biden Weighs Vaccine Mandate for Federal Workers

WASHINGTON — President Biden, in what would be a significant shift in approach, is considering requiring all civilian federal employees to be vaccinated against the coronavirus or be forced to submit to regular testing, social distancing, mask requirements and restrictions on most travel, officials said on Tuesday.

White House officials said they would reveal more about the president’s plans later this week. Mr. Biden said he would deliver a speech on Thursday about “the next steps in our effort to get more Americans vaccinated.”

The deliberations reflect growing concern among top federal health officials about the spread of the highly contagious Delta variant, which poses a special threat to children, older Americans and those with weakened immune systems, including cancer patients. But that concern, officials said, must be balanced against the threat of a backlash that could drive opposition to vaccination.

Asked by a reporter on Tuesday whether he would require vaccinations for the nation’s nearly two million federal workers, Mr. Biden was blunt.

“That’s under consideration right now,” he said, adding, “But if you’re not vaccinated, you’re not nearly as smart as I thought you were.”

Mr. Biden did not provide details, but administration officials said the idea being debated was similar to a mandate New York City announced on Monday, which would require all 300,000 city employees to be vaccinated or submit to weekly testing.

It was not clear if Mr. Biden was planning something similar for the military, although he does have the authority to do so. Defense Secretary Lloyd J. Austin III has said he would not be comfortable with a mandate until the Food and Drug Administration fully approved the vaccine.

The officials said that there was no consideration of simply firing federal employees who refuse to get vaccinated, but that the government could add burdens or restrictions — like extensive testing or a ban on all but essential travel — for those who do not willingly get the protections. They said there was evidence that making life inconvenient for those who refuse the vaccine works reasonably well to increase inoculation rates.

The move underscores the need by Mr. Biden and his top health advisers to grapple with the limits of his legal authority when it comes to forcing Americans to get vaccinated. Aides say the president has no power to simply order all Americans to get a shot, and he cannot require children to be vaccinated as a condition of attending school; that is a function reserved for state or local governments.

But the rapidly spreading variant is forcing the administration to move just as quickly to adjust its response to a pandemic that has already killed more than 600,000 Americans and is once again surging in parts of the country where vaccination rates are low.

On Tuesday, the Centers for Disease Control and Prevention revised its guidance and recommended that vaccinated people wear masks indoors in certain parts of the country — a change that follows reports of rising breakthrough infections with the Delta variant in people who were fully immunized.

At the White House, staff members were instructed to start wearing masks indoors again.

Around the country, mayors, chief executives, hospital administrators and college presidents are requiring vaccinations, even for those who have refused to voluntarily roll up their sleeves. In California, Gov. Gavin Newsom said the state’s 246,000 employees would have to be vaccinated by Aug. 2 or would be tested at least once a week.

But such a move is politically fraught. On Capitol Hill, three Republicans — Senators Charles E. Grassley of Iowa, James Lankford of Oklahoma and Bill Cassidy of Louisiana — said Mr. Biden would have to offer more scientific evidence before requiring vaccination.

Mr. Cassidy, a medical doctor, was the most charitable, saying that imposing requirements such as mask wearing and social distancing in lieu of vaccination would be “consistent with what hospitals do with other types of vaccines.” But Mr. Grassley and Mr. Lankford balked.

“This is America,” Mr. Grassley said. “You can’t force people to get vaccinated.”

In fact, all 50 states have laws requiring children to be vaccinated against certain diseases before enrolling in school. And inside the West Wing, Mr. Biden’s top public health experts are furiously debating the right path forward as the Delta variant spreads.

Aides said the discussion inside the White House was similar to the one raging outside, with some of Mr. Biden’s top health experts arguing for a more forceful approach that embraces vaccine mandates. Others are cautioning that the president could inadvertently incite a dangerous political backlash by wading into the culture wars that surround the idea of forcing people to get a shot.

Just weeks ago, Jen Psaki, the president’s press secretary, refused to endorse vaccine mandates by private employers or other institutions, saying that “we’re going to leave it up to them to make these decisions.” Now, two White House officials said that all options were being discussed as the White House took account of the evolving forms of the virus.

On Monday, the Department of Veterans Affairs announced that it would require vaccines for some workers at its network of hospitals, a first for the federal government. And Ms. Psaki said the president “certainly supports” a move by dozens of national health care groups to require vaccinations by their employees.

With the Delta variant threatening a grim surge of cases in the fall, the basic question confronting Mr. Biden is this: If the most sacred obligation of a president is to protect the health and safety of the American people, should he go beyond his efforts to cajole and persuade by embracing the power of the government to compel action?

The answer appears to be a limited yes.

“You want to be careful,” said Dr. Marcus Plescia, the chief medical officer of the Association of State and Territorial Health Officials. “You don’t want to put wind in the sails of the anti-vax movement.”

But other experts say Mr. Biden must protect Americans from a public health threat they believe is every bit as dangerous as a foreign invasion. Dr. Paul A. Offit, the director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, said the president should abandon his hesitance and mandate vaccines to the degree that he can, among federal employees and the military.

“Sure, it will cause a backlash — so what?” Dr. Offit said, adding: “It isn’t a personal choice. It’s a choice for others. It’s not an American’s right to potentially catch and spread a fatal infection.”

In the last six months, Mr. Biden’s administration has led a successful effort to fully vaccinate about 163.3 million people — nearly half of the country, including 80 percent of those 65 and older. But as Dr. Offit said, that effort has “hit a wall.” Tens of millions of people remain unprotected against what the C.D.C. director has called one of the most contagious respiratory diseases known to scientists.

Experts say their refusal to get vaccinated puts others at risk — especially those who cannot get inoculated for medical reasons, or whose immune systems are too weak to respond to the vaccine. Vaccine hesitancy is also responsible for the rise of the Delta variant.

The numbers tell the story. On July 4, when the president asserted that “we’re closer than ever to declaring our independence from a deadly virus,” about 11,500 new cases were recorded in the United States. By Sunday, that figure had nearly quadrupled, to more than 42,000.

“The ongoing transmission of this virus is in fact largely due to the unvaccinated,” said Michael T. Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

Mr. Biden’s reach only goes so far; vaccination is the province of the states. All 50 states already have laws requiring specified vaccines for children, though all offer exemptions for medical reasons. A majority — 44 — also include exemptions for religious or philosophical reasons.

While Dr. Osterholm said he was ordinarily “a strong supporter” of mandates, he said the prospect of businesses and universities requiring vaccination against Covid-19 gave him pause. He fears that people who are hesitant and might be persuaded to get their shots would simply take advantage of exemptions and become unpersuadable as a result.

Still, there is real-world evidence that mandates work.

Dr. Offit said Mississippi, which has one of the nation’s lowest coronavirus vaccination rates, has extraordinarily high rates of childhood immunization because its state law does not allow philosophical or religious exemptions.

When a measles outbreak erupted among Orthodox Jews in Brooklyn two years ago, officials tried education and outreach, but Mayor Bill de Blasio ultimately declared a public health emergency requiring people in the Williamsburg neighborhood to be vaccinated. A month later, an anti-vaccine rally drew hundreds of Orthodox Jews. The state later repealed its religious exemption.

But in an era when public health has become politicized and state legislatures around the country are moving to restrict emergency health powers, some experts worry that if Mr. Biden begins to push for mandates, it would provoke conservative state lawmakers to undo requirements even for basic childhood vaccinations.

“There’s concern if you cause a lot of controversy and you open that whole thing up, not only could the legislature go in and say, ‘You’re not going to include Covid,’ but they could also tinker with the idea that maybe all of these childhood vaccines are an overreach of government,” Dr. Plescia, of the state and territorial health officials group, said.

In some states, including Florida and Texas, requiring proof of Covid-19 vaccination is already against the law. “In Florida, your personal choice regarding vaccinations will be protected,” Gov. Ron DeSantis of Florida said in May, after signing legislation barring businesses and government entities from requiring proof of coronavirus vaccination.

On Tuesday, Mr. Biden made it clear that he was running out of patience with people who refuse to get a shot that could save their lives and protect others.

“The more we learn about this virus and the Delta variation, the more we have to be worried or concerned,” Mr. Biden said. “And only one thing we know for sure: If those other 100 million people got vaccinated, we’d be in a very different world.”