Vaccine Mandates Will Slow Pandemic in the Long Run, Experts Say

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 said.

“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’s new vaccine requirements, announced Thursday, drew praise from doctors eager to slow the spread of the coronavirus, caution from experts who felt it may be “too little, too late” and condemnation from members of the G.O.P. who called the move “unconstitutional.”

Mr. Biden took his most expansive actions yet to control the coronavirus pandemic by mandating shots for 100 million Americans, including some private sector employees, health care workers, federal contractors and the vast majority of federal workers.

Although epidemiologists have spent months stressing an urgent need to increase vaccination rates as the highly contagious Delta variant took hold in the United States, Mr. Biden’s plan was unveiled in a deeply polarized environment and even experts seemed split on how effective it will 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 the moves “may result in exacerbating the severe work force shortage problems that currently exist.”

But Dr. William Schaffner, an infectious disease expert at Vanderbilt University, said the policy was necessary, and likened it 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.”

Some big companies voiced support, including Amazon. “We know vaccines, coupled with widespread and convenient testing, serve as powerful tools to help slow the spread of Covid-19 in our communities, keeping the U.S. economy open, and protecting America’s work force,” said Brian Huseman, vice president of public policy for the retailer.

The sweeping actions, which the president announced in a White House speech, will impact almost every aspect of American society. They also reflect Mr. Biden’s deep frustration with the roughly 80 million Americans who are eligible for shots but have not been vaccinated.

They are also all but certain to be the subject of legal challenges; already, the largest union representing federal workers has raised questions.

“Getting vaccinated isn’t just the best way for us to end this pandemic, it is the best way for us to protect each other in the workplace,” said Everett Kelley, the national president of the American Federation of Government Employees. But he expressed that such changes should be negotiated with bargaining units. “Workers deserve a voice in their working conditions.”

Republican officials were quick to express opposition. Gov. Kristi Noem of South Dakota promised legal action against the “unconstitutional rule.”

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 will be displaced, businesses fined, and children kept out of the classroom because of the mandates, and he vowed to push back.

But the president made it clear on Thursday that he would do what he could to “require more Americans to be vaccinated to combat those blocking public health,” a reference to Republican governors who have banned attempts to mandate masks or require vaccines.

“If those governors won’t help us beat the pandemic,” he said, “I will use my power as president to get them out of the way.”

President Biden on Thursday laid out a wide-ranging plan to tackle the pandemic, including requiring companies with more than 100 employees to mandate that their workers get vaccinated or face weekly testing.

The move comes as airlines, restaurants and other businesses are already feeling the pain of an economic pullback caused by the Delta variant of the virus. The new rule, which Biden instructed the Occupational Safety and Health Administration to put in place by drafting an emergency temporary standard, will affect some 80 million workers.

Many companies were already moving toward mandates. In a recent Willis Towers Watson survey, 52 percent of respondents said they planned to institute vaccine mandates by the end of the year, and 21 percent said they already had such requirements.

But many of those mandates, including at companies like Goldman Sachs and UPS, have focused on white-collar workers, who tend to have higher vaccination rates. This presidential directive will help industries that are facing labor shortages, like retail and hospitality, institute a requirement on their frontline workers.

“It levels the playing field,” said Ian Schaefer, a partner at the law firm Loeb & Loeb.

Companies will now face new decisions, like whether to pick up the tab for weekly testing and how to handle religious exemptions — tasks many are already finding challenging.

A recent poll by Aon of 583 global companies found that of the employers that have vaccine mandates, 48 percent said they were allowing for religious exemptions; only 7 percent said they would fire a worker for refusing to get vaccinated.

Among unanswered questions:

• How will the government gather, store and track information on employee vaccinations?

• What penalties will companies face if they choose not to follow the new requirement?

• Does it apply to all workers, or only those going into an office?

• When will the new rules take effect?

Reaction was, unsurprisingly, mixed. The Business Roundtable and the U.S. Chamber of Commerce both welcomed the Biden administration’s actions. But Gov. Greg Gianforte, Republican of Montana, the only state to ban vaccine mandates, called the new rules “unlawful and un-American.” The Republican National Committee said it intended to sue.

Whether legal challenges will prove successful is unclear. OSHA’s emergency temporary standards pre-empt state governments’ existing rules, except in states that have their own OSHA-approved workplace agencies. (About half do.) The legal basis for a challenge is likely to be weakest in states that are directly within OSHA’s jurisdiction, like Montana, Texas and Florida.

Do you run or work at a business that will be affected by the new vaccine mandate? If so we’d like to hear from you. Email [email protected] and please let us know how to reach you if we need to learn more.

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.”

The makers of the Pfizer-BioNTech vaccine will soon ask regulators to approve 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 approval of the use of the vaccine for that age group, including in Europe.

Both the European Union and the United States approved the Pfizer vaccine for use in children 12 and over in May. They have not approved 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 an approval 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.