U.S. pivots to mandates, tough rules as vaccinations stall

No more Mr. Nice Guy.

After months of pleading and arm-twisting with the public to increase vaccinations, policymakers and employers are imposing mandates or devising rules that make life miserable for holdouts.

New York City Mayor Bill de Blasio told private employers Friday to “do the maximum you can do” in requiring COVID-19 vaccines, and praised San Francisco for mandating the shots among city workers. 

The National Football League said unvaccinated players who screw up gameday will not get paid.

Mr. de Blasio, a Democrat, recently mandated vaccination or weekly testing for public hospital workers, but he’s being coy about when and if he will extend the requirement to tens of thousands of other city workers.

“We’ve obviously got a lot more people to deal with and some complexities that are different here [than San Francisco], but this is the shape of things to come,” the mayor told the Brian Lehrer Show on WNYC public radio. “I think you’re going to see more and more mandates of different kinds because the key is vaccination.”

Roughly 54% of the city population is fully vaccinated — better than the U.S. rate of 49%, but not the 70%-90% prescribed by scientists to get the virus under control, as the delta variant threatens to upend the Big Apple’s recovery.

Mr. de Blasio told private employers in the city to devise stronger rules.

“Let me make the signal explicit. I’m calling upon all New York City employers, including our private hospitals — move immediately to some form of mandate, whatever the maximum you feel you can do,” Mr. de Blasio said. “We have reached the limits of a purely voluntary system.”

The NFL late Thursday said teams who cause a game cancelation due to outbreaks among the unvaccinated will face financial penalties and their players will forfeit pay.

“We are starting to see a shift away from pleading, begging and bribing — which have worked a little but not enough — to, ‘We’ve got to get tougher if we don’t want to ruin sports, close schools and throw the economy back into a horrible lockdown,’” said Arthur Caplan, director of the division of medical ethics at the New York University Grossman School of Medicine. “It’s clear to anyone paying attention that the only way out of this is vaccination.”

The Biden administration has studiously avoided talk of government mandates, but has given tacit approval to colleges and businesses that decide a vaccine requirement is the best way to protect their workers and campuses.

Dr. Anthony Fauci, director of the National Institutes for Allergy and Infectious Diseases, said the NFL sent a “strong signal” with its policy and he expects other employers to join them.

“I think that gives them the impetus to do the same sort of thing. And I think you’re going to be seeing that there will be local mandates, be they from colleges and universities or places of business that there will be pressures for people to get vaccinated,” Dr. Fauci said.

A union representing workers at New York-Presbyterian Hospital, a major medical center, protested on Thursday a company policy that requires workers to get at least one shot by September.

“We believe that our members are best equipped to make the healthcare decisions that are right for their bodies and for their families,” Communications Director Cara Noel of 1199-SEIU told ABC 7. “We have been promoting vaccination, but to make vaccination a condition of employment is absolutely wrong.”

Mandates are likely to spark legal challenges, too, particularly since the vaccines are approved for emergency use instead of fully licensed by the Food and Drug Administration. Regulators are working on full approval, but it could take months.

Mr. Caplan said the lack of full approval makes some employers and their lawyers nervous, especially in unionized jobs where employees have a lot of bargaining power. But he thinks many employers will win in court even under the emergency-use authorization, pointing to a major Houston hospital that won its battle with health workers who refused the shots.

“They will lose,” he said of challengers. “Given the Mount Everest of evidence that it works and it’s safe, it’s hard for me to imagine a challenge holding up.”

Policymakers are talking tough amid fears of a major setback in the COVID-19 fight.

Administration officials say the delta variant first detected in India makes up more than 80% of sequenced virus samples in the U.S. and is one of the most contagious viruses they’ve ever seen.

The variant is fueling reports of “breakthrough infections” in people who’ve been fully vaccinated, though officials insist that severe disease will remain rare.

Panagis Galiatsatos, an assistant professor at Johns Hopkins School of Medicine in Baltimore, said the average age of his COVID-19 patients is 52, compared with the older patients and nursing-home residents he saw last year. Most seniors are vaccinated.

“It’s only unvaccinated persons in the ICU,” he said. “I have yet to see a vaccinated person in our ICU.”

He said the vaccines’ job is not to prevent all infections, but to turn COVID-19 into something akin to a common cold.

In fact, until 2003, when the first SARS outbreak occurred, coronaviruses were seen only as common-cold pathogens, he said. The hope is to nudge the latest coronavirus into a mild problem in the background, too, through widespread vaccination.

“So among vaccinated individuals, spreading it is just spreading the cold,” he said.

Pockets of the country with low vaccination rates are seeing something much worse. They include Alabama, where Gov. Kay Ivey unloaded on unvaccinated people for driving coronavirus outbreaks and hospitalizations in her state.

“It’s time to start blaming the unvaccinated folks, not the regular folks. It’s the unvaccinated folks that are letting us down,” the Republican said Thursday in comments to reporters that aired on the CBS  affiliate WIAT.

Only about one-third of Alabama’s population is fully vaccinated against COVID-19, putting it worst in the nation, alongside Mississippi.

About 49% of the U.S. population is vaccinated. The rates for Alabama and Mississippi are around 34%.

The top reasons that people give for not getting the shot include fearing side effects are worse than COVID-19, and not trusting the vaccine because it only has emergency approval from the FDA.

Ms. Ivey said she doesn’t understand why people would want to “mess around with temporary stuff” when the vaccine is the most long-lasting tool for wrangling the virus.

She said nearly all of the recent hospitalizations are among unvaccinated persons, and deaths are “certainly” occurring among those who’ve balked at the shots.

“These folks are choosing a horrible lifestyle of self-inflicted pain. Y’all, we’ve got to get folks to take the shot,” Ms. Ivey said, noting she took the vaccine in December. “The vaccine is the greatest weapon we have to fight COVID, the data proves it.”