President Joe Biden is expected to announce Thursday that the federal government, the nation’s largest employer, will require its civilian workers to get COVID-19 shots or follow more stringent protections, a move that could encourage other businesses and local governments to follow suit. 

The shift in strategy is already winning praise from public health advocates and raising concerns among some libertarians even before the details are announced. The pending policy has the potential to meaningfully boost vaccination rates, given the government’s outsized influence and 2.1 million civilian workforce outside of the Postal Service.

White House Deputy Press Secretary Karine Jean-Pierre referred to the policy Wednesday as a vaccine “attestation” rather than a “mandate.”

“While no decision has been finalized, I will say that the attestation of vaccination for federal employees is one option under strong consideration,” she told reporters. 

People unwilling to confirm their vaccination status may have to follow other mitigation measures like wearing masks and routine testing, even in places where transmission is relatively low, she said. 

The policy would represent a major change in the White House’s vaccination campaign. 

“Mandates have to be a last resort. But we’ve tried begging, pleading, cajoling, incentives, and none of that worked,” said Lawrence Gostin, a Georgetown Law School global health law expert.

As of July 28, Centers for Disease Control and Prevention data shows that 69 percent of adult Americans have been partially vaccinated and about 60 percent were fully vaccinated. 

Once considered a controversial third rail, many experts have embraced vaccine requirements as the highly infectious and potentially more virulent delta variant has torn through the country, putting vulnerable populations at risk.

The number of COVID-19 cases jumped more than 300 percent in a little over a month through July 23, CDC said.

“This is the best thing Biden has done to increase vaccination coverage in America,” said Gostin.

Biden previously sought to persuade federal employees to get a shot by mandating they receive paid leave to do so. That was in addition to a number of other private and public sector incentives like expanded pharmacy hours, free child care, promotional beer, and state lotteries offering a chance to win a million dollars. 

Mario Macis, a Johns Hopkins University economics professor and expert in economics in health care, said small incentives may be more successful with people who are on the fence and may just need a push. 

“The disappointing effect of lotteries suggests that the number might not be large, indicating that the reasons for vaccine hesitancy are more profound,” he said, adding that individuals not swayed by a lottery or other financial incentive may have concerns about safety or not trust the government or health authorities. “Those are barriers that small incentives are unlikely to overcome.”

Adopting a requirement with a penalty involves weighing the negative externalities, or the costs that being unvaccinated imposes on society, he said.

“When someone refuses to get vaccinated, they are not only putting themselves at risk, but they are generating negative consequences for others: If they get infected, they can spread the disease, and if they become hospitalized, they contribute to burdening the health care system,” he said. “Negative externalities often prompt and justify regulation. A general principle is that more severe externalities call for stricter regulation.”

A CDC alert sent to health care providers Tuesday said they should “evaluate whether your facility can implement vaccine requirements or vaccine incentives.”

Still, CDC Director Rochelle Walensky acknowledged Wednesday that mandating vaccines may not always work.

“Some people are sort of allergic to the mandatory and I don’t want to turn them off, either. So, this is something that may very well be better off done community by community, and I would endorse any way that we can get more people vaccinated to prevent severe disease and death,” she said on SiriusXM’s  “Doctor Radio Reports” with Dr. Marc Siegel.

The administration’s legal footing is supported by a recent Justice Department legal opinion that backed up an earlier decision in favor of vaccine mandates by the Equal Employment Opportunity Commission.

The Department of Veterans Affairs announced Monday it would be the first federal agency to require vaccinations. Nearly 50 percent of VA patients are over the age of 65, many with serious health conditions, according to a spokesperson.

Sen. Bill Cassidy, R-La., said Tuesday that the VA announcement requiring medical staff to receive the COVID-19 vaccine built on existing requirements for vaccinations, which are commonplace for schools as well.

“If they add the COVID virus to this, it’d be frankly just part of what they normally do. You don’t want people who are sick to be exposed to a health care worker who may have an infection which is vaccine-preventable,” he said.

Bracing for reaction

The policy is expected to generate some backlash.

So far, 117 bills have been introduced in state legislatures seeking to bar employers from firing unvaccinated employees, according to the National Academy for State Health Policy.   

Polling from the Axios-Ipsos Coronavirus Index released last week suggests that vaccine holdouts aren’t budging.

Of the 30 percent of adults who have not received a vaccine, half say they are not likely to be persuaded to take it. 

“It is important to think of these groups not necessarily as a single monolith. Efforts can move some populations, but that ‘hard pass’ group, that group that’s just fully against getting the vaccine, is unmovable, really, at least with the questions we asked,” Chris Jackson, senior vice president and head of polling at Ipsos, said.

The Federal Law Enforcement Officers Association President Larry Cosme has raised concerns about the potential changes.

“FLEOA fully supports individuals who voluntarily choose to be vaccinated, agree that it is safe and the most effective means of combatting the pandemic, and encourage our members to be vaccinated,” he said. “However, forcing people to undertake a medical procedure is not the American way and is a clear civil rights violation no matter how proponents may seek to justify it.”

Cosme said the group would “encourage the administration to work collaboratively with FLEOA and other federal employee groups to incentivize all federal employees to be vaccinated, rather than penalize those who do not.”

Growing push

The federal policy is expected to mirror prior actions by Democratic politicians in New York and California. 

New York City announced it will require its government workers to be vaccinated by mid-September.

California also said it would be the first state to require state workers and workers in health care and other high-risk settings to either show proof they have been vaccinated or adhere to a weekly testing schedule. It is encouraging local government and other employers to do the same.

The majority of cases continue to occur among unvaccinated individuals, with California reporting that case rates are 600 percent higher among unvaccinated residents compared to those who are vaccinated.

“As the state’s largest employer, we are leading by example and requiring all state and health care workers to show proof of vaccination or be tested regularly, and we are encouraging local governments and businesses to do the same,” Gov. Gavin Newsom said Monday.

A shift by the federal government could serve as a catalyst for private and public employers hoping to institute their own vaccine mandates but previously were wary about action until the Food and Drug Administration fully approves the shots, which have emergency authorization.

Employers should follow the government’s lead and provide ample paid time off to get the vaccine and rest if they experience side effects to minimize backlash, said University of Denver bioethics expert Govind Persad, the co-author of a 2020 study on vaccine attitudes.

Jen Kates, Kaiser Family Foundation senior vice president and director of global health and HIV policy, suggested that employers could be more effective at encouraging vaccination than insurance providers.

About 10 percent of people in a KFF poll of vaccinated and unvaccinated Americans said they wanted to wait before getting a vaccine, 14 percent said they definitely would not get it, and 6 percent said they’d get it “only if required” at school, work or another activity.

Of those who are unvaccinated, 92 percent do not want their employer to require vaccination, the KFF data show.

Mary Ellen McIntire contributed to this story.