WASHINGTON — President Joe Biden's Covid-19 vaccination push began with pitches and ramped up to incentives — but as the fight against the delta variant of the coronavirus has gotten tougher this summer, so has his approach, with his administration increasingly embracing vaccination mandates and ratcheting up pressure on Republican governors who have rejected public health recommendations.
Biden has moved beyond the incentive-based strategy that drove his early vaccination efforts, adopting a more demanding approach in recent weeks following a steady decline in the number of shots being given and a new wave of infections in areas with low vaccination rates.
The posture is a sharp strategic about-face from just a month ago, when press secretary Jen Psaki said it wasn't the federal government's place to impose or encourage mandates. Back then, the White House promoted celebrity endorsements and the ability to take more convenient vacations while combating misinformation.
But the surge in cases due to the delta variant led outside public health advisers to push the White House behind the scenes to take a stronger approach — one that became particularly evident in a wave of actions and statements over the past week.
As the Supreme Court suggested that vaccination mandates by public institutions would not run afoul of legal review, Biden increased the ranks of federal workers facing the same demand, announcing Thursday that all employees of the Health and Human Services Department who may come in contact with patients must be vaccinated.
The move affected 25,000 workers, including those for the Indian Health Services and the National Institutes of Health. It followed a requirement that all federal employees be vaccinated or undergo routine testing and the Defense Department's announcement Monday that members of the military will soon face a vaccination requirement of their own.
Administration officials have indicated in recent days that there is more pressure to come.
The White House is looking into whether the federal government can act against states that have banned mask requirements. It is also weighing whether federal dollars can be used to pressure nursing homes and other institutions to require worker vaccinations, administration officials have said.
Officials are also leaning on school districts to require teacher vaccinations, a proposal Biden's chief medical adviser, Dr. Anthony Fauci, and Dr. Francis Collins, director of the NIH called for Tuesday in interviews on MSNBC. Biden said the same day that he would use his full authority as head of the federal government to do what he could.
"I wish I could have thought of something beyond what we thought of to make everybody want to get the vaccine, but that hasn't been the case," Biden said. "Now, at a federal level, what I'm going to be doing is making sure that they understand that I do have authority to say if you're going to come into this building, into a federal building, that you have to have been vaccinated and show that or be wearing a mask."
While Republicans have used the prospect of vaccination mandates to accuse Biden of government overreach, the majority of Americans say they support them, according to recent polls. About 60 percent of adults said vaccinations should be required by federal, state and local governments, along with employers, schools and businesses, according to a Morning Consult poll released at the end of July.
Vaccination requirements by employers get the strongest support from Democrats, 76 percent of whom are in favor of the idea, which also has the backing of 46 percent of independents and 38 percent of Republicans, according to the poll.
The harder-line strategy may be paying off. The average number of new doses administered has more than doubled since it hit its low point on July 7, when the White House was brushing aside the suggestion of vaccination mandates.
The federal government is limited in how far it can go to require vaccinations based on legal precedent, which has left much of the authority to state and local governments. An area that remains under its purview is domestic air travel, in which it is already requiring people to wear masks.
Administration officials have said they expect more local governments, schools and employers to require vaccinations once the Food and Drug Administration gives the shots final approval, which is expected this month.
Biden, who has prided himself on his bipartisan style, has attacked Republican governors, such as Ron DeSantis of Florida, who have sought to prohibit schools and local governments from requiring masks. "If you aren't going to help, at least get out of the way of the people who are trying to do the right thing," he said last week.
Psaki said the administration was looking at ways Covid relief funds could be used to help school districts that face penalties from governors for enforcing masking requirements. DeSantis has said he would look to cut state funding for schools that require masks.
Two of Texas' largest school districts have vowed to defy a ban on mask requirements. The requirements were upheld last week by two state district judges in a rebuke to Gov. Greg Abbott.
Education Secretary Miguel Cardona said he would be watching closely whether a ban on mask requirements appears to be preventing students from attending and pursuing their right to public education as schools open in the coming days.
"I'm also going to be monitoring where places have rules that are limiting mask use, whether or not students that need to be in school are not going because of a lack of confidence," Cardona said. "To me, those are adult actions preventing students their right of public education."
Biden is using his bully pulpit to praise heads of institutions that have required vaccinations for their workers with the same vigor he used earlier in the summer to encourage companies to offer vaccination incentives, like gift cards, lotteries and paid time off.
Since he announced the requirement for federal workers to be vaccinated or be routinely tested, a wave of companies have announced plans to follow suit, including United Airlines, whose CEO met with Biden virtually on Wednesday.
"I know this isn't easy," Biden said last week of private companies' imposing mandates. "But I will have their backs and the backs of other private- and public-sector leaders if they take such steps."