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Biden Seeks to Revive Vaccine Effort With New Guidelines and Incentives

WASHINGTON — President Biden on Thursday sought to revive the nation’s stalled push to vaccinate Americans against the surging Delta variant of the coronavirus, announcing new requirements for federal workers to be vaccinated and urging local and state governments to offer $100 to anyone willing to get a shot voluntarily.

His announcement included only federal civilian employees, but hours later the Pentagon said members of the military would also be subject to the same rules: Get vaccinated or face regular testing, social distancing, mask wearing and limits on official travel.

Although those steps fall short of a mandate, Mr. Biden also ordered the Defense Department to move rapidly toward one for all members of the military, a step that would affect almost 1.5 million troops, many of whom have resisted taking a shot that is highly effective against a disease that has claimed the lives of more than 600,000 Americans.

The announcement marked the first time he has suggested that a mandate could come for active-duty members of the military before any of the three federally authorized vaccines receives full approval from the Food and Drug Administration.

In a speech from the East Room of the White House, Mr. Biden effectively conceded that the worst-in-a-century viral scourge he once thought was under control had come roaring back, threatening public health and the economic recovery that is central to the promise of his presidency.

But after months of trying to persuade and cajole, the president on Thursday cast the crisis as one that pits the vaccinated against the unvaccinated, and said those refusing to get a coronavirus shot should expect inconveniences as long as they decline a vaccine that protects them and others from illness and death.

“This is a pandemic of the unvaccinated,” Mr. Biden said, calling it an “American tragedy” and talking directly to the 90 million Americans who are eligible for a vaccine but have not gotten one. “People are dying and will die who don’t have to die. If you’re out there unvaccinated, you don’t have to die. Read the news.”

Mr. Biden said that federal workers who remained unvaccinated would have to submit to the extra inconveniences — essentially creating a two-tier system for the government’s more than four million employees and hundreds of thousands of private contractors who work at federal facilities around the world.

The president’s move stopped short of a vaccine mandate for federal workers. But the president said he hoped that by imposing new requirements on daily work life, more unvaccinated federal employees will choose to get a shot.

Mr. Biden said he was ordering agencies to find ways to ensure that all federal contractors — even those working for private businesses out of their own offices — could be required to be vaccinated as a condition of their work with the federal government. That could extend the president’s plan to millions more workers, including those in places where vaccination rates are stubbornly low.

“If you want to do business with the federal government, get your workers vaccinated,” the president said bluntly.

Mr. Biden urged companies and local governments to mimic his new vaccine requirements for federal employees, which he noted had the support of the U.S. Chamber of Commerce. The group said on Thursday that the president’s new rules were “prudent steps to protect public health.”

But the administration’s move quickly sparked consternation from some of the federal government’s largest unions representing teachers, police officers and postal workers, who called for negotiations on the subject.

“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,” Larry Cosme, the president of the Federal Law Enforcement Officers Association, said in a statement.

The president also announced that small and medium-size businesses would be reimbursed for providing paid leave so employees and their families could get vaccinated. He called on school districts to host a “pop-up vaccination clinic” to get children vaccinated before the start of school. And he urged private businesses, sport leagues and other institutions to get their employees vaccinated.

Appealing directly to Americans who are “unvaccinated, unbothered and unconvinced,” Mr. Biden asked them to recall the depths of the lockdowns during 2020 and to “really remember just how dark that winter was.”

“With incentives and mandates, we can make a huge difference and save a lot of lives,” he said.

Coronavirus vaccines are available to Americans ages 12 and older. But as of Thursday, just 57.7 percent of those eligible were fully vaccinated, according to data collected by the Centers for Disease Control and Prevention. The figure is much higher among the oldest Americans; nearly 80 percent of Americans 65 or older are fully vaccinated.

Updated 

July 29, 2021, 10:02 p.m. ET

During his campaign against former President Donald J. Trump, Mr. Biden promised that he could vanquish the virus despite the polarized politics of the country he inherited. Just weeks ago, Mr. Biden hosted a Fourth of July party at the White House to declare “independence” from the virus. Now, he must reckon with rising caseloads and hospitalizations that are threatening a return to work and school in the fall.

Behind the scenes, Mr. Biden’s top public health officials have been deliberating for weeks, including in daily calls, about the best way to push more people to get vaccinated without prompting legal challenges or an anti-vaccine backlash.

A July 27 internal assessment for the senior leadership of the Department of Health and Human Services delivered the grim news about the trajectory of the pandemic: deaths up 45 percent from the previous week, hospitalizations up 46 percent and cases surging. “Since the lowest value observed on June 19, 2021, cases have increased 440 percent,” the assessment concluded.

Aides said the president hoped his solution could become a model for state and local governments and businesses around the country. But his announcement on Thursday lagged the efforts of many of those very institutions, which moved more quickly than the Biden administration to grapple with the issue.

Mayor Bill de Blasio of New York and Gov. Gavin Newsom of California both announced on Monday that they would require hundreds of thousands of government workers to get inoculations or face weekly testing. Gov. Andrew M. Cuomo of New York soon followed suit.

Numerous businesses — including Netflix, Saks Fifth Avenue, The Washington Post, Ascension Health, Lyft, Google and Morgan Stanley — all announced get-tough policies that require their workers to get shots as a condition of employment. Unvaccinated workers at MGM casinos will be tested regularly, at their own cost, and if they test positive they will be required to quarantine.

In a joint statement this week, dozens of medical groups, including the American Medical Association and the American Academy of Pediatrics, called for all health care and long-term care workers to be vaccinated. The Department of Veterans Affairs became the first federal agency to require many of its employees to get a shot. The Centers for Disease Control and Prevention revised its earlier stance and recommended that vaccinated people wear masks indoors in areas where rates of transmission are high.

Understand the State of Vaccine Mandates in the U.S.

“This is a very fluid situation,” said Dr. Richard E. Besser, the chief executive of the Robert Wood Johnson Foundation and a former acting director of the C.D.C. “There’s a lot of uncertainty and change.”

Few in Mr. Biden’s administration doubted that the president could force federal employees to take the vaccine as a condition of employment. But a heavy-handed mandate was more likely to backfire, most argued.

The solution Mr. Biden announced on Thursday is aimed at sidestepping accusations that the president is using the power of his office to force shots in people’s arms. Instead, officials hope the new workplace rules will make employees want to become vaccinated.

When it comes to the military, Mr. Biden signaled that he could take a tougher stance, placing the armed forces firmly at the center of an escalating debate over vaccine mandates.

As commander in chief, the president has the authority to order the troops to take an experimental vaccine — a move that would have a deep reach into areas of the country with low rates of vaccination. The bulk of federal workers live in the Washington region, including the Maryland and Virginia suburbs, where rates of vaccination are already high.

“I think it would have a much bigger impact in parts of the country that have low vaccination rates and also get into populations that have been reluctant and hopefully show them that getting a vaccine is not problematic,” said Dr. Ezekiel J. Emanuel, a bioethicist at the University of Pennsylvania who advised Mr. Biden during his transition.

Members of the military are regularly given vaccines, and unvaccinated service members are sometimes not allowed to deploy abroad and face other restrictions. But as a political matter, forcing vaccines on the military would be all but certain to set off a firestorm among Mr. Biden’s critics.

Many members of the military have been reluctant to take coronavirus vaccines. Dr. Besser said he was surprised the administration has not required them to do so sooner. Military leaders cannot require the shots because they are currently authorized on an emergency basis. Mr. Biden could order them, but has been reluctant to exercise that authority.

The White House was already taken aback, some military officials said, by the blowback to its door-to-door vaccine information campaign and has since treaded carefully on mandates, especially for troops.

Younger troops have been most hesitant to get the shot, calculating that their symptoms would be mild if they caught virus. But the Delta variant has been hitting younger patients, and with more force.

Dr. Besser said Mr. Biden’s move “makes sense,” adding, “It’s highly contagious, people in the military are in very close quarters with each other, and in terms of force readiness you wouldn’t want to see Covid ripping through unvaccinated soldiers.”

Senator Mitch McConnell of Kentucky, the Republican leader and a polio survivor, encouraged people to get the vaccine. With the virus on the rise in conservative swaths of the country, Mr. McConnell is among a handful of Republican leaders who are now explicitly calling for vaccination.

“Honestly, it never occurred to me we’d have difficulty getting people to take the vaccine,” he said.

Dr. Patrick Godbey, the president of the College of American Pathologists, which is advocating for greater use of Covid-19 testing, said even before Mr. Biden spoke that the events of this week had changed the discussion. His own medical institution, in Brunswick, Ga., has not yet required workers to get vaccinated, he said.

“People are now looking at it; they are evaluating it in their own institutions, and that’s an important step forward,” he said, adding, “It’s a real line in the sand when the federal government comes out and does it.”

Jennifer Steinhauer and Eileen Sullivan contributed reporting.

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Health

Nations weigh mandates and incentives to drive up vaccination charges.

The coronavirus pandemic has exposed economic and social upheaval around the world, but Covid-19 vaccines have made the gap even wider: while some poor countries are asking for doses to save their populations, some rich countries are being inundated by gunfire and are missing to customers.

For example, a handful of US states have tried to incentivize more people to be vaccinated. But in Moscow, as Covid hospital admissions spiked this week, city government took a tougher line, ordering vaccinations for many workers in public jobs.

Some other governments have also tried to require vaccines. A province in Pakistan has announced that it will cut salaries for officials who have not been vaccinated starting next month. And the UK, which is seeing an increase attributable to the spread of the Delta variant of the virus, is considering making syringes mandatory for all healthcare workers.

The Moscow Times quoted the city’s mayor, Sergei S. Sobyanin, on Wednesday as saying, “When you go out and come into contact with other people, you are an accomplice in the epidemiological process – a chain in the link that is spreading this dangerous virus . “The mandate he announced focuses on education, entertainment, healthcare and hospitality and will continue until at least 60 percent of employees are vaccinated, the newspaper reported.

In the UK, officials said vaccinating health workers would help stop the virus from spreading in hospitals. Nadhim Zahawi, the UK’s vaccines minister, said there was a precedent for such a requirement. “Of course, surgeons are vaccinated against hepatitis B so we definitely think about it,” he told Sky News last month.

Many universities in the United States now require at least some students and employees to be vaccinated. Earlier this week, the University of California’s system announced that it would make Covid-19 vaccinations mandatory for all faculties, staff and students, including the university’s health care system, this fall.

Federal officials have repeatedly made it clear that most companies with at least 15 employees have the right to require workers to be vaccinated.

But the need for vaccines continues to meet resistance from some.

In 15 American states, not a single college had announced any type of vaccine requirement until last month. Days ago, 178 Houston Methodist Hospital employees who refused to receive a coronavirus injection were suspended. And on Saturday, protesters are expected at the New York State Bar Association offices in Albany, where officials will discuss a report recommending prescribing a coronavirus vaccine for all New Yorkers unless doctors exempt them.

But for the undecided, persuaded, incentives to get the vaccine remain common: there are lotteries in California, college scholarships in New York state, and free drinks in New Jersey.

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Health

Do vaccine incentives work? Krispy Kreme says freebies have helped

What will it take to convince people to get vaccinated against Covid? From free doughnuts to million-dollar payouts, public and private groups are trying it all.

In March, Krispy Kreme was one of the first businesses to roll out a nationwide Covid vaccine incentive, offering a free glazed doughnut to any adult with a vaccination card.

Since then, the company said it has given away more than 1.5 million doughnuts. (The offer still stands through the remainder of the year.)

“We were the first national brand to launch a campaign to show support for Americans choosing to get vaccinated, and we were hopeful that others would join us,” said Dave Skena, chief marketing officer at Krispy Kreme.

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“So, it’s very gratifying to see so many companies, organizations, communities and even state governments encouraging and incentivizing people to protect themselves and others by getting vaccinated.”

While some states, like New Jersey and Connecticut, are offering a free beer or nonalcoholic beverage to encourage more people to get vaccinated against Covid, others like Ohio and Maryland have gone much further. 

Last week, Maryland held the first of its $40,000 lottery drawings for people who have been vaccinated. There will be 40 consecutive days of drawings for a $40,000 prize, ending on July 4 with a final drawing for a $400,000 payout.

Ohio is also holding a series of drawings for cash prizes, although its “Vax-a-Million” contest ups the ante significantly.

The latest data from the Centers for Disease Control and Prevention shows that about half of the U.S. population has had at least one shot — and yet, the pace of Covid vaccinations has slowed nationwide.

Incentives may become increasingly important to move the needle from here, according to Bob Bollinger, a professor of infectious diseases at the Johns Hopkins University School of Medicine and inventor of the emocha Health app.

“It really depends on what the barriers are that people have about getting vaccinated,” Bollinger said. The higher those barriers are, the harder they are to overcome, he added.

A handful of states have reported that vaccine incentive programs have increased local vaccination numbers in some demographics after recent drops.

For its part, Ohio said its vaccination rates doubled in some counties after the state vaccine lottery was announced.

Recent data shows that the gambit might be more effective among certain demographics, but with little downside overall, according to a report by Morning Consult.

The poll of 2,200 adults, including nearly 1,600 people who are unvaccinated, found that men are more inclined than women to say these offers would make them sign up to receive a shot. Democrats, more than Republicans, also said they’d be more likely to get vaccinated if they could get free goods or services and, when broken down by generation, millennials were the most likely to say certain freebies would motivate them to get vaccinated.

An earlier survey by Blackhawk Network found that more than two-thirds of adults said they would accept a monetary incentive ranging from as little as $10 to as much as $1,000. One-third said they would get vaccinated for $100 or less. Blackhawk Network polled more than 2,000 adults in January.

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Professor says incentives for employees are higher

According to Nancy Rothbard, professor at the Wharton School, companies should encourage their employees to get vaccinated against Covid through incentives, not mandates.

“There are many challenges to assign employees to do anything,” said Rothbard on Thursday in the “Squawk Box” of CNBC. “Any boss will tell you, it’s a lot more about persuasion than telling a story.”

The question of whether workers need to get vaccines to return to the office has come into focus lately, with around 3 million people shot dead in the US every day. The latest figures from the Centers for Disease Control and Prevention show that nearly a quarter of the adult American population is fully vaccinated.

While many experts believe it is legal for employers to make vaccines mandatory, business leaders may worry about alienating employees.

“Trying to really motivate people to get vaccinated is going to be a much more popular avenue than mandates, in my opinion,” said Rothbard, a management professor whose research has focused in part on work motivation and engagement.

Companies like Tractor Supply offer their employees one-time cash payments to encourage them to get a Covid vaccine. The aim is to offer hourly workers up to four hours of wages – two hours for each dose of Pfizer and Moderna vaccines that require two shots. It also aims to help with paying for Lyft rides to and from appointments.

Johnson & Johnson’s vaccine, the only other emergency approved by the Food and Drug Administration in the United States, is just one dose.

Companies should consider employee preferences regarding vaccination status disclosure, Rothbard said, adding that some people are less comfortable sharing personal information of any kind with employers and colleagues.

“There are ways to do this more privately when you want to take a member of staff aside and say, ‘See, have you been vaccinated? … If you haven’t, we need to take alternative precautions'” for the safety of others, she offered.

The debate over vaccine disclosure in the workplace does not reduce the need for Americans to be vaccinated to end the pandemic, Rothbard said. “The term ‘herd immunity’ implies that it has a collective cost, not just an individual choice that people make when they choose to be vaccinated.”

Despite the importance, Rothbard stressed that incentives are likely to be effective in helping companies achieve high vaccination rates among their employees.

“I have a newspaper called ‘Mandatory Fun’. People don’t even like it when they are forced to have mandatory fun when they don’t feel legitimate in the workplace,” she said. “People don’t respond well to mandates. They respond better to incentives and encouragement.”

Evidence of vaccines for customers

Whether or not customers need to show proof of vaccination in order to receive services in a business – such as eating out in a restaurant – has become another controversial issue in the US. Some critics have raised concerns about civil liberty, while proponents of the so-called vaccination passport say that requiring people to prove they have been vaccinated benefits public health and allows the economy to reopen safely.

Last week, Florida Republican Governor Ron DeSantis signed an executive order preventing companies from requiring a customer to provide evidence that they received a Covid vaccine as a requirement for service. In his order, DeSantis claims that Covid vaccine passports “restrict individual freedom and compromise patient privacy”.

Texas governor Greg Abbot issued a similar order Tuesday banning the state government and private entities receiving public funding for requiring Covid vaccination certificates.

Dr. Scott Gottlieb, a former FDA commissioner, told CNBC on Wednesday that he believed the conversation about reviewing vaccine status was not okay.

“I think we thought about vaccination cards through the wrong lens. I think the way they are likely to be used is to create two access routes to different venues,” Gottlieb said in an interview on Squawk Box . “”

Covid testing may be required along with secondary symptom screening for people who cannot prove they have been vaccinated, said Gottlieb, who is now on the board of directors at vaccine maker Pfizer.

“The other will be in a fast lane. If you can prove that you’ve been vaccinated, you don’t have to provide evidence that you’ve recently been tested,” or go through some sort of symptom screening, Gottlieb said.

“It will be like an E-ZPass where you can either go through the fast lane or if you still want to pay the toll because you think the police are following you with the E-ZPass device, you can stop and stand in line and pay the toll, “he said.

Disclosure: Scott Gottlieb is a CNBC employee and a member of the boards of directors of Pfizer, genetic testing startup Tempus, health technology company Aetion Inc., and biotech company Illumina. He is also co-chair of Norwegian Cruise Line Holdings and Royal Caribbean’s Healthy Sail Panel. The Associated Press contributed to this report.

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World News

Trump Incentives for Signing Peace Accords With Israel Might Be at Threat

WASHINGTON – For Sudan, agreeing to normalize relations with Israel was the price paid for being removed from the US list of state sponsors of terrorism.

A similar diplomatic agreement with Israel sealed Morocco’s demand for the United States to recognize its sovereignty over Western Sahara.

UAE officials looking to buy clandestine F-35 fighter jets from the United States first had to sign up to the Abraham Accord, which was the result of President Trump’s campaign to promote stability between Israel and alienated or even hostile Muslim states .

Either way, the incentives the Trump administration dangled in exchange for the easing could fail – either rejected by Congress or overturned by the administration of President-elect Joseph R. Biden Jr.

Not only does this jeopardize the series of regional rapprochement agreements, but it also exacerbates a worldview that the United States cannot rely on to halt the end of diplomatic deals.

The Abraham Accords, Trump’s foreign policy achievement, have either re-established or re-established Israel’s economic and political ties with Bahrain, the United Arab Emirates, Sudan and Morocco. Officials familiar with the government’s efforts said Oman and Tunisia could be the next states to join, and warming could be extended to countries in Asia and sub-Saharan Africa, even after Mr Trump is in January Resigned from office.

The formal relaxation of tensions between Israel and its regional neighbors is, of course, a success that former Republican and Democratic presidents have long tried to promote.

“All diplomacy is a transaction, but these transactions mix things up that shouldn’t have been mixed up,” said Robert Malley, president and chief executive officer of the International Crisis Group, which is close to Antony Blinken, of Mr. Biden’s election as secretary of state.

Mr Malley predicted that the incoming Biden administration would seek to backtrack or water down portions of the normalization agreements that contradict international norms, such as the case of Morocco’s sovereignty over Western Sahara, or otherwise seek to dilute longstanding United States policies such as the F. – 35 sales to the Emirates.

Congress has also sounded the alarm on the deal.

The Senate narrowly accepted the Emirates’ purchases of stealth jets, drones and other precision weapons last week, indicating concerns over expanded arms deals for the Persian Gulf. This could be reversed if the Democrats take control of the chamber after next month’s runoff elections in Georgia. Separately, the move is being reviewed by the Biden administration to ensure the $ 23 billion sale to the UAE does not detract from Israel’s military lead in the region.

A day after the Senate vote, Republican Armed Forces Committee chairman, Oklahoma Senator James M. Inhofe, said it was “shocking and disappointing” that the Trump administration had decided to recognize Morocco’s sovereignty over Western Sahara and predicted it would be reversed. The United Nations, the European Union and the African Union regard Western Sahara as a disputed area.

“I am sad that the rights of the people in Western Sahara have been traded away,” Inhofe said in a statement. “The president was badly advised by his team. He could have made this deal without trading the rights of a voiceless people. “

Prime Minister Saad Eddine el-Othmani of Morocco said Tuesday that his government “didn’t want it to be an exchange”.

“We are not negotiating with the Sahara,” said Othmani in an interview with Al Jazeera. “But victory in this battle required company.”

Nowhere has the diplomatic agreement proved more delicate than in Sudan.

The State Department had already decided to remove Sudan from its list of state sponsors of terrorism in order to compensate victims of the 1998 bombings against American embassies in Kenya and Tanzania. As part of these negotiations, the Sudanese transitional government had called for the dismissal of all other terrorism lawsuits it had faced as a result of attacks in the 27 years it was on the list.

The Foreign Ministry agreed and countered last summer with a condition of its own: Sudan begins to thaw half a century of hostilities with Israel.

However, only Congress can grant Sudan the legal peace it is striving for. For the past few months, lawmakers have been bogged down as it would deny families of the victims of September 11, 2001, to challenge their days in court.

“We always wanted all terrorists to be held accountable for what they did on September 11,” said Kristen Breitweiser, an attorney whose husband was killed in the attacks on New York, in a statement released last week during angry negotiations in the Congress was published.

Sudan insists that it is not liable for the 9/11 attacks because al-Qaida leader Osama bin Laden left his sanctuary in the country five years before they were carried out. But The Congressional compromise, which officials and others close to the negotiations said have been drafted, will allow the 9/11 lawsuits to continue, potentially holding Sudan liable for billions in compensation for victims.

Representatives from the Sudanese embassy in Washington declined to comment, but previously said the country could potentially withdraw from the peace accords with Israel if it does not receive immunity from terrorism lawsuits. As the Trump administration tries to keep the deal from falling apart, an official confirmed a Bloomberg report that the United States had offered Sudan a $ 1 billion loan to settle its arrears and annual development aid of up to $ 1.5 billion. Treasury Secretary Steven Mnuchin is expected to visit Sudan, Israel and the Emirates in a high-level delegation in the region next month.

Bahrain appears to be a single exception among countries incentivized under normalization agreements with Israel, although the Foreign Ministry this week labeled Iran-linked Saraya al-Mukhtar a terrorist organization, in part because of its aim of overthrowing the tiny Sunni monarchy.

It has also raised concerns among current and former government officials and conflict analysts that the United States will identify Houthi rebels in Yemen as a foreign terrorist organization in an attempt to convince Saudi Arabia to sign the agreements with Israel.

Officials close to the decision said Secretary of State Mike Pompeo was inclined to use the designation to cut off Iranian support for the Houthis, who have taken control of most of Yemen, overthrowing its government and neighboring Saudi -Arabia on their five year border have attacked war. It could also ban the delivery of humanitarian aid to Yemen’s major ports, most of which are controlled by the Houthis, and exacerbate famine in one of the world’s poorest countries.

It is doubtful, however, that the very name terrorism would convince Saudi Arabia – the most powerful monarchy in the Middle East – to normalize relations with Israel. This thaw could last for years, if it happens at all, and until then it could possibly be driven more by an increasing number of young adults in the kingdom who are more concerned with jobs and economic stability at home than a generation-old conflict between Israel and Palestine.

Nikki Haley, who was Trump’s first ambassador to the United Nations, said a secret trip Israeli Prime Minister Benjamin Netanyahu made to Saudi Arabia last month to meet Crown Prince Mohammed bin Salman was a bold signal of detente.

“These Arab countries want to be friends with Israel,” said Ms. Haley on Wednesday at the Israel-based DiploTech Global Summit.

Even if they disapprove of Mr. Trump’s transactional diplomacy, Mr. Biden and Mr. Blinken will be cautious about withdrawing from Israel, which is the U.S.’s strongest ally in the Middle East and has significant political influence on American evangelicals and Jewish voters.

“I think President-elect Biden will try to move on with the momentum because it is beneficial to the US and US allies and I think this will be the right thing,” said Danny Danon, who retired this year as Israel’s ambassador to the United Nations.

Alan Rappeport reported from Washington and Aida Alami from Rabat, Morocco.