Just one day after President Biden issued broad mandates encouraging American workers to get vaccinated against the coronavirus, federal health officials released new data showing that unvaccinated Americans are 11 times more likely to die from Covid-19 than vaccinated people.
Three large studies published on Friday by the Centers for Disease Control and Prevention also emphasised the effectiveness of the shots in preventing virus infection and hospitalizations.
The study confirmed scientists’ deep conviction that vaccine hesitancy and refusal have prolonged the pandemic. According to several experts interviewed, the administration’s new plan should stem the tide of infections and return the country to some semblance of normalcy in the long run.
“It will fundamentally change the arc of the current surge,” said Dr. Ashish Jha, dean of Brown University School of Public Health. “It’s exactly what we need right now.”
The new data may also help to restore trust in the nation’s vaccines, which has been shaken by unexpected reports of breakthrough infections.
Between April and July, one of the studies examined more than 600,000 virus infections in 13 states, representing roughly one-quarter of the U.S. population. The researchers concluded that Americans who had not been fully vaccinated were far more vulnerable to virus infections, illness, and death.
Even after the Delta variant became dominant in the United States over the summer, the vaccines’ protections remained strong: adults who were not fully vaccinated were 4.5 times more likely to become infected, 10 times more likely to be hospitalised, and 11 times more likely to die from Covid.
According to the researchers, the cumulative data show that the country cannot hope to end the pandemic with 37 percent of Americans not having received a single dose of Covid vaccine. Cases and hospitalizations are expected to rise as Americans return indoors in the fall to their homes, schools, and offices.
That is why scientists have generally praised the Biden administration’s aggressive vaccination campaign. Mandatory vaccinations, according to Natalie Dean, a biostatistician at Emory University in Atlanta, will be critical for keeping the virus in check as it becomes endemic in the United States: “It’s part of the shift from short-term reactions to long-term solutions.”
Nonetheless, some experts warned that the administration’s plan would take many weeks to bear fruit. It is unclear when the new requirements will be finalised or how Republicans’ promised legal challenges will play out in courtrooms. Furthermore, while the administration claimed that the mandates would cover 100 million American workers, no one knows how many have already been immunised.
In any case, immunisation is not a quick process, taking at least six weeks for a two-dose vaccine. The administration did not emphasise measures that work faster to stop the virus, such as masking and widespread rapid testing.
To combat the Delta variant, a far more formidable foe than the original virus, the country will need every tool at its disposal. Only in mid-July did the variant become the dominant version of the virus in the United States, and the consequences have been far beyond what experts predicted.
Reassuringly low numbers of cases and hospitalizations in June have steadily increased for weeks to nearly tenfold their previous levels. Every day, approximately 1,500 Americans die, the vast majority of whom are unvaccinated.
According to the new C.D.C. research, much of the misery could be avoided. An analysis of 32,867 patient visits in nine states discovered that, despite the Delta variant predominating, the vaccines had an overall effectiveness rate of 86 percent in preventing hospitalizations, though they were less protective for adults 75 and older.
Moderna vaccines had the highest efficacy rate, at 95 percent, compared to Pfizer-80 BioNTech’s percent and Johnson & Johnson’s 60 percent.
As the variant spread, the effectiveness of the shots in preventing infection decreased slightly, from 91 percent to 78 percent. The Moderna vaccine was 92 percent effective against infection, compared to 77 percent for the Pfizer-BioNTech vaccine and 65 percent for Johnson & Johnson.
“There are more breakthrough infections than ever before — that’s a real phenomenon,” said Heather Scobie, an epidemiologist at the CDC and lead author of the largest of the studies. “But, for the most part, people who have been vaccinated do not visit hospitals.”
According to Dr. Dean, the new data show that vaccine mandates will protect millions more people, particularly against severe disease, and will relieve pressure on the health-care system. “It also establishes a precedent for other organisations to make similar decisions” regarding mandates, she added.
The administration’s new mandates include health care workers, requiring any provider receiving Medicaid or Medicare funding to require staff members to be vaccinated. According to experts, this is the most likely measure to have an immediate impact because health care facilities are high-risk settings for transmission.
Dr. Jha stated that there is ample historical precedent for the decision to hold hospitals to certain standards, most notably the historical directive to desegregate patients based on race.
“There is a real lack of leadership from health care systems that have not mandated within their own organisations, and it is critical that the president require that patients be protected,” he added.
The requirement may drive some health care and nursing home workers out of the profession, particularly those nearing retirement age, thereby exacerbating staffing shortages. Nonetheless, the mandates have more benefits than drawbacks, according to Dr. Nahid Bhadelia, founding director of Boston University’s Center for Emerging Infectious Diseases Policy and Research.
“This is a critical step in getting us out of the pandemic,” she said. “The very people who are caring for the most vulnerable patients in the hospital must be our first line of defence.”
The Labor Department will require all private-sector businesses with more than 100 employees to require full vaccination or testing at least once a week. Employers will be required to provide employees with paid time off to get vaccinated.
That action alone will have an impact on 80 million Americans. However, Bill Hanage, an epidemiologist at Harvard University, was sceptical that the mandates would succeed in inoculating millions more people than had previously opted for the vaccine.
He noted that some of the people who need to be protected the most urgently are older adults who will be unaffected by workplace requirements. On Friday, new C.D.C. research confirmed that this population was particularly vulnerable.
One study, conducted at five Veterans Affairs medical centres where patients are more likely to be burdened by chronic illnesses that contribute to severe Covid disease, discovered that the vaccines’ protection against hospitalisation declined with age, falling to 80% for those aged 65 and older, down from 95% for adults aged 18 to 64. A second study discovered that vaccine effectiveness began to decline at the age of 75.
And mandates are already being chastised by conservative Americans. Republican governors in several states have called the mandates unconstitutional and have said they intend to sue to stop them.
“My question is whether this actually causes people to get vaccinated, or if it just raises the political temperature around it,” Dr. Hanage said.
More than half of Americans support workplace vaccine mandates, but according to a recent poll, 87 percent of those who are unvaccinated say they will not get the shots even if their employers require them.
By insisting that vaccination is the only way out of the pandemic, officials in both the Trump and Biden administrations have downplayed the importance of masks, testing, and ventilation, despite the fact that many people are likely to remain unvaccinated, according to several experts.
“Many measures, such as an indoor mask mandate tied to community transmission rates or minimum ventilation standards for schools and workplaces, were left on the table,” said Dr. Gavin Yamey, a global health expert at Duke University.
Recently, Dr. Yamey was unable to find a single Binax rapid test within a 100-mile radius of Durham, N.C., which he described as “pathetic.” “I was recently in England, where home antigen tests are both free and plentiful.”
Dr. Bhadelia noted that simple and inexpensive tests are critical for monitoring the virus’s rise and fall: “If you don’t have eyes on the ground, if you don’t have the lay of the land, you really can’t do any other planning.”
The Occupational and Safety and Health Administration, which regulates workplace safety, will require private employers to require their employees to be vaccinated or to provide weekly proof of a negative test.
Weekly tests, however, are unlikely to be effective against the Delta variant because the virus replicates quickly in the airways and an infection spreads quickly. Businesses in hard-hit areas, at the very least, should consider testing twice a week, according to Dr. Bhadelia.
Many public health experts were “uncomfortable” when Americans, urged by the administration, prematurely celebrated a summer free of the virus, she said. However, with much of the world still unprotected from the virus, new variants of the virus may resurface in the country.
“We need an honest conversation about what it means to be on the other side of this crisis’s pandemic phase,” she said. “This is a once-in-a-century pandemic, and we must correct course — and it is OK to do so.”