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  • The Biden administration released details this week on COVID-19 vaccine rules for larger businesses and certain healthcare facilities.
  • The rules apply to businesses with 100 or more employees, along with certain healthcare workers and federal contractors.
  • Vaccination rates in the South and parts of the West continue to lag, leaving millions of Americans at risk of severe COVID-19.

Millions of Americans will come under COVID-19 vaccine requirements in early January, when new rules announced Nov. 4 by the White House kick in.

The rules apply to businesses with 100 or more employees, along with certain healthcare workers and federal contractors.

Employees who fall into these groups will need to be fully vaccinated — two doses of the Pfizer-BioNTech or Moderna-NIAID vaccine or one dose of Johnson & Johnson’s vaccine — by Jan. 4.

President Joe Biden said in a statement that these rules will protect workers and help boost the economy.

“Vaccination is the single best pathway out of this pandemic. And while I would have much preferred that requirements not become necessary, too many people remain unvaccinated for us to get out of this pandemic for good. So I instituted requirements — and they are working,” Biden said in a statement.

Together, the new rules will cover about 100 million Americans — two-thirds of all workers in the country.

In September, Biden announced a six-step plan to get the pandemic under control in the United States, including boosting vaccination rates.

Although vaccinations have increased since then, about one-fifth of Americans over 12 years old have yet to receive a single dose. About one-third are not fully vaccinated, according to the Centers for Disease Control and Prevention (CDC).

Vaccination rates in the South and parts of the West continue to lag, leaving millions of Americans at risk of severe COVID-19.

Earlier this week, the United States passed the grim milestone of over 750,000 COVID-19 deaths since the start of the pandemic.

“With the spikes of COVID-19 case counts that we saw over the summer and what our neighbors in the [United Kingdom] are experiencing, we know that many are still vulnerable to this virus,” said Ken Thorpe, PhD, chairman of the Partnership to Fight Chronic Disease and a professor of health policy at Emory University.

“We also know that these spikes are largely preventable, thanks to the safe and effective available vaccines,” he added.

Here are the details of the new rules.

The first rule, issued by the Occupational Safety and Health Administration (OSHA), covers employers with 100 or more employees.

Companies must ensure that their employees are fully vaccinated by Jan. 4 or that workers get tested for COVID-19 at least once a week.

Employers will also need to provide paid time off for employees to get vaccinated, and if needed, sick leave for workers to recover from the side effects of vaccination.

The rule does not require employers to provide or pay for testing, although other laws or collective bargaining agreements may require them.

In contrast, COVID-19 vaccines continue to be free for all Americans.

Workers who are not fully vaccinated will also need to wear a mask while in the workplace.

The vaccination and testing requirement goes into effect on Jan. 4. But other requirements — including paid time off for vaccination appointments and masking of unvaccinated workers — kick in on Dec. 5 of this year.

This rule will cover about 84 million Americans.

“In our collective effort to beat this pandemic, employers are uniquely positioned to help us make major strides to continue to stem the spread [of the coronavirus] and protect workers and their families,” said Thorpe.

A second rule issued by the Centers for Medicare & Medicaid Services (CMS) requires all workers — clinical and non-clinical — at healthcare facilities participating in Medicare or Medicaid to be fully vaccinated by Jan. 4.

Employees at these facilities do not have the option of weekly testing instead of vaccination, which experts say will help protect patients.

“Vaccines are … another workplace safeguard to minimize risk among employees and patients,” said Thorpe. “People visiting a healthcare facility are there for health-related reasons, most of which makes them more vulnerable to a COVID-19 infection.”

The rule covers more than 17 million workers at about 76,000 facilities, including hospitals, outpatient surgery centers, dialysis centers, home health agencies, and long-term care facilities.

Also covered are students, trainees, and volunteers at these facilities and contract workers who provide treatment or other services in those locations.

Margaret Foster Riley, JD, a law professor at the University of Virginia, said that although vaccine requirements may not be popular among certain groups, they work — often better than more popular incentive programs such as vaccine lotteries.

“Our previous experience with flu vaccine mandates in healthcare settings shows that vaccine mandates can bring compliance up from about 70 to 90 percent,” she said. “Anecdotal evidence from employer mandates with COVID seem to be similar.”

However, she said the response to the new vaccine rules might not be uniform throughout the country.

She has heard of greater resistance in some rural areas, where hospital staff has vowed to quit rather than get vaccinated.

“That doesn’t mean that when push comes to shove — jab? — that they’ll actually quit,” she said, “but they are, at least so far, voicing greater resistance.”

Previously, federal contractors had until Dec. 8 to be fully vaccinated. On Nov 5, the White House extended that deadline to Jan. 4, so it aligns with the other two vaccination rules.

People who cannot be vaccinated due to medical reasons or religious reasons are exempt from these rules, said a senior administration official during a media briefing on Nov. 4.

Each facility will be responsible for having a plan in place to comply with the exemptions that will be outlined in the final rule that is published in the Federal Register.

“Other than vaccine mandates for military personnel and immigrants, we haven’t seen a national federal vaccine mandate before,” said Riley, “so some aspects [of the response] are difficult to predict, especially since vaccination has become so politicized.”

Some companies and states, though, are pushing back on these rules. In addition, several states have already filed lawsuits against the administration’s vaccine rules.

Riley thinks “legal challenges are unlikely to succeed in the long run,” although she said it would depend in part on how the rules are drafted.

However, “legal challenges may be politically useful even if the chance of success is remote,” said Riley.