The Washington Post

U.S. has weighed vaccine rule for internatio­nal fliers

- BY ANNIE LINSKEY AND YASMEEN ABUTALEB

As White House officials rushed to shape last week’s sweeping new vaccine mandates, they debated the idea of requiring internatio­nal air travelers to be vaccinated before boarding a plane, as part of a larger effort to persuade more Americans to get immunized, according to two people familiar with the plans.

Some aides argued that other countries already require vaccinatio­ns to fly and that the United States should join their ranks, according to an administra­tion official. But others said mandates work best when they require people to prove they are immunized only once — like at work — rather than repeatedly, like every time they board a plane.

The idea was shelved, but top White House officials say that proposal and similar ones are still under considerat­ion — including, potentiall­y, a broader vaccine mandate that would include domestic air travel.

“We’re discussing it,” Anthony S. Fauci, President Biden’s chief medical adviser, said about the

idea of a broader requiremen­t in an interview. “It’s on the table for discussion.”

White House officials stressed that no additional mandates are imminent, as the Biden administra­tion is still sorting through how to implement the ones announced last week.

The debate over an airplane mandate, which many public health officials say is a logical next step, highlights Biden’s struggle to balance public health needs with practical, economic and political considerat­ions. Some at the White House warn, for example, that an air mandate could prompt frustratin­gly long lines at airports.

Either way, Biden’s top advisers say that significan­tly more measures may be needed to convince — or coerce — Americans to get vaccinatio­ns, as more than 70 million Americans who qualify for coronaviru­s shots have not gotten them.

That could mean more social tumult ahead, since Republican­s are increasing­ly embracing a nomandate message. GOP governors have announced lawsuits to block last week’s actions, and House Minority Leader Kevin Mccarthy (R- Calif.) on Monday tweeted, “NO VACCINE MANDATES.”

Requiring vaccines for air travel would be a big step beyond Biden’s announceme­nt last week that businesses with more than 100 employees must require their workers to get vaccines or regular tests. Biden also ordered all federal employees to get shots and said most health-care facilities that get Medicare or Medicaid funding will now have to immunize their workers.

In a departure for the discipline­d Biden White House, some of the disagreeme­nts about an air travel mandate have broken into the open. Fauci, for example, applauded the idea in an interview for The Skimm podcast, saying, “I would support that if you want to get on a plane and travel with other people, that you should be vaccinated.”

But in a different podcast, “Pod Save America,” White House Chief of Staff Ron Klain challenged the notion, suggesting it’s impractica­l and possibly unnecessar­y. “We’re going to pick up the vast majority of Americans with the requiremen­ts we’ve [already] put in place,” Klain said.

Still, he added that the air travel mandate “is something we continue to look at.”

One person who talks regularly with White House officials said they often seem overwhelme­d with the sheer number of anticovid proposals being tossed at them from various quarters.

Mandates are only one of the anti-covid measures the White House is juggling. The administra­tion moved this week to stave off shortages of monoclonal antibodies, taking over distributi­on of the critical covid-19 therapy and purchasing 1.4 million additional doses.

That change, which took effect Monday, is all but certain to result in cuts to some states, especially seven in the Deep South with high infection rates that have been using about 70 percent of the national supply.

Soaring demand for the therapy represents a sharp turn from just two months ago, when monoclonal antibodies were widely available. Since then, word of the highly effective therapy — which is free to patients — has spread, with federal officials and Republican­s, including Florida Gov. Ron Desantis, urging their use.

So the Department of Health and Human Services will, at least temporaril­y, set the rules for their distributi­on instead of allowing states, medical facilities and doctors to order them directly. “HHS will determine the amount of product each state and territory receives on a weekly basis,” an HHS spokesman said.

The issue of a potential vaccine requiremen­t for air travel arose several weeks ago, during an administra­tion discussion of whether to extend the current airplane mask mandate. Some advisers suggested that — besides masking up — internatio­nal travelers be required to prove they had been vaccinated or tested negative, according to a person familiar with the conversati­on who spoke on the condition of anonymity because they were not authorized to describe it.

It is unclear whether the policy would apply to Americans traveling abroad, to foreigners visiting the United States or to both.

There was also a discussion of whether a mandate for domestic flights might also be necessary, the person said. But some administra­tion officials challenged that idea, asking how the rule would apply in emergency situations, or if an unvaccinat­ed traveler was headed to a funeral and had no time to get inoculated.

The White House has also been contending with pushback from the airline industry to the idea of further domestic mandates.

Industry officials have told the administra­tion that they have already been hit hard by the pandemic and contended that air travel is now a relatively safe activity, because airlines are requiring masks and have increased airflow in the cabin in response to the pandemic.

“A4A passenger carriers comply with all [Centers for Disease Control and Prevention] guidelines and requiremen­ts, and remain committed to leaning into science to guide policies and protocols that prioritize the wellbeing of all travelers and employees,” said Katherine Estep, a spokeswoma­n for Airlines For America, an industry trade group.

Fauci suggested that it made sense for Biden to consider an array of issues — including the likely reaction to a policy — in deciding what anti-covid steps to take. “The president has to make decisions based on a number of factors — the acceptance of it, the impact of it, what the response would be of it,” Fauci said.

One question the administra­tion has so far stayed away from is what constitute­s an acceptable proof of vaccinatio­n, an issue that seems central to any mandate. The administra­tion has said it will not create vaccine “passports” or ID cards but has not specified what kind of evidence employers should require instead.

U.S. vaccinatio­n rates began to tick up recently after weeks of stagnation as the delta variant surged and more people feared infection. But they are still nowhere near where they were in the spring, when more than 3 million people a day were getting shots, according to a Washington Post vaccine tracker.

Mandates have been shown to be perhaps the most effective tool to compel hesitant people to get vaccinated, and several European countries saw vaccinatio­n figures rise after they instituted mandates for activities such as going to restaurant­s, bars and gyms. There is a growing consensus among public health experts that Biden will similarly have to go further.

“What they did is fantastic, don’t get me wrong,” said Ezekiel Emanuel, a bioethicis­t at the University of Pennsylvan­ia who was on Biden’s transition team. “But unfortunat­ely we need more, because there are lots of people who will fall through the cracks with what’s been done.”

He added, “The easiest and best thing to do at this point is probably a travel mandate.”

White House officials stress that since they announced a major package of mandates just last week, they are focused on implementi­ng those before they add new ones. “Right now, our focus is on operationa­lizing this plan as quickly and effectivel­y as possible,” said Kevin Munoz, a White House spokesman.

But other officials leave little doubt that other actions could come. “We’re not taking any measures off the table,” Jeff Zients, the top White House covid-19 response coordinato­r, said Friday.

Zients suggested that the White House prefers prodding private companies to require vaccines, as in last week’s mandates, rather than implementi­ng mandates itself, as it would have to do for air travel. The more visible the government is in enforcing mandates, he said, the more likely it is to antagonize vaccine resisters.

“We believe that workplaces are a very efficient and effective way to ensure that people get vaccinated or, at minimum, get tested one time per week,” Zients said. “And verifying in the workplace that someone is vaccinated does not place an ongoing burden on vaccinated people.”

Similarly, the White House has urged the nation’s governors to enact various mandates, including one for teachers, school staffers and students 12 and older.

Some critics have accused Biden of being too slow to use the levers available to him to require that all Americans get vaccines, given how quickly the pandemic would end if more people took them. But others say the president was right to calibrate his actions to the public’s sentiment, which has grown more supportive of mandates.

“You go incrementa­lly. You build up toward mandates,” said Celine Gounder, an epidemiolo­gist who was a member of Biden’s covid task force during the transition. “You need to show that less-aggressive approaches are not working before you go to a more aggressive approach.”

Gounder said she has told administra­tion officials that if they impose a travel mandate, they should make sure vaccines are available at travel hubs so that the unvaccinat­ed can get shots there. Such a scenario would envision a travel mandate where Americans would not have to be fully vaccinated to travel, since a second shot comes several weeks later.

Other countries have been more willing than the United States to impose far-reaching mandates. In France, vaccines are mandatory for health-care workers, and patrons of restaurant­s, bars, museums and other public venues will be required to present a “health pass” demonstrat­ing they are fully vaccinated, have a negative test or have recovered from the virus.

French officials, who forged ahead despite protests, have reported a surge in vaccine appointmen­ts after announcing the mandates. In the European Union, in general, more than 70 percent of the population is fully vaccinated.

Even before Biden’s sweeping mandates were announced last week, some businesses in the United States had instituted mandates or penalties for those who do not get vaccinated. Delta Air Lines, which last month said employees who do not get vaccinated will have to pay $200 more per month for their health care, said a fifth of its unvaccinat­ed employees received shots within two weeks of the company’s announceme­nt.

Tyson Foods said 5,400 workers received their first coronaviru­s shots or were fully vaccinated about a week after it announced its workforce had to be inoculated by November.

The administra­tion still must write a rule to implement Biden’s new policy that firms with more than 100 employees must require vaccines or regular testing. The rule will also almost certainly face legal challenges from Republican­s who have said they will sue the administra­tion.

Klain, speaking on the “Pod Save America” program, said he is confident the move will survive legal scrutiny, saying it is a “very standard applicatio­n” of the authority of the Occupation­al Safety and Health Administra­tion.

He compared it to the rule that constructi­on workers must wear hard hats. “We’re in a pandemic right now,” Klain said. “To keep workers safe, to keep people in the workplace safe, requiring vaccinatio­ns is part of OSHA’S mandate.”

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 ?? DEMETRIUS FREEMAN/THE WASHINGTON POST ?? President Biden speaks with reporters as he heads for Marine One on the South Lawn at the White House on Sept. 3. Debate has ensued about the pace of Biden’s efforts to encourage or require Americans to get vaccinated against the coronaviru­s.
DEMETRIUS FREEMAN/THE WASHINGTON POST President Biden speaks with reporters as he heads for Marine One on the South Lawn at the White House on Sept. 3. Debate has ensued about the pace of Biden’s efforts to encourage or require Americans to get vaccinated against the coronaviru­s.

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