The Food and Drug Administration on Wednesday offered the first public look at Pfizer’s application for a booster coronavirus shot, two days before an outside advisory committee of experts is scheduled to meet to recommend whether or not the agency should approve the company’s request.
It also comes amid significant disagreement about the need for boosters between career scientists at the agency and top Biden health officials, who have already started planning a broad booster campaign for this fall.
In a 23-page document reviewing the company’s application, regulators examined safety and immune response data on roughly 300 adults who received a booster shot of Pfizer-BioNTech’s vaccine six months after their second dose, finding an increased immune response in study participants, even as they said that coronavirus vaccines were holding up powerfully against severe forms of Covid-19. There were no serious safety concerns associated with the booster injection, the regulators reported.
Pfizer said in a separate filing that one month after a third injection, levels of neutralizing antibodies against the Delta variant in a subgroup of trial volunteers were between five and seven times higher, roughly, than they were a month after the second dose. The company also reiterated its findings that the effectiveness of its vaccine against symptomatic disease fell from about 96 percent to about 84 percent by six months after the second shot, although it held steady against severe disease.
Pfizer argued in its filing that ebbing of the vaccine’s potency was the dominant reason for breakthrough infections among vaccinated people in Israel, which has relied almost exclusively on the Pfizer vaccine and has vaccinated its population faster than the United States.
But the F.D.A. regulators wrote that while waning immunity is one potential factor in breakthrough infections, other variables, including the Delta variant, may also have contributed to the cases.
In an interview, Pfizer officials acknowledged that the company’s booster study was quite small. But they said that the data they have delivered meets the F.D.A.’s criteria for justifying third shots for people 16 and up. Pfizer has another, much bigger booster study underway, with results expected this fall.
The F.D.A.’s analysis noted that Pfizer provided data on immune response against the Delta variant, by far the dominant variant in the U.S., in only two dozen people. Understanding the effectiveness of boosters against variants would likely be critical to the F.D.A.’s review, the document suggested. “Available data should support the effectiveness of the booster dose, particularly against currently circulating” variants, regulators wrote.
The analysis also suggested that regulators are cautiously weighing studies from Israel, which top Biden administration officials have said were key to their decision to recommend starting a booster campaign this month. Israel is already providing booster shots to most of its population.
“While observational studies can enable understanding of real-world effectiveness, there are known and unknown biases that can affect their reliability,” the regulators wrote. Studies in the United States “may most accurately represent vaccine effectiveness in the U.S. population,” they added.
Wading into an acrimonious debate over booster doses, researchers in Israel reported on Wednesday that a third dose of the Pfizer-BioNTech coronavirus vaccine can prevent both infections and severe illness in adults older than 60 for at least 12 days.
The study, published in the New England Journal of Medicine, is the latest salvo in the conflict over whether booster doses are needed for healthy adults and whether they should be given out, as the Biden administration plans to do, when so much of the world remains unvaccinated.
Several independent scientists said the cumulative data so far suggest that only older adults will need boosters — and maybe not even them.
Vaccination remains powerfully protective against severe illness and hospitalization in the vast majority of people in all of the studies published so far, experts said. But the vaccines do seem less potent against infections in people of all ages, particularly those exposed to the highly contagious Delta variant.
What the Israeli data show is that a booster can enhance protection for a few weeks in older adults — a result that is unsurprising, experts said, and does not indicate long-term benefit.
“What I would predict will happen is that the immune response to that booster will go up, and then it will contract again,” said Marion Pepper, an immunologist at the University of Washington in Seattle. “But is that three- to four-month window what we’re trying to accomplish?”
Federal health officials — including Dr. Anthony S. Fauci, President Biden’s top medical adviser on the pandemic — have justified plans to distribute booster shots by pointing to emerging evidence from Israel and other countries suggesting that immunity from vaccination wanes over time.
The idea has sent some Americans trying to get booster shots before they are formally authorized, a step the F.D.A. may take as soon as Friday. But even among government scientists, the idea has been met with skepticism and anger.
Two scientists who lead the F.D.A.’s vaccine branch said they would leave the agency this fall, in part because of their unhappiness over the administration’s push for booster doses before federal researchers could review the evidence.
Health officials are investigating a cluster of at least 16 Covid cases linked to an electronic music festival earlier this month on Randalls Island in New York City and urging everyone who attended the event to get tested.
The city’s Department of Health and Mental Hygiene said in a statement on Wednesday that the cases were connected to Electric Zoo, a three-day music festival that started Sept. 3. The department also identified eight people who may have attended the event while they were contagious.
“Anyone who attended this festival should get tested immediately, regardless of whether or not they have been vaccinated,” Dr. Dave A. Chokshi, New York City’s health commissioner, said in the statement.
Electric Zoo’s organizers did not immediately respond to a request for comment.
On Aug. 19, the festival announced that attendees would need to show proof of at least one vaccination or a negative Covid-19 test taken within 72 hours of the event. Masks were encouraged but not required.
New York City is grappling with a late-summer surge fueled by the Delta variant. The city reported a seven-day average of 1,489 new cases daily on Tuesday, despite the fact that 61 percent of its eligible residents are fully vaccinated.
News of the cluster comes as the concert industry faces a reckoning over how to rebound safely amid the highly contagious Delta variant.
After being shut down for more than a year, the industry’s comeback started promisingly. Restrictions were being eased and fans were snapping up tickets to events. But as the spread of the Delta variant accelerated, concerns mounted over safety. Artists including Stevie Nicks and Fall Out Boy canceled shows.
For those moving forward with concerts or festivals, a loose consensus took shape that fans should be required to provide proof of vaccination, or at least a negative test. But anecdotal reports suggest that the rigor of vaccine checks can be lacking, and the question of who bears responsibility for setting and enforcing those rules — especially when governments in major markets like Texas and Florida oppose such mandates — remains a matter of debate.
After the rapper Nicki Minaj questioned the efficacy of the Covid-19 vaccine in a Twitter post this week, the White House confirmed on Wednesday that it had offered her a call with a doctor to answer questions about the safety of the vaccine.
“As we have with others, we offered a call with Nicki Minaj and one of our doctors to answer questions she has about the safety and effectiveness of the vaccine,” a White House official said in a statement on Wednesday night.
Ms. Minaj appeared to believe that she was going to visit the White House. She said on Twitter on Wednesday that she would “be dressed in all pink like Legally Blonde so they know I mean business.”
“I’ll ask questions on behalf of the ppl who have been made fun of for simply being human,” she added.
Asked about the possibility of dialogue between Ms. Minaj and the White House, Jen Psaki, the White House press secretary, told reporters on Thursday that officials had proposed “a very early stage call” that amounted to an “offer to have a conversation” about the safety of the vaccine.
“If we believed that everybody who had skepticism about the vaccine wasn’t someone we should engage with or talk to, we wouldn’t have made the progress we’ve made,” Ms. Psaki said.
Ms. Psaki said she was unsure whether the call would take place.
On Monday, Ms. Minaj asserted that her cousin’s friend in Trinidad and Tobago “became impotent” after receiving the vaccine, a claim that nation’s minister of health, Terrence Deyalsingh, rejected.
“There has been no such reported either side effect or adverse event,” he said in a news conference online. “And what was sad about this is that it wasted our time yesterday, trying to track down, because we take all these claims seriously, whether it’s on social media or mainstream media.”
Pope Francis on Wednesday urged people to get vaccinated against Covid-19, adding that it was “ironic” that a cardinal who was not vaccinated had been hospitalized with the virus.
The pope, who has said that getting the vaccine is an “act of love,” made the comments to reporters on his plane. He seemed to be referring to an American cardinal, Raymond Burke, who spread vaccine misinformation and then was treated for Covid-19 at the Mayo Clinic in Rochester, Minn.
“Even in the College of Cardinals,” Francis said, “there are some anti-vaxxers, and one of them, poor man, is in hospital with the virus. But life is ironic.”
He said he didn’t know how to explain why people don’t trust the vaccines.
“Humanity has a history of friendship with vaccines,” he said. “As children, we got them for measles, for other things, for polio. All the children were vaccinated, and no one said anything. Then this happened.”
Francis added that everyone in the Vatican, “except for a small group,” was inoculated against the virus.
Los Angeles County next month will require proof of coronavirus vaccination to enter bars, nightclubs and other drinking establishments, as it joins the list of places putting pressure on people to get vaccinated, the county authorities said.
The county will require customers and employees at such establishments, which also include wineries, breweries and lounges, to show proof that they have at least one dose of the vaccine starting on Oct. 7 and both doses by Nov. 4. The move was announced on Wednesday by Dr. Barbara Ferrer, the director of the Los Angeles County Department of Public Health, at a meeting of the Los Angeles County Board of Supervisors.
“This is a reasonable path forward that could position us to be better able to break the cycle of the surges,” Dr. Ferrer said.
The requirement also extends to “outdoor mega events,” where attendees and employees starting on Oct. 7 must show either proof of a vaccine or of a negative Covid test within the past three days, the authorities said. Restaurants will not be included in this mandate, although the county recommends that restaurants follow it anyway. It wasn’t clear why restaurants were omitted.
The county already requires people to wear masks indoors, regardless of vaccination status.
County authorities did not specify how they would ask people to prove they were vaccinated. In New York, which last month became the first U.S. city to require proof of at least one dose for a variety of activities, workers and customers can either show their paper vaccination card or present evidence using one of two apps: NYC Covid Safe, issued by the city, or Excelsior Pass, issued by New York State.
In France, as of Aug. 1, anyone without a “health pass” showing they have been vaccinated or recently tested negative will not be admitted to restaurants, cafes or movie theaters, and they will not be able to travel long distances by train. The Italian government announced in July that it would require people to show proof of vaccination or a recent negative test in order to participate in certain public activities, including indoor dining, visiting museums and attending shows.
The move in Los Angeles County comes as debate is heating up over how far governments should — or can — go in circumscribing the life of the unvaccinated. That debate has intensified after many areas, including Los Angeles County, saw a wave of new coronavirus infections fueled by the Delta variant.
The seven-day average of new cases in the county has decreased slightly after reaching a peak of 3,477 on Aug. 18, according to a New York Times database. Of the county residents eligible for a vaccine, 58 percent are fully vaccinated.
France this summer began requiring patrons to show proof of vaccination to eat at restaurants or visit other public spaces — similar to rules that New York City started to enforce on Monday.
Here’s a look at the French system →
After months of delay, the Federal Emergency Management Agency has agreed to reimburse New York City’s public hospital system almost $1 billion for its expenses treating patients during the city’s brutal first wave of Covid-19 in 2020.
Senator Chuck Schumer, the majority leader, and Representative Ritchie Torres, both of whom represent New York, announced the news Wednesday outside of Lincoln Hospital in the Bronx, one of the city’s 11 public hospitals. The hospital is in Mr. Torres’s congressional district.
Mayor Bill de Blasio, also in attendance, praised the work the public hospital system has done during the pandemic, calling the system “the tip of the spear.” Nearly 3,000 patients died of Covid-19 in the system’s hospitals between March and September of 2020, according to state data. He added, “What I saw from all of you was extraordinary courage, strength, resiliency, incredible commitment.”
In October 2020, the system, known as NYC Health + Hospitals, requested roughly $900 million from FEMA to cover costs related to hiring extra staff and expanding its capacity to treat coronavirus patients. FEMA had initially agreed to reimburse only $260 million, less than one-third of the request, arguing that the remainder consisted of costs that were not necessarily related to the virus.
But the public hospital system, backed by the lawmakers, maintained that it was impossible to separate specific Covid-related expenses at a time when the system was swamped by the disease.
Mr. Torres’s office said Wednesday that after the lawmakers got involved, FEMA relented and agreed to send the system an additional $620 million.
In a June letter to FEMA, the head of NYC Health + Hospitals, Dr. Mitchell Katz, wrote that the system had spent about $2 billion in its response to Covid-19, and that it needed more reimbursement immediately “to provide critically needed cash flow to our safety net system.”
The reimbursement will cover staffing, equipment and patient care efforts that were necessary during the surge of Covid-19 cases, according to Mr. Torres’s office.
FEMA did not immediately respond to a request for comment.
At the Wednesday announcement, Dr. Katz thanked Mr. Schumer and Mr. Torres for “proving that the federal government can work.”
“We were short on supplies,” he said, recalling the worst days of the first Covid wave. “We were short on staffing, and the mayor never questioned whether or not we would get fully reimbursed. He always said, ‘Mitch, do what you need to do.’”
While the spread of new coronavirus cases is steady or slowing in much of the world, it is accelerating in the Western Hemisphere, where new case reports rose by 20 percent in the past week, the World Health Organization warned on Wednesday.
North America, where new case reports are up by one-third, is the chief driver of the new infections.
New cases doubled in the Canadian province of Alberta, “where hospitals are experiencing a critical staffing shortage,” Dr. Carissa F. Etienne, the director of the Pan American Health Organization, a division of the W.H.O., said at a news conference. And with new cases in the United States reaching levels not seen since January, Dr. Etienne said, “hospital capacity in many Southern U.S. states remains worryingly low.”
Several Central American countries are also experiencing infection surges, including Costa Rica, Guatemala and Belize. The spread of the virus has slowed somewhat in the Caribbean, but there are exceptions, including Jamaica, where new case reports are at their highest of the pandemic.
By contrast, in most of South America, which was very hard hit earlier in the year, reports of new infections and Covid-19 deaths are declining. The organization’s experts are not sure why, though they dismissed speculation that a decline in testing might be responsible.
“It’s important to note that this drop in South America is not an effect of laboratory testing,” said Dr. Sylvain Aldighieri, P.A.H.O.’s incident manager for Covid-19. “Laboratory vigilance has been maintained.”
Dr. Aldighieri said a number of factors could be at work in South America, including strict social distancing measures and reduced mobility in some countries. The change of season may also play a role, he added, noting that “the epidemiological curves for influenza between 2014 and 2019 in South America have a similar behavior to Covid-19 between 2020 and 2021.”
Although the highly infectious Delta variant is becoming predominant in the Caribbean, it has yet to make significant inroads in South America, Dr. Aldighieri said.
W.H.O. officials called on national governments to pay more attention to how the pandemic affects children, both directly and indirectly.
“At the beginning of the pandemic, the virus was having a disproportionate impact on our elderly,” Dr. Etienne said, “and as a result, too many children and young people still don’t think they’re at risk. We must change that.”
The strains that the pandemic has placed on health services also mean that many young people are not getting annual checkups, routine vaccinations and other services, including reproductive health services. That is helping to “fuel one of the largest jumps in teenage pregnancy that we’ve seen in more than a decade,” Dr. Etienne said.
And the closing of schools because of the pandemic “has triggered the worst educational crisis we have ever seen in this region,” she added.
— Daniel Politi
President Biden met on Wednesday with top executives from Microsoft, the Walt Disney Company, Kaiser Permanente and other companies that have endorsed vaccine mandates, days after he announced a federal effort to require employees of large companies to be vaccinated against the coronavirus or be tested regularly.
The administration sought to use the meeting to show that vaccine mandates are good for the economy while spotlighting employers that have mandates for workers or have praised Mr. Biden’s order. The meeting was meant to rally more business support for mandates.
“It’s about saving lives — that’s what this is all about,” said Mr. Biden, who was flanked by Treasury Secretary Janet Yellen and Jeffrey D. Zients, the White House pandemic coordinator.
“Vaccinations mean fewer infections, hospitalizations and deaths, and in turn it means a stronger economy,” he added.
One of the invitees to the meeting, Tim Boyle, the chief executive of Columbia Sportswear, said in an interview on Wednesday that his company had drafted a policy mandating vaccines months ago. But it had held off carrying it out until Mr. Biden announced last week that he was directing the Labor Department to issue an emergency safety declaration that would effectively function as a vaccine mandate for tens of millions of workers. Columbia Sportswear told its workers that it will put a vaccine requirement in place next week.
Mr. Boyle said Columbia was concerned that by acting alone it would risk losing as many as half of its workers in distribution centers and retail stores. Mr. Biden’s order, he said, reduced the risk that workers who don’t want to get vaccinated would quit to work elsewhere.
“There’s much less opportunity for people to go somewhere they don’t need to be vaccinated,” he said.
Mr. Boyle said vaccinations had divided Columbia’s work force. Managers in its Portland, Ore., headquarters have largely embraced the shots, he said, but retail and warehouse workers throughout the country have been more reluctant. He said that hesitancy had hurt the company, with infections and the threat of infection forcing closures and cleanings of locations.
“Those operations are predicated on people working together closely,” he said. Having unvaccinated workers is “highly disruptive.”
Several of the business leaders who met with Mr. Biden have installed mandates already, for at least part of their work force, including Disney, Walgreens and Children’s Hospital of Philadelphia.
Beginning Oct. 1, new immigrants to the United States must be fully vaccinated against Covid-19, the U.S. Citizenship and Immigration Services said in a news release on Tuesday.
People seeking to become “lawful permanent residents” — or green card holders — have permission to live in the United States and eventually seek citizenship. Applicants for permanent residency must undergo a medical examination.
The Covid vaccine joins a list of others that applicants must have, including inoculations against measles, mumps, rubella, polio, and hepatitis A and B, according to the Centers for Disease Control and Prevention. Some people may be exempt from the new rules, including those who are too young to be vaccinated and those who have medical conditions that make the shots dangerous for them.
About 54 percent of the U.S. population is fully vaccinated against Covid-19, and some people have begun to get booster shots.
The new requirement for those seeking permanent U.S. residency is in line with President Biden’s new vaccine mandates for federal workers and contractors. The Pentagon has announced that active-duty military personnel also must be vaccinated.
Mr. Biden has rolled back several Trump-era immigration rules, including a ban on legal immigration that Donald J. Trump implemented at the beginning of the pandemic.
— Kaly Soto
The European Union announced on Wednesday the creation of a new biomedical authority designed to better respond to future pandemics, as it seeks to avoid repeating the mistakes that plagued its early response to the coronavirus.
Ursula von der Leyen, the president of the European Commission, the bloc’s executive arm, also pledged to donate 200 million extra coronavirus vaccine doses to middle- and low-income countries by mid-2022, in addition to 250 million already promised by the end of the year.
In her annual speech on the state of the union, Ms. von der Leyen described vaccination discrepancies as one of the greatest geopolitical issues facing nations.
“The scale of injustice and the level of urgency are obvious,” Ms. von der Leyen told lawmakers at the European Parliament in Strasbourg, in eastern France, acknowledging that the bloc and other rich nations had fallen short on their promises.
But the bloc’s pledges on vaccine donations have so far rung hollow: E.U. member countries had only donated 18 million doses as of early September, a fraction of the 200 million promised. Covax, the global vaccine-sharing program, of which the European Union is a part, last week slashed its forecast for doses available this year, in part because rich countries continued to hold most of the world’s doses.
Still, Ms. von der Leyen’s speech served as a reset for the European Commission after early missteps in vaccine procurement that took a more positive turn in recent months.
While most developing countries have yet to administer a single dose of a coronavirus vaccine, including in the European Union’s immediate neighborhood, more than 70 percent of adults across the bloc have been fully vaccinated.
“We delivered,” she said, although she conceded that the bloc faced wide discrepancies domestically, as several Eastern European countries have been lagging behind.
Ms. von der Leyen’s confident tone on Wednesday came in great contrast with her speech last year, when new Covid-19 cases were picking up across the bloc and coronavirus vaccines were months away.
“When I stood here in front of you a year ago, I didn’t know when and if we could have a safe and effective vaccine against the pandemic,” she said.
The European Commission, which negotiated for vaccines on behalf of member countries, was heavily criticized for the sluggish beginning of its vaccination program. The commission signed its first deal on behalf of member nations months after the United States, hampering vaccine deliveries and, later, inoculation campaigns.
Yet the rollout gained speed in recent months, and many E.U. countries have now overtaken other rich nations like the Britain, Israel and the United States. Some have started administering booster shots to millions of older and vulnerable residents, even though the World Health Organization has called on the richest nations to delay boosters until the end of the year, to allow more doses to go to poorer countries.
To help the bloc be better prepared for future health crises, Ms. von der Leyen said that the new agency — known as the Health Emergency Preparedness and Response Authority, or HERA — would aim to “make sure that no virus will ever turn a local epidemic again into a global pandemic.”
It is set to receive 50 billion euros (about $59 billion) in funding by 2027 and will function alongside the E.U.’s existing health agencies, the European Center for Disease Control and the European Medicines Agency.
But its exact role remains unclear, as E.U. members each run their own health policies. The pandemic brought to light the limits of the European Center for Disease Control, which is in charge of coordinating individual nations’ pandemic response plans but has had limited powers in enforcing or modifying states’ actions.
Still, many welcomed the creation of the new agency, highlighting a need for more coordination at an E.U. level. Véronique Trillet-Lenoir, an oncologist and a lawmaker in the European Parliament, said the agency could reinforce solidarity among the bloc’s member countries, something it lacked in the early stages of the pandemic.
“What the coronavirus pandemic has shown is that the 27 member states have fared much better all together,” Ms. Trillet-Lenoir said, “and that no European country would have done better on its own.”
The last 18 months have been exceptionally difficult for Public School 5 in the South Bronx, which serves low-income Black and Latino elementary- and middle-school students in a neighborhood that has been ravaged by the coronavirus.
Last year, about 80 percent of the school’s roughly 600 students chose to learn remotely.
But Danielle Keane, the school’s principal, believed her students needed to be back in classrooms this fall. And she knew she couldn’t just hope that her families would suddenly feel comfortable sending their children back.
So over the summer, she set out to make P.S. 5 a place that people wanted to be. There were comedy nights for families, along with literacy classes for parents still learning English, an outdoor movie night in the park adjacent to the school and a carnival that was wildly successful.
On Monday, nearly 90 percent of students on Ms. Keane’s register returned to classrooms, a higher percentage than the citywide average of just over 82 percent.
The school felt as vibrant as Ms. Keane hoped it would. “What a beautiful day,” she said.
But it’s only a first step toward achieving something like a normal school year.
Ms. Keane’s work is being put to the test this week, as New York’s school system, the nation’s largest, fully reopens for the first time since March 2020 — with no remote learning option.
There’s so much the school’s teachers don’t know about what the hundreds of children who were remote last year have been through. The academic and mental health challenges that will reveal themselves in the coming days and weeks may be enormous.
When Prime Minister Boris Johnson fumbled his initial response to the coronavirus pandemic, his political fortunes faltered. Then when Britain’s vaccine rollout proved surprisingly effective, his standing rebounded.
Now, with his popularity waning again — this time over tax policy — Mr. Johnson is hoping that the shots will turn things around for him a second time.
He is placing his faith in a redoubled vaccine campaign, including initial shots for children 12 to 15 and boosters for anyone over 50, to protect Britain’s health service from being overwhelmed by a winter surge, and to spare him from having to order lockdowns that would depress the economy and infuriate a noisy caucus of his own lawmakers.
If a major winter surge does develop, Mr. Johnson could reinstitute a mask mandate, introduce “vaccine passports,” and urge workers to stay home if possible, under what the government calls its Plan B. Full lockdowns would be a last resort.
“We’re now in a situation where so many of the population have some degree of immunity, smaller changes in the way we’re asking people to behave can have a bigger impact,” Mr. Johnson said at a news conference on Tuesday.
For a leader who often seems to defy political gravity, the risks are high. Poll ratings are slipping for Mr. Johnson’s Conservative Party, and some of the new voters he attracted in the 2019 election might be drifting away. “His premiership currently doesn’t seem to have delivered on the things that these voters want,” said Matthew Goodwin, professor of politics at Kent University.
“The vaccine bounce helped him the first time around, Mr. Goodwin said, “and if the booster plan — which will be a massive story in British politics — goes well and he’s able to say the rollout is going to plan, that will potentially help him.”
Like other Republican governors around the country, Tate Reeves of Mississippi reacted angrily to the coronavirus vaccine mandates President Biden imposed on private businesses. Declaring the move “terrifying,” he wrote on Twitter: “This is still America, and we still believe in freedom from tyrants.”
There is a deep inconsistency in that argument. Mississippi has some of the strictest vaccine mandates in the nation, which have not drawn opposition from most of its elected officials.
Not only does it require children to be vaccinated against measles, mumps and seven other diseases to attend school, but it goes a step further than most states by barring parents from claiming “religious, philosophical or conscientious” exemptions.
Resistance to vaccine mandates was once a fringe position in both parties, more the realm of misinformed celebrities than mainstream political thought. But the fury over Mr. Biden’s mandates shows how a once-extreme stance has moved to the center of the Republican Party.
Mr. Biden also imposed vaccine mandates on federal workers and many health care workers. But Republican outrage is really boiling over his plan to require all private-sector businesses with more than 100 employees to mandate vaccines or weekly testing for their work forces.
Gov. Greg Abbott of Texas called the president’s move “a power grab.” Gov. Henry McMaster of South Carolina promised to fight Mr. Biden in court, to “the gates of hell.” Gov. Greg Gianforte of Montana called it “unlawful and un-American.” Gov. Kay Ivey of Alabama called the move “outrageous” and “overreaching.”
But each of these states — like every state in the country — already mandates certain vaccinations for children, and sometimes for adults, including health care workers and patients in certain facilities.
Republican suspicion of vaccines was building before the pandemic; when Donald J. Trump was running for president in 2016, he rejected established science by raising the debunked claims that vaccines cause autism.
Now, some of the governors argue that given the country’s outsize divisions, and widespread suspicion of Washington, federal intervention would be counterproductive. It would be best, they say, to let state officials continue making the case that the vaccines are safe and effective, and to allow people to decide themselves.
Three-quarters of American adults have had at least one Covid-19 shot, which suggests growing acceptance of the vaccine. Mr. Biden’s move is aimed at the roughly 80 million Americans who are eligible but remain unvaccinated.
As a coronavirus vaccination mandate for health workers went into effect in France on Wednesday, government officials said that some were still holding out against the obligation.
Under a law passed this summer, nearly 3 million people who work in health care or other essential fields — including hospital workers, retirement home employees and firefighters — must get at least a first shot or face job suspensions without pay. Those who have already received their first dose have until Oct. 15 to get a second one.
Gabriel Attal, the French government spokesman, said at a news conference on Wednesday that more than 90 percent of health workers had received at least a first dose, compared with 64 percent in early July, when President Emmanuel Macron first announced the mandate.
“A vast majority of health workers have made the choice of responsibility,” Mr. Attal said, adding that the measure aimed to “protect hospitals, protect our health workers, protect vulnerable patients.”
Mr. Macron had announced the mandate and a broader health pass policy in July to counter slumping vaccination rates. The health pass — which shows proof of vaccination, a recent negative coronavirus test or recovery from Covid-19 — is now mandatory to eat at restaurants, go to the movies and attend other public venues.
Protesters angered by the policy marched through cities around France over the summer, calling the pass an infringement on their freedom. But the demonstrations have dwindled in size over the past weeks. The policy is now broadly accepted, and France has seen an uptick in vaccination rates.
Still, several hundred health care workers demonstrated in front of the health ministry in Paris over the weekend, voicing their discontent.
Some union leaders, who favor vaccination but say the government should convince health workers instead of forcing them, have warned that France’s health care system could come under strain if even a small number of unvaccinated workers were suspended.
But most officials were reassuring.
“It won’t destabilize hospitals,” Frédéric Valletoux, the head of France’s hospital federation, told RTL radio on Wednesday, adding that “it might disturb the functioning of a department here or there, but hospital workers will step up, reorganize, and life will go on.”
The attitude of health workers who refuse to get vaccinated is “very individualistic, very selfish,” Mr. Valletoux added.