COVID-19 vaccination in the United States

COVID-19 vaccination campaign in the United States

United States. Percentage with at least one vaccination dose. See Commons source for date of last upload. US territories: GU = Guam. AS = American Samoa. RP = Republic of Palau. FM = Federated States of Micronesia. MP = Northern Mariana Islands. MH = Marshall Islands. VI = Virgin Islands.[1]
Date	December 14, 2020 (2020-12-14) – present
Location	United States Compact of Free Association:[2][3]  Palau  Marshall Islands  Micronesia
Cause	COVID-19 pandemic in the United States
Organized by	Center for Disease Control and Prevention
Participants	209,982,936 people have received at least one dose administered of Pfizer–BioNTech, Moderna or Janssen (September 14, 2021) 179,289,983 people have been fully vaccinated (both doses of Pfizer–BioNTech or Moderna, or one dose of Janssen)[4]
Outcome	63% of the United States population has received at least one dose of a vaccine 54% of the United States population is fully vaccinated
Website	COVID-19 Vaccine: CDC COVID-19 Vaccinations in the United States

The COVID-19 vaccination campaign in the United States is an ongoing mass immunization campaign for the COVID-19 pandemic in the United States. The FDA granted emergency use authorization to the Pfizer–BioNTech vaccine on December 10, 2020;^[5] mass vaccinations began on December 14, 2020. The Moderna vaccine was granted emergency use authorization on December 17, 2020,^[6] and the Janssen (Johnson & Johnson) vaccine was granted emergency use authorization on February 27, 2021.^[7] By April 19, 2021, all U.S. states had opened vaccine eligibility to residents aged 16 and over.^[8] On May 10, 2021, the FDA approved the Pfizer-BioNTech vaccine for adolescents aged 12 to 15.^[9] On August 23, 2021, the FDA granted full approval to the Pfizer–BioNTech vaccine for individuals aged 16 and over.^[10]

The U.S. government first initiated the campaign under the presidency of Donald Trump with Operation Warp Speed, a public–private partnership to expedite the development and manufacturing of COVID-19 vaccines. Joe Biden became the new President of the United States on January 20, 2021. Biden began his term with an immediate goal of administering 100 million vaccine doses within his first hundred days in office, signing an executive order which included increasing supplies for vaccination.^[11][12][13] This goal was met on March 19, 2021.^[14] On March 25, 2021, he announced he would increase the goal to 200 million within his first 100 days in office.^[15] This goal was eventually reached on April 21, 2021.^[16]

By July 4, 2021, 67% of the United States' adult population had received at least one dose, just short of a goal of 70%. This goal was eventually met on August 2, 2021. While vaccines have helped significantly reduce the number of new COVID-19 infections nationwide, states with below-average vaccination rates began to see increasing numbers of cases credited to the highly infectious Delta variant by July 2021, which led to an increased push by organizations and companies to begin imposing de facto mandates for their employees be vaccinated for COVID-19.

In early September 2021, President Biden announced plans by the federal government to use executive orders and emergency temporary standards enforced by OSHA to mandate the vaccination of all federal branch employees, and require that all companies with more than 100 employees regularly test all employees who are not yet fully vaccinated for COVID-19.

Vaccination program[]

Vaccines were distributed to states on a population basis, with the vaccine rollouts being administered by each individual U.S. state. The Center for Disease Control and Prevention suggested that hospital workers and nursing home personnel be the first individuals vaccinated. The subsequent phases of the rollout are determined by each individual state agency.

The CDC has issued cards that can be used to track vaccine progress and serve as a proof of vaccination when requested (such as during international travel).^[17] States such as California and New York have offered a digital immunity passport accessible via a mobile app.^[18][19]

Eligibility of non-citizens[]

On February 1, 2021, the Department of Homeland Security said it "fully support[s] equal access to the COVID-19 vaccines and vaccine distribution sites for undocumented immigrants" and that related federal agencies "will not conduct enforcement operations at or near vaccine distribution sites or clinics".^[20]

States may have intended that vaccines be prioritized for their residents ahead of tourists, but there was some difficulty communicating and enforcing this. Some American adults have no driver's license,^[21] and the United States does not automatically provide each citizen with identity documentation in a centralized system. Furthermore, when people did not show up for their vaccine appointments, many clinics vaccinated anyone else who happened to show up so that the doses would not be wasted. As a result, some tourists as well as undocumented immigrants were vaccinated.^[22]

As of early February 2021, states including Florida, California, New York, and Texas were specifically trying to restrict "vaccine tourism": brief visits to the US with the primary intention of obtaining a vaccine.^[23] However, contrary to rumors that spread on social media, the United States did not have a policy of cancelling visas or imposing fines on tourists who sought vaccination. Diplomats pointed out that the B1/B2 tourist visa allows people to seek medical treatment while within the United States, even if they do not turn out to be eligible for the COVID-19 vaccine.^[24]

As of May 13, 2021, according to the Colombian newspaper El Tiempo, the following U.S. states were not requiring foreigners to present proof of residency to receive the vaccine: Alabama, Arizona, California, Colorado, Florida, Iowa, Louisiana, Maryland, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Wyoming.^[25] Thousands of Latin Americans were booking travel to the United States and being vaccinated in the country. Vaccination centers in some U.S. states were accepting foreign passports as valid identification. Travel agencies were advertising "vaccination tourism," and the U.S. embassy in Peru, for example, advised that travelers to the United States could seek vaccination.^[26][27] The governor of Alaska announced that, as of June 1, any international visitor over age 12 could be vaccinated in Alaska and vaccines would be available at airports for convenience.^[28]

Background[]

From early 2020, more than seventy companies worldwide (with five or six operating primarily in the U.S.) began vaccine research.^[29][30] The global competition had national security implications for various countries.^[31]

In preparation for large-scale production, Congress set aside more than $3.5 billion for this purpose as part of the CARES Act.^[32][30] Among the labs working on a vaccine is the Walter Reed Army Institute of Research, which has previously studied other infectious diseases, such as HIV/AIDS, ebola, and MERS. By March 18, tests had begun with dozens of volunteers in Seattle, sponsored by the U.S. government, and similar safety trials were planned for other potential vaccines.^[33] Bill Gates, whose foundation shifted its focus nearly entirely to the pandemic, anticipated in early 2020 that a vaccine could be ready by early 2021.^[34]

On August 5, 2020, the United States agreed to pay Johnson & Johnson more than $1 billion to create a hundred million doses of COVID-19 vaccine. The deal gave the U.S. an option to order an additional two hundred million. The doses were supposed to be provided for free to Americans if they are used in a COVID-19 vaccination campaign.^[35]

Senior citizens await COVID-19 vaccine at a Maryland pharmacy in January 2021.

BIO, a trade group of all coronavirus vaccine makers except AstraZeneca, tried to persuade Secretary Azar to publish strict FDA guidelines that would help ensure the safety and public uptake of the vaccine. Politics impacted scientific practice, however, when chief of staff Mark Meadows blocked the FDA when it was realized that the timing of the provisions would make it impossible for a vaccine to be authorized before the November election.^[36][37] Ultimately, the guidelines emerged^[38] from the Office of Management and Budget and were published on the FDA website.^[39]

As of October 2020, 44 were in clinical trials on humans, and 91 pre-clinical vaccines were being tested on animals.^[40] Most of these trials were underway.^[41]

On November 20, 2020, the Pfizer–BioNTech partnership submitted a request for emergency use authorization (EUA) to the Food and Drug Administration (FDA),^[42][43] and the FDA announced that its Vaccines and Related Biological Products Advisory Committee (VRBPAC) would review the request.^[44][45] An EUA is a mechanism under the Pandemic and All-Hazards Preparedness Reauthorization Act of 2013 that permits products not yet fully approved by the FDA to be used as part of a current state of emergency.^[46]

On December 11, the FDA granted emergency use authorization for the Pfizer–BioNTech vaccine.^[47][48] An initial shipment of 2.9 million doses were scheduled to be distributed rapidly, and Pfizer promised to continue supplying the rest of the hundred million doses through March 2021.^[49][50] Pfizer had adequate stocks available and began this distribution on December 17, 2020, but the federal government reduced the amount Pfizer was allowed to distribute.^[51][52]

On December 18, 2020, the FDA granted the Moderna vaccine emergency use authorization,^[53][54] which Moderna had requested on November 30, 2020.^[55][56] The U.S. planned to rapidly distribute 5.9 million doses with more to come later.^[57][58]

Despite his involvement in spurring their development via Operation Warp Speed, Trump largely downplayed vaccines during his final months in office, and both Trump and First Lady Melania Trump received the vaccine in private before Joe Biden took office as the new president in January 2021.^[59][60][61]

On February 27, 2021, the Janssen COVID-19 vaccine was granted emergency use authorization by the FDA for use. However, this vaccine has faced backlash from some government officials, believing it to be not as effective as Pfizer or Moderna. On March 5, the mayor of Detroit, Mike Duggan, rejected a shipment of the Janssen vaccine, saying, "Moderna and Pfizer are the best. And I am going to do everything I can to make sure the residents of the city of Detroit get the best."^[62] After backlash, Duggan declared he would no longer decline the vaccine.^[63]

On March 11, 2021, President Biden announced that he would direct all states to make vaccines available to all adults no later than May 1.^[64] On April 6 he said he would direct states to make all adults eligible for vaccination by April 19.^[65] This deadline was met after several states opened up vaccination to everyone 16 and above the same day.^[66]

As of May 2021, most experts thought the United States would be unable to achieve herd immunity, at least in the near term, given insufficient demand for the vaccines.^[67] On that note, many sources are saying the new variants last longer than 14 days, such as those found at home and abroad.^[68]

On July 6, Biden announced plans for more targeted outreach in order to reach under-vaccinated populations, such as shifting from larger mass clinics to having wider availability at community locations and events, and going "neighborhood by neighborhood, and oftentimes, door to door—literally knocking on doors—to get help to the remaining people protected from the virus" ^[69][70][71]

On July 16, the FDA approved a request by Pfizer to give its vaccine a priority review designation, meaning that final approval of the vaccine would be pursued on an expedited timetable. While priority review processes usually take up to six months, it was expected that the Pfizer vaccine may be approved within weeks.^[72][73][74]

On August 12, the FDA amended the EUA for the Moderna and Pfizer vaccines in order to allow a third, booster dose for patients who are immunocompromised or have received organ transplants. Director of the CDC Rochelle Walensky stated in a press briefing that "certain people who are immune compromised, such as people who have had an organ transplant and some cancer patients, may not have had an adequate immune response to just two doses of the [vaccine]." In an interview with Today, Director of the National Institute of Allergy and Infectious Diseases (NIAID) Anthony Fauci stated that "inevitably, there will be a time when we'll have to give boosts [to the general public]. What we're doing literally on a weekly and monthly basis is following cohorts of patients to determine if, when and whom should get it. But right now at this moment, other than the immune compromised, we're not going to be giving boosters to people."^[75] The World Health Organization (WHO) discourages the use of booster shots for COVID-19 in developed countries, as they would divert supplies away from the unvaccinated.^[76]

On August 18, Walensky and acting Commissioner of the FDA Janet Woodcock released a joint statement indicating that, pending FDA approval, booster doses for the Moderna and Pfizer vaccines would become generally available by the week of September 20, for those who had received their second dose at least eight months prior. They stated that that protection against severe outcomes or death "could diminish in the months ahead, especially among those who are at higher risk or were vaccinated during the earlier phases of the vaccination rollout", such as health care workers and seniors.^[77]

On August 23, the FDA announced that it had formally approved the Pfizer vaccine for individuals 16 and over. It remains subject to EUA for individuals aged 12 to 15.^[10][78]

Incentives[]

Efforts have been made by private businesses to help encourage vaccination, including ridesharing services offering free transport to vaccine clinic sites, and promotional incentives and discounts being offered to those who present proof of a recent vaccination. Free items included beer, pizza, crawfish, donuts, and french fries.^[79][80][81] Some sports teams established partnerships to offer vaccine clinics at their venues on game days, with free tickets to games offered to those who use the clinics.^[82][83] Free cannabis was available in Washington State when getting a vaccine at a dispensary.^[84]

Massachusetts ran a free lottery for fully vaccinated people, and gave out $6.5 million to ten people in the form of cash and scholarships.^[85] Ohio ran a similar lottery, Maine gave away hunting licenses, and West Virginia gave away $100 savings bonds.^[81]

Vaccines on order[]

Vaccine	Submitted (EUA)	Emergency use Authorization	Deployment	Submitted (Full)	Full Approval
Pfizer–BioNTech	November 20, 2020	December 11, 2020	December 14, 2020	May 7, 2021	August 23, 2021
Moderna	November 30, 2020	December 17, 2020	December 21, 2020	June 1, 2021	Pending
Janssen	February 4, 2021	February 27, 2021	March 1, 2021	No	No
Novavax	TBA (fourth quarter of 2021)	No	No	No	No
Astrazeneca	N/A	N/A	No	No	No
Sanofi–GSK	No	No	No	No	No

Vaccine distribution[]

Listed in millions,

As of September 14, 2021^[86][87]

Timeline[]

Timeline of daily COVID-19 vaccine doses administered in the US.[88]

See the latest date on the timeline at the bottom.

Vice President Elect Kamala Harris, like many other public officials, was vaccinated on-camera.^[89][90][91]

Drive-through vaccination site at the Larkspur Ferry Terminal in Larkspur, California

December 2020[]

On December 14, 2020, the first vaccine doses were administered. Sandra Lindsay of Queens, New York City, was the first American to be administered an FDA-authorized COVID-19 vaccine.^[92][93]

On December 21, President-elect Joe Biden and Vice President-elect Kamala Harris publicly received their first doses of the Pfizer vaccine during a media event at Christiana Hospital in Delaware. The event was intended as a means by the incoming Biden administration to boost public confidence in the vaccines. Biden stated that Trump "deserve[d] some credit getting this off the ground with Operation Warp Speed", and told the press "It's going to take time, and in the meantime—I don't want to sound a sour note here—but I hope people listen to all the experts."^[94][95][96]

March 2021[]

On March 12, 2021, the United States surpassed 100 million doses administered.^[97]

Over the course of the month, seven states (Arkansas,^[98] Mississippi,^[99] Ohio,^[100] Connecticut, Arizona, Texas,^[101] and Georgia^[102]) made the vaccine available to all adults, following a period of selective vaccination for elderly and other vulnerable populations. California and Washington announced that all adults would be eligible for a vaccine starting April 15.^[103] Indiana announced that it would make vaccines available to university students and would specifically facilitate the transfer of vaccines to university-based vaccine clinics, including one such clinic at the University of Notre Dame.^[104]

April 2021[]

On April 3, more than four million doses of the COVID-19 vaccine were reported administered in the past 24 hours, setting a new record and bringing the seven-day average to more than three million a day.^[105] As of April 11, more than 187 million vaccine doses have been administered.^[106] On April 13, the CDC and FDA issued a statement recommending a pause in the use of the Johnson & Johnson vaccine "out of an abundance of caution" after six women aged 18 through 48 developed a rare and severe type of blood clot called cerebral venous sinus thrombosis; on April 23, the recommended pause was lifted.^{[107][108][109]} By April 19, all U.S. states had made Americans aged 16 and older eligible for vaccination.^[8]

As of April 28, the CDC reported an average of 2.7 million daily vaccinations over the past week.^[110]

May 2021[]

On May 4, 2021, Biden announced a new target of having at least 70% of U.S. adults receive one vaccine dose by July 4.^[111]

On May 10, 2021, the FDA granted emergency use authorization for the Pfizer vaccine for use on adolescents aged 12–15, making the United States the second country in the world, after Canada, to do so.^[112] On May 12, Director of the CDC Rochelle Walensky approved the recommendation.^[113]

June 2021[]

By June 2021, the pace of vaccination had begun to decrease, amid increasing spread of the highly-infectious Delta variant across the country.^[114] On June 3, the White House announced additional private-sector partnerships in order to expand targeted outreach and vaccine availability, including an initiative to promote and offer vaccines through Black-owned barber shops throughout June, and a partnership with brewery Anheuser-Busch—who pledged in a promotional campaign to offer a "free beer" to all adults over 21 if the country met Biden's 70% goal.^[114][115]

By late-June, one-quarter of COVID-19 cases in the United States were the Delta variant. Fauci warned that vaccination disparities could lead to "two Americas" where less vaccinated U.S. populations were at much higher risk of COVID-19.^[116]

July 2021[]

The U.S. missed Biden's 70% goal by approximately three million residents, or 3%. Only 18 states reached the 70% goal among their local population.^[117] Generally, the goal was met for adults 27 and over, but not for younger populations. By early-July 2021, the number of daily COVID-19 cases in the U.S. had declined by around 90% since the peak in January. However, cases had also begun to increase in parts of the country with below-average vaccination rates, and hesitancy towards the vaccine had become a partisan issue: a poll by The Washington Post and ABC News found that 86% of self-identified Democrats surveyed had received at least one dose, as opposed to 45% of self-identified Republicans, the 18 states that did reach 70% of first doses by July 4 were all won by Biden during the 2020 election,^[118][117] and a July 8 report by KFF found that the average vaccination rate in counties that voted for Biden was growing in comparison to those that voted for Trump.^[119]

Anti-vaccination rhetoric increased among conservatives, including Republican politicians and right-wing media outlets (such as Fox News and Newsmax) promoting misinformation and conspiracy theories (such as falsely claiming that the Biden administration would impose mandatory door-to-door vaccination—an exaggeration of Biden's recently announced plans for targeted outreach),^{[69][120][121][122]} Republican lawmakers attempting to inhibit vaccine outreach,^[122] and state laws to prohibit "discrimination" against the unvaccinated (which effectively ban vaccine mandates).^{[123][124][125]}

On July 15, Surgeon General Vivek Murthy warned that health-related misinformation was a public health threat.^[126][127] The next day, President Biden accused social networking service Facebook of "killing people" by enabling the spread of vaccine misinformation.^[128] On July 19, after criticism from Facebook over the comments, Biden stated that they were based on a report suggesting that approximately 12 social media users were responsible for at least 60% of vaccine misinformation, and clarified that "Facebook isn't killing people, these 12 people are out there giving misinformation. Anyone listening to it is getting hurt by it. It's killing people. It's bad information". He went on to explain that "My hope is that Facebook, instead of taking it personally that somehow I'm saying Facebook is killing people, that they would do something about the misinformation, the outrageous misinformation about the vaccine".^[126]

In late-July, amid increasing COVID-19 hospitalizations in a number of Republican-led states, some Republican politicians became more vocal in promoting vaccination, including Senate Minority Leader Mitch McConnell,^[129] Senator of Texas John Cornyn, and former Surgeon General Jerome Adams.^[59][60] Governor of Florida Ron DeSantis—who has been critical of Fauci and COVID-19 restrictions—stated in a press appearance that vaccines were "saving lives" and "reducing mortality" (citing the majority of hospitalizations being unvaccinated individuals), while criticizing mask mandates as displaying a lack of confidence in the efficacy of vaccines.^[130] McConnell used campaign funds to purchase radio advertisements in his home state of Kentucky to promote vaccination; the ad features McConnell discussing his childhood battle with Polio, and stating that the development of multiple safe and effective COVID-19 vaccines in such a short time was "nothing short of a modern medical miracle", in comparison to the "decades" it took to develop a Polio vaccine.^[129][131]

A number of conservative commentators also abruptly made statements in support of vaccination, including Fox News hosts Steve Doocy and Sean Hannity during broadcasts of Fox & Friends and Hannity respectively, Newsmax CEO and Trump confidant Christopher Ruddy (who praised Biden in an op-ed for "making a huge dent" in the pandemic by embracing and prioritizing the rollout of the "effective vaccine" inherited from the Trump presidency),^[132] and conservative commentator Ben Shapiro.^[60] However, Hannity subsequently walked back his remarks on his radio show and Hannity, arguing that he never urged his viewers to get the vaccine, and adding the caveat that they should get the vaccine "if it's right for you", after doing "all of your research" and speaking with medical professionals that they trust.^[133][134]

On July 26, 2021, a number of organizations announced that they would mandate the vaccination of their employees, including the American Medical Association and American Nurses Association, and frontline health care workers of the Department of Veterans Affairs. California and New York City announced that all government employees would be subject to weekly testing if they are not vaccinated.^[135][136]

On July 29, President Biden similarly announced that unvaccinated federal employees and on-site contractors will be subject to mandatory social distancing, masks, weekly or bi-weekly COVID-19 testing, and limitations on work travel.^[137] Biden cited Delta variant and a "pandemic of the unvaccinated" as justification for the measures. He also announced that the federal government planned to use funds from the American Rescue Plan to reimburse small and medium-sized businesses for paid time off for employee vaccine appointments (similar to paid time off provided for voting in elections), and called for states to offer $100 payments to the newly vaccinated using American Rescue Plan funding as an "extra incentive to boost vaccination rates, protect communities, and save lives." Biden stated that "I know that paying people to get vaccinated might sound unfair to folks that have gotten vaccinated already but here's the deal: if incentives help us beat this virus, I believe we should use them."^{[138][139][140]}

August 2021[]

On August 1, the CDC reported that there had been a 24% week-over-week increase in the number of first doses administered, especially in states with lower vaccination rates. As of August 2, at least 70% of U.S. adults had received at least one vaccine dose.^[141] On August 6, the CDC reported that half of the U.S population has been fully vaccinated.^[142] Several major cities announced or approved plans to restrict access to non-essential indoor locations such as cinemas, restaurants, and other entertainment venues, to those who are vaccinated.^{[143][144][145]}

The FDA gave full approval to the Pfizer-BioNTech vaccine on August 23 for patients 16 and older, prompting President Biden to encourage those who had been waiting for full approval to get vaccinated.^[146] Anthony Fauci projected that at least 20% of unvaccinated Americans "will now step forward and get vaccinated" due to the approval.^[147] With the approval, it was also announced that the Department of Defense was preparing guidance requiring the vaccination of military members for COVID-19, with press secretary John Kirby stating that this would "ensure the safety of our service members and promote the readiness of our force, not to mention the health and safety of the communities around the country in which we live."^[148]

September 2021[]

Despite months of vaccine availability and incentives, many Americans continued to resist vaccination amid rising cases in several states. On September 9, Biden announced a six-point plan of new measures to help control the pandemic, which included new executive orders and regulatory actions to effectively mandate vaccination for COVID-19 among a large swath of the American workforce. Executive orders were announced directing all federal agencies to mandate the vaccination of their employees (with exceptions as required by law, and no option for regular testing in lieu of vaccination)^[149] per guidance to be developed by the Safer Federal Workforce Task Force, and all future government contracts to include a clause requiring compliance with guidance to be developed by the Safer Federal Workforce Task Force (likely to include a similar mandate).^[149][149] It was also announced that the employees of all federally-funded Medicaid and Medicare-certified health care facilities, and Head Start program facilities, must also be vaccinated.^{[150][151][149]}

Furthermore, it was announced that the Occupational Safety and Health Administration (OSHA) was developing an Emergency Temporary Standard to require all companies with more than 100 employees to, at a minimum,^[149] conduct weekly testing of employees who are not yet fully-vaccinated for COVID-19, and provide paid time off to employees for vaccination appointments.^[152] In total, these policies were estimated to apply to at least 100 million Americans.^[149] Biden explained that corporate vaccine mandates had already been implemented by "some of the biggest companies" in the country, including Disney, Fox News, Tyson Foods, and United Airlines, and that "We’ve been patient. But our patience is wearing thin, and your refusal has cost all of us."^[153]

Many Republicans asserted Biden's order was an unconstitutional overreach of federal authority, and some Republican governors said they would sue to block it.^[154] Despite the network being specifically cited by Biden during his speech as a major employer with vaccine requirements, Fox News pundits criticized the move; Sean Hannity described Biden as having "cancelled all medical freedom".^[155][156] The next day, Biden responded to the threats, stating "Have at it. Look, I am so disappointed that, particularly some of the Republican governors have been so cavalier with the health of these kids, so cavalier with the health of their communities. We're playing for real here, this isn't a game, and I don't know of any scientist out there in this field that doesn't think it makes considerable sense to do the six things I've suggested."^[157]

Vaccination mandates[]

When acting as president-elect in December 2020, Biden said he would not mandate that all citizens receive a COVID-19 vaccine, arguing that "I will do everything in my power as president to encourage people to do the right thing and when they do it, demonstrate that it matters." BBC News writer Anthony Zurcher felt that Biden avoided a general mandate due to the "stubbornly pervasive" anti-vaccine movement in the country, which "could create a groundswell of opposition that would prove counterproductive to public health."^[158] Furthermore, in April 2021, the Biden administration ruled out plans for a federal database, "credential", or "passport" to verify COVID-19 vaccination status, citing data privacy and discrimination concerns.^[159]

To protect co-workers and the general public, mandates have largely been enforced by means of employers (including private businesses and governmental divisions) requiring that their staff be vaccinated for COVID-19,^{[160][137][135]} while some private businesses (such as restaurants and event promoters) may also decline to serve customers if they do not present proof of vaccination.^{[161][162][163]} In August 2021, several cities announced plans to require proof of vaccination for patrons of certain types of non-essential indoor venues.^{[145][144][164]}

In some cases, provisions that are described as a vaccine mandate are officially termed as a constraint requiring the unvaccinated to undergo regular COVID-19 testing if they are not fully-vaccinated—thus allowing for medical or religious exemptions to be fulfilled when needed.^{[137][135][136][165]}

The initial EUA status of the vaccines led to questions over whether such mandates were legal,^[46] as FDA regulations state that a person must be informed "of the option to accept or refuse administration of the product, of the consequences, if any, of refusing administration of the product, and of the alternatives to the product that are available and of their benefits and risks." As these regulations refer to an "option to accept or refuse", many legal experts have questioned whether a vaccine issued under EUA can be mandated. Since the law is relatively new, courts had not previously ruled on this issue, making it unclear how the law may be interpreted.^[166][167] However, in the summer of 2021, mandates under this status were upheld with respect to an employer in the United States District Court for the Southern District of Texas, and a university in the United States District Court for the Northern District of Indiana.

On May 28, 2021, the Equal Employment Opportunity Commission (EEOC) issued guidance stating that employers can require their employees to be vaccinated, unless covered by an exemption under the Americans with Disabilities Act (medical exemptions) or Title VII of the Civil Rights Act (religious exemptions).^{[46][168][169]} By contrast, a presidential waiver would have been required for the U.S. military to mandate vaccination while still under EUA status.^[148] With the Pfizer vaccine formally receiving FDA approval on August 23, it was anticipated that more organizations and employers would become willing to introduce vaccine mandates.^[147][170]

State and territorial vaccine mandates for workers[]

Several states have enacted vaccine mandates for certain employees.

State	State government workers	Health care workers	Educational workers	Hospitality workers	Testing alternative
California	Yes	Yes	Yes[171]		Yes (except for healthcare workers)
Maine		Yes[172]			No
Washington	Yes[173]	Yes	Yes[174]
Hawaii	Yes				Yes
Delaware	Yes[175]
Minnesota	Yes[176]
Pennsylvania	Yes (if involved in healthcare settings)[177]				Yes
Oregon	Yes (in October, for executive branch employees)[178]	Yes[179]	Yes[179]
New York	Yes (by September 6)[180]	Yes[181]
Virginia	Yes (by September 1)[182]
Illinois	Partial (for workers in high-contact settings)[183]		Yes[184]
New Mexico	Yes[185]
Vermont	Partial (for workers in high-contact settings)[186]
Maryland	Partial (for workers in corrections, veterans and healthcare settings)[187]	Yes[188]
District of Columbia	Yes[189]	Yes (by September 30)[190]
Guam	Partial (for executive branch workers)[191]
Puerto Rico	Yes[192]	Yes		Yes	Yes
Connecticut	Yes[193]	Partial (for nursing home workers)[194]	Yes		Yes
Rhode Island		Yes[195]
Massachusetts	Yes[196]	Partial (for nursing home workers)[197]
Colorado		Yes[198]
New Jersey	Yes[199]	Partial (State-owned health care agencies, correctional facilities)[200]	Yes		Yes

County and municipal vaccine mandates for workers[]

Private organizations requiring proof of vaccination[]

A COVID-19 vaccination record card issued by the CDC.

In order to protect their employees and patrons, some businesses and entities may mandate that their on-site employees be vaccinated. Some employers were initially hesitant to impose vaccine requirements, citing concerns over their validity due to the present EUAs among other factors. A June 2021 survey of companies found that only 3% planned to implement a vaccine mandate.^[225][226]

However, by late-July 2021 due to the threat of Delta variant, a number of major private employers across many industries announced vaccination requirements for employees.^[160] Similar mandates were announced for California state employees,^[135][136] and federal employees and contractors.^[137]

In an effort to protect their employees and other customers, some businesses may voluntarily require that their customers or patrons present proof of vaccination or a recent negative test in order to receive service or access.^[161]

Many U.S. colleges and universities, both public and privately owned, have started requiring students to be vaccinated before attending in-person classes in fall 2021. This has led to a black market in counterfeit CDC vaccination cards for students who want to violate this requirement instead of attending a different school.^[227]

The National Football League made rule changes intended to place liabilities on unvaccinated players, including monetary fines for each individual violation of COVID-19 protocol, and making teams liable for games canceled due to COVID-19 outbreaks involving unvaccinated players if they cannot be made up during the regular season (which will count as a loss by forfeit, and require the team to pay financial compensation to the opposing team).^[228][229]

In mid-August 2021, Anschutz Entertainment Group (AEG) and Live Nation Entertainment both announced that they will mandate vaccination at their venues (where legally possible) in October 2021, with AEG requiring all attendees, staff and performers to be vaccinated with no exceptions effective October 1, and Live Nation requiring attendees to be vaccinated or have recently tested negative for COVID-19 effective October 4.^[163]

Government-required proof of vaccination for entry to private facilities[]

Vaccination incentives were used in California and New York as part of their easing of restrictions in mid-2021; New York allowed seating sections of outdoor venues to operate at full capacity if they were exclusive to vaccinated attendees,^[83] and California allowed venues to operate at a higher capacity than normally allowed under its Blueprint for a Safer Economy framework if all patrons present proof of vaccination or a recent negative test.^[230]

With the increased spread of Delta variant in the United States and to overcome vaccine hesitancy, several major U.S. cities announced in August 2021 that individuals 12 and older would be required to present proof of vaccination in order to enter certain non-essential indoor businesses, such as gyms, dine-in restaurants, bars, and entertainment venues;^{[145][144][164]}

• On August 3, 2021, Mayor of New York City Bill de Blasio announced that a vaccine mandate known as Key to NYC Pass would take effect August 16, with enforcement beginning September 13. Anyone 12 and older must present proof that they have received at least one vaccine dose (using either a physical record, the state Excelsior Pass app, or the city's NYC COVID Safe app) in order to enter indoor gyms, bars, restaurants, and entertainment venues.^{[231][145][232][233]} Ahead of the announcement, The Broadway League, Carnegie Hall, and the Metropolitan Opera had announced similar policies, with the latter two also prohibiting attendees younger than 12 from attending shows.^[162]
• On August 11, 2021, Los Angeles City Council unanimously approved a motion proposing an ordinance requiring patrons 12 and older of indoor public spaces to have received at least one vaccine dose.^[143][234]
• San Francisco announced a vaccine mandate on August 12, 2021, requiring the patrons of indoor bars, restaurants, and any entertainment venue that serves food or drink, to be fully-vaccinated.^[144]
• New Orleans also announced a vaccine mandate on August 12, 2021, effective August 23, mandating that patrons of indoor venues such as gyms, restaurants, casinos, arenas, and stadiums, as well as any outdoor gathering of more than 500 people that exceeds half of the venue's total capacity, present proof of vaccination or recent negative test.^[164]
• On September 10, 2021, West Hollywood, California announced that by October 11, patrons 18 and older of the indoor portions of health and fitness facilities, personal care facilities, and any venue that serves food and drink indoors, must be fully-vaccinated.^[235]
• On September 14, 2021, Contra Costa County, California announced that a health order requiring patrons 12 and older of indoor gyms, bars, restaurants, and entertainment venues to be fully-vaccinated, effective September 22. The employees of such venues must also be fully-vaccinated by November 1, 2021, or they must be tested weekly for COVID-19.^[236]
• On September 15, 2021, the Los Angeles County Department of Public Health (LAC DPH) announced that effective October 7, proof of at least one vaccine dose will be required to enter indoor bars and nightclubs, and outdoor events with more than 10,000 people. Beginning November 4, full vaccination will be required.^[237]

Political views[]

As with mask mandates before, support and opposition towards vaccine mandates and immunity passports has fallen along party lines, with Democrats largely supporting such measures, and Republicans considering them to be an infringement of personal freedoms and choice.^[238]

As of August 12, 20 states—all controlled by Republicans—had passed legislation or issued executive orders prohibiting state agencies from issuing vaccine passports or otherwise requiring proof of vaccination as a condition of service.^[238] Alabama,^[239] Florida,^[240] Montana,^[241] and Texas^[242] also prohibit private businesses from requiring proof of vaccination as a condition of service, with the Florida order threatening fines of $5,000 per-instance,^[243] the Montana order terming it as a prohibition of "discrimination" on the basis of vaccination status (with exceptions for long-term care facilities and public schools),^[244][241] and the Texas order enforceable by state licensing agencies (such as the Texas Alcoholic Beverage Commission, which has threatened to revoke the liquor licenses of establishments that request proof of vaccination in violation of state law).^[245] There have also been bills enacted or introduced to prohibit employers from enforcing vaccine mandates, and prohibiting vaccine mandates that apply to students.^[246]

Some politicians and conspiracy theorists, such as Marjorie Taylor Greene, have incorrectly claimed that under the Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA), individuals have the right not to disclose their vaccination status to others. The Privacy Rule only applies to specific "protected health information" being stored by a "covered entity" (such as a health plan, health insurer, health care clearinghouse, or medical service provider), and does not generally prohibit private businesses or employers from requesting information on vaccination status directly from individuals.^{[247][248][249][250]}

Legal challenges[]

On May 29, 2021, a lawsuit was filed by 117 employees of Houston Methodist Hospital, who were fired refusing to comply with the hospital's vaccine mandate.^[251] The lawsuit was dismissed by a federal judge roughly a couple weeks later.^[225] An appeal was filed following the ruling.^[252]

In July 2021, Norwegian Cruise Line sued the Surgeon General of Florida over the state's prohibition of vaccine mandates by private businesses.^[253] On August 8, District Judge Kathleen M. Williams issued a preliminary injunction in favor of Norwegian, stating that the Florida state government failed to "provide a valid evidentiary, factual, or legal predicate", and that "documentary proof of vaccination will expedite passengers' entry into virtually every single country and port where Plaintiffs intend to sail."^[254][255]

A vaccine mandate being enforced by the Indiana University (requiring those who are unvaccinated to submit to weekly testing if they attend in-person classes) was challenged by a group of eight students, who argued that risks of the vaccines outweighed the benefits, and that it was a violation of the 14th Amendment. District judge Damon R. Leichty rejected a motion for a preliminary injunction, ruling that the university had a right to "a reasonable and due process of vaccination in the legitimate interest of public health for its students, faculty, and staff", that the students had alternatives (such as agreeing to testing or applying for an exemption, remote learning, or going to a different university) if they did not want to be vaccinated, and that "the situation here is a far cry from past blunders in medical ethics like the Tuskegee Study."^[256] The 7th Circuit Court of Appeals upheld the ruling, citing case law dating back to smallpox in 1905.^[165][257]

On August 12, Supreme Court Justice Amy Coney Barrett, who is assigned to the Seventh Circuit, denied a request for emergency relief in the Indiana University matter; she acted with no comment, and did not refer the case to the full Supreme Court. Media outlets believed that Barrett's decision to uphold the mandate may have implications in future legal challenges.^{[165][257][258]}

Vaccinations by state and territory[]

This section may contain misleading parts. Please help according to any suggestions provided on the talk page. (July 2021)

Number of people who have received at least one dose of a COVID-19 vaccine. Also, the percentage by state or territory.

As of August 29, 2021.^[259]

State/Territory	Vaccinated	% of pop.
Alabama	2,415,007	49.3
Alaska	394,238	53.9
Arizona	4,103,699	56.4
Arkansas	1,595,968	52.9
California	27,088,268	68.6
Colorado	3,636,131	63.1
Connecticut	2,612,564	73.3
Delaware	621,419	63.8
Florida	13,612,965	63.4
Georgia	5,397,628	50.8
Hawaii	1,046,096	73.9
Idaho	785,845	44.0
Illinois	8,311,714	65.6
Indiana	3,357,492	49.9
Iowa	1,768,626	56.1
Kansas	1,661,048	57.0
Kentucky	2,529,693	56.6
Louisiana	2,290,715	49.3
Maine	957,643	71.2
Maryland	4,105,299	67.9
Massachusetts	5,175,924	75.1
Michigan	5,500,024	55.1
Minnesota	3,474,987	61.6
Mississippi	1,377,669	46.3
Missouri	3,223,430	52.5
Montana	556,369	52.1
Nebraska	1,106,883	57.2
Nevada	1,775,020	57.6
New Hampshire	909,747	66.9
New Jersey	6,184,301	69.6
New Mexico	1,457,191	69.5
New York	13,038,225	67.0
North Carolina	5,799,543	55.3
North Dakota	366,118	48.0
Ohio	6,108,967	52.3
Oklahoma	2,094,129	52.9
Oregon	2,685,416	63.7
Pennsylvania	8,842,653	69.1
Rhode Island	754,639	71.2
South Carolina	2,634,412	51.2
South Dakota	494,543	55.9
Tennessee	3,355,302	49.1
Texas	16,464,695	56.8
Utah	1,803,113	56.2
Vermont	473,902	75.9
Virginia	5,544,291	65.0
Washington	5,136,319	67.5
West Virginia	842,448	47.0
Wisconsin	3,396,977	58.3
Wyoming	259,664	44.9
50 states	199,128,959	59.2
American Samoa	30,600	54.9
District of Columbia	474,086	67.2
Guam	114,602	69.1
Northern Mariana Islands	34,870	61.3
Puerto Rico	2,347,524	73.5
US Virgin Islands	50,807	48.5
US territories	3,052,489	62.4
United States	202,181,448	59.5
Marshall Islands	21,160	36.2
Micronesia	40,403	39.0
Palau	16,227	90.6
Compact of Free Association	77,790	55.3
USA + CoFA	202,259,238	59.3

US military vaccination program[]

On August 9, 2021, all servicemembers received a memo explaining that, under a plan endorsed by President Biden and by military leadership, COVID-19 vaccination would become mandatory within about a month.^[260] About a third of active U.S. military service members had already been vaccinated as of late April;^[261] and about two-thirds (73% of all service members) had already been vaccinated by the time the memo was sent.^[262]

The U.S. Navy had been the fastest to begin vaccination in early 2021. As of April 22, 2021, considering active military personnel who had received at least one dose, the U.S. Navy had the highest percentage at 51%, the Marines at 36%, the Air Force/Space Force at 34%, and the Army at 27%.^[261] By late May, at least 58% of active military personnel had received at least one dose of the COVID-19 vaccine.^[263]

As of April 9, 2021, 39% of U.S. Marines to whom the military offered the vaccine had refused it. The highest rate of refusal was at Camp Lejeune in North Carolina, where 57% of Marines had refused the vaccine.^[264]

On August 23, 2021, the Pfizer-BioTech vaccine got its full FDA approval, prompting vaccinations be required for all active duty, reserve, and National Guard troops starting August 25.^[265] By the time the vaccination requirement order was sent out, only 68% of active-duty troops were fully vaccinated.^[266]

Public opinion[]

The Kaiser Family Foundation conducts ongoing polling and analysis in a project called the KFF COVID-19 Vaccine Monitor. It considers demographics including age, race, political party, education, and insurance status when examining vaccine hesitancy.^[267]

Political leanings are reflected in vaccine hesitancy. Early in the pandemic, before vaccines were available, a poll conducted May 20–21, 2020, found that 44% of Republicans and 19% of Democrats believed a debunked conspiracy theory that Bill Gates was plotting to use a COVID-19 vaccine to inject microchips into the population.^[268] Months after vaccination began, a Monmouth poll conducted April 8–12, 2021, found that two-thirds of Democratic voters had already been vaccinated but only one-third of Republican voters had done so.^[269] A Quinnipiac poll conducted on the same dates found that 45% of Republicans said they did not plan to be vaccinated.^[270] The New York Times wrote that the vaccination program was "hitting what appears to be a soft ceiling" as it moved to dealing with the demographic groups where vaccine hesitancy was stronger.^[271]

A Frank Luntz poll in mid-April 2021 found a rise in vaccine confidence from the previous month, despite the pause of the Johnson and Johnson vaccine.^[272]

A later poll by The Washington Post and ABC News found that 86% of self-identified Democrats surveyed had received at least one dose, as opposed to 45% of self-identified Republicans.^[118][117]

In July 2021, The New York Times noted that there were two groups of Americans who remained hesitant to get the vaccine, the first group being "a mix of people but tend to be disproportionately white, rural, evangelical Christian and politically conservative" and the second group being "a broad range of people, but tend to be a more diverse and urban group, including many younger people, Black and Latino Americans, and Democrats."^[273]

See also[]

• Deployment of COVID-19 vaccines
• COVID-19 pandemic in the United States
• COVID-19 vaccine
• Ohio Vax-A-Million

Notes[]

References[]

External links[]

• COVID-19 Vaccinations in the United States CDC.
• Tracking COVID-19 vaccines in the US. CNN.