The announcement of the mandate has people asking many questions.

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President Joe Biden unveiled a sweeping COVID-19 vaccination mandate on September 9 that increases vaccine requirements for many Americans.

Under the new mandate, all federal government employees and contractors are require to be fully vaccinated against COVID-19. The Department of Labor's Occupational Safety and Health Administration (OSHA) will create an "emergency temporary standard" for private businesses with 100 or more employees to either require their employees to get vaccinated against the virus or undergo weekly testing.

The mandate will also require that employees at health facilities that receive federal Medicare or Medicaid be fully vaccinated against the virus.

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Credit: AdobeStock / Jo Imperio

"We need to do more," Biden said in a press conference. "This is not about freedom or personal choice. It's about protecting yourself and those around you—the people you work with, the people you care about, the people you love."

The mandate has gotten praise from the medical community and pushback from some politicians, with South Carolina Governor Henry McMaster vowing on Twitter that "we will fight them to the gates of hell to protect the liberty and livelihood of every South Carolinian."

OK, but…what is a mandate, exactly, who does it apply to, and how will it be enforced? Here's what we know so far.

What is a mandate, exactly?

A mandate is an official order made by a senior government official, like the president. It is different from a law, which is passed on a federal level through the House of Representatives and Senate before it is signed by the President, Larry Stuart, an employment lawyer in the Houston-based law firm Stuart PC and an adjunct professor at the Jones Graduate School of Business at Rice University, tells Health.

This mandate is technically an executive order, Stuart says, which the president is granted the power to issue on certain topics. "The president can't just unilaterally declare war, but it's under his authority to issue agencies to set temporary rules," he explains.

OSHA has the power to set emergency temporary standards when workers are considered to be in grave danger, Stuart says. "Normally, it's due to exposure to toxic chemicals and things like that," he explains.

Both are mandates and laws are legally enforceable, Stuart says.

"We're in a war against this virus, and so far we've depended on a volunteer army," William Schaffner, MD, an infectious disease specialist and professor of health policy at the Vanderbilt University School of Medicine, tells Health. "But the enemy has just been reinforced with Delta. It's much stronger than we originally anticipated. Now we need to institute a draft. You have to oblige to serve not only yourself but your country."

FWIW: Stuart says that the federal government has the power to require that all Americans get vaccinated in an emergency situation, like a global pandemic. "They just haven't done it," he says.

What other vaccine mandates are out there?

Several large companies have already enacted their own vaccine mandates, and Biden name-checked some of them in his speech: United Airlines, Disney, Tysons Food, and Fox News.

United made headlines earlier this week after announcing that employees who are not vaccinated against COVID-19 will be either be put on unpaid leave or face termination. Those who have been granted religious or medical exemptions will also be put on unpaid leave.

What is a federal employee?

People who work for the federal executive branch are required to be vaccinated, along with those who are federal employees and federal contractors. That includes employees of government agencies and the military. The mandate does not apply to those who work outside the executive branch, though, so members of Congress or those in the judicial system are not affected.

As of now, it's unclear if teachers—who are state employees—will be under the OSHA requirement that companies with 100 or more employees get vaccinated or undergo weekly testing, Stuart says. "We have to wait and see," he adds.

What will the mandate do?

The hope is that this mandate will get more people vaccinated and the country closer to normalcy, John Sellick, DO, an infectious disease expert and epidemiological researcher at the University at Buffalo/SUNY, tells Health. "We've been playing nice for months and now we've hit a brick wall," he says.

COVID-19 is "never going to go away completely," Dr. Sellick says. "Even though we don't know what the magical herd immunity number is—my guess is 80% of the population vaccinated—when we get closer to that number, things will start to look normal again," he says. "There will always be these little hotspots, but we won't be seeing these big, overwhelming of hospitals that we're seeing now."

The mandate doesn't go far enough, Stanley Weiss, MD, professor of medicine at the Rutgers New Jersey Medical School and professor of biostatistics and epidemiology at the Rutgers School of Public Health, tells Health. "It's much too limited," he says. "The excuse to get tested as a substitute for vaccination is insufficient. A person who tests positive is infected and infectious risk to others, and they may have been for several days. People need to be vaccinated fully."

What is the penalty if you don't comply?

Employers will likely make their own rules about this, Stuart says. While Biden didn't explicitly mention fines for companies that don't comply, there are reports that businesses will have to pay fines of up to $14,000 if they don't adhere to the mandate.

Stuart says he's spoken with some employers who are relieved the government has taken this step. "They were hesitant about doing vaccine mandates because they did not want to alienate employees and cause them to quit, but many have indicated that they appreciate having the mandate because it takes the pressure off of them," he says. "They're no longer the bad guy."

When does the mandate go into effect?

It's not entirely clear, although OSHA is expected to release its emergency rule in a few weeks, the White House said.

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