Biden will direct the Department of Health and Human Services to draft new regulations making vaccinations for nursing home employee a condition for such facilities to participate in the Medicare and Medicaid programs, the officials said.

The move represents a significant escalation in Biden’s campaign to get Americans vaccinated and the tools he is willing to use, marking the first time he has threatened to withhold federal funds in order to get people vaccinated.

Nursing home residents, largely the elderly with pre-existing medical conditions, were among the hardest hit in the early stages of the pandemic. Such facilities being largely confined space without enhanced ventilation contributed to high case rates. The virus’s highly contagious delta variant threatens to create a similar situation with high hospitalization and death rates.

“As we see the spread of Delta and the threat of Covid cases, it is really especially important that we ensure that those caring for our most vulnerable are vaccinated,” Carole Johnson, a senior official on the White House’s Covid-19 response team, told CNN in an interview.

In the seven states in which less than half of nursing home staff is vaccinated, weekly cases were 7.9 times higher in the week ending August 1 than they were in the week ending June 27. Meanwhile, in states that have vaccinated a larger share of staff than average, cases reported in the week ending August 1 were three times higher than cases reported in the last week of June, the new outlet also reports.

The new regulations could go into effect as early as next month. However, Johnson told CNN the Centers for Medicare & Medicaid Services will work with nursing homes, employees and their unions to ramp up staff vaccinations before the regulations go into effect.

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