After months of vaccine incentives, nation changes course

Life may be about to get tougher for the unvaccinated -- and it's not only because of their significantly increased risk of getting COVID-19 and becoming very sick.

A rising chorus of states, cities and private sector titans have implemented new vaccine requirements for their employees and patrons. It marks a new, less negotiable phase in the fight against the coronavirus, after months of cajoling and material goodies leading the vaccination campaign.

The new incentives aren't financial. They draw motivation from immediate and tangible fears: of losing time to go get tested, losing a job, losing money or missing out on social events, as well as the ever more apparent pain of the pandemic hitting home through loss of life and loved ones. More than 97% of hospitalized COVID-19 patients in the country are unvaccinated, according to the White House COVID-19 Task Force.

Now, after months of vaccine rates tapering off, vaccination rates are heading back up with the recent surge of serious illness. On Thursday alone, the U.S. saw its highest vaccination numbers in over a month -- 585,000 new vaccinations in a single day, the White House COVID-19 data director announced. Some of the most dramatic upticks in recent vaccinations have been in states with the highest surges in new cases and hospitalizations and some of the lowest vaccination rates.

"Watching more people dying in the ICU, kids getting sick? Yes, that motivates," said Dr. Arthur Caplan, professor of bioethics and the founding head of New York University School of Medicine's medical ethics division. "Free beer, fishing license, free marijuana, college tuition didn't move many people to get vaccinated."

Unvaccinated Americans must now weigh their own personal risk-benefit ratio: Take the vaccine or face restrictions.

"The carrots do not work much," Caplan said. "Now, we're seeing more pressure coming from the other side."

That pressure is coming in the form of federal, state and local vaccine requirements.

Requirements that government employees get vaccinated or face regular testing, social distancing and masks were accompanied by a slew of major companies like Google, Facebook, Tyson Foods and Disney, which is the parent company of ABC News, now requiring the vaccine for their employees.

"I think we've taken significant steps to make it difficult to come back to work, or more difficult to come back to work, if you're not vaccinated," White House Coronavirus Response Coordinator Jeff Zients said.

The Biden administration has made clear there will be no federal mandate; but its recent lean-in to vaccine requirements marks a shift in tone, going from from removing barriers to getting the vaccine to making it harder to move about "normal" life for those who choose not to get it.

"There's a bit of a hassle factor that plays into whether or not people are willing to get an exemption," Julie Morita, executive vice president of the Robert Wood Johnson Foundation, told ABC. "And if it's too difficult or more challenging, people might opt just to get vaccinated."

As the NFL season gets into gear, the league informed clubs that it would not extend the season to accommodate a COVID-19 outbreak among unvaccinated players that leads to a game cancellation, the NFL Network reported, a stark turn from the season prior, when the league flexed the schedule to avoid missed games amid outbreaks. Additionally, players on both teams would forfeit pay for the lost contest, and the team responsible for the cancellation brought on by unvaccinated players would cover the financial losses and face potential disciplinary action.

Caplan suggests framing vaccination as the more appealing choice; opting out will make life harder.

New York is the first city in the country that will require proof of at least one dose of vaccination for some of the main modes of basic leisure -- dining out inside, indoor entertainment and working out at the gym. All state employees will be required to get vaccinated or get tested weekly beginning Labor Day.

Major privately run hospitals in New York will impose a similar vaccine requirement. In internal emails obtained by ABC News, New York Presbyterian and Mount Sinai both notified staff that beginning in September, there will be new requirements for employees. At New York Presbyterian, staff must be vaccinated or obtain a valid exemption – those who are granted exemptions will be tested frequently. At Mount Sinai, workers must show proof of vaccination or undergo weekly testing. State-run, patient-facing hospital workers will have no testing option.

"Please note that compliance -- either by vaccination or exemption -- will be required for your continued employment," New York Presbyterian's hospital president, and their executive vice president and chief operating officer said in a letter to staff. "We want all of our team members to continue working with us, but we have to balance that with the imperative to protect our patients, employees and communities."

The move earned protest from the largest health care union in the U.S. Members of the 1199SEIU United Healthcare Workers East said they shouldn't have to be vaccinated to keep their jobs -- especially if it risks losing front-line health workers at a time they're most needed. That mirrored some national unions' concerns about protecting individual freedoms -- and not forcing their workers to pay for government-enforced testing.

Experts note there's a fine line between requirements being "part of what's going to nudge more people to get vaccinated," as Surgeon General Vivek Murthy told ABC's Start Here podcast, and pushing them away.

A full federal mandate might make hesitant and unvaccinated Americans "dig in their heels" further, Morita said.

"Generally, with mandates of any kind, you want to do everything else possible before you mandate something," she said. "But when the vaccine is free, it's accessible, and you're still struggling, then mandates make sense. But you really want to give people the chance to do it on their own."

The advent of more local mandates looms on the imminent horizon as soon as the vaccine is fully FDA-approved, which could come as soon as early September, a senior White House official familiar with the FDA approval process told ABC News.

Dr. Anthony Fauci called that moment a "game-changer," one that will possibly provide more legal cover for companies to implement vaccine imperatives.

"'My body, my choice' is not an ethic for a plague," Caplan said. "The ethics of plague are, 'my body, vaccinated' -- more choices for everybody."

ABC News' Eric M. Strauss contributed to this report.