Vaccination is the only way out of the nation’s current COVID-19 surge. Immediate masking and other pandemic mitigation efforts are simply a bridge to the ultimate method for stopping the delta variant spread: widespread inoculation among U.S. residents.

But the Biden administration’s largely effective vaccination program has run up against a red-state wall. In a sign of the frustration mounting within the West Wing, President Joe Biden on Wednesday told GOP governors who were thwarting local mitigation efforts to “get out of the way.” Though Biden didn’t name names or even parties, the comment was clearly directed at governors like Ron DeSantis in Florida, who only recently endorsed the vaccines but has tied the hands of local officials and school systems on issuing mask mandates.

According the White House, Florida and Texas alone have accounted for one-third of all new U.S. COVID-19 infections over the past week. Governors like DeSantis are literally telling Biden “do your job” on the pandemic while singlehandedly dooming him through their own gross mismanagement. 

That has left Biden with the very real life-and-death predicament of how to reverse the current delta surge that has taken root in GOP-led states. 

The administration is already requiring federal workers and contractors to either prove their vaccination status or be subject to mandatory mask-wearing and other pandemic mitigation efforts. The order covers some 4 million Americans nationwide, and the White House recently added teeth to the penalties for those who try to game the system.

Now the administration is reportedly weighing whether to withhold federal funding from certain institutions and entities as a way to potentially boost vaccination in regions where Biden lacks political sway. Roughly 90 million eligible Americans remain unvaccinated. 

The Washington Post reports the move could affect entities ranging from long-term care facilities to cruise ships to universities. One possibility, for instance, is threatening to place restrictions on Medicare funding in order to push some nursing homes to enact vaccine mandates among their employees. 

The president said his administration was exploring making such a policy move during a press event on Thursday. But time is of the essence. The mRNA vaccines like Pfizer and Moderna require at least a handful of weeks before the two-shot regimen provides full protection against infection. On Wednesday, the U.S. reported 100,000 new infections, numbers comparable to those in February, before the nationwide vaccination push had really ramped up.

Lawrence Gostin, director of Georgetown University’s O’Neill Institute for National and Global Health Law, has advocated for the White House to pull that lever. He told the Post it makes sense to push vaccinations in “high-risk settings with an absolute ethical obligation and legal obligation to keep your workers and your clients safe.”

But some public health experts want Biden to go even further, potentially mandating vaccinations nationwide. Last week, Biden said there was “still a question” whether he has the legal authority to issue such a blanket order. 

Gostin is doubtful he does. 

“The federal government can’t directly mandate a vaccine,” he said. “It can use its spending power to say to a state, ‘You mandate vaccinations. And if you don’t, we’ll withhold certain federal dollars.’ ” That’s a lever that has been pulled in the past to compel states to raise their legal drinking age to 21 in order to get federal highway funding, for example. 

Vaccine passports, which the White House had previously seemed to take off the table, are another possibility. 

“If you established federal vaccine verification and then you required it for an increasing number of things, that would be helpful,” offered Tom Frieden, Obama’s former CDC director. 

There’s a model for taking such an action. French President Emmanuel Macron has effectively implemented a nationwide vaccine requirement for residents to participate in public life, spurring vehement resistance in some places but also pushing up vaccination rates. In the port city of Marseille, which is reportedly a hotbed of vaccine skepticism, appointments at one mass vaccination site have risen from under 1,500 a day to 2,500 a day more recently, according to Politico. 

Any nationwide vaccination mandate Biden makes will likely draw legal challenges and surely draw political backlash.

But neither are a good reason for Biden to pull back from using every available tool that he reasonably determines could increase U.S. vaccination rates. No matter what happens, politically speaking, Biden needs to be able to argue that he exhausted every option he thought he could in order to save American lives.