U.S.  President Joe Biden on Thursday announced sweeping new federal vaccine requirements affecting as many as 100 million Americans in an all-out effort to increase COVID-19 vaccinations and curb the surging Delta variant.

Speaking at the White House, Biden sharply criticized the roughly 80 million Americans who are not yet vaccinated, despite months of availability and incentives.

“We’ve been patient. But our patience is wearing thin, and your refusal has cost all of us,” he said, all but biting off his words. The unvaccinated minority “can cause a lot of damage, and they are.”

The expansive rules mandate that all employers with more than 100 workers require them to be vaccinated or test for the virus weekly, affecting about 80 million Americans. And the roughly 17 million workers at health facilities that receive federal Medicare or Medicaid also will have to be fully vaccinated.

Biden is also signing an executive order to require vaccination for employees of the executive branch and contractors who do business with the federal government — with no option to test out. That covers several million more workers.

Biden announced the new requirements in a Thursday afternoon address from the White House as part of a new “action plan” to address the latest rise in coronavirus cases and the stagnating pace of COVID-19 shots that has raised doubts among the public over his handling of the pandemic.

In addition to the vaccination requirements, Biden moved to double federal fines for airline passengers who refuse to wear masks on flights or to maintain face covering requirements on federal property in accordance with Centers for Disease Control and Prevention guidelines.

Biden announced that the federal government will work to increase the supply of virus tests, and that the White House has secured concessions from retailers including Walmart, Amazon, and Kroger to sell at-home testing kits at cost beginning this week.

The administration was also sending additional federal support to assist schools in safely operating, including additional funding for testing. And Biden will call for large entertainment venues and arenas to require vaccinations or proof of a negative test for entry.

The requirement for large companies to mandate vaccinations or weekly testing for employees will be enacted through a forthcoming rule from the Occupational Safety and Health Administration that carries penalties of $14,000 per violation, an administration official said. The White House did not immediately say when it would take effect, but said workers would have sufficient time to get vaccinated.

The rule would also require that large companies provide paid time off for vaccination.

More than 177 million Americans are fully vaccinated against the coronavirus, but confirmed cases have shot up in recent weeks to an average of about 140,000 per day with on average about 1,000 deaths, according to data from the Centers for Disease Control and Prevention.

Most of the spread — and the vast majority of severe illness and death — is occurring among those not yet fully vaccinated. So-called breakthrough infections in vaccinated people occur, but tend to be far less dangerous.

Officials are aiming to administer booster shots about eight months after the second dose of the two-dose vaccines.

Check out The China Report, our new weekly newsletter. Subscribe here!