For the first time, a government has mandated vaccination against Covid-19. Indonesia, seeking to quicken its inoculation program to curb Southeast Asia’s largest outbreak, announced that it’s requiring those eligible for the vaccine to take it. Mandates have been under discussion as well in the U.S., which has one of the worst outbreaks anywhere. Some health experts worry that too few people will get the shots for the immunization campaign to stop the spread of the disease. Under U.S. law, both government authorities and employers have the power to issue such orders. Whether mandates are effective in expanding the uptake of a vaccine is a matter of debate, however.

1. Can U.S. government authorities require people to get vaccinated against Covid?

President Joe Biden has said he doesn’t support making vaccinations mandatory, and in any case, the federal government’s power to impose vaccine requirements is limited. However, states clearly have that authority, and they’ve used it. Mandates don’t mean forced vaccinations, but rather penalties or denial of services for those who don’t get them. In Indonesia, those who refuse Covid vaccines are subject to fines and denial of government services and assistance. A New York state lawmaker proposed a bill in early December that would require Covid vaccines for all residents who can safely take them should public health officials determine that an insufficient percentage of people are getting immunized. It provides no penalty for noncompliance. A competing bill would prohibit New York from mandating immunization, as would proposed laws in a few other states.

2. What are the precedents for government mandates?

At the turn of the 20th century, the city of Cambridge, Massachusetts mandated that residents get a smallpox vaccination. Pastor Henning Jacobson rejected both the shot and the obligation to pay a $5 fine, appealed all the way to the Supreme Court, and lost in a landmark 1905 ruling. More recently, New York City ordered people in a part of the Brooklyn borough to be vaccinated against measles or pay a $1,000 fine after an outbreak there in 2019. On a standing basis, all 50 U.S. states require specific vaccines for students to attend school, with each setting its own mandate for inoculations against diseases such as hepatitis B, mumps and chickenpox. Medical exemptions are universally granted, 45 states allow unvaccinated students to attend school if their parents object to immunization for religious reasons, and 15 states permit philosophical objections. States also set out vaccine requirements for college and university students, and many of them have mandates for workers and patients in certain health-care facilities, notably hospitals and nursing homes.

3. Do other countries use vaccine mandate?

According to a study published in October in the journal Vaccine, of the 193 members of the United Nations, more than 100 have nationwide mandates requiring one or more vaccines. Of those, 62 impose a penalty for noncompliance. The most common penalties are fines and denial of school enrollment for children who aren’t vaccinated. A few countries, including Canada, are like the U.S. in that they have regional rather than national mandates.

4. Are there likely to be Covid vaccine mandates for U.S. schoolchildren?

Not anytime soon. The two vaccines authorized for distribution in the U.S. by the Food and Drug Administration, one made by Pfizer Inc. and BioNTech SE and another by Moderna Inc., were only given a green light for people age 16 and older and 18 and older, respectively. That’s because they were only proved safe and effective for those groups. The vaccines are being tested in children as young as 12.

5. Can U.S. employers require vaccinations?

In general, yes, and about 0.5% of them already were mandating Covid vaccines for all their employees in mid-January, according to a survey of employers by the law firm Littler Mendelson. Most nonunion companies have relatively wide latitude to create such requirements largely because employment relationships are presumed to be “at-will” in nearly every state. Companies can fire at-will workers for any legal reason, which could include refusal to comply with a vaccine mandate. In addition, employers have a legal duty to provide a safe and healthy workplace. Even before the pandemic, many health-care facilities required workers to get inoculated against certain diseases, sometimes in response to state provisions.

6. What objections can workers raise?

• To start with, rules related to the FDA’s sped-up procedure for authorizing the Covid vaccines amid a public health emergency state that individuals have the option to refuse the shots. That gives some workers an avenue to sue over vaccine mandates as long as the FDA hasn’t given the shots formal approval, according to management lawyers.

• The Americans with Disabilities Act allows a worker to request an exemption from a vaccine mandate if she has a disability that’s covered by the law. In such a case, the employer must communicate with the worker to determine whether an exemption is a reasonable accommodation given her disability and job responsibilities -- and isn’t an undue burden for the employer. Failing to engage in that process or provide a reasonable accommodation could be grounds for a lawsuit. A worker with a health condition that compromises her immune system has a good chance of prevailing on a claim if she has a doctor’s advice that she should avoid a vaccine. An employer would need to show that allowing a worker to remain unvaccinated would cause an undue burden or pose a direct threat in the workplace, which would be difficult to do if there are alternatives available such as working from home or moving to an area segregated from coworkers. The Equal Employment Opportunity Commission, which enforces federal laws against job discrimination, has said that ADA protections apply to Covid vaccines.

• Title VII of the 1964 Civil Rights Act prohibits workplace discrimination based on religion, giving workers the right to seek an exception to a vaccination mandate based on religious beliefs. The EEOC defines religion beyond membership in a church or belief in God. Religion for the purposes of federal anti-discrimination law covers strongly and sincerely held moral or ethical beliefs, according to the agency. But employers can deny religious accommodations if they would create an undue burden.

7. Are employer mandates likely to become common?

Probably not, based on the results of the survey by Littler Mendelson of U.S. employers of various sizes across a range of industries. Just 6% of them said they planned to make vaccination a requirement for their staffs when doses become readily available, the FDA grants full approval to vaccines, or both things happen.

8. Are vaccine mandates effective?

There are lively debates among public health authorities and academics about the efficacy of vaccine mandates. Supporters cite studies showing that stricter rules on inoculating schoolchildren lead to lower rates of vaccine-preventable diseases. Most of the data, however, relates to children, whereas a Covid vaccination campaign needs to reach a significant portion of adults. Some health specialists argue that mandates -- especially if they’re imposed by governments -- will only boost resistance to taking vaccines and provide ammunition for anti-vaccine activists at the political fringe.

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