Employer Vaccine Mandates – Top 3 Pros and Cons

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Army Spc. Angel Laureano holds a vial of the COVID-19 vaccine at Walter Reed National Military Medical Center in Bethesda, MD.
Source: Lisa Ferdinando, “Pfizer-BioNTech COVID-19 Vaccine,” wikimedia.org, Dec. 14, 2020

While the current debate about employer vaccine mandates in the United States centers upon COVID-19 requirements, mandates and the debate about them are as old as the country itself.

The first American “vaccine” mandate was issued by then General George Washington in 1777. Washington ordered Continental Army troops to be inoculated against smallpox with the precursor to the smallpox vaccine during the Revolutionary War. According to Andrew Wehrman, Associate Professor of History at Central Michigan University, the soldiers themselves “were the ones calling for it.… There’s no record that I have seen — and I’ve looked — of any soldier turning it down, protesting it.” [1]

Continental Army soldiers may have welcomed inoculation, but plenty of other people did not. After the Reverend Cotton Mather promoted and introduced smallpox inoculation in Boston in 1721 to battle a deadly outbreak of the viral disease, a man threw a bomb through a window of his home with the note: “Cotton Mather, you dog, dam you! I’ll inoculate you with this; with a pox to you.” In fact, most of the doctors in Boston were against inoculation; they even formed an organization called the “Society of Physicians Anti-Inoculators.” Dr. Benjamin Waterhouse introduced a smallpox vaccine into the country in 1800, courtesy of his friend, the British discoverer of the vaccine, Edward Jenner. The Founding Fathers welcomed the innovation, though too late in the case of Benjamin Franklin, who initially battled inoculation until his un-inoculated four-year-old son died from smallpox. “I long regretted bitterly and still regret that I had not given it [a preventative dose of smallpox] to him by inoculation,” admitted Franklin in his 1771 autobiography. [2] [3] [4] [5] [6] [7]

Most early vaccine mandates were implemented by state and local governments. For example, Massachusetts was the first state to mandate vaccines for school children in the 1850s. By 1900, half of the US states had school vaccine mandates; by 1980, all US states had them. [2] [8] [9]

The debate about mandates had taken full form by the end of the 1800s, with dissenting opinions looking much like contemporary arguments: “Some Americans opposed mandates on the grounds of personal liberty; some because they believed lawmakers were in cahoots with vaccine makers; and some because of safety concerns.” [1]

In 1905, the US Supreme Court entered the debate, ruling in Jacobson v. Massachusetts that compulsory vaccination laws enacted by state and local governments were constitutional and enforceable. Justice John Marshall Harlan, who wrote the majority opinion, argued that individual liberty is not absolute: “The liberty secured by the Constitution of the United States does not import an absolute right in each person to be at all times, and in all circumstances, wholly freed from restraint.… [T]he fundamental principle of the social compact… [is] that all shall be governed by certain laws for the protection, safety, prosperity and happiness of the people, and not for the profit, honor or private interests of any one man, family or class of men.” The ruling allowed for medical exemptions, and it has been considered the authority on the subject ever since. School vaccine mandates were subsequently upheld by the US Supreme Court in Zucht v. King (1922). [2] [10]

During World War II, the US military began mandating a host of vaccines for service members, including typhoid, yellow fever, and tetanus. As of 2021, the US military required service members to get 18 vaccines, including adenovirus, COVID-19, hepatitis A, hepatitis B, flu, meningococcal, MMR (measles, mumps, and rubella), polio, tetanus-diphtheria, and varicella (chicken pox). Members can be required to be vaccinated against other diseases based on service location: anthrax, haemophilus influenzae type B, Japanese encephalitis, pneumococcal disease, rabies, smallpox, typhoid fever, and yellow fever. Civilian military employees are also subject to vaccine mandates, including the COVID-19 vaccine. The US military allows administrative, medical, and religious vaccine exemptions, though they are rare. [10] [11] [12] [13] [14] [15]

Other than the US military, healthcare facilities are the most common type of employer to mandate vaccines. For years, some healthcare workers have been required to have multiple vaccinations including: hepatitis B, influenza, MMR (measles, mumps and rubella), pertussis, pneumococcal disease, and varicella (chickenpox). [16]

Healthcare workers, among employees in other industries, are also increasingly required to have COVID-19 vaccinations. A Dec. 2, 2021, survey found that 25% of employers planned on implementing a COVID-19 vaccine mandate, regardless of a federal mandate. 32% only planned to implement a mandate if the federal government required employee vaccination. And 33% said they would enforce a testing protocol rather than mandate COVID-19 vaccines. [17]

Many states and DC have implemented COVID-19 vaccine or vaccine-or-test mandates as employers. The mandates may cover executive branch staff, teachers at state schools and pre-schools, state-run healthcare facility employees, and other state government employees. Conversely, several states have enacted laws banning employers from implementing vaccine mandates. [18] [19]

The US Supreme Court ruled on Jan. 13, 2022, that the Biden Administration does not have the authority to impose a COVID-19 vaccine-or-test mandate. The White House mandate would have required people who work for employers with 100 or more employees to either be vaccinated or tested weekly and wear a mask indoors if unvaccinated. The Court allowed the White House COVID-19 vaccine mandate to stand for medical facilities that take Medicare or Medicaid payments. [20]

In the wake of this ruling, many large companies were rethinking the implementation or enforcement of a COVID-19 vaccine mandate. Many companies, including Carhartt, CitiGroup, and United Airlines, maintained their mandates, while others, including Boeing, GE, and Starbucks, did not. [21]

Whatever the status of COVID-19 vaccine mandates, many employers have legally required certain employees to be vaccinated against other diseases. The US Equal Employment Opportunity Commission explained that employers may require employees to be vaccinated as long as the businesses “comply with the reasonable accommodation provisions of the ADA [Americans with Disabilities Act] and Title VII of the Civil Rights Act of 1964 and other EEO considerations.” Those accommodations include but are not limited to medical and religious exemptions. [22]

Should Employers Be Able to Mandate Vaccinations?

Pro 1

Vaccine mandates have a history of effectively reducing the spread and health consequences of communicable disease.

Mandates increase vaccination rates, and high vaccination rates lower disease infection rates overall, as well as the severity of diseases in vaccinated people. This is proven by data related to American school kids. States with stricter school vaccine mandates had a higher percentage of vaccinated children and a lower rate of vaccine-preventable diseases in children. [23]

The history of vaccine mandates effectively curbing the spread and consequences of disease date to the first US “vaccine” mandate. The smallpox mortality rate during the US Revolutionary War was about 50%. Both sides were losing troops at an alarming rate. The British Army did not inoculate their troops. However, once General George Washington ordered all Continental Army troops be inoculated against smallpox, the mortality rate for Washington’s troops dropped to 2%–a feat some historians say won the Revolutionary War. [4] [24]

For a more current example, journalist Dan Gorenstein, summarized a 2020 study on hospital employee vaccine mandates: “So in the case of the California hospitals, the [flu vaccine] mandates increased uptake of the flu shot by about 10%. But… what makes this paper really interesting is that… [t]here was a 40% drop in the number of people who entered the hospital and caught the flu inside the facility… [and] a 20% drop in the number of people coming to the hospital with flu-like symptoms. So here’s the big idea: Increasing vaccination rates made the hospitals themselves safer and it meant fewer people in the community were getting sick. So for employers who are thinking about whether to institute the [vaccine] mandate or not, they could ask themselves, is my business a social hub the way, like, a hospital is? And the bigger your business is a social hub, the more a vaccine mandate could curb spread.” [25] [26]

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Pro 2

Vaccine mandates are time-tested policies, proven successful in the workplace.

The CDC found that when healthcare employers required the flu vaccine, 85% of employees complied. When employers did not mandate the flu vaccine, only 43% got the flu vaccine. [27]

Essentia Health, a hospital chain in the US Midwest, had a 70% flu vaccination rate among employees from 2012 to 2015. When employees had to report whether they were vaccinated with a simple “yes” or “no” in 2016, the vaccination rate rose to 82%. And, when a vaccine mandate with exemptions was implemented in 2017, the compliance rate rose to 99.5%. [27]

Lawrence O. Gostin, Professor of Global Health Law at Georgetown University, explained, “Many business and educational mandates fall into the ‘hard’ [mandate] category—that is, students or workers cannot attend classes or the workplace unless they are fully vaccinated. ‘Soft’ mandates ‘nudge’ people to get vaccinated. When getting a vaccine is the ‘easier’ or ‘default’ option, most opt for the [vaccination] jab. Thus, when given the choice between getting a vaccine or having to undergo one to two SARS-CoV-2 [COVID-19] tests weekly and masking up, most people will eventually roll up their sleeves. How do we know? Well, in states that have wide and easy exemptions for childhood vaccines, a significant number of parents opt out. But if a state makes getting the exemption hard, such as requiring a written declaration, a doctor’s certificate or attending vaccine literacy classes, vaccine hesitancy melts away.” [19]

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Pro 3

Vaccine mandates are reasonable conditions of employment, and most employees agree.

While headlines abound proclaiming the firing of workers who have refused vaccination, most workers comply with mandates to keep or start a job.

For example, a Jan. 25, 2022, headline in The Hill stated, “73 San Diego school workers terminated over vaccine mandate.” Buried in the article is the fact that 99% of San Diego school workers were vaccinated or received an exemption. [28]

When Essentia implemented a flu vaccine mandate across their Midwest hospital chain in 2017, only 50 of almost 14,000 employees were fired for non-compliance with the mandate, or about 0.35% of the workforce. [27]

A Dec. 2, 2021, survey found that 31% of employers worried vaccine mandates would result in employee resignations. However, only 13% of employers reported resignations connected to vaccine mandates. [17]

A Jan. 2022 poll completed after the US Supreme Court struck down the federal vaccine mandate found 56% of those surveyed supported employer COVID-19 vaccine mandates, with 33% opposed to such mandates and the other 10% saying they had no opinion. Even 23% of unvaccinated employees supported a mandate. [29] [30]

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Con 1

Employer vaccine mandates violate personal privacy and may exacerbate intolerance and discrimination in the workplace.

Employees may have health or other reasons for not being vaccinated. While employers are required to allow exemptions, the paperwork may require an employee to disclose sensitive personal information that could, unfortunately, be used against the employee. [22]

Religious intolerance has been on the rise in the US, particularly antisemitism and Islamophobia. If a person declares a sincerely held religious belief as a reason for non-vaccination, an employer could discriminate against the employee either by not accommodating a vaccine waiver or other actions. Vaccine mandates force employees to disclose religious beliefs they may have otherwise kept secret if their workplace is an intolerant environment. [31] [32]

Some people with less visible disabilities or medical conditions who do not require other accommodation may prefer not to divulge medical information to their employers. A medical waiver often requires “medical evidence” for the exemption, exposing private information to an employer. While such discrimination is illegal, several healthcare providers have recently been successfully sued by employees who claimed their sincerely held religious beliefs and medical conditions were not accommodated as vaccine mandate exemptions. [33] [34] [35]

Further, exemptions often require that the employee wear a mask, be tested daily, or work from home, which broadcasts vaccination status to coworkers who may ask intrusive questions or discriminate, straining employee relationships. Google employees wrote, “​​barring unvaccinated Googlers from the office publicly and possibly embarrassingly exposes a private choice as it would be difficult for the Googler not to reveal why they cannot return.” [36]

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Con 2

Vaccine mandates are not the most effective workplace policy; offering alternatives to vaccinations works better.

Journalist Yasmeen Serhan noted, “In the United States, being vaccinated is more common than drinking coffee, owning a television cable box or satellite dish, or even watching the Super Bowl.” [37]

Because a high percentage of employees will already be vaccinated, or agreeable to additional vaccines, employer policies are necessarily directed toward people who are under- or unvaccinated and who may be vaccine hesitant.

A 2019 study found vaccine hesitant people “far outnumbered” vaccine refusers and recommended counseling and education because mandates are not the best way to change peoples’ minds about vaccines. [38]

As lawyers Charlene A. Barker Gedeus and Alexis Aloi Graziano explained, “In an effort to increase employee immunization, employers may choose to educate and incentivize vaccinations. Employers opting out of mandatory vaccines should educate staff about how to prevent disease and the benefits of vaccination, sponsor vaccination sites at work, and institute policies that encourage employees to remain at home if they aren’t feeling well. Providing employees with credible information from the CDC is a necessary and meaningful step toward ensuring a safe work environment.” Offering alternatives, including testing, masking, and working offsite, may be more effective for the few who refuse vaccination.[39]

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Con 3

Employer vaccine mandates can doubly harm marginalized communities.

People of color and LGBTQ+ people have high rates of healthcare distrust due to current and historical medical mistreatment and discrimination, which can translate into vaccine hesitancy. [40] [41]

As the Commonwealth Fund explained, “The medical establishment has a long history of mistreating Black Americans — from gruesome experiments on enslaved people to the forced sterilizations of Black women and the infamous Tuskegee syphilis study that withheld treatment from hundreds of Black men for decades to let doctors track the course of the disease.” These concerns have continued into the modern medicine era and are applicable to other communities of color, including Hispanics and Native Americans. [40] [42] [43] [44]

LGBTQ+ people frequently face discrimination, refusal of care, assault, and other hurdles when accessing healthcare, and they therefore often forgo or delay medical care. [41]

Additionally, these communities face pay gaps, high rates of unemployment, and job insecurity. In Feb. 2021, Black (9.9%) and Hispanic (8.5%) workers had higher unemployment rates than white workers (5.6%). A 2020 report indicated 17% of LGBTQ+ people lost jobs due to the pandemic, compared to 13% of the general population. Combining a legitimate, historical distrust of institutionalized healthcare with a threat of job loss is not good policy. [45] [46]

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Discussion Questions

1. Should employers mandate vaccines? Consider specific types of employers (healthcare, the military, schools, restaurants, etc), as well as various diseases (COVID-19, the flu, or measles, for example). Explain your answer(s).

2. Should employers be involved in employee health in other ways? Consider incentives to stop smoking or lose weight, for example. Explain your answer(s).

3. What policies—from mandates to educational and incentivizing measures–are best to contain a communicable disease like COVID-19 or the flu? Consider various kinds of employers.  Explain your answer(s).

Take Action

1. Examine Karen Mulligan and Jeffrey E. Harris’ position that more companies should mandate vaccination.

2. Consider the US Equal Employment Opportunities Commission COVID-19 workplace guidance.

3. Analyze Katie Attwell and Mark Navin’s position that employers should not mandate vaccination.

4. Consider how you felt about the issue before reading this article. After reading the pros and cons on this topic, has your thinking changed? If so, how? List two to three ways. If your thoughts have not changed, list two to three ways your better understanding of the “other side of the issue” now helps you better argue your position.

5. Push for the position and policies you support by writing US national senators and representatives.


1.Maggie Astor, “Vaccination Mandates Are an American Tradition. So Is the Backlash.,” nytimes.com, Sep. 9, 2021
2.Tara Law, “Schools Could Help More Kids Get the COVID-19 Vaccine. but History Has Some Warnings,” time.com, Nov. 1, 2021
3.Matthew Niederhuber, “The Fight over Inoculation During the 1721 Boston Smallpox Epidemic,” harvard.edu, Dec. 31, 2014
4.Dan Liebowitz, “Smallpox Vaccination: An Early Start of Modern Medicine in America,”​​ ncbi.nlm.nih.gov, Jan. 7, 2017
5.Olivia B. Waxman, “Benjamin Franklin's Writing about Losing His Son to Smallpox Is a Must-Read for Parents Weighing COVID-19 Vaccines Today,” time.com, Nov. 2, 2021
6.M. Best, D. Neuhauser, and L. Slavin, “’Cotton Mather, you dog, dam you! I’l inoculate you with this; with a pox to you’’: Smallpox Inoculation, Boston, 1721,” ncbi.nlm.nih.gov, 2004
7.Amitabha Palmer, “Black History and the Early History of Inoculation in America,” wrestling-with-philosophy.com, Feb. 8, 2021
8.Kevin M. Malone and Alan R. Hinman, “Vaccination Mandates: The Public Health Imperative and Individual Rights,” cdc.gov, 2007
9.Hedy Phillips and Jessica Rendall, “School Vaccine Mandates Aren't New: A History of Requirements,” cnet.com, Oct. 7, 2021
10.David Oshinsky, “The Long History of Vaccine Mandates in America,” wsj.com, Sep. 17, 2021
11.Khaleda Rahman, “Full List of Vaccines Mandated by the U.S. Military,” newsweek.com, Oct. 21, 2021
12.Jennifer Steinhauer, “As Biden Moves to Vaccinate Federal Workers, Troops Get a Pass,” nytimes.com, Nov. 2, 2021
13.Secretary of Defense, “Memorandum for Senior Pentagon Leadership, Commanders of the Combatant Commands, [and] Defense Agency and DOD Field Activity Directors,” defense.gov, Aug. 24, 2021
14.Congressional Research Service, “The Military’s COVID-19 Vaccination Mandate,” crsreports.congress.gov, Nov. 8, 2021
15.Oren Liebermann and Ellie Kaufman, “US Military Has Approved Religious Exemptions to Vaccine Mandate for 15 Service Members Out of 16,000 Requests,” cnn.com, Feb. 17, 2022
16.CDC, “Vaccination Laws,” cdc.gov, Feb. 28, 2018
17.Willis Towers Watson, “Fall 2021 COVID-19 Vaccination and Reopening the Workplace Survey Results,” wtco.com, Dec. 2, 2021
18.Littler Mendelson, “Mandatory Employee Vaccines – Coming to A State Near You?,” littler.com, Feb. 1, 2022
19.Lawrence O. Gostin, “Vaccine Mandates Are Lawful, Effective and Based on Rock-Solid Science,” scientificamerican.com, Aug. 5, 2021
20.Kevin Breuninger and Spencer Kimball, “Supreme Court Blocks Biden COVID Vaccine Mandate for Businesses, Allows Health-Care Worker Rule,” cnbc.com, Jan. 13, 2022
21.Becky Sullivan, “Carhartt Blowback Shows the Tightrope Companies Face over Vaccine Mandate Decisions,” npr.org, Jan. 19, 2022
22.US Equal Employment Opportunity Commission, “EEOC Issues Updated COVID-19 Technical Assistance,” eeoc.gov, May 28, 2021
23.Emily Oster and Geoffrey Kocks, “After a Debacle, How California Became a Role Model on Measles,” nytimes.com, Jan. 16, 2018
24.Boston National Historical Park, “Smallpox, Inoculation, and the Revolutionary War,” nps.gov (accessed Feb. 3, 2022)
25.David Brancaccio and Daniel Shin, “How Effective Are Employer Vaccine Mandates?,” marketplace.org, May 28, 2021
26.Corey White, “Measuring the Total Benefits of Influenza Vaccination,” uwpress.wisc.edu, May 22, 2020
27.Maggie Fox, “They Didn’t Get Vaccinated. Now They’re out of Jobs.,” nbcnews.com, Nov. 22, 2017
28.Olafimihan Oshin, “73 San Diego School Workers Terminated over Vaccine Mandate,” thehill.com, Jan. 25, 2022
29.Alison Durkee, “Majority of Americans Still Want Employer Vaccine Mandates after Supreme Court Blocks Biden Policy, Poll Finds,” forbes.com, Jan 19, 2022
30.Gaby Galvin, “Following Supreme Court’s Decision to Nix Federal Vaccine Requirement for Private Workers, More Than 1 in 2 Adults Say They Back Mandates by Employers,” morningconsult.com, Jan. 19, 2022
31.Paul Caine, “Report Finds Antisemitism on the Rise in America,” news.wttw.com, Oct. 26, 2021
32.Kiara Alfonseca, “20 Years after 9/11, Islamophobia Continues to Haunt Muslims,” abcnews.go.com, Sep. 11, 2021
33.Richard Dahl, “What Are the Requirements for a Vaccine Medical Exemption?,” findlaw.com, Nov. 16, 2021
34.Dylan J. Yépez, “Healthcare Employers: Exercise Caution When Enforcing Mandatory Vaccination Policies,” natlawreview.com, July 5, 2019
35.Y. ​​Tony Yang, Elizabeth Pendo, and Dorit Rubinstein Reiss, “The Americans with Disabilities Act and Healthcare Employer-Mandated Vaccinations,” slu.edu, 2020
36.Jennifer Elias, “Several Hundred Google Employees Sign Manifesto against Widened COVID Vaccine Mandate,” cnbc.com, Nov. 23, 2021
37.Yasmeen Serhan, “The Silent, Vaccinated, Impatient Majority,” theatlantic.com, Jan. 17, 2022
38.Shixin (Cindy) Shen and Vinita Dubey, “Addressing Vaccine Hesitancy: Clinical Guidance for Primary Care Physicians Working with Parents,” ncbi.nlm.nih.gov, Mar. 2019
39.Charlene A. Barker Gedeus and Alexis Aloi Graziano, “Can Healthcare Providers Require Employee Vaccinations?,” bipc.com, July 18, 2019
40.Martha Hostetter and Sarah Klein, “Understanding and Ameliorating Medical Mistrust among Black Americans,” commonwealthfund.org, Jan. 14, 2021
41.Shabab Ahmed Mirza and Caitlin Rooney, “Discrimination Prevents LGBTQ People from Accessing Health Care,” americanprogress.org, Jan. 18, 2018
42.B. Ashleigh Guadagnolo, “Medical Mistrust and Less Satisfaction with Health Care among Native Americans Presenting for Cancer Treatment,” ncbi.nlm.nih.gov, Apr. 6, 2009
43.Eric Whitney, “Native Americans Feel Invisible in U.S. Health Care System,” npr.org, Dec. 12, 2017
44.Katrina Armstrong, et al., “Racial/Ethnic Differences in Physician Distrust in the United States,” ncbi.nlm.nih.gov, July 2007
45.Nate Rattner and Thomas Franck, "Black and Hispanic Women Aren’t Sharing in the Job Market Recovery," cnbc.com, Mar. 5, 2021
46.Daniel Thomas Mollenkamp, "LGBTQ+ Pay Gap and Unemployment," investopedia.com, Apr. 19, 2021

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