Vaccine Mandates: The Supreme Court’s Decisions on the Future of Public Health

By: Mia Xia

Edited By: Katherine Ferreira O'Connor and Luke Vredenburg

        As COVID-19 has taken the United States by storm, resistance against mask and vaccine mandates has quickly followed. With anti-vaccine marches across Washington D.C, thousands of Americans have made their stance on the vaccine clear [1]. Federal judges have also rejected immunization requirements for federal workers, and the legality of vaccination mandates is making headway into the Supreme Court [2]. The Court’s most recent decisions blocked the Biden Administration’s attempt to institute vaccine mandates for businesses with more than 100 employees but provided an exception allowing mandates for healthcare workers at hospitals receiving federal money, prompting greater questions regarding where the lines for vaccination mandates are drawn [3]. Though federal vaccination mandates have been employed in past efforts to combat novel diseases, the Biden Administration has faced resistance from the courts in its attempts to implement similar policies. 

        In America, most vaccination mandates come into effect during childhood. For diseases like Hepatitis A and B, Tuberculosis, Polio, and Meningococcal ACWY, many states have implemented vaccine mandates as a prerequisite to enrolling in K-12 schools, both public and private [4]. Oftentimes, if families have not stated religious or medical reasons for opting out of immunization, children will not be allowed to enroll in daycares or attend school [5]. Some states have specific vaccine requirements – in New York and Rhode Island, all healthcare workers must be vaccinated against measles and rubella, with Rhode Island workers also being mandated to get the annual flu shot [6]. In many American universities, both public and private, vaccine mandates for diseases like Human Papillomavirus (HPV) are common, and COVID-19 vaccine requirements have become prevalent as well [7]. Thus, if immunization requirements are not abnormal in American society, what are the legal grounds for blocking legislation supporting COVID-19 vaccination mandates?

        In the recent decision concerning National Federation of Independent Business v. OSHA, the Supreme Court voted 6-3 against vaccination mandates for large, private businesses, with the majority reasoning that Congress does not have the power to regulate public health [8]. The dissenting opinion from Justices Breyer, Sotomayor, and Kagan wrote that the majority overruled legislative and executive powers without a proper legal basis [9]. For the majority to undermine the Occupational Safety and Health Administration’s (OSHA) jurisdiction to protect public safety, the minority argued, a greater burden would be placed on healthcare workers and future economic opportunities [10]. It is worth noting that within the clauses of OSHA’s Enabling Act, Congress grants the agency the ability to set an emergency standard if it believes workplace safety is at grave risk of toxic or physical harm [11]. In this regard, even with the OSHA reporting that blocking a vaccination mandate would mean “6,500 deaths and 250,000 preventable COVID cases,” the majority came to the conclusion that the OSHA had overexerted its powers to enact rules to protect workers [12]. However, considering the measurable steps OSHA took to define the public health risk and propose a vaccination mandate in response, the agency appears to make constitutional decisions and still remain within the bounds of its granted powers. The majority decision appears to have prioritized personal liberties and individual agency, where workers ought to have a say over their vaccination status. Meanwhile, the dissenting opinion’s interpretation regards vaccination mandates as a means of protecting public health, following the precedent of the use of previously enforced vaccination mandates for previous public health risks as the basis of their dissent. 

        In a similar case ruled alongside National Federation of Independent Business v. OSHA, the 5-4 decision made in favor of vaccine mandates in Missouri v. Biden contradicts the majority decision of OSHA. With Justices Roberts and Kavanaugh joining the liberal Justices in a majority decision, the Supreme court ruled that healthcare providers who are employed at facilities that accept Medicare and Medicaid are required to abide by a vaccination mandate for COVID-19 [13]. In the Congressional statute defining the Secretary of Health and Human Services abilities, the Secretary is allowed to issue regulations that ensure proper administration of federal healthcare programs like Medicare and Medicaid and ultimately, protect the health and safety of constituents [14]. In this decision, the majority argued that mandates enforced by current Secretary Alex Azar were made within the bounds of authority Congress had granted him [15]. The dissenting opinion instead regarded these statutes as “scattered provisions” that did not justify a vaccination mandate, employing a similar argument from the OSHA case that healthcare workers ought not to be subjected to procedures against their will [16]. 

        Vaccines and masks are the answer to the public health crisis that continues to ravage this nation [17]. However, in the Court’s divisive rulings which favor the interests of private industries, the lines drawn between public and private institutions have been made extremely clear. On one hand, the Court has allowed for private entities to function under the radar of public health expectations, opting for the prioritization of individual liberties and choice. Meanwhile, for federally supported health care facilities already burdened with the increasing number of COVID cases and extreme fatigue, the Court has recognized the cruciality of vaccination mandates to protect both workers and patients. Vaccination mandates are essential for individuals to not only preserve their own health and wellbeing but also to protect those around them who may be in a more vulnerable position. There exists a historical precedent for federal vaccination mandates, yet questions of constitutionality still linger. Vaccine and mask mandates are the best solutions to protect the collective health of a community, and the race against time to prevent further deaths is limited. Taking the necessary steps to stop the spread is key to ending the pandemic once and for all. 

NOTES:

1. Katie Mettler et al, Anti-Vaccine Activists March in D.C. - a City That Mandates Coronavirus Vaccination - to Protest Mandates, (The Washington Post, 24 Jan. 2022), https://www.washingtonpost.com/dc-md-va/2022/01/23/dc-anti-vaccine-rally-mandates-protest/. 

2. Peter Sullivan, Federal Judge in Texas Blocks Biden's Vaccine Mandate for Federal Workers, (The Hill, 21 Jan. 2022), https://thehill.com/policy/healthcare/590797-federal-judge-in-texas-blocks-bidens-vaccine-mandate-for-federal-workers. 

3. Adam Liptak, Supreme Court Blocks Biden's Virus Mandate for Large Employers, (The New York Times, 13 Jan. 2022), https://www.nytimes.com/2022/01/13/us/politics/supreme-court-biden-vaccine-mandate.html. 

4. Drew DeSilver, States Have Mandated Vaccinations since Long before COVID-19, (Pew Research Center, 8 Oct. 2021), https://www.pewresearch.org/fact-tank/2021/10/08/states-have-mandated-vaccinations-since-long-before-covid-19/. 

5. Drew DeSilver, States Have Mandated Vaccinations since Long before COVID-19.

6. Ibid.

7. Ibid.

8. Kevin Breuninger and Spencer Kimball, Supreme Court Blocks Biden Covid Vaccine Mandate for Businesses, Allows Health-Care Worker Rule (CNBC, 14 Jan. 2022), https://www.cnbc.com/2022/01/13/supreme-court-ruling-biden-covid-vaccine-mandates.html. 

9. Breuninger and Kimball, Supreme Court Blocks Biden Covid Vaccine Mandate for Businesses, Allows Health-Care Worker Rule. 

10. Richard Lempert, The Vaccine Mandate Cases, Polarization, and Jurisprudential Norms, (Brookings Institute, 15 Jan. 2022), https://www.brookings.edu/blog/fixgov/2022/01/15/the-vaccine-mandate-cases-polarization-and-jurisprudential-norms/. 

11. Lempert, The Vaccine Mandate Cases, Polarization, and Jurisprudential Norms.

12. Ibid. 

13. Liptak, Supreme Court Blocks Biden's Virus Mandate for Large Employers. 

14. Ibid. 

15. Ibid. 

16. Ibid. 

17. Lindsay Kalter, Why Vaccine and Mask Mandates Hold up in Court, (WebMD, 12 Oct. 2021), www.webmd.com/vaccines/covid-19-vaccine/news/20211012/why-mandates-hold-up-in-court. 

Bibliography:

Breuninger, Kevin, and Spencer Kimball. “Supreme Court Blocks Biden Covid Vaccine Mandate for Businesses, Allows Health-Care Worker Rule.” CNBC, 14 Jan. 2022, https://www.cnbc.com/2022/01/13/supreme-court-ruling-biden-covid-vaccine-mandates.html. 

DeSilver, Drew. “States Have Mandated Vaccinations since Long before COVID-19.” Pew Research Center, 8 Oct. 2021, https://www.pewresearch.org/fact-tank/2021/10/08/states-have-mandated-vaccinations-since-long-before-covid-19/. 

Kalter, Lindsay. “Why Vaccine and Mask Mandates Hold up in Court.” WebMD, 12 Oct. 2021, www.webmd.com/vaccines/covid-19-vaccine/news/20211012/why-mandates-hold-up-in-court. 

Lempert, Richard. “The Vaccine Mandate Cases, Polarization, and Jurisprudential Norms.” Brookings Institute, 15 Jan. 2022, https://www.brookings.edu/blog/fixgov/2022/01/15/the-vaccine-mandate-cases-polarization-and-jurisprudential-norms/. 

Liptak, Adam. “Supreme Court Blocks Biden's Virus Mandate for Large Employers.” The New York Times, 13 Jan. 2022, https://www.nytimes.com/2022/01/13/us/politics/supreme-court-biden-vaccine-mandate.html. 

Mettler, Katie, et al. “Anti-Vaccine Activists March in D.C. - a City That Mandates Coronavirus Vaccination - to Protest Mandates.” The Washington Post, 24 Jan. 2022, https://www.washingtonpost.com/dc-md-va/2022/01/23/dc-anti-vaccine-rally-mandates-protest/. 

Sullivan, Peter. “Federal Judge in Texas Blocks Biden's Vaccine Mandate for Federal Workers.” The Hill, 21 Jan. 2022, https://thehill.com/policy/healthcare/590797-federal-judge-in-texas-blocks-bidens-vaccine-mandate-for-federal-workers.