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Legal questions are centering on whether a college or hospital can mandate COVID-19 vaccinations. Drazen Zigic/Getty Images
  • A growing number of medical facilities are requiring employees to be vaccinated against COVID-19 before returning to on-site work.
  • Some colleges and universities are also requiring students and staff to be vaccinated before coming back to campus.
  • There are legal questions surrounding these mandatory vaccinations, particularly whether an institution can require a vaccine that hasn’t received full government approval.

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Employees of the Houston Methodist Hospital system in Texas are up against a deadline.

They have to get a COVID-19 vaccine by June 7 or they could be fired.

A spokesperson for Houston Methodist told Healthline that their hospital is the first major health system in the country to mandate a COVID-19 vaccine.

The order affects 26,000 employees at all of Houston Methodist’s hospitals and outpatient clinics.

In emails and statements sent to employees and obtained by Healthline, Dr. Marc L. Boom, Houston Methodist’s president and CEO, wrote: “As healthcare workers we must do everything possible to keep our patients safe.”

The spokesperson said employees can apply for a medical or religious exemption. So far, 89 percent of the workers have complied. When managers were asked to meet an April 15 deadline, two resigned.

A recent Kaiser Family Foundation/Washington Post survey reported that 48 percent of frontline healthcare workers were still not vaccinated.

“It’s very disappointing that healthcare workers do not have a 100 percent uptake of the vaccine,” said Dr. Amesh Adalja, FIDSA, a senior scholar at Johns Hopkins Center for Health Security and an adjunct professor at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

“One thing hospitals may be considering is if they make it mandatory, staff might quit because there is a high level of vaccine hesitancy in certain geographic areas,” he told Healthline. “I suspect more hospitals may make it mandatory once full FDA (Food and Drug Administration) licensure occurs.”

Nancy Foster, the vice president of the American Hospital Association, said most of their member hospitals are encouraging workers to get vaccinated but are hesitant to make them mandatory while the vaccines remain under the FDA’s emergency use authorization.

“What we’re hearing from most of our members is that they will likely make a determination of the COVID-19 vaccine for their workers based on safety and efficacy data available at the time the vaccines receive full approval from the FDA, which hasn’t happened yet,” she told Healthline in a statement.

A growing number of colleges and universities have either already put a COVID-19 vaccine mandate in place for the fall semester or are considering it.

According to a tally by the Chronicle of Higher Education, more than 80 colleges have issued vaccine mandates so far.

But some of the colleges are making the policy contingent on the vaccines getting full FDA approval.

The University of Southern California, for example, says its faculty, students, and staff who will be on campus are required to get a COVID-19 vaccine by June 1.

But the policy also says as long as the vaccines are not yet fully approved by the FDA, they can opt-out by filing a “personal declination form.”

The mandates could result in millions of college-age adults getting vaccinated.

“Colleges have seen themselves become completely disrupted by the spread of the virus on campus. The vaccine is the best way to prevent that from happening,” said Adalja.

“If in-person learning, college sports, and extracurricular activities are to return to normalcy, the more vaccinated the student population, the easier it will be,” he added.

Are vaccine mandates legal?

Lawrence O. Gostin, a professor at the Georgetown University Law Center in Washington, D.C., who specializes in health law, said, “As long as they can make sure that everybody who wants a vaccine can get a vaccine, I think it’s ethically and legally permissible.

“Ethically permissible because there’s a duty to create a safe environment for people to be in,” he told Healthline. “And while people have a right to make decisions about their own health and well-being, they have no right to expose another person to a potentially dangerous, even fatal, infectious disease.”

The U.S. Supreme Court weighed in on this issue in a 1905 case. The justices ruled that the board of health in Cambridge, Massachusetts, had the right to mandate that the city’s population be vaccinated against smallpox or face a fine.

Now, two new lawsuits are challenging the COVID-19 vaccine mandate, saying employers have no right to require workers to take a vaccine that does not have full FDA approval.

One was filed by a corrections officer in New Mexico.

Employees of the Los Angeles Unified School District launched the other legal action.

Both Pfizer and Moderna now have 6 months of data and are expected to apply for full approval soon.

Meanwhile, the governors of Utah, Texas, Florida, and Montana have signed orders banning institutions from requiring proof of vaccination.

In Texas, the order refers to any public or private institution that gets state funds. The spokesperson for Houston Methodist says the order doesn’t apply to their healthcare system because they don’t receive state funding.