Effective vaccines are critical in the fight against SARS-CoV-2, the virus that causes COVID-19. Every individual that gets a shot helps slow the spread of the disease, even when newer variants emerge. "If enough people do not take the vaccine, then it won't work to curb the pandemic," explains epidemiologist Supriya Narasimhan, M.D., M.S. (Epi), the Division Chief of Infectious Diseases and Medical Director of Infection Prevention at Santa Clara Valley Medical Center in San Jose, California.
Children have more options than ever when it comes to getting vaccinated. Those as young as 5 can be inoculated with Pfizer's vaccine under an emergency use authorization by the Food and Drug Administration (FDA), which has also formally approved the shot for those ages 16 and older. Kids over 18 are eligible for Moderna's Spikevax vaccine, also granted full approval by the FDA. Johnson & Johnson's Janssen vaccine serves the same age group under its own emergency use authorization.
These vaccines raise some important questions for parents, who may be concerned about their safety and efficacy. You might wonder: Can the federal, state, or local government mandate vaccines? What about my child's school or my employer? Here's what you need to know.
First, Is The COVID-19 Vaccine Safe?
To some parents, the pace of vaccine authorization and approval has been too quick. According to a Gallup Survey released in November 2021, about 80 percent of Americans say they're already vaccinated or plan to be. But others worry that researchers sacrificed safety precautions to develop a COVID-19 vaccine faster. Medical professionals, however, don't necessarily share their fears.
The FDA has been working with experts to develop an effective vaccine design for much longer than people realize, says pediatrician Christine Turley, M.D., vice chair for research at Atrium Health Levine Children's Hospital in Charlotte, North Carolina. The organization did speed through administrative components, but safety protocols have been followed properly, she adds. "I'm encouraged that the National Institutes of Health and Dr. Anthony Fauci promised data transparency and ensured us that scientific rigor will not be compromised by the Data and Safety Monitoring Board," adds Dr. Narasimhan.
Currently, children younger than 5 years old can't receive any vaccine—but that might change soon because Pfizer and Moderna are conducting clinical trials with kids 6 months and older. Johnson & Johnson is also working on its own pediatric clinical trials.
Can the Government Mandate a COVID-19 Vaccine?
Dr. Anthony S. Fauci, M.D., the country's top infectious disease expert and chief medical advisor to President Biden, has said that he supports the idea of a mandatory COVID vaccine for school children, but doesn't think a vaccine will be mandated for all Americans. When it comes to public health, our federal, state, and local governments have different regulations and policies. Here's where they stand.
Federal Government and Vaccines
The federal government would have a difficult time mandating a vaccine. Thanks to limitations set forth by the Constitution, public health measures generally fall to the states. White House officials still encourage vaccination, even saying in a March 2022 press conference that they will be "ready and prepared" to help parents vaccinate kids aged 2 to 5 against the coronavirus once the FDA approves it. In the meantime, the government could implement incentives—for example, requiring people to get vaccinated to get a U.S. passport or making it impossible to get a driver's license without vaccination.
State Governments and Vaccines
States can require vaccines if it's deemed necessary for public health. You can thank a 1905 Supreme Court case called Jacobson v. Massachusetts, which upheld states' compulsory vaccination laws after a man in Cambridge, Massachusetts, refused the smallpox vaccination during an outbreak. His failure to comply resulted in a $5 fine, and established a precedent that is still with us today.
Of course, states can't just decide to make any vaccine mandatory. It must first be recommended by the Advisory Committee on Immunization Practices (ACIP) to the Centers for Disease Control and Health and Human Services. Even if those institutions endorse the recommendation, there will likely be ample legal debate about it within state legislatures or city councils. State officials know that any type of mandate will result in a public outcry, and must consider whether universal vaccination is worth it.
Local Governments and Vaccines
As long as it's reasonable and in the public interest, cities can mandate vaccines. Some experts believe this could take place in hot spots, such as big cities. It actually happened during the New York City measles outbreak of 2019, which led to vaccination orders in four zip codes in Williamsburg, Brooklyn. Those who refused the measles-mumps-rubella (MMR) vaccine faced a $1,000 fine.
In December 2021, New York City launched the Key2NYC program, requiring proof of COVID-19 vaccination from anyone aged 5 and over who wished to enter indoor dining establishments, entertainment venues. (stadiums, museums, concert halls), fitness centers, and more. In March 2022, that requirement was lifted, following similar actions in Philadelphia and Washington, D.C.
Can School Districts Mandate Vaccines?
Yes. U.S. schools already mandate that their students get a long list of vaccines before starting class, ensuring that they guard against measles, polio, tetanus, chicken pox, and hepatitis B, among other things. There's nothing to say that schools can't also mandate the COVID-19 vaccine.
In July 2021, the Department of Justice published a memo making clear that schools have the right to insist their staff and students be vaccinated, even if the vaccines still fall under emergency use authorization. By February 2022, New Orleans had begun requiring kids age 5 and older to be vaccinated to attend school. California and Louisiana have announced plans to institute vaccine mandates for K-12 students statewide (and Washington, D.C. has done the same), though they are waiting until the FDA fully approves the vaccines for schoolchildren of all ages.
Individual districts differ on how to handle vaccine mandates. Nearly 40 California school districts have declared some kind of vaccine mandate for students and staff, according to research published in January 2022 from the non-profit news organization CalMatters. Other school districts across the country have introduced varying mandates. Some focus exclusively on older children or student athletes, while still others allow parents to offer up a negative COVID-19 test or letter of objection in lieu of a vaccine. Depending on the state, exemptions may be allowed for religious, personal, and medical reasons.
Not all states agree with the idea of school vaccine mandates. As of March 1, 2022, at least 17 states had banned student vaccine mandates, though some of these bans are partial or apply only to institutes of higher education. While school faculty in 11 states must be vaccinated (or undergo weekly testing to show they are COVID-free), another 11 states have banned the use of faculty vaccine mandates, too.
Officials who consider instituting mandates must weigh the benefits of vaccination against any potential risks. COVID-19 generally presents with mild symptoms in children, but a small number have suffered severe complications or death. Without vaccines, however, students could spread the virus to their family members and those with compromised immunity. Vaccinating kids may eliminate a major source of coronavirus spread, possibly increasing the effectiveness of herd immunity, says Dr. Turley.
Can Employers Regulate Vaccines?
That depends. In November 2021, the Department of Labor proposed that large companies require their employees to be fully vaccinated or undergo coronavirus testing every week. (By then, some businesses had already created customized mandates for workers.) But in January 2022, the Supreme Court blocked the rule, leaving it up to companies to decide for themselves what to do. With one exception: Workers at federally funded healthcare facilities must get vaccinated or tested.
Can Businesses Mandate Vaccines?
Yes. As seen in New York City, Philadelphia, New Orleans, and many other places around the country, businesses can indeed mandate that their customers have proof of vaccination before entering their store, restaurant, salon, or event venue. Even without a statewide or local vaccine mandate, businesses are allowed to set their own policies—just like they can turn away shirtless or shoeless customers. They simply can't discriminate against shoppers based on their race, ethnicity, culture, or religion.