Accommodating Religious Objections to Vaccination Mandates

The Supreme Court decision concerning Title VII of the Civil Rights Act of 1964 raises new questions about the ability of private employers—including health-care organizations—to enforce vaccination requirements for employees who have religious objections. In this JAMA Health Forum commentary, Michelle Mello and colleagues consider the implications.
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During the COVID-19 pandemic, courts have limited the federal government’s ability to impose vaccination mandates; some judges have also questioned whether states must grant religious exemptions to vaccination mandates. The Supreme Court’s June 2023 decision in Groff v DeJoy2 concerning Title VII of the Civil Rights Act of 1964 raises new questions about the ability of private employers—including health-care organizations—to enforce vaccination requirements for employees who have religious objections.

Title VII Challenges to Vaccination Mandates

Title VII requires employers to accommodate an employee’s religious beliefs and practices unless doing so creates an “undue hardship” for the employer’s business. Until Groff, courts and the Equal Employment Opportunity Commission (EEOC) interpreted “undue hardship” to mean a burden that is more than “de minimis,” or so small that it is hardly noticeable.

Before COVID-19, most Title VII challenges to vaccination mandates involved health care employers because vaccination requirements were most common in health care settings. During the pandemic, school districts, airlines, and state and local governments also were among the employers that had to defend their decisions to enforce COVID-19 vaccination requirements for religious objectors. Several takeaways emerge from this pre-Groff case law.

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