With three COVID-19 vaccines approved by the FDA, many parents are wondering if vaccination will be mandated by the government, schools, or employers. Here’s what you need to know.

Effective vaccines are crucial in the fight against SARS-CoV-2, the virus that causes COVID-19. After months of clinical trials and research, three vaccine candidates (Pfizer, Moderna, and Johnson & Johnson) have received emergency use authorization from the Food and Drug Administration (FDA). Pfizer recently got full FDA approval for those ages 16 and up.

In order for coronavirus spread to slow down, a large portion of the population would need to get vaccinated. "If enough people do not take the vaccine, then it won't work to curb the pandemic," explains Supriya Narasimhan, M.D., M.S. (Epi), Division Chief of Infectious Diseases, Hospital Epidemiologist, and Medical Director of Infection Prevention at Santa Clara Valley Medical Center. 

Naturally, this raises some questions for parents—especially those concerned about the vaccine's safety. Can the federal, state, or local government mandate vaccines? What about your child's school or your employer? Here's what families need to know.

First, Is The COVID-19 Vaccine Safe?

Not everyone is happy with the government's sped-up vaccine approval timeline. According to a Gallup Survey released in early August 2021, about 77 percent of Americans say they're already vaccinated or plan to get the vaccine. Many of the others worry that researchers sacrificed safety precautions to develop a COVID-19 vaccine faster. Medical professionals, however, don't necessarily shares these fears.

The FDA worked closely with experts to develop an effective vaccine design—even before they had any candidates, says Christine Turley, M.D., Pediatrics Specialist and vice chair of research at Atrium Health Levine Children's. The organization saved time by speeding through administrative components, she says, but the safety protocols have been followed properly. "I'm encouraged that the National Institutes of Health (NIH) and Dr. Anthony Fauci promised data transparency and ensured us that scientific rigor will not be compromised by the Data Safety Monitoring Board (DSMB) for vaccine monitoring," 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 pediatric testing in kids 6 months and older. Johnson & Johnson has also announced its own pediatric clinical trial plans.

Can the Government Mandate a COVID-19 Vaccine?

In an interview with Newsweek, infectious disease expert Anthony Fauci said he doesn't think a vaccine would be mandated for all American citizens. That said, when it comes to public health, the 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 in the Constitution, public health measures generally fall to the states. Nevertheless the White House could still encourage or recommend that American citizens get the COVID-19 vaccine. It could also implement incentives—for example, citizens can't get a U.S. passport or driver's license without proof of vaccination. 

State Governments and Vaccines

States can require vaccines if it's considered necessary for public health. You can thank a 1905 Supreme Court case called Jacobson v. Massachusetts, which set the precedent by letting Cambridge mandate the smallpox vaccination during an outbreak. Failure to comply resulted in a $5 fine.

Keep in mind that states can't just mandate any vaccine. It must be recommended by the Advisory Committee on Immunization Practices (ACIP)—and even then, it will likely go through plenty of legal debates with state legislatures or city councils. Given the current political climate, experts also acknowledge that public outcry would probably result from a mandate, and they'll consider whether universal vaccination is worth the unrest.

Local Governments and Vaccines

As long as it's reasonable and in the public interest, cities can also 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.

Indeed, New York City is currently requiring proof of COVID-19 vaccination at indoor dining establishments, certain indoor entertainment venues (like stadiums, museums, and concert halls), indoor fitness centers, and more.

Pediatrician gives vaccination to patient
Credit: Getty Images

Can School Districts Mandate Vaccines?

In September, California became the first state to announce plans to mandate COVID-19 vaccination for students in public and private schools. The timeline depends on the vaccines receiving full approval from the FDA; Pfizer currently is fully approved for those 16 and up, while those ages 5 to 15 can get vaccinated under emergency use authorization.

California governor Gavin Newsom said the vaccine mandate for students will happen in two phases. First will be students in seventh through 12th grades, according to The New York Times. Mandates for those in kindergarten through sixth grades would likely come after that. Of course, as with other state-required vaccines, exemptions will be allowed for religious, personal, and medical reasons.

In August, California mandated vaccinations for teachers in public and private schools, kindergarten through 12th grade. Without vaccinations, teachers will face weekly testing.

New York City is also mandating vaccination for every one of its 148,000 Department of Education employees; this includes teachers, principals, and other school staff. Unlike in California, weekly testing isn't an option. The New York Times said that employees needed to have at least one dose by September 27.

According to U.S. Surgeon General Vivek Murthy, M.D., vaccination mandates for students could happen at the state and local level, once the vaccines are approved for pediatric use by the FDA. Schools already mandate certain vaccines—such as polio, DTap (diphtheria, tetanus, and pertussis), MMR (measles, rumps, and rubella), varicella (chickenpox), and hepatitis B—and there's nothing to say they can't also mandate the COVID-19 vaccine.

When making the decision, experts will weigh the pros and the cons, deciding if the benefits of vaccination outweigh any potential risks. They'll also consider the following information: COVID-19 generally presents with mild symptoms in children, although severe cases and deaths have rarely been reported. However, school-bound children could spread the virus to parents, grandparents, and others with underlying health conditions. Vaccinating children could eliminate one major source of coronavirus spread, possibly increasing the effectiveness of herd immunity, notes Dr. Turley.

Can Employers Regulate Vaccines?

Listen up, moms and dads: Employers have the power to mandate vaccinations for their employees, and they could technically fire anyone who doesn't follow protocol. Many companies across the nation have already implemented these mandates for their workers.

Of course, certain companies (such as healthcare facilities and nursing homes) are more likely to implement regulations. Employers must also consider religious exemptions under the Civil Rights Act of 1964, as well as medical exemptions under the Americans with Disabilities Act.

Can Businesses Mandate Vaccines?

Can your family's favorite store, restaurant, salon, or event venue require vaccinations? As it turns out, the answer is yes. 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. Business owners simply can't discriminate based on cultural, religious, or other reasons.