COVID-19 Vaccine Mandates and Exemptions

Updated January 14, 2021

The Latest: Supreme Court Upholds CMS Vaccine Mandate for Health Care Workers

On Jan. 13, the U.S. Supreme Court ruled on COVID-19 vaccine mandates. They struck the vaccine mandate for employers with 100+ employees, but upheld the vaccine mandate for health care workers. This decision sets a consistent COVID-19 vaccination standard for workers in facilities that participate in Medicare and Medicaid.

The AAFP's statement, All Options Must be on the Table to Get Americans Vaccinated, shows support for the decision to uphold the CMS mandate but expressed disappointment that the Supreme Court struck down the vaccine mandate for large employers. The AAFP emphasized that every eligible individual should get the COVID-19 vaccine as a way to prevent disease in people of all ages. CMS also released a statement by administrator Chiquita Brooks-LaSure on the decision on vaccine requirements. 

Background on CMS Requirement

CMS requires that all health care workers be fully vaccinated against COVID-19 at facilities that participate in Medicare and Medicaid. This requirement is necessary to protect patients, residents and and staff during the COVID-19 public health emergency. More information is outlined in the CMS Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule.

Vaccine Exemptions

The AAFP has reviewed and approved all of the CDC’s ACIP recommendations related to COVID-19 vaccines. AAFP supports the vaccines as safe and effective tools to end the pandemic and encourages all individuals to get vaccinated.

As outlined in the Immunization Exemptions policy, with the exception of policies allowing for refusal due to a documented allergy or medical contraindication, the AAFP does not support immunization exemption policies.

The AAFP also holds a strong position on immunizations. This issues backgrounder outlines how vaccines can prevent much of the high morbidity and mortality associated with most preventable diseases.

Contraindications

The CDC’s current interim clinical considerations lists contraindications for COVID-19 vaccines. View a brief summary sheet.

• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to component of the COVID-19 vaccine
• Immediate (within 4 hours of exposure) allergic reaction of any severity to a previous dose or known (diagnosed) allergy to a component of the vaccine
• Vaccine components  https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html#Appendix-C

Precautions

Individuals with the following characteristics can receive and are recommended to receive a vaccine. However, certain factors should prompt a risk assessment and potential referral to allergist/specialist.

• Immediate allergic reaction to any other vaccine or injectable therapy (i.e., intramuscular, intravenous, or subcutaneous vaccines or therapies [excluding subcutaneous immunotherapy for allergies, i.e., “allergy shots”])
• People with a contraindication to one type of vaccine have a precaution to the other type

Pregnancy

Please note that pregnancy/desiring pregnancy are not considered contraindications. The CDC, AAFP, ACOG, and others strongly recommend individuals who are pregnant or lactating to get vaccinated against COVID-19. Data have demonstrated that the vaccines are effective and safe for people who are considering pregnancy, are pregnant, or recently pregnant. Vaccination provides protection for the parent and baby against major issues seen after infection with COVID-19.