With FDA approval of first COVID-19 vaccine, let the mandates begin: US military, Disney World, CVS Health and more

With FDA approval of first COVID-19 vaccine, let the mandates begin: U.S. military, Disney World, Ohio State University and more

The Food and Drug Administration's full approval of the Pfizer-BioNTech COVID-19 vaccine launched a flood of vaccination mandates across the United States that will push millions of Americans to either get vaccinated or face serious consequences.

The range of people covered by vaccine requirements on the heels of Monday's action now includes the U.S. military, New York City public school teachers and staffers, all New Jersey teachers and state employees, students at multiple university systems, corporate employees and pharmacists at CVS Health, and 30,000 unionized workers at Disney World.

That adds to millions of Americans for whom putting off COVID-19 vaccination could mean anything from having to get tested for the virus every week to losing their job or being barred from school.

"Full approval will be a much bigger deal than people think," said Dr. Robert Murphy, executive director of the Institute for Global Health at Feinberg School of Medicine at Northwestern University. 

Though the U.S, vaccination rate has increased in the past few weeks, it remains at less than a quarter of the peak in early April, when nearly 2 million people were getting the shot every day.

Surveys show an estimated 30% of  Americans are reluctant to get vaccinated. About 73% of Americans 18 and older had gotten at least one shot of a COVID-19 vaccine as of Tuesday; 62.6% were fully vaccinated.

"The only thing that’s really going to work is mandates, and since the federal government has a limited impact, it’s going to be individual companies and hospitals making those decisions,” Murphy said. 

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Legally, not much has changed for businesses, despite the Pfizer-BioNTech vaccine having already been approved under an emergency use authorization.

"But it does provide an additional level of comfort," said Nicholas Diamond, who leads the Global Health Group for C&M International.

There had been legal protection for mandates before the full approval was issued. In July, the Department of Justice saidemergency authorization didn't prohibit employers from requiring COVID-19 vaccines.

That didn't stop legal challenges and state legislative discussions, but the FDA's official license makes those arguments moot. 

"Now that the change has been made, I expect we will see new requirements trickling in over the next few weeks," Diamond said.

The largest so far came hours after the FDA announcement from the U.S. military, which said it would require vaccination against COVID-19 for all service members.

"We're preparing the guidance to the force right now," Pentagon Press Secretary John Kirby said.

The mandate will apply to all 1.3 million U.S. service members. The Defense Department administers 17 vaccines, depending on a service member's occupation, the location of their deployment and mission requirements. 

"We have to look at every single lever the federal government can pull," Jeff Zients, White House COVID-19 response coordinator, said Tuesday. "We expect more and more vaccination requirements."

Schools, universities and staff

Universities are among the first to use the approval as a trigger to institute mandates.

The University of Minnesota movedforward Monday with its plans add COVID-19 to the list of vaccines required for all its 67,000 enrolled students, and to require all 23,000 faculty and staff at the system's five campuses to be vaccinated.

Ohio State University, with 68,000 students and 45,000 faculty and staff, announced Tuesday that all must have at least one dose of vaccine by October 15. 

Louisiana State University president William F. Tate IV said the university would be communicating with students about the mandate by Tuesday. The Baton Rouge campus has nearly 35,000 students.

The University of Louisiana also announced COVID-19 vaccination would be mandatory for the spring semester. The Louisiana state government announced Monday that all 70,000 state workers who are not vaccinated will be subject to mandatory testing and "other requirements" now that full approval has been issued. 

Thus far, about 750 colleges have required COVID-19 vaccines, according to the Chronicle of Higher Education. Those that have required vaccines for in-person classes are primarily in blue states, but most universities are strongly encouraging or otherwise pleading with students to get inoculated. 

The nation's largest medical organization, the American Medical Association called for the public and private sectors to adopt mandates, saying incentives have not gotten the nation where it needs to be. 

“The AMA has robust policy on vaccine mandates – a tool that has been used across the U.S. and around the world for generations to defeat polio, measles, and other vaccine-preventable disease. And now, we urge similar mandates to defeat the COVID-19 pandemic," AMA president Dr. Gerald Harmon said in a statement. 

The effort has to happen locally because it can't happen nationally. There are no federal mandates in part because the U.S. Constitution includes no such provisions for them, said Northwestern's Murphy.

“There’s nothing about public health in our Constitution," he said, "because there wasn’t such a thing (as public health) when it was written." 

Reach Elizabeth Weise at eweise@usatoday.com