See Where 12 Million U.S. Employees Are Affected by Government Vaccine Mandates
Which states have
Covid-19 vaccination mandates
Mandates for some workers
Mandates banned or blocked
No statewide policy
Government orders requiring coronavirus vaccinations have been expanding across the United States but have not provided the significant boost to state and local vaccination rates that some experts had hoped for, according to a New York Times analysis. Meanwhile, at least 49,000 people have left their jobs or have been disciplined at work because they did not comply.
Mandates requiring shots cover at least 12 million people, according to a Times survey of every state and the nation’s 100 largest cities. At least 8 million people employed by state or city governments must get vaccinated. In every state, even those that have banned some vaccine requirements, at least some people are mandated to be vaccinated because they are members of the military or federal employees, two groups totaling some 4.1 million people.
Millions more would be covered by federal requirements for health workers, employees of large private companies and federal contracting employees. Portions of those mandates have been stalled in court over the past several weeks. A new requirement in New York City for on-site employees at all of the city’s approximately 184,000 private businesses to get vaccinated by late December would cover hundreds of thousands of additional people. Many private companies across the country have also instituted their own vaccine rules.
To arrive at the total estimate of at least 8 million people covered by state and city requirements, The New York Times identified vaccine requirements, beyond those mandated by the federal government, that apply to health care workers, long-term care workers, city or state public employees, correctional workers and education employees in the kindergarten-through-12th-grade system. At least 25 states and 39 cities have required shots for some portion of these employees, who otherwise would face ongoing testing requirements or, in some cases, disciplinary action or termination.
The estimate is an undercount because some states and cities did not respond to questions about their vaccination requirements. The Times also removed people from the state estimates who might have been counted multiple times under different mandates. Many of the people covered by these requirements had already been vaccinated before the mandates were announced, but it is not clear how many.
In almost all of these states and in all of the counties surrounding the cities with mandates, a majority of the residents voted for President Biden. Statewide mandates tend to be most popular along the West Coast and in the Northeast, whereas states banning some mandates tend to be clustered in the South.
Many of the deadlines for vaccination compliance are still in the future. Among those that have already passed, some are not actively being enforced yet.
Across many different ways of analyzing the data, states and cities with vaccination mandates did not seem to see any significant increase in the rate of vaccinations after the mandates, possibly because many of those areas already had relatively high vaccination rates.
Vaccination rates for adults in states with and without vaccine mandates
States that imposed vaccine requirements have had higher vaccination rates throughout, and creating the requirements did not lead to any clear increase in rates there.
To try to measure the impact of vaccine requirements on vaccination rates, The Times analyzed the shares of adults with at least one shot in 15 states, plus Washington, D.C., and in 15 counties surrounding big cities where compliance deadlines passed on or before Dec. 1. The analysis excluded states and counties for which the Centers for Disease Control and Prevention lacked adequate historical data.
To determine the requirements’ effects in a state or county, The Times found how many adults received at least one shot before the earliest mandate was announced, then measured the rate of growth in that number by the latest deadline for compliance with mandates. That rate of growth was then compared with the overall change in vaccinated adults across the nation in the same time period.
The Times also measured growth in each location and across the nation from the date of the earliest mandate to Dec. 1. This alternative analysis was made on the presumption that people might not prioritize getting shots in places where the consequence for not getting vaccinated is regular testing, rather than discipline or job loss, or where the appeals process for a termination is lengthy. Some places, like Mississippi, also announced mandates requiring vaccination or regular testing that went into effect almost immediately and, in those cases, The Times only measured the time period ending in Dec. 1.
In most locations, the number of adults with at least one shot grew at a slower pace after states and cities announced mandates than it did nationwide in the same time periods.
Of the 31 locations analyzed by The Times, eight places outpaced the country by more than one percentage point in the period between the earliest mandate announcement and the latest date of compliance — Washington, D.C.; Mississippi; Nevada; New York City; Fresno County in California; Miami-Dade County in Florida; Orleans Parish in Louisiana and St. Louis in Missouri. New York State also outpaced the country when the analysis was extended to Dec. 1.
Though state- and city-level mandates may have contributed to the rise in adults getting shots in those areas, other factors may also help explain some of the increases.
In the nation’s capital, for example, the federal employee mandate may have played a role since those workers make up a significant portion of the population. New York City, in addition to job-based mandates, has also restricted access to some businesses unless customers can provide proof of vaccination. Mandates in Orleans Parish, St. Louis and Miami were announced as coronavirus infections were surging in Louisiana, Missouri and Florida, and Mississippi’s requirement for long-term care staff has coincided with a roughly 60 percent surge in cases there.
The Times also compared the growth rate in vaccinations in the 31 states and counties to the growth in the directly previous comparable time period to see if any locations outpaced themselves by more than one percentage point after mandate announcements. Only Mississippi outpaced itself in a significant way. Maine, Fresno County and Orleans Parish did, but by fewer than two percentage points.
It can be challenging for a place with a vaccination rate that is already high to increase that rate substantially, and The Times found that states with mandates tended to be vaccinated at levels above the national rate when their requirements were announced. Thirteen states with vaccination mandates, as well as Washington, D.C., already had surpassed the national adult vaccination rates when their mandates were announced, according to the analysis. In those places, 78 percent of adults on average had at least one shot when mandates were announced, higher than the national rates at the same time by 8.1 percentage points, on average.
Dr. Lisa Cooper, director of the Johns Hopkins Center for Health Equity, said she thought it was possible that mandates still might help raise vaccination rates as time wears on and more government agencies enforce the rules with disciplinary action or termination. But she doubts that those consequences will be enough to sway people who are deeply against getting vaccinated.
“Mandates might help for people who are just finding it inconvenient, but have no really legitimate reason to not get the vaccine,” she said. “But then you have people who have strong beliefs against it or who really have significant other struggles, and the mandates are not going to do anything for those people.”
Dr. Cooper said that vaccine requirements for domestic travel or access to businesses or places where people can socialize might have more of an impact than job-based mandates.
“People feel like, ‘I don’t have to do that. I can just get another job,’” she said.
| Number of workers covered | Industry |
|---|---|
| 4,798,000 | |
| 2,144,000 | |
| 1,978,000 | |
| 108,000 | |
| 1,644,000 | |
| 2,017,000 | |
| 12,689,000 |
The Times survey also found that more than 49,000 people across the country have been disciplined or left jobs — either by quitting or being fired — because they did not comply with vaccine orders from state or city governments. This is an underestimate because most states and cities did not answer questions about employees who had been punished or had quit. Some provided numbers of people who left their jobs, but did not say whether the departures were related to mandates; The Times did not include those people in the analysis.
Debra Furr-Holden, an epidemiologist at Michigan State University, said it was possibly too late for employers or the government to compel the unvaccinated with a mandate because vaccine hesitancy and refusal have been reinforced over time. She pointed to the proliferation of myths about vaccines causing fertility problems, being microchipped or magnetizing people, and to safety concerns about the Johnson & Johnson vaccine after a small number of cases of a rare blood-clotting disorder emerged.
“Incentives and lotteries and money and all of that isn’t going to change their mind, and having their hands forced isn’t going to change their mind,” she said. “It’s confirming their bias. People are thinking, ‘Well, if this vaccine was good, they wouldn’t have to force me to take it.’”
Dr. Furr-Holden added that government pressure to get vaccinated might actually be having the opposite effect, driving some people who may be distrustful of authority away from getting a shot.
There is modern precedent for vaccine mandates in the United States, most commonly applied to children in order to enter schools or day care centers, but also applied to employees in health care settings.
All 50 states, plus Washington, D.C., require children to get immunized for diphtheria, tetanus, pertussis, polio, measles, rubella and chickenpox in order to attend school or daycare, with varying exemptions.
From approval to requirement
For vaccines developed recently, the process from first approval to universal requirement for school attendance has been ongoing
Approved
Recommended by C.D.C.
First state requirement
Required in all states
1981
1991
1993
Hepatitis B
Required in all states except
Alabama and South Dakota
1995
1997
2015
Chickenpox
Required in all states
1995
1998
Hepatitis A
Required in 25 states
2001
Pneumococcal conjugate
Required in 42 states
2005
2008
Meningococcal conjugate
Required in 35 states
2006
2008
Rotavirus
Required in 9 states
2006
2009
H.P.V.
Required only in D.C., Rhode Island, Hawaii and Virginia
1981
1990
2000
2010
2020
Approved
Recommended by C.D.C.
First state requirement
Required in all states
1981
1990
2000
2010
2020
1993
Required in all states except
Alabama and South Dakota
Hepatitis B
1995
1997
2015
Chickenpox
Required in all states
1995
1998
Hepatitis A
Required in 25 states
2001
Pneumococcal conjugate
Required in 42 states
2005
Meningococcal conjugate
Required in 35 states
2006
Rotavirus
Required in 9 states
2006
2009
H.P.V.
Required in 4
states
The most recent inoculation to be required in every state was the chickenpox vaccine, which was approved in 1995. Most states began requiring it in the late 1990s and early 2000s. The last state to require it, Montana, did so in 2015.
Only three states and Washington, D.C., require the human papillomavirus (or H.P.V.) vaccine, which has been available since 2006. Efforts to require that vaccine quickly led to pushback from some parents who associated the virus with sexual activity.
Even if government vaccine orders do not, in the end, give a major boost to vaccination rates across the board, vaccination requirements can still make a significant impact.
The Times measured the percentage of unvaccinated people who got at least one shot in each state during the period from the earliest mandate announcement to the latest compliance deadline. Of the 15 states, plus Washington, D.C., that were analyzed, nine had given at least one shot to a larger percentage of unvaccinated adults, compared with those at the national level. The Times excluded states with compliance deadlines after Dec. 1 and those lacking robust C.D.C. historical data.
Washington, D.C., Maryland and Virginia, for instance, saw about half or more of their unvaccinated adults get at least one shot after Mr. Biden announced a mandate for federal employees, who make up a large portion of both populations.
In Tucson, Ariz., a requirement for city employees to get vaccinated by Dec. 1 survived challenges by state lawmakers and the governor, who issued an executive order banning city and town vaccine mandates. As of Dec. 2, the city said 3,513 out of 3,923 permanent employees had been fully vaccinated and an additional 399 had obtained medical exemptions or religious accommodations.
Eleven did not comply with the requirement and received notices of termination, meaning that they were placed on paid leave as part of a normal appeals process.
The vaccinations of almost 4,000 people, some of whom had gotten their shots before the city’s mandate, did not have a major impact on the adult vaccination rate in surrounding Pima County, which has about one million people.
But Lane Mandle, a spokeswoman for Tucson, explained that the requirement was put in place to protect the health of employees and maintain staffing levels, particularly in critical areas, so that public services would not be negatively affected by a Covid-19 outbreak. “If 40 people get sick at our 9-1-1 call center, that would impact service to the community,” Ms. Mandle said. “It could be a fatal incident if someone doesn’t pick up the phone.”