Executive Summary ............................................................................................................. 3

History of Vaccination Requirements ................................................................................. 5

The Biden Administration’s Vaccination Requirements .................................................... 7

Vaccination Requirements Sector Analysis ........................................................................ 9

In Brief ............................................................................................................................. 9

Health Care Sector Analysis ............................................................................................ 9

Corporate and Public Sector Analysis ............................................................................ 11

Education Sector Analysis ............................................................................................. 13

Vaccination Requirements Economic Impact ................................................................... 17

In Brief ............................................................................................................................ 17

President Biden has been clear that vaccinations are the best tool in our fight against the

COVID-19 pandemic. Since January, the Biden-Harris Administration has taken

aggressive actions to make vaccinations free and convenient, executed a robust

campaign to educate Americans about the importance of getting vaccinated, and

deployed hundreds of millions of dollars in resources for states, localities, Tribes, and

community organizations to encourage vaccinations.

These efforts have led to tremendous success. At the start of the year, only 34% of adult

million when the President took office. The unprecedented pace of the President’s

unvaccinated. The strain on our hospital systems, our economy, and the risk to our

children was too great not to use every tool available. To that end, last month, the

President laid out a six-part plan to accelerate our path out of the pandemic. Central to

that plan is getting remaining Americans vaccinated, and to do so, the President

announced vaccination requirements that in total will cover approximately 100 million

people.

As this report demonstrates, it is clear that vaccination requirements result in millions

more people getting vaccinated. Without vaccination requirements, we face endless

months of chaos in our hospitals, further detrimental impacts on our economy, and

percentage points to over 90% in many organizations. An analysis of

health care systems, educational institutions, public-sector agencies, and private

businesses shows that organizations with vaccination requirements have seen

their vaccination rates increase by more than 20 percentage points and have

routinely seen their share of fully vaccinated workers rise above 90%. That is

substantially higher than broader working-age vaccination rates for Americans

aged 18 to 64 where only 63% are fully vaccinated.

20 percentage points or more—consistent with what vaccination requirements

have been able to accomplish to date—would reduce the number of unvaccinated

Americans by tens of millions of people, profoundly reducing the risk of COVID-

19 to individuals and communities.

Vaccination requirements are good for the economy.

the labor force. An economic analysis by Goldman Sachs found that “an

increase in vaccination and almost full vaccination at workplaces should

economy. During the recent spread of the Delta variant, cases, hospitalizations,

and deaths were roughly two-and-a-half times higher in states with low

vaccination rates compared to high-vaccination states. Small business employee

hours grew faster and stayed higher during the rise of the Delta variant in the

states that have higher working-age vaccination rates, versus states with lower

vaccination rates.

time, thousands more businesses will put in place requirements over the weeks

ahead as new rules for employers with 100 or more workers are finalized.

support vaccination requirements. The Business Roundtable—which

represents more than 200 businesses that employ a total of 20 million workers—

as well as some of the largest labor unions in the country, including the National

Education Association and the American Federation for Teachers, all support the

President’s plan to increase vaccinations. And, public polls from Fox News, Axios,

and the Associated Press among others, show that strong margins of Americans

Vaccination requirements have a long history in the United States dating back to the

American Revolution. More than 90% of deaths among Continental soldiers in the

American Revolution were due to disease.

George Washington mandated smallpox inoculations for the soldiers under his

command in 1777, writing, “Necessity not only authorizes but seems to require the

measure, for should the disorder infect the Army . . . we should have more to dread from

it, than from the Sword of the Enemy." Smallpox largely disappeared among the

Continental Army’s ranks after the requirement went into effect.

required smallpox vaccination for students as early as 1827. Urbana, Ohio, enacted a

California, some counties introduced flu vaccination requirements for all workers in

licensed health care facilities between 2017 and 2019, whereas other counties did not

institute such requirements. One study compared health outcomes in counties before

and after they adopted these requirements relative to counties in California with no

requirements over the same period. It found these requirements increased the

vaccination rate of health care workers by 10 percentage points, from 74% to 84%, and

reduced the number of inpatient influenza diagnoses by 20%, as shown in Figure 1.

nursing homes fell 20% and 10% respectively, relative to states without changes in

policy over the same period.

Among K-12 students, all 50 states require vaccinations for school attendance, and every

state has held student vaccination requirements for the last 40 years.

requirements have been key to reducing vaccine inequities that have existed among

school-age children.

Evidence of the effectiveness of vaccination requirements for children abound. During

the 20th century, measles infected an average of more than 500,000 Americans each

went into effect, about 7,400 students failed to provide proof of vaccination and were

excluded from school. After one month, more than 7,300 of those students were in

compliance with the requirement and no further cases of measles occurred.

workers across the country.

communities, in the coming weeks, HHS will implement a requirement that

educators, teachers and staff at Head Start and Early Head Start programs be

fully vaccinated. In addition, vaccination requirements are being implemented

for teachers and youth program personnel at the DoD and teachers and staff at

Bureau of Indian Education-operated schools. These schools and programs

collectively serve more than 1 million children each year and employ nearly

And since the President first announced COVID-19 vaccination requirements, hundreds

of private and public sector institutions have stepped up and adopted requirements of

their own, covering tens of millions of Americans.

In July, prior to New York City putting into place vaccination requirements, only about

60% of New York City Department of Education educators and staff were vaccinated.

Following implementation of a full requirement for all 150,000 school staff across 1,600

public schools, the City reported that more than 95% of all K-12 teachers and staff were

vaccinated by the city’s deadline.

This included an increase of about 10 percentage

points for all staff over the course of the final weeks before deadline to submit proof of

vaccination, leading to a significant uptick of last-minute vaccinations.

In mid-August, Portland Public Schools, the Portland Association of Teachers, and the

Portland Federation of School Professionals came to an agreement that all employees—

Educators and their unions overwhelmingly support vaccination requirements. The

National Education Association released polling in September indicating that nearly

90% of members are vaccinated, and nearly two-thirds (65%) support their school

district requiring school staff to receive COVID-19 vaccinations.

Increased vaccination coverage could result in as many as 5 million American workers

going back to work

were disproportionately impacted by the economic consequences of COVID.

And

because high rates of COVID-19 cases can also suppress economic demand—particularly

percentage points, and in some cases by significantly more. More than three out of four

(75.5%) working-aged adult Americans are currently in the labor force, so increasing the

share of workers who are fully vaccinated by 20 to 25 percentage points could vaccinate

an additional 30 to 38 million working-age Americans, cutting the total share of

unvaccinated Americans roughly in half. This could have a major effect on case rates,

hospitalization rates, and death rates—preventing future waves of the virus from having

as significant an effect as occurred during the spread of the Delta variant. At an

individual level, unvaccinated people are more than five times as likely to get a

symptomatic case of COVID-19 and more than 10 times as likely to be hospitalized or to

die from COVID-19.

productivity, increase participation in the labor market, and increase consumer

spending by diminishing the actual and perceived health risks of COVID-19. The bottom

line is that increased vaccination rates through requirements enables a faster and

stronger economic recovery.

As University of Michigan economist Justin Wolfers has noted, “Viewing [President]

Biden’s vaccine mandate as simply economic policy, it’s surely the cheapest and most

powerful economic stimulus ever enacted.” Wolfers went on to explain that “People are

recover from COVID-19. In May and June of this year 2% of adults aged 18 to 44 could

not work because they or a family member had COVID-19.

In early September, 4.6

million Americans reported not working because they were either caring for someone—

or sick themselves—with COVID-19.

June, before the spread of the Delta variant.

or to receive lower-quality care, putting health and life at risk.

In addition to the 4.6 million workers not working because they or someone they cared

for had COVID-19 in September, another 4.7 million Americans reported in September

having been laid off or furloughed due to the pandemic, with 2 million reporting their

employer was temporarily closed due to the pandemic and another 1.5 million reporting

million below pre-pandemic levels, and those missing jobs are concentrated in in-person

declines since February 2020 and represent a 10% decline from pre-crisis levels.

Substantial employment declines persist across nearly all leisure and hospitality

industries.

from the government or other employers. One survey, fielded in August 2021, showed

that the top three concerns that were cited among employers regarding COVID-19

Government vaccination requirements can help employers overcome barriers to

extend to every community.

Moreover, it is not just the direct impact of COVID-19—sickness, hospitalization, and

the Delta variant. In August 2021, growth in nonfarm employment in the U.S. slowed to

235,000—a decline of 73% from the monthly rate of 876,000 from May to July. One

should never overinterpret a single month of jobs data; that said, some of the slowdown

in the August recovery likely stems from continuing COVID-induced labor market

disruption.

Press show considerable support for the President’s plan to require vaccinations in

different settings.

According to Fox News, nearly 60% of Americans support the federal government

requiring federal employees to be vaccinated and 56% support businesses requiring

workers to be vaccinated or regularly tested. According to Axios, a majority of

Americans, 60%—including a majority of voters—support vaccination requirements for

federal workers as well as private companies. According to Gallup, roughly six in 10 U.S.

adults are in favor of vaccination requirements for federal government workers,

employees of large companies, and workers at hospitals that receive federal health care