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A Texas hospital chain with 26,000 employees is demanding they all get vaccinated against Covid-19 by June 7 or lose their jobs, although it offered exemptions for pregnant women, other medical reasons, and religious objectors.

Some of those not eligible for exemption are unhappy, and 117 of them are going to court to reverse that policy (read story here).

Despite some of the lawsuit’s squirrely allegations — for example, it alleges the policy violates the Nuremberg Code against forced medical experiments and claims the policy’s real purpose is to increase the hospital’s profits — the issue is tricky.

The plaintiffs allege their employer is requiring them to subject themselves to an “experimental vaccine” as a condition of remaining employed. This isn’t quite true. All three Covid-19 vaccines being used in the U.S. currently have only emergency-use authorizations from the FDA, and aren’t fully approved and licensed, but they’ve been through a standard vetting process that includes the usual clinical trials, and in FDA technical terms, “emergency use” and “experimental” are two different things. The vaccines, at this point, have advanced well beyond the experimental stage, and are in a subsequent phase of the regulatory approval process.

However, there’s an argument to be made that something less than full approval is reason enough for the employees lack full confidence in the vaccines and balk at getting vaccinated for now, and that’s essentially the argument being made in a number of similar lawsuits (see story here).

In general, it seems, employers can require employees to get vaccinated against contagious diseases, but anti-discrimination laws (which vary from state to state) also require them to make “reasonable accommodations” for employees with valid objections to being vaccinated (typically for medical or religious reasons).

That’s the law. In philosophical terms, affording exemptions creates a quandary: How can an employer who exempts some of its employees claim that requiring vaccinations for any of its employees is essential to its interests?

In general society, where herd immunity can be achieved by vaccinating less than 100% of the population, a limited number of exemptions can be granted without compromising the goals of mass vaccination. Thus, a public policy broadly requiring vaccination but making individual exceptions isn’t illogical or self-defeating.

But that argument doesn’t apply in a hospital setting, where the goal isn’t herd immunity, but 100% prevention of staff-to-patient infections. Even before Covid-19, hospitals had rigorous infection-control procedures in place (for obvious reasons), and they can plausibly argue that requiring staff to get vaccinated is merely a logical extension of those policies.

I’d be inclined to side with the hospitals. It’s one thing for government to force vaccinations on its citizens (although the U.S. Supreme Court ruled in 1905 it can). But working for a hospital, college, or other employer is voluntary; if one doesn’t wish to be vaccinated as a condition of employment, he or she can choose another job or employer. People who go into health care work should expect to be vaccinated against various transmissible diseases (not just Covid-19) in order to work in those settings, and they generally are.

The military shoves a variety of shots and pills into its personnel, including (now) for Covid-19. We haven’t had a military draft since 1973, but during the Vietnam War and earlier conflicts, conscripts were vaccinated (and then shot at) whether they liked it or not. It’s pretty our government can do that to us, and our courts allow it.

So the question really is who, when, and under what circumstances. Employers generally can set the terms of employment, subject to a limited amount of government regulation of employment practices involving wages, hours, working conditions, workplace safety, discrimination, and so on. No law I’m aware of prohibits employers from making vaccination a general condition of employment, subject to the exemptions previously mentioned.

But don’t hold your breath. In states they control, Republicans are making mask mandates illegal and prohibiting businesses from asking customers if they’ve been vaccinated. Laws against requiring workers to get vaccinated can’t be far behind. That, of course, will impact the co-workers, patients, and customers whom vaccination mandates are intended to protect from less considerate neighbors; and those Republican politicians shouldn’t be surprised if those folks decide to vote with their feet — perhaps leaving the state altogether.

I recently wrote about this in a slightly different context: An attack on diversity education by a conservative student at Iowa’s dental school. The end result of the uproar he started is that almost none of the dental school’s minority students plan to stay in Iowa to practice dentistry. It’s hard for me to imagine doctors and nurses wanting to work in a state that prohibits requiring health workers to get vaccinated. Those states might expect a health care worker drain to follow.

So, politicians should think carefully before they act rashly. But we haven’t seen a whole lot of thinking from Republican leaders lately. They’re hellbent on catering to the ignorant masses picking up wild conspiracy theories from reckless purveyors of falsehoods and nonsense on Fox (e.g., Tucker Carlson) and other rightwing media and blogs. Covid-19 is real, has killed a lot of Americans (and humans elsewhere), is a serious threat to all of us, and throughout the pandemic Republicans and their political leaders have been acting like they want to kill themselves and take the rest of us with them.

Based on that track record, I’ll never consider living in a Republican state again, and I can tell you that I have a relative who does who’s considering leaving that state for good.

Related story: “The big problem with herd immunity.” Not herd immunity per se, but the fact we’re not there yet. Over half of the U.S. adult population is now vaccinated, although that’s still well short of the 70% medical experts say is needed, but many red states are lagging far behind, for example in Mississippi barely a third of adults are vaccinated. Yet, many people are acting like the pandemic is over. Read story here. Keep in mind, too, what herd immunity is: It slows transmission to the point where it eventually dies out, but as long as the virus remains in circulation, herd immunity provides no protection at all to unvaccinated people exposed to it. If you’re not vaccinated, you’re still in as much danger as you ever were.

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