Roundtable #10 | COVID-19 Vaccination Law

Section 1: An Introduction to Modern Vaccination Law

In the midst of a global pandemic, signs of hope have started to emerge from beneath the shadow of COVID-19. SARS-CoV-2 has killed millions and fundamentally changed the world, but there is cause for optimism with the development and implementation of life-saving vaccine technology. Faced with an unprecedented public health crisis, experts agree that the quickest way for the world to return to normal conditions involves vaccinating as many people as possible, establishing herd immunity, and decreasing the transmission of COVID-19. [1] Vaccinations—in addition to health and safety protocols like masks and social distancing—help diminish the number of active cases in a community and protect against future mutations. [2]  

Yet, in the status quo, many people have expressed hesitancy over receiving the COVID-19 vaccine. Common reasons include concerns about the vaccine timeline and rushing of the medical process, the politicization of public health, new mRNA-based vaccine technology, and general distrust of the government. [3] Those who refuse to receive the vaccination pose a public health threat, and with some people expressing reluctance over receiving vaccinations, “institutions” have started thinking about ways they can keep their constituents safe from those without vaccinations. 

An institution can be broadly defined as an organization that people join for a specific purpose—whether that is religious, educational, or social. In the context of COVID-19, institutions are components of society which have their own rules and regulations. The prominent examples of institutions on which this roundtable will concentrate are schools, employers, and countries governing international travel. The central question is whether these institutions are legally permitted to require vaccinations. This roundtable will examine the topic of vaccination law through a comparative analysis of the legal approaches to vaccinations in the United States and United Kingdom. 

To better understand the debate surrounding vaccine requirements, a specific legal framework ought to be utilized. In 1905, the U.S. Supreme Court case Jacobson v. Massachusetts established that the state could enforce “compulsory vaccination laws.” [4] In early 1902, the City of Cambridge mandated vaccination against Smallpox after a city-wide outbreak. The defendant, Henning Jacobson, leveraged the Fourteenth Amendment’s Equal Protection Clause against the State and argued that the vaccination requirement, and a subsequent fine for non-compliance, deprived individuals of their liberty without due process. The Court ruled that states could interfere with certain liberties for the purposes of ensuring public health—so long as it was “enforced by the reasonable regulations, as the safety of the general public may demand.” [5] Subsequent U.S. Supreme Court cases have drawn on this precedent, including the school vaccination case Zucht v. King (1922). Petitioner Rosalyn Zucht refused to comply with a vaccine mandate, and sued when she was not allowed to enter a school. However, the Court simply relied on the Jacobson precedent to justify the State’s authority on public health matters such as vaccinations. [6] 

In another case, Buck v. Bell (1927), the Court rendered permissible state-sanctioned sterilization. This dark ruling functionally justified eugenic practices (and, indeed, it was used as such), but, crucially, it relied on the legal precedent formed by the Jacobson decision, and the ruling concluded that a compulsory policy can be utilized by the State in the name of public health and avoid individual protections. Justice Holmes wrote: “It is better for all the world if, instead of waiting to execute degenerate offspring for crime or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes.”  [7] These cases indicate that the Jacobson ruling has been applied to all institutions and has not been limited to schools. Thus, legal precedent indicates the State has full authority to require mandatory vaccinations—the only question remaining is one of “reasonableness.” In other words, does the scope and severity of a disease make a vaccination requirement “reasonable” to impose on a general population? Subsequent sections of this Roundtable will discuss the “reasonableness” problem posed by individual cases in further detail. 

A corresponding legal framework exists in a comparative context as well, with law in the United Kingdom having a similar mandate, albeit severely weakened by exceptions. The 1853 Vaccination Act made it possible for the government to require vaccinations; yet, within 20 years, the laws were updated after popular unrest forced the government to incorporate conscientious objections. These objections exist regardless of the “reasonableness” doctrine established in the United States, and the exemptions are far broader than the ones available in the United States—undermining the mandatory aspect of the Act. [8] More recently, the government implemented the Public Health Act of 1984, a framework which draws on the aforementioned Vaccination Act and gives governmental institutions in England and Wales any powers needed to prevent or control the spread of disease. However, although this act allows for certain, local public health measures, it cannot be extended to vaccination. Due to updates to the aforementioned Vaccination Act, a true mandate remains impossible in the United Kingdom. The idea of a “conscientious objection” offers a check on prospective government requirements. [9]

United States vaccination law also contains exemptions to public health measures that complicate the question of the “reasonableness” of institutional mandates. In the context of schools, there are three broad categories of exemptions for students—medical, religious, and philosophical—none of which the state can disregard, provided that these exemptions are well warranted. [10] These exemptions require good reason, and the process required to obtain an exemption is generally arduous. However, importantly, the stringency associated with an exemption exponentially decreases as the case rate of a disease goes down. For example, after the Measles disease grew universally rare, student health measures in Minnesota became more lenient—leading to an outbreak several years ago. [11] A similar concern exists for COVID-19; as cases inevitably decrease through the end of 2021, it is conceivable that the stringency of an exemption will also diminish. Thus, the permission of exemptions—in both schools and other institutions—could be a major hurdle for COVID-19 vaccinations. The “reasonableness” qualification, for both vaccine mandates and exemptions, is the central challenge for COVID-19 when it comes to U.S. vaccination law. 

As the world attempts to return to normalcy, vaccinations remain at the forefront of public debate and discourse. Science shows that the most effective method for decreasing COVID-19 cases is through vaccination, and many institutions may feel the need to require individuals to take a vaccine—whether it be schools, employers, or international travel agencies. When it comes to vaccination law, both the United States and the United Kingdom have precedents for vaccination requirements; both also have exemptions that substantially weaken any mandates to varying degrees. Jacobson frames much of the discourse in U.S. vaccination law, but the “reasonableness” of a mandate will continue to be a complicating factor in any contemporary setting. Similarly, the United Kingdom’s Vaccination Act’s allowance of conscientious objectors diminishes its effectiveness as well. The subsequent roundtables will analyze, using the specific context of an institution, how vaccine requirements might be employed and justified through existing law. 

by Animesh Joshi, Roundtable Contributor from Columbia University

Section 2: A Jab at Compulsory Vaccinations in Schools

On March 18, the United Kingdom government announced the closure of all schools. [1] On March 25, four days after the WHO declared the pandemic, all public school buildings within the United States were shut down due to rising COVID-19 infections across the country. [2] With the shut down of schools due to the COVID-19 pandemic a full-year ago, the experiences of learning for millions of children across the world have changed. Face to face interactions between peers and teachers have been replaced with interactions with a screen and most assignments and school events made completely virtual. Now, with the approval of four different vaccines for use in the fight against COVID-19, schools are now forced to consider whether making mandatory COVID-19 vaccinations is the next phase for reopening schools to their normal capacity in both the United States and the United Kingdom. However, legal interests and public health organizations persist in questioning whether or not schools have the right to require COVID-19 vaccinations for all students—even if that may achieve the sense of normalcy to which students are accustomed.

Almost a year after schools were shut down, the U.K. published official guidelines for the reopening  of schools in which all students were expected to return beginning on March 8, 2021. [3] While the U.S. has no federal guidance or regulations for school reopening procedures, reopenings of schools in the U.K. and the U.S. have been contingent on weekly testing programs, masks, social distancing, among other measures. [4] Although this is expected given the current conditions of the pandemic, returning to school under normal conditions, similar to the pre-pandemic era, is a lingering but hopeful prospect for most people. With the development of vaccines, widespread vaccination is now the baseline for a return to normalcy. [5]  But, this desire to return to pre-pandemic conditions must contend with the fact that mandatory vaccinations have a troubling questionable legal basis and a long and telling legal history.

In the United States, the first school vaccine mandate occurred in Massachusetts in the 1850s for smallpox prevention, and other states soon began to follow this model and mandate their own vaccinations. [6]  By 1905, nearly half of the states had their respective vaccine requirements. [7] Similarly, the U.K. began its national vaccination programs in the 19th century, and with the development of the United Kingdom National Health Service (NHS) in 1948, a recommended national vaccine schedule including 14 vaccines was established, most of which are administered during childhood. [8] Despite the differences in the origins of vaccination law and policy in the U.K. and the U.S., there are similarities  in their vaccination policies. 

In 1905, the U.S. Supreme Court established in Jacobson v. Massachusetts, “it is within the police power of a State to enact a compulsory vaccination law, and it is for the legislature, and not for the courts, to determine in the first instance whether vaccination is or is not the best mode for the prevention of smallpox and the protection of the public health.” [9] Though the Supreme Court was responding to the issue with smallpox vaccination, this set precedent for states to implement compulsory COVID-19 vaccination policies for school reopenings. The U.S. is insistent that this is indeed a states right with the affirmation of this precedent in Zucht v. King, which the court found that complaints against local governments that do not allow children to attend school without vaccine verification were invalid and that compulsory vaccination is not an abuse of state power. [10] Between both Zucht and Jacobson the similarity is that compulsory vaccinations is not a federal issue and it is vested in the individual states power to decide how to navigate vaccinations necessary for school reopening. 

In the U.K., Vaccination Acts have determined schools' oversight of vaccinations. The Vaccination Act of 1840 created a program for free vaccinations. [11] In 1867, the U.K. government made vaccinations mandatory and reformed the Vaccination Act of 1853, which stipulated that refusal to comply would result in fines and other penalties. [12] After various reforms because of public interest in objecting public vaccination programmes, efforts of the U.K. government diminished its prior choice to mandate vaccinations, and instead gave choice to individuals to decide whether to follow the national vaccine programme. For example, in the Vaccination Act of 1907, clause 1 states that, “No parent or other person shall be liable to any penalty under Section 29 or 31 of the Vaccination Act, 1867, if within four months from the birth of the child he makes a statutory declaration that he conscientiously believes that vaccination, would be prejudicial to the child.” [13] In 1907, vaccinations were still somewhat compulsory but with the ability, with statutory declaration, to be exempt from vaccination. However, this was not the end of vaccination policies to which the U.K. operates under today.   

When the U.K. passed the Public Health (Control of Disease) Act of 1984 in England and Wales, the Act gave the government the power to enact public health regulations in response to infection or contamination [14]. The Public Health (Control of Disease) Act established section 45B, which develops health protection regulations for international travel. More importantly to this roundtable, section 45C which established the same health protection regulations but for domestic concerns, stating “The appropriate Minister may by regulations make provision for the purpose of preventing, protecting against, controlling or providing a public health response to the incidence or spread of infection or contamination in England and Wales.” However, section 45E states that “Regulations under section 45B or 45C may not include a provision requiring a person to undergo medical treatment.” Further, “Medical treatment’ includes vaccination and other prophylactic treatment.” [15] The amalgam of these Acts would mean that vaccinations in the U.K. are merely recommendations, and in response to pandemics, the U.K. government can not mandate vaccinations. Therefore, any level of government in the U.K. can not mandate COVID-19 vaccinations for school reopening. Thus, in the U.K., it is clear through precedent that vaccination even on the federal level is not established—let alone schools being able to mandate the COVID-19 vaccination for children to return to school. 

In both the U.S. and the U.K., there is no federal authority that can directly mandate vaccinations. In the United States, even with compulsory state vaccination laws, there is an exemption process to which parents and students can choose to opt out of vaccination requirements for school attendance. All 50 states indeed have their own vaccine requirements, but 44 of those states have bills that accommodate for exemptions either for religious or personal beliefs. [16] For example, Colorado Senate Bill 20-163 allows for religious and personal exemptions with certificates for nonmedical exemption or the completion of an online education module which warms students and parents the risks of not being vaccinated [17]. These processes for exemption exist, and can only be expected to be used if individual states made COVID-19 vaccinations mandatory for the reopening of schools. Whereas in the U.K., no process for exemption has to exist because objections already exist without need for defined reasons such as religious or personal belief. Evidently, this is an issue for attempts to mandate  COVID-19 vaccinations in a way that is effective for dealing with a global pandemic which is contingent on the choices of communities, states, and countries as a collective.  

Now, more than a year after the declaration of the school closures due to the COVID-19 pandemic, the legal status of mandatory vaccinations remains unclear. In the U.S., because states have the power to mandate vaccinations with no federal mandate, recovery from the pandemic conditions will be a long process. On the other hand, in the U.K., given the current policy on vaccinations from the Vaccination Act of 1907 and the Public Health (Control of Disease) Act of 1984s, mandating vaccinations in the U.K. for children returning back to school, legally, is not an option. Since mandating vaccines on the federal level will likely not happen, schools should take a different approach. Instead, encouraging the vaccination of its students and families with hopes to return back to pre-pandemic conditions so that students can partake in the school activities so many have missed because of the pandemic: playing with friends, sitting in class without masks, and attending school dances and graduations. 

by Phillip Le, Roundtable Contributor from Columbia University

Section 3: Employee Vaccinations: Making It Work

In December 2020, the MHRA granted regulatory approval to the first COVID-19 vaccine in the U.K. [1] The vaccine was then granted emergency use authorization status by the FDA in the U.S, essentially fast-tracking its distribution provided that it met key statutory requirements. [2] Guided by the rather uncontentious advice of governmental agencies such as OSHA, CDC and HSE, employers initially opted to mitigate the spread of COVID-19 by carrying out risk assessments, implementing working-from-home policies, and mandating mask use. The vaccine rollout has now added a layer of complexity to this already onerous task. [3][4] Employers have a general duty to mitigate risk and free the working environment of recognised hazards to ensure the health and safety of their workers; paired with this duty are powers vested in them to make this possible. It is now up to employers to ascertain whether it is both feasible and appropriate to mandate vaccinations in the workplace.

Although there is no precedent for mandatory vaccinations in U.S. federal law, state law tells a different story, as unpacked more meaningfully within the first and second sections of this Roundtable. [5] In the U.K., there is currently no statutory basis for  mandatory vaccinations on the part of employers. [6] The relevant laws on pandemic control measures, the Public Health (Control of Disease) Act of 1984 and the Coronavirus Act of 2020, do not grant executive power to mandate vaccines. The PHA in 1984 in fact clarifies that members of the public cannot be required to undergo medical treatment, vaccinations included. [7][8] An enactment of further primary legislation would be required to mandate the vaccine, but doing so would likely be considered irreconcilable with the Human Rights Act of 1998 (HRA) as it would potentially violate the right to private and family life protected under Article 8 of the European Convention on Human Rights which has been domestically codified. If legislation for mandatory vaccinations was created, the judiciary would presumably make a declaration of incompatibility and opt not apply it in courts after taking into account both the rule of law and the incongruence above-noted. [9] Given this situation, can employers viably mandate the COVID-19 vaccine?

In the U.K., employers can argue that mandating the vaccine is a proportionate means of achieving the legitimate aim to protect staff health and safety in alignment with their statutory duty to take all reasonably practicable steps to reduce workplace risks under The Health and Safety at Work Act 1974 (HSWA 1974). [10] Employers must demonstrate this in order to claim that they are acting under the HSWA and, while it may be easy to establish that they are acting in pursuit of the legitimate aim highlighted above, convincingly asserting that their means for doing so, that being to implement a mandatory vaccination policy, is both appropriate and proportionate will be more difficult. This is entirely dependent upon the nature of work and the varying levels of physical interaction present in the workplace; while it may not be considered appropriate to mandate vaccinations in workplaces in which employees rarely come into contact with other people, instructing frontline staff to be vaccinated may be perfectly appropriate. Deciding whether it is more equitable to require all employees to be vaccinated or only select those who are in closer proximity to one another also presents difficulty. It is therefore not easy to decipher a situation in which an argument for mandating the vaccine at work would succeed, but in the event that it does, employees who have no reasonable justification for refusal will then have to be vaccinated because they are obligated to cooperate under the Act. [11]

In the U.S., identifying the basis for employers’ implementation of a mandatory vaccination policy is much simpler. States already have the ability to mandate vaccinations as established in Jacobson v. Massachusetts (1905), and the Equal Employment Opportunity Commission (EEOC) has clarified that employers are lawfully permitted to require employees to be vaccinated before returning to work. [12][13] Federal employees may also be lawfully instructed to take the vaccine considering the nature of work.

However, the permissibility of a mandatory vaccination policy is subject to numerous hurdles and stringent qualifications in both countries. A mandatory vaccination policy may be indirectly discriminatory towards those who are vaccine hesitant or yet to be offered the vaccine, therefore U.K. employers attempting to sanction an employee refusing the vaccination will have to tread carefully. [13] An employer cannot bar an employee from returning to work if their refusal of vaccination is reasonably justified, namely if their reasoning is linked to a protected characteristic under the Equality Act of 2010 (e.g., religious belief or disability). [15] This is not contingent on the persuasiveness of an employer’s argument for the appropriateness and proportionality of a mandatory vaccination policy. The situation is similar in the U.S. where, despite the permission of the EEOC, employers are obliged to accommodate those with disabilities or sincerely held religious beliefs. [16] Approaching employees with vaccination-related queries alone also raises unique problems. The Americans with Disabilities Act could curtail an employer's ability to ask pre-screening questions related to COVID-19 vaccination because it is doubtful that requiring this medical information is job-related and consistent with business necessity. [17]

How, then, can employers fulfil their duty to reduce risks in the workplace if not through a mandate? Some have begun introducing the ‘no jab no job’ clause; a specific provision in employment contracts which require new recruits to be vaccinated against the virus. [18] This approach is evidently contentious and its popular use is stagnant considering that it is subject to the same discrimination-related concerns as those that were presented earlier. Instead, an encouragement policy is a preferable alternative for employers, proportionate to the needs of the conceivable end of the COVID-19 pandemic. Encouragement, such as offering support and distributing information materials, will relieve employers of the burden of navigating a maze of inevitable issues that arise from mandating vaccinations, and employees’ mounting fears regarding an interference with their autonomy and rights will be alleviated; a mutually beneficial compromise. Such a policy has its limitations, but alongside government guidance on social distancing, risk assessments and workplace testing, this should be sufficient and it is as far as employers can reasonably go in mitigating the spread of the virus. Legislation to institute encouragement policies has not yet appeared but, considering that doing so wouldn’t pose the myriad concerns that legislation mandating vaccinations would, it may be something to contemplate as it appears to be a step in the right direction.

In sum, U.S. and UK employers alike would subject themselves to an array of criticisms should they attempt to mandate the vaccine in the workplace. There are real difficulties in addressing these ethical issues which explains the reluctance, and lack of power, of both the U.S. and the U.K. governments to mandate the vaccine on a national scale. Employers should instead foster a policy of encouragement above one of compulsion if they are eager to avoid these issues and make a swift return to a working environment that resembles pre-pandemic conditions. Given the importance of clear communication and trust in companies, this is the most sensible approach to current issues.

by Yasmine Chbary, Roundtable Contributor from Cambridge University

Section 4: International travel: vaccination before reaching your destination 

The role of international institutions in explaining legal responses to the pandemic cannot be ignored. The International Health Regulations (2005), a legally binding instrument of international law to which the U.K. and the U.S. are state parties, is a testament to the power of international institutions. [1] The IHR allows the World Health Organisation to coordinate a global surveillance network in which countries can work together to monitor, report and stop disease outbreaks. Despite the IHR’s principal purpose of preventing, protecting and controlling the international spread of disease according to Article 2 of the IHR, COVID-19 cases are still rampant. The return to physical interconnectivity will require a robust legal framework to facilitate international travel, which can be achieved by utilising the existing IHR framework while improving its enforcement by integrating its obligations into national law.

Introducing mandatory COVID-19 vaccinations for international travel will not be an extension of legal principle because it can be built upon well-established precedent. For instance, “vaccination against yellow fever” is specifically designated under Annex 7 of the IHR for which proof may be required for travellers as conditions of entry to a state party. The U.K. and the U.S. do not have such a requirement because yellow fever is not prevalent within the respective territories. [2] [3] Of course, because Annex 6 stipulates that any vaccine specified in Annex 7 “shall be subject to its (WHO) approval” there is a temporary impediment in introducing mandatory COVID-19 vaccination under the IHR. Given the novelty of the COVID-19 vaccine, it would take time before its efficacy can be gauged and its use approved. [4]

If a vaccine has WHO approval, why should an international legal instrument act as the source of this mandate? Despite the fact that it is binding on 196 states, the continual infections indicate that the IHR has failed to achieve its objectives in controlling the pandemic. [5] Moreover, Annex 7 doesn’t impose a positive legal obligation on state parties to adopt a vaccination mandate for international travel – it merely sanctions such mandates. Perhaps the greatest criticism of the IHR is the inherent weakness of effective enforcement of international agreements. Premised on the notion of sovereign equality, the idea that no states are subject to the absolute authority of other states or entities, international law depends in large part on voluntary state compliance. [6] Indeed, Article 44 of the IHR stipulates that “state parties shall undertake to collaborate with each other, to the extent possible,” yet the absence of visible cooperation and the hoarding of vaccines and protective equipment undermines the effectiveness of the IHR. [7] 

The answer to the question posed lies in the compelling logic of intergovernmental collaboration. [8] The pandemic is a borderless problem which merits a supranational legal response; adopting a shared and consistent system of verification and enforcement of the vaccine mandate will buttress international travel, accelerating the return to normality; and most importantly, international cooperation serves a normative function in establishing a foundation of mutual trust and understanding between the states that voluntarily subscribe to the IHR. This final point recognises the fundamental tension between state sovereignty and the idea of communitarianism, whereby some states may not want to institute such collaborative policies. We must accept that they are at liberty not to accede to the IHR. Such is the necessary compromise if nations are to respect sovereign equality, without which peaceful international relations may be destabilised, resulting in a lack of international cooperation in the long run.  

If the IHR is adopted to provide the framework for mandatory COVID-19 vaccinations for international travel, it needs to be better enforced. Greater integration of the IHR within the health system and strengthening efforts at national level will enable better compliance with its obligations. [9] [10] Thus, any vaccine mandate for international travel should be introduced at the international and the national level. 

The vaccine mandate must also comply with national constitutional and human rights obligations. The compatibility of such a mandate with the obligations of the European Convention on Human Rights (ECHR) to respect the private lives of individuals is very relevant to the U.K. (Article 8). In 1985, it was held by the European Court of Human Rights (ECtHR) in X and Y v the Netherlands that the concept of “private life” includes the right not to be subjected to compulsory physical invasion. [11] Building upon this in 2012, the ECtHR held in Solomakhin v. Ukraine that compulsory vaccination amounts to an interference with private life. [12] However, in recognising that needs of the community may trump the needs of the individual, Article 8(2) establishes that the right to respect for private life is qualified, meaning that the U.K. can depart from Article 8 if it is “necessary in a democratic society” to pursue a “legitimate aim.” [13] The interference must be proportionate with the legitimate aim pursued; it must not go beyond what is needed to address what is “necessary”. A vaccine mandate is only necessary in a democratic society if there is a “pressing social need” for it (Dudgeon v. United Kingdom (1981)). [14] In light of the need to reinvigorate international travel safely, this will likely be satisfied because, as it was stated in Jehovah’s Witnesses of Moscow v. Russia (2010), “mandatory vaccination during an epidemic” may justify interference with private life. [15]

These qualifications developed in the context of epidemics. It is therefore necessary to determine whether these qualifications are also applicable in the context of a pandemic. There could be a material difference; the present analysis asks whether a vaccine mandate is needed to protect the health and safety of the international community at large – not just the respective populations of the U.K. and the U.S. This is most obvious in the requirement for outgoing travellers to prove their vaccination status. The protection of the international community – an indefinite category of persons – may inappropriately widen the scope of the kinds of interferences to the rights in question that are deemed “proportionate” (Article 8) or “reasonable” (Jacobson v Massachusetts), leading to an unacceptable degree of infringement on the rights of individuals in the U.K. and the U.S. [16] It is possible that case law may still be lawfully extended to the present context given that preventing international spread of COVID-19 reduces global infection rates and protects the health and safety of U.K. and U.S. nationals. 

It is hopeful that mandatory vaccination for international travel may be lawfully incorporated into the domestic laws of the U.K. and U.S. The case law demonstrates a fundamental tension between personal and communitarian values, at times leading to the qualification of certain rights. It is the communitarian values that should guide and inform the use of international institutions to foster greater intergovernmental collaboration in paving the road to recovery. 

by Joyce Leung, Roundtable Contributor from Cambridge University

This Roundtable was edited by Lorenzo Garcia

Citations Section 1: 

[1] CDC, Benefits of Getting a COVID-19 Vaccine, Centers for Disease Control and Prevention, (2021), online at https://www.cdc.gov/coronavirus/2019-ncov/vaccines/vaccine-benefits.html (visited March 27, 2021). 

[2] CDC, When You’ve Been Fully Vaccination, Centers for Disease Control and Prevention (2021), online at https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html (visited March 27, 2021). 

[3] Jeffrey Kluger, Too Many Americans Still Mistrust the COVID-19 Vaccines. Here’s Why, Time (2021), online at https://time.com/5925467/covid-19-vaccine-hesitancy/ (visited March 27, 2021). 

[4] Wendy K Mariner, George J Annas, and Leonard H Glantz, “Jacobson v Massachusetts: It’s Not Your Great-Great-Grandfather’s Public Health Law,” 95 American Journal of Public Health, 582 (2005).

[5] id at 583

[6] id at 584

[7] Buck v Bell, 274 U.S. 200, 274 (1927).

[8] Jack Goodman, Coronavirus: Compulsory vaccines in the UK and other rumours fact-checked, BBC News (2020), online at https://www.bbc.com/news/52565764 (visited March 28, 2021). 

[9] id 

[10] Erin Flanagan-Klygis, “School Vaccination Laws,” 5 American Medical Association Journal of Ethics, 386 (2000)

[11] Mark Zdechlik, Skipping the Measles Vaccine is Easy in Minnesota, MPR News (2017), online at https://www.mprnews.org/story/2017/05/24/skipping-the-measles-vaccine-is-easy-in-minnesota (visited March 28, 2021). 

Citations Section 2:

[1]  “One Year since Lockdown: the UK Covid Timeline.” The Week UK. The Week, __Date published__, online at https://www.theweek.co.uk/107044/uk-coronavirus-timeline (visited March 23, 2021). 

[2] “The Coronavirus Spring: The Historic Closing of U.S. Schools (A Timeline).” Education Week.  Education Week, 8 Feb. 2021, online at  https://www.edweek.org/leadership/the-coronavirus-spring-the-historic-closing-of-u-s-schools-a-timeline/2020/07 (visited March 23, 2021). 

[3] “Schools Coronavirus (COVID-19) Operational Guidance.” GOV.UK, 2021. https://www.gov.uk/government/publications/actions-for-schools-during-the-coronavirus-outbreak/schools-coronavirus-covid-19-operational-guidance (visited March 20, 2021). 

[4] “Map: Where Schools Are Reopening in the US.” CNN. Cable News Network, 2021. https://www.cnn.com/interactive/2020/health/coronavirus-schools-reopening/ (visited March 21, 2021). 

[5] "COVID-19 Vaccination". 2021. Centers For Disease Control And Prevention. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/keythingstoknow.html (visited March 22, 2021).

[6] Malone, Kevin M. “ Vaccination Mandates: The Public Health Imperative and Individual Rights.” Essay. In Law in Public Health Practice, edited by Alan R Hinman, 262–84. Oxford Scholarship Online, 2007 (visited March 20, 2021). 

[7] id 

[8] Vagnoni, Cristiana, Elizabeth Rough, and Sarah Bunn. “UK Vaccination Policy.” House of Commons Library, January 21, 2021. https://commonslibrary.parliament.uk/research-briefings/cbp-9076/.

 [9] Jacobson v. Massachusetts, 197 U.S. 11 (1905)

[10] Zucht v. King, 260 U.S. 174 (1922)

[11] Wolfe, Robert, and Lisa Sharp. 2002. "Anti-Vaccinationists Past And Present". National Center For Biotechnology Information. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1123944/.

[12] id

[13] Vaccination Act of 1907  

[14] Public Health (Control of Disease) Act (1984)

[15] id

[16] Erik Skinner, Alise Garcia. States With Religious and Philosophical Options From School Immunization Requirements. Accessed March 30, 2021. https://www.ncsl.org/research/health/school-immunization-exemption-state-laws.aspx. 

[17] Colorado School Entry Immunization, SB20-163, 2020 Regular Session (2020). 

Citations Section 3:

[1] Medicines and Healthcare products Regulatory Agency, UK Medicines Regulator Gives Approval for First UK COVID-19 Vaccine, GOV UK Press Release, 2020, online at https://www.gov.uk/government/news/uk-medicines-regulator-gives-approval-for-first-uk-covid-19-vaccine (visited April 1, 2021).

[2]  U.S. Food and Drug Administration, FDA Takes Key Action in Fight Against COVID-19 By Issuing Emergency Use Authorization for First COVID-19 Vaccine, FDA News Release (2020), online at https://www.fda.gov/news-events/press-announcements/fda-takes-key-action-fight-against-covid-19-issuing-emergency-use-authorization-first-covid-19 (visited April 1, 2021).

[3] United States Department of Labour, Protecting Workers: Guidance on Mitigating and Preventing the Spread of COVID-19 in the Workplace, Occupational Safety and Health Administration (2021), online at https://www.osha.gov/coronavirus/safework (visited March 31, 2021).

[4] Health and Safety Executive, Coronavirus (COVID-19): working safely, Health and Safety Executive (2021), online at https://www.hse.gov.uk/coronavirus/index.htm (visited March 30, 2021).

[5] Sarah Fujiwara, “Is Mandatory Vaccination Legal in Time of Epidemic?” 8 Ethics Journal of the American Medical Association 4, 227 (2006).

[6] Elizabeth Rough, UK Vaccination Policy  38 (Parliament: House of Commons 2021).

[7] Forsberg, Dr Lisa, Dr Isra Black, Douglas, Dr Thomas, Pugh, Dr Jonathan, Compulsory vaccination for Covid-19 and human rights law, Parliament Committee (2020), online at https://committees.parliament.uk/writtenevidence/9253/html/ (visited March 29, 2021).

[8] Public Health (Control of Disease) Act 1984, s.45E (UK)

[9] Human Rights Act 1998, s.4 (UK)

[10] Health and Safety at Work etc. Act 1974, s.2 (UK)

[11] id at s.7(b)

[12] Jacobson v. Massachusetts, 197 U.S. 11 (1905)

[13] U.S Equal Employment Opportunity Commission, What You Should Know About COVID-19 and the ADA, the Rehabilitation Act, and Other EEO Laws, U.S EEOC (2020), online at https://www.eeoc.gov/wysk/what-you-should-know-about-covid-19-and-ada-rehabilitation-act-and-other-eeo-laws (visited April 3, 2021).

[14] Equality Act, s.19(d) (UK)

[15] id at s.4

[16] Title VII of the Civil Rights Act of 1964 

[17] Sec. 12112 (d) Americans with Disabilities Act 1990

[18] BBC News, Coronavirus: 'No jab, no job' policies may be legal for new staff, BBC News (2021), online at https://www.bbc.co.uk/news/business-56113366 (visited April 6, 2021).

Citations Section 4:

[1] International Health Regulations (2005), Appendix 1.

[2] Mark D. Gershman, Emily S. Jentes, Rhett J. Stoney, Kathrine R. Tan, Paul M. Arguin, Yellow Fever Vaccine & Malaria Prophylaxis Information, by Country, Centers for Disease Control and Prevention, 2020, online at https://wwwnc.cdc.gov/travel/yellowbook/2020/preparing-international-travelers/yellow-fever-vaccine-and-malaria-prophylaxis-information-by-country (visited March 30, 2021).

[3] NHS, Vaccination, National Health Service (2019), online at https://www.nhs.uk/conditions/yellow-fever/vaccination/ (visited March 30 2021).

[4] WHO, Interim position paper: considerations regarding proof of COVID-19 vaccination for international travellers, World Health Organisation (2021), online at https://www.who.int/news-room/articles-detail/interim-position-paper-considerations-regarding-proof-of-covid-19-vaccination-for-international-travellers (visited March 31, 2021).

[5] Kumanan Wilson, Sam Halabi, Lawrence O. Gostin, “The International Health Regulations (2005), the threat of populism and the COVID-19 pandemic,” Global Health 16, 70 (2020): 1. 

[6] Alex Ansong, “The Concept of Sovereign Equality of States in International Law,” GIMPA Law Review (2016): 14-34.

[7] Oona Hathaway, Alasdair Phillips-Robins, COVID-19 and International Law Series: WHO’s Pandemic Response and the International Health Regulations, Just Security (2020), online at https://www.justsecurity.org/73753/covid-19-and-international-law-series-whos-pandemic-response-and-the-international-health-regulations/ (visited April 1, 2021).

[8] Bump et al, “International collaboration and covid-19: what are we doing and where are we going?” BMJ (2021): 180

[9] id at [7]

[10] Hans Kluge et al, “Strengthening global health security by embedding the International Health Regulations requirements into national health systems,” BMJ Global Health (2018): 5.

[11] X and Y v the Netherlands [1985] ECHR 4.

[12] Solomakhin v Ukraine [2012] ECHR 451.

[13] ECtHR, “Guide on Article 8 of the European Convention on Human Rights,” Council of Europe (2020).

[14] Dudgeon v United Kingdom [1981] ECHR 5.

[15] Jehovah’s Witnesses of Moscow v Russia [2010] ECHR 472.

[16] Jacobson v Massachusetts, 197 U.S. 11 (1905).