Can Employers Require Measles Vaccines?

​The recent measles outbreak, resulting in mandatory vaccinations in parts of New York City, raises the question of whether employers can require that workers get the vaccine to protect against measles, mumps and rubella (MMR) or prove immunity from the illness. 

The answer generally is no, but there are exceptions.

Offices and manufacturers probably can't require vaccination or proof of immunity because the Americans with Disabilities Act (ADA) generally prohibits medical examinations—unless the employer is in a location like Williamsburg, the neighborhood in Brooklyn where vaccinations are now mandatory. Health care providers, schools and nursing homes, however, probably can require them because their employees work with patients, children and people with weak immune systems who risk health complications from measles.

But even these employers must try to find accommodations for workers who object to vaccines for a religious reason or because of a disability that puts them at risk if they're vaccinated, such as having a weak immune system.

Proof of Immunity

Proof of immunity includes one of the following:

• Written documentation of adequate vaccination.
• Laboratory evidence of immunity.
• Laboratory confirmation of measles.
• Birth before 1957. The measles vaccine first became available in 1963, so those who were children before the late 1950s are presumed to have been exposed to measles and be immune.

Measles, which is contagious, typically causes a high fever, cough and watery eyes, and then spreads as a rash. Measles can lead to serious health complications, especially among children younger than age 5. One or two out of 1,000 people who contract measles die, according to the U.S. Centers for Disease Control and Prevention.

Outbreak Has Spread to 20 States

As of April 11, 555 cases have been reported in the United States this year. This is the second-greatest number in any year since the United States proclaimed measles eliminated in 2000; 667 cases were reported in all of 2014.

On April 9, New York City Mayor Bill de Blasio declared a public health emergency in Williamsburg, requiring the MMR vaccine in that neighborhood. Those who have not received the MMR vaccine or do not have evidence of immunity may be fined $1,000.

Since the outbreak started, 285 cases have been confirmed in Williamsburg, including 21 hospitalizations and five admissions to intensive care units.

If a city requires vaccinations, an employer's case for requiring them is much stronger, said Robin Shea, an attorney with Constangy, Brooks, Smith & Prophete in Winston-Salem, N.C. But employers usually should not involve themselves in employees' health care unless they are making an inquiry related to a voluntary wellness program, or the health issue is job-related, she cautioned.

The measles outbreak has spread this year to 20 states—outbreaks linked to travelers who brought measles to the U.S. from other countries, such as Israel, Ukraine and the Philippines, where there have been large outbreaks.

Strike the Right Balance

Health care employers typically require vaccinations or proof of immunity as a condition of employment, said Howard Mavity, an attorney with Fisher Phillips in Atlanta. He noted that most schoolchildren must be immunized, so many employees can show proof of immunity years later.

If an employee provides current vaccination records when an employer asks, the ADA requires that those records be kept in separate, confidential medical files, noted Meredith Shoop, an attorney with Littler in Cleveland.

All employers must balance their health and safety concerns with the right of employees with disabilities to reasonable accommodations under the ADA and the duty to accommodate religious workers under Title VII of the Civil Rights Act of 1964.

Under the ADA, a reasonable accommodation is required unless it would result in an undue hardship or direct threat to the safety of the employee or the public. The direct-threat analysis will be different for a registered nurse than for someone in a health care provider's billing department, for example, who might not work around patients.

[SHRM members-only toolkit: Accommodating Employees' Disabilities]

Even if the ADA permitted mandatory vaccines in a manufacturing setting in limited circumstances, such as in Williamsburg now, any vaccination orders may need to be the subject of collective bargaining if the factory is unionized. Shoop has seen manufacturers shut down because employees were reluctant to come to work when their co-workers were sick on the job.

An employer does not have to accommodate someone who objects to a vaccine merely because he or she thinks it might do more harm than good but doesn't have an ADA disability or religious objection, said Kara Shea, an attorney with Butler Snow in Nashville, Tenn.

If someone claims to have a health condition that makes getting vaccinated a health risk, the employer does not have to take the person's word for it. The employer instead should ask the person to sign a consent form allowing the employer to learn about the condition and get documentation from the employee's doctor, she said. Before accommodating someone without an obvious impairment, the ADA allows employers to require medical documentation of the disability.

Courts don't closely scrutinize religious objections to immunizations, Mavity remarked.

"Some people have extremely strong beliefs that they don't want a vaccine in their body," said Kathy Dudley Helms, an attorney with Ogletree Deakins in Columbia, S.C. If the employer works with vulnerable people but can't find an accommodation for a worker who refuses vaccination, the employee may have to work elsewhere, she said.