NVIC Vaccine News

1964 Civil Rights Act Protects Some Healthcare Workers with Religious Objections to Employer Flu Shot Mandates

By Carolyn Hendler, JD.
Published August 22, 2019 in Rights & Ethics


The federal government policy directs all healthcare workers to get an annual influenza vaccination.1 Today, nearly 70% of hospitals in the U.S.2 require healthcare workers to get a flu shot every year as a condition of employment.3  This mandate causes conflict for certain healthcare workers whose religious beliefs prevent them from receiving the influenza vaccine. Healthcare workers who request a religious exemption may face retaliation from an employer, including being fired or not hired for a job.

Civil Rights Act of 1964 Prohibits Discrimination for Religious Beliefs

Title VII of the Civil Rights Act of 1964 (“the Act) may offer legal protection to employees when their religious beliefs prevent them from receiving a flu vaccination at their workplace. The Act prohibits employers from refusing to hire, fire or otherwise use discriminatory practices against current and prospective employees on the basis of sex, race, color, national origin or religion.

holding hands

An employee with a sincerely held religious belief is a protected class under the Act.  In order to establish a case under the Act, an employee must establish that a mandatory job requirement conflicts with a sincerely held religious belief, that the employer was informed of this belief, and that the employer took disciplinary action or otherwise sanctioned the employee for refusing the vaccination.4

Equal Employment Opportunity Commission (EEOC) Enforces the Act

The Equal Employment Opportunity Commission (EEOC) enforces the Act and investigates charges of unlawful employment discrimination. The EEOC is a five-member panel appointed by the U.S. President with the advice and consent of the U.S. Senate and EEOC members serve a five-year term.5

The EEOC often receives complaints from healthcare workers who faced retaliation for refusing a mandatory flu vaccination for religious reasons. Recently, the EEOC has been more hawkish in pursuing this type of legal action but has seen mixed results.6

Healthcare Workers Win EEOC Lawsuits in Michigan and Pennsylvania

In 2019 in Michigan, the EEOC filed a lawsuit on behalf of a healthcare worker who alleged that she was not hired for a medical transcript position at a hospital because she refused to get the influenza vaccine based on her religious beliefs. The EEOC lawsuit was successful and the hospital was ordered to pay $75,000 in back pay, compensatory and punitive damages, and to train management and post its policy prohibiting religious discrimination. The court found that a reasonable accommodation for religious views in this situation would have been for the hospital administration staff to allow the employee to wear a mask, just as an employee declining the vaccine for medical reasons would be allowed to wear a mask.7

In 2016, a Pennsylvania hospital entered into a consent decree with the EEOC in a lawsuit brought by six employees who were fired when their religious exemption to influenza vaccination was denied, despite the hospital granting 14 medical exemptions to other employees that year. The hospital agreed to pay $300,000 in back pay and compensatory damages and the healthcare workers were reinstated.8

Healthcare Worker Loses Lawsuit in Massachusetts

Not all EEOC lawsuits filed against employers on behalf of employees, who were sanctioned for seeking religious exemptions to mandatory flu shot policies, have proven successful. In an often cited case, a district court in Massachusetts found that a hospital’s effort to accommodate an employee’s religious beliefs opposing mandatory flu shots, including (1) offering alternative work in the hospital that did not include patient contact; (2) offering a medical exemption; and/ or (3) providing a pork free vaccine that did not conflict with the employee’s religious beliefs, constituted a reasonable accommodation under the law.

sad doctor

The court concluded that allowing the employee to forgo the flu shot at her current position working with patients would have placed an undue burden on the hospital. The court argued that patients could be at risk of contracting influenza when coming in contact with the unvaccinated employee.9

Employers Must Make “Reasonable” Accommodations for Religious Beliefs

When an employee makes a request for an accommodation due to a sincerely held religious belief, employers are urged to seriously consider the request, enter into good faith talks and offer appropriate accommodations.  An appropriate accommodation is a reasonable one that does not place more than a de minimis (minimal) hardship on the employer.10  The court has found that, “an employee is "not entitled to any specific accommodation… only a reasonable one.”11

Accommodation requests are not considered reasonable when they place an undue hardship on employers. This is not an extraordinarily difficult hurdle for employers to get past.

Although it may suffice for the employer of healthcare workers to show that patients could be put at risk for exposure to influenza if a healthcare worker is allowed to forgo a flu shot, the “no exceptions” mandatory flu shot policy should be applied equally to all employees directly interfacing with patients.12 If healthcare workers exempt from the flu shot for medical reasons are allowed to keep their jobs, an argument could be made that allowing religious exemptions provides no greater risk to a patient’s health.

However, a counter argument could be made that only a small percent of healthcare workers would qualify for a medical exemption under narrow federal vaccine contraindication guidelines set by the CDC’s Advisory Committee on Immunization Practices (ACIP) that have been adopted by the employer.13 Therefore, in terms of total numbers, unvaccinated healthcare workers with medical exemptions would pose less of a risk, while a potentially greater number of unvaccinated healthcare workers with religious exemptions would present an unreasonably higher risk to patients.

A court will look at all the facts and circumstances surrounding the employer’s offered accommodation to an employee for religious beliefs.  “In analyzing whether an employer provided a reasonable accommodation, "a court should take a 'totality of the circumstances' approach and consider whether the combination of accommodations provided by the employer was reasonable."14

General EEOC Guidelines Broadly Define Religion

The EEOC has offered general guidance on what constitutes an undue hardship to an employer of healthcare workers with regard to religious exemptions from mandatory vaccinations.  In an informal discussion letter, the EEOC's Office of Legal Counsel wrote that:

"[f]acts relevant to undue hardship…would presumably include, among other things, the assessment of the public risk posed at a particular time, the availability of effective alternative means of infection control, and potentially the number of employees who actually request accommodation."15

The EEOC defines religion broadly and includes organized religions, as well as uncommon personal religious beliefs held by an individual or a minority of people. The religious belief does not need to be espoused by an established church or even supported by the employee’s religion.16 The key factor is that belief is sincerely held and religious in nature.


A district court in Ohio refused to dismiss an employee’s case when she requested an exemption from receiving a mandatory flu shot because she was vegan. The court found that the employee’s views on veganism could equal the sincerity of belief that one would hold with traditional religious beliefs.17

Title VII of the Act only protects religious beliefs and does not extend to personal, moral or conscientiously held beliefs. The Third Circuit Appellate Court has affirmed a district court case in Pennsylvania finding that an employee was not subject to religious discrimination when he was fired from his healthcare position when he refused the mandatory flu vaccine due to his moral beliefs. 

Employers Can Be Sanctioned for Religious Belief Discrimination

When a court finds that the employer has unlawfully discriminated against an employee for sincerely held religious beliefs, the court can order the employer to halt unlawful employment practices and/or order that the employee be reinstated or hired and award the employee, back pay and damages, or other equitable relief.18

The Civil Rights Act of 1964 provides healthcare workers protection from retaliation for requesting a religious exemption to mandatory flu vaccinations, but whether a case is ultimately successful depends on the facts of the case and the jurisdiction of the court.


1 National Vaccine Advisory Committee. Recommendations from the National Vaccine Advisory Committee: Standards for Adult Immunization Practice. Public Health Rep 2014; 129(2): 115-123.

2 Non-VA Hospitals

3 University of Michigan Institute of Healthcare Policy and Innovation.  Most hospitals now require workers to get flu shots – except those that treat veterans, study finds.  June 1, 2018.

4 Fallon v. Mercy Catholic Med. Ctr. of Se. Pa., 877 F.3d 487 (3d Cir. 2017).

5 The U.S. Equal Employment Opportunity Commission. Title VII and Other EEOC Enforced Laws: General Inquiry. Dec. 15, 2015.

6 Smith, Allen. J.D. EEOC Opposes Mandatory Flu Shots for Workers. SHRM.org. Nov. 22, 2016.

7 WILX. Com. Hospital settles lawsuit filed over the flu vaccine. June 28, 2019.

8 U.S. Equal Employment Opportunity Commission Saint Vincent Health Center To Pay $300,000 To Settle EEOC Religious Accommodation Lawsuit.. Press release. Dec. 23, 2016.

9 Robinson v. Children's Hosp. Bos., Civil Action No. 14-10263-DJC, at *10 (D. Mass. Apr. 5, 2016.)

10 Bombatch, Zachary. EEOC Litigation Persists Against Hospitals with Mandatory Flu Vaccine Program. The National Law Review. December 5, 2018.

11 Robinson v. Children's Hosp. Bos., Civil Action No. 14-10263-DJC, at *10 (D. Mass. Apr. 5, 2016) citing O'Brien v. City of Springfield319 F. Supp. 2d 90, 105 (D. Mass. 2003).

12 Smith, Allen. J.D. EEOC Opposes Mandatory Flu Shots for Workers. SHRM.org. Nov. 22, 2016.

13  CDC. Recommendations and Guidelines of the Advisory Committee on Immunization Practices (ACIP): Contraindications and Precautions. Table 4-2. Conditions incorrectly perceived as contraindications or precautions to vaccination (i.e., vaccines may be given under these conditions). Jan. 10, 2019.

14 Robinson v. Children's Hosp. Bos., Civil Action No. 14-10263-DJC, at *10 (D. Mass. Apr. 5, 2016)

15 Ibid.

16 Wolters Kluwer. EEOC letter explains why employers may be required to exempt healthcare workers from mandatory vaccines as a religious accommodation.

17 Chenzira v. Cincinnati Children's Hosp. Med. Ctr., NO. 1:11-CV-00917 (S.D. Ohio Dec. 27, 2012)

18 U.S. Equal Employment Opportunity Commission. Title VII of the Civil Rights Act of 1964.

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14 Responses to "1964 Civil Rights Act Protects Some Healthcare Workers with Religious Objections to Employer Flu Shot Mandates"
Commenter Name
Paula Youmell
Posted: 8/27/2019 2:09:31 PM
Much needs to be done to protect all citizens rights to religious, philosophical, and medical exemptions.
Commenter Name
Posted: 8/27/2019 2:34:37 PM
That was a different country then when people still had rights under the law. Sadly it no longers matters that we are winning the conversation with facts like Rachel Carson did against DDT the rule of law is now determined by the Globalist and their allies. Oh and the Constitution died on 9/11 it turned out to be an epic fail.
Commenter Name
Hans Kasper
Posted: 8/27/2019 2:48:21 PM
The Massachusetts case simply needs to be appealed.
Commenter Name
Leonard Umina
Posted: 8/27/2019 3:28:43 PM
I wonder if that protection gets extended by Equal Protection or other decisions since that time to the entire population.
Commenter Name
Leonard Umina
Posted: 8/27/2019 3:29:48 PM
This protection may be extended with later decisions. Something related to equal protection for example.
Commenter Name
constanze asaad
Posted: 8/27/2019 5:12:59 PM
I realize that the employer is only required to make reasonable accommodations for religious beliefs regarding vaccines but there is something much greater at stake here namely one's health. A job, a career is not one's entire life and if given a vaccine full of mercury (according to my information 51,000 ppb) which can trigger severe health problems for the rest of the employee's life. It is simply not worth it to take the risk and then suffer lifelong. I think when an employer really considers the gravity of the demand for vaccination, the employer must reconsider. Refusing a vaccine for religious reasons usually means that the employee objects to have foreign anything injected into him/her and especially objects to the aborted fetal DNA. This decision by the employee to refuse the vaccine must be respected and the employee should not have to choose between a career and their spiritual health.
Commenter Name
Eleanor Milligan
Posted: 8/27/2019 7:36:30 PM
July 22, 2019 the Office of Civil Rights passed a law “Protecting Statutory Conscience Rights In Health Care, Declarations of Authority.” There is over 400 pages. Health care workers are protected from vaccination against their will. Also, protected if against abortion. Parents have rights to care for child by means of medications, or prayer or natural remedies without repercussions. Many other rules set in place. Check it out. I have not seen much on this new law.
Commenter Name
Eleanor Milligan
Posted: 8/27/2019 7:46:52 PM
Check out new law effective July 22, 2019. The Office of Civil Rights passed “Protecting Statutory Conscience Rights In Health Care , Delegations of Authority “. This protects workers against vaccination, abortion etc. Parents also are protected concerning treatments for their children. Many other laws covered. Check it out. Very lengthy.
Commenter Name
Posted: 8/29/2019 10:49:29 AM
Problem is: Employers have the requirement of clergy signature to attest to religious exemption. Where do you find one who will. My Pastor told me there was nothing in the Bible about it. He must belong to Clergy Response Team, certainly has no consideration for religious conviction, which is clear in Bible.
Commenter Name
Posted: 9/2/2019 2:59:34 PM
the taking away of medical exemptions is something that boggles the mind. they are forcing a doctor to things against his/her conscience and against the oath he/she took to first do no harm. how will a doctor who truly believes he will harm a person go against his conscience? I don't envy those in that position. I had to move from that state to practice cuz going against what you know to be true would just be too hard. tough times for sure.
Commenter Name
Posted: 10/19/2019 7:13:22 AM
How does this compare with the mandatory vaccines one must take to enter college nursing programs? They aren’t required to let them in the program. Also, could we get a medical exemption because of MTHFR and it cross state lines?
Commenter Name
Posted: 10/20/2019 1:58:21 PM
It's amazing the rate of speed this vaccine frenzy has picked up. I have been a RN for 8 years. And when I first started nursing nobody even talked about the flu shot. It was offered, but barely anyone took it, and nobody made a big deal about any of it. Now due to all the fear mongering, and propaganda all of the sudden if you don't take the flu shot you are a horrible human being, who is endangering many. It's so ridiculous. It's like..... wow,so a few years ago I was a great nurse, helping people, now just because I refuse the flu vaccine I am a terrible nurse. LOL. It's really a joke how people are so easily influenced.
Commenter Name
William Ruffner Chilton
Posted: 10/24/2019 1:04:36 PM
The multiple dose flu shot contains ethyl mercury -aka- “thimerasol” which is mutagenic, sufficient to, extinguish successful reproduction of one’s family lineage. Article in SCIENCE shows volcanic mercury led to past mass extinctions, other than the asteroid impact. SEE: “Volcanic **mercury** and mutagenesis in land plants during the end-Triassic mass extinction”. | Science Advances - https://advances.sciencemag.org/content/5/10/eaaw4018.full
Commenter Name
Just curious
Posted: 3/20/2020 12:22:28 PM
Just curious: Which religion forbids flu shots? Mercury is not in shots anymore and they don't use eggs, so vegans can't gripe. Editors note: Religious Exemption: The constitutional right to have and exercise personal religious beliefs, whether you are of the Christian, Jewish, Muslim or other faith, can be defended. In the Old Testament of the Bible, Abraham is asked by God to sacrifice his son to demonstrate his faith. Although Abraham is willing, God does not force Abraham to sacrifice his son. In fact, God makes it clear that human sacrifice to demonstrate allegiance is not appropriate. Constitutionally, Americans have an expectation that their religious beliefs will be respected and that government will not pass laws that obstruct the exercise of this most fundamental of freedoms. Faith and religion If you exercise your right to religious exemption to vaccination, you must be prepared to defend it, and explain your religious or spiritual beliefs in your own words. Due to differences in state laws and the personal nature of a religious or spiritual belief, the NVIC does not recommend or provide a prewritten statement to use an example for filing a religious exemption. The religious exemption is intended for people who hold a sincere religious belief opposing vaccination to the extent that if the state forced vaccination, it would be an infringement on their constitutional right to exercise their religious beliefs. A state must have a "compelling State interest" before this right can be taken away. Limiting the spread of serious communicable diseases has been defined as a "compelling State interest" in court cases after the 1905 U.S. Supreme Court decision Jacobson v. Massachusetts affirmed the right of states to mandate smallpox vaccine. In a number of state court cases setting precedent on the issue of vaccine mandates, the freedom to act according to one’s religious beliefs is subject to reasonable regulation, if exercise of personal religious beliefs substantially threatens the welfare of society as a whole. State requirements for religious exemption can vary widely state to state and below are examples of how religious exemption may be defined in your state and what may be required to obtain a religious exemption to vaccination: The exemption’s definition may be broadly defined to include philosophical, personal or conscientiously held beliefs not necessarily tied to an organized religion. Membership in an organized religion that has written tenets prohibiting invasive medical procedures such as vaccination. However, this kind of language has been ruled unconstitutional when it has been challenged in State Supreme Courts. A signed affidavit from your pastor or spiritual advisor from the church you attend. Notarization of your signature on a religious exemption statement attesting to your sincerely held religious beliefs about vaccination. As of 2016, all U.S. states allow a religious exemption to vaccination except California, Mississippi and West Virginia. Prior to registering your child for school, you should check your state law to verify what proof is needed if you intend to file an exemption for sincerely held religious or spiritual beliefs. If you belong to a church, consider educating the head of your local church about the sincerity of your personal religious beliefs regarding vaccination. You may be able to obtain a letter from your pastor, priest, rabbi or other spiritual counselor affirming the sincerity of your religious beliefs and file it along with any statement you may be required to write explaining your religious or spiritually held beliefs about vaccination. Philosophical, Conscientious or Personal Belief Exemption: This type of exemption is for individuals who hold conscientious objections to one or more vaccines. Less than half of U.S. states allow for an exemption to vaccination based on philosophical, personal or conscientiously held beliefs. To learn if your state offers this type of exemption, please visit NVIC’s State Law & Vaccine Requirements webpages. Argue with us. Educate us. Persuade us. Don't force us to violate our moral conscience. Each state's requirements for this exemption vary greatly from state to state. In some states parents or children old enough to give consent (usually age 12 or older) must object to all vaccines and not just one vaccine. In Washington and Oregon, parents seeking a personal belief exemption must first obtain a signature from a medical doctor or other state-designated health care worker in order to file the exemption or may be required to complete a state vaccine education program (Oregon). From a spiritual standpoint, conscientious freedom is considered defined and discussed in Catholic canon, and states that “Conscience is a judgment of reason whereby the human person recognizes the moral quality of a concrete act that he is going to perform, is in the process of performing or has already completed. In all he says and does, man is obliged to follow faithfully what he knows to be just and right. It is by the judgment of his conscience that man perceives and recognizes the prescription of the divine law.” In even stronger terms, the Catholic Church warns that “a human being must always obey the certain judgment of his conscience. If he were deliberately to act against it, he would condemn himself." While the term "conscientious objector" is generally associated with someone who refuses to serve in the military due to matters of conscience, according to the College of Physicians of Philidelphia it was The British Vaccination Act of 1898 that created a vaccine exemption based on conscienctious objections that gave rise to this popular term. The National Vaccine Information Center (NVIC) has always endorsed the right to informed consent as an overarching ethical principle in the practice of medicine for which vaccination should be no exception. We maintain this is a responsible and ethically justifiable position to take in light of the fact that vaccination is a medical intervention performed on a healthy person that has the inherent ability to result in the injury or death of that healthy person. To learn more about the history and ethics for this exemption, please visit NVIC's fully referenced Informed Consent webpage. Proof of Immunity: Some state laws allow individuals to be exempted from vaccination or re-vaccination, if proof of existing immunity for certain diseases can be shown. If a person has recovered from the natural disease or has been vaccinated, a blood titer test may indicate that there are enough naturally acquired or vaccine acquired antibodies to “prove” immunity to a particular disease. Private medical laboratories can perform the blood titer test and measure the level of antibodies and provide you with a report that you can submit with the request for an exemption if the antibody titers are high enough according to accepted standards. A blood titer test that measures antibody levels can cost $55 or more, depending on the disease.

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