What you need to know about Monday’s mega-mandate for vaccinations against COVID-19

Vaccines are set to become mandatory in Oregon for an increasingly large portion of the working public over the next few weeks. The Employment Department estimates that more than 1.1 million Oregonians will need to get vaccinated against COVID-19 to comply with either federal, state or local vaccine mandates. That’s three out of five working Oregonians.

Employees covered by the mandate need to be vaccinated, granted an exemption, or face losing their jobs. Some of those mandates go into effect on Monday. Others still have details that need to be worked out.

Why do we have vaccine mandates at all?

Vaccines remain one of the most effective ways to prevent deaths and hospitalizations caused by the coronavirus. The vaccines are also effective at slowing transmission.

But the delta variant is significantly more contagious than previous versions of the coronavirus. It’s better at spreading, which means one sick person can expose a lot of people. It’s also better at infecting people, which means breakthrough cases are more likely. Vaccinated people who get the delta variant are also more likely to transmit it, compared to other strains like alpha and beta.

Put together, it means that getting vaccinated isn’t enough to protect someone from COVID-19: everyone around them needs to be vaccinated, too. It’s about group risk, not just individual risk.

Although COVID-19 cases have dropped since early September and the strain on hospitals has eased a bit, the pandemic is far from over. As flu season begins, public health officials are worried there could be a second wave of hospitalizations, this one driven by not one, but two respiratory viruses.

Who will the mandates protect?

A large part of our population — kids — still can’t get vaccinated against COVID-19. And older people, people who are immunocompromised, or people who got inoculated soon after the vaccination was available might not have a very strong immune response. If more people are vaccinated, cases will go down — and the risk to unvaccinated and vaccinated people will decrease.

And if that doesn’t happen, children remain at greater risk. Although they are much less likely to get seriously ill or die from COVID-19, as more children are exposed, we will also see more infections and deaths in children.

If you want to protect kids, you should really also get vaccinated against the flu.

Plot twist: COVID-19 might be mild in kids and worse in adults, but the flu works the opposite way. School-aged children are at a much higher risk of hospitalization from the flu than adults are. Statistically, there is about one pediatric flu death in Oregon each year — though there have been more in pandemic years. Since it’s been a while since most of us have had the flu, it’s possible this flu season could be worse than others. It’s also possible that masking could make this flu season mild, like the season last year.

Is it legal to mandate vaccines?

Broadly speaking, yes. All 50 U.S. states, the District of Columbia, and U.S. territories mandate vaccinations for children to attend school. Federal employers and the military also mandate vaccines.

The legality of Oregon’s COVID-19 mandates is still being determined by the courts. There are several lawsuits underway, but two initial rulings by courts this month were not favorable to plaintiffs who were trying to get judges to block Gov. Kate Brown’s executive order from taking effect.

Related: Oregon Health Authority punts question of how to ration care in a crisis

The courts said that arguments being made by state police officers, health care workers and others impacted by the mandate did not warrant immediate intervention because they had little-to-no chance of succeeding.

But legal experts say this isn’t the end should these lawsuits fail. They expect plaintiffs to appeal. There could be dozens of lawsuits that do the same in other states such as Maine and New York where we’ve seen lower courts rule differently, setting up a much larger legal fight that could come before the U.S. Supreme Court very soon.

What are the different vaccine mandates, and when will they come into effect?

Here’s a breakdown at the various levels of government:

Local mandates: Both Multnomah County and the city of Portland require all employees (with the exception of some police officers and members of the sheriff’s department) to be fully vaccinated by Monday. All told, both mandates apply to over 11,600 individuals.

State mandates: Brown signed two executive orders mandating vaccines, both of which go into effect on Monday. The first applies to employees of executive-branch agencies, which account for most of the state government and includes about 42,000 employees. Unions representing about half of those employees were able to negotiate for an extended deadline. Roughly 26,500 executive-branch employees now have until Nov. 30 to be fully vaccinated.

The second executive order applies to educators and health care workers, and no extensions were granted. Some health care networks implemented their own workplace mandates that have already gone into effect.

Mandate for federal employees and contractors: Employees of federal agencies and companies that work for the federal government need to be fully vaccinated by Dec. 8.

Federal OSHA mandate for private businesses: the Occupational Safety Health Administration proposed a mandate that is currently being reviewed by the White House. Once approved, it will apply to companies with more than 100 employees. People who work for those companies will need to be vaccinated or tested for COVID-19 weekly. It is not clear when the mandate would go into effect.

All told, about three-fifths of adult working Oregonians are covered under one or more of these mandates.

Are the vaccine mandates working? Where are we seeing compliance?

Vaccine mandates work. Since mandates were first announced, the number of new people getting vaccinated against COVID-19 each day has grown.

Oregon hospitals that had only vaccinated around 80% of employees before the mandate are now boasting vaccination rates between 88% and 95%.

It’s a lot harder to tell what’s going on with smaller health care organizations, though, or first-responders like firefighters or emergency medical service workers.

School districts have also seen fairly high compliance with vaccine mandates. Some are taking Monday off to help transition to lower staffing, but other districts say they’ve known for a while who will still be working come, and have planned around it.

Multnomah County and the city of Portland both report vaccination rates at about 92% - higher than the 80% vaccination rate for adults in the Portland metropolitan area.

Are there any professions covered by the mandate that remain under-vaccinated or are at especially low compliance levels?

According to the Oregon Department of Corrections, just 50% of DOC employees are currently fully vaccinated. Service Employees International Union Local 503 and American Federation of State, County and Municipal Employees Council 75 represent employees of the DOC and other parts of the government. They successfully negotiated for an extension. Now, employees that have received at least one dose of the COVID-19 vaccine by Monday have until Nov. 30 to be fully vaccinated.

There were so many concerns about employee shortages and mass terminations. What are we seeing?

It’s too early to say if these mandates will lead to mass terminations. But we can get an idea of the impact by looking at hospital systems: some, like Legacy Health System, set their own vaccine requirements. Legacy employees had to be fully vaccinated by Sept. 30, just over two weeks ago.

Even though 95% of Legacy employees are fully vaccinated, operations were impacted by the number of employees placed on administrative leave. Legacy had to consolidate some labs and temporarily closed some urgent care centers.

In Oregon’s rural counties, where there has been more resistance towards vaccine mandates, we could see larger numbers of layoffs. Some counties have taken the steps to declare a state of emergency ahead of the deadline.

Now, there are some employees who were granted exemptions from the vaccine mandate for religious or medical reasons. What happens to them?

It depends on their employer and the mandate they fall under. Broadly, unvaccinated employees who were granted exemptions can return to work if they receive weekly COVID-19 tests, but many individual employers have stricter rules than that.

It’s also clear that medical and religious exemptions are being held to different standards, depending on the industry and employer. Major health care networks in Oregon are approving very few exemptions — just a small percentage of total applications. School districts are approving slightly more exemptions, but the percentages are still in the single digits. The Department of Corrections, on the other hand, has granted 12% of all exemptions.

Can people go back to work once they get COVID-19? Won’t they be immune?

People have been advocating for vaccine exemptions for people who have previously contracted COVID-19.

It’s true that after catching COVID-19, most people have an immune response — for some people, it can be very strong. But everyone’s response is different. People who struggle to clear infections and people who clear infections very quickly might not be immune.

COVID-19 vaccines produce a more reliable and predictable level of immunity, at a time when there aren’t as many studies on the impacts of natural immunity. Employers and the federal government want that guarantee.

Additionally, catching COVID-19 is still very dangerous. One early study, which was not peer-reviewed, suggests that people who contracted COVID-19 earlier in the pandemic were more protected against the delta variant than those who had only been vaccinated. But to get natural immunity, you also need to survive COVID-19 and any long-term complications that come with it. The same study also found that people who had previously been infected with COVID-19 and who were also vaccinated were the least likely to get infected.

Although some employees may quit rather than face vaccine mandates, state, local and federal governments are weighing the risk of layoffs versus the risk of staff shortages due to COVID-19 outbreaks.

Correction: Oct. 18, 2021. An earlier version of this story misnamed a health care system in a section describing what happened after its Sept. 30 deadline for employees to be vaccinated against COVID.19. That section describes the situation at Legacy Health System.