A unanimous panel of the U.S. Court of Appeals for the First Circuit recently affirmed the Maine District Court’s denial of a motion for a preliminary injunction challenging Maine’s COVID-19 vaccination mandate for health care workers. The plaintiffs, a group of unvaccinated health care workers, raised constitutional and statutory challenges to the mandate in their requests for a temporary restraining order and preliminary injunction. In its decision, the First Circuit emphasized the validity of Maine’s purpose in issuing the mandate and emphasized a state statute that sets this matter apart from similar challenges throughout the country.
In May 2019, the Maine legislature enacted a statute that disallowed religious or philosophical exemptions from all vaccine mandates. The law took effect in early 2020 after nearly three-quarters of voters rejected a referendum opposing the law.
In managing the COVID-19 pandemic, Maine faces two issues that factor seriously into its risk profile: the largest population of elderly citizens by the percentage of any state in the country and a limited health care workforce. Public health authorities in Maine, therefore, sought to reach a vaccination rate of 90% to stop community spread and protect its most vulnerable residents. Despite several efforts to encourage and incentivize vaccination, the state was unable to reach its 90% goal. As the Delta variant emerged, the state deemed the number of outbreaks occurring in health care facilities unacceptable. On August 12, 2021, the state issued a vaccine mandate for all workers in licensed health care facilities. The mandate, which included only a medical exemption, did not include a religious exemption for on-site employees per the above-mentioned 2019 statute.
With the enforcement of the mandate set to begin on October 29, 2021, plaintiffs sought relief by way of a temporary restraining order and preliminary injunction, both of which the District Court denied. On appeal, the First Circuit affirmed the lower court and rejected the appellants’ constitutional challenges. Under the First Amendment Free Exercise clause, the court subjected the mandate to rational basis review after determining that it was facially neutral and generally applicable. The mandate’s medical exemption furthers Maine’s interest in protecting the health of its most vulnerable residents, the court determined, whereas a religious exemption would defeat that purpose. In declining to apply strict scrutiny, the court wrote, “Few interests are more compelling than protecting public health against a deadly virus.”
The court put litigants in other states on notice by distinguishing why the Maine plaintiffs’ challenge failed whereas challenges elsewhere succeeded. In New York, for example, a group of similarly aligned plaintiffs succeeded in challenging a comparable vaccine mandate for health care workers. There, the district court granted a preliminary injunction on the grounds that New York eliminated its religious exemption after promulgating the mandate.
While the broader implications of the First Circuit’s decision remain unknown, employers in the health care sector should track their state’s public health authorities closely as new mandates roll out across the country. As the Delta variant and lower-than-desired vaccination rates persist, states will likely aim to improve conditions in clinical settings through mandates and incentive programs.
Daniel Curran also contributed to this article.
 Does, et al. v. Mills, No. 21-1826 (1st Cir. Oct. 19, 2021).
 Me. Stat. tit. 22, § 802 (2021).
 Dr. A. v. Hochul, No. 1:21-cv-1009, 21 WL 4734404 (N.D.N.Y. Oct. 12, 2021).