December 2020

COVID-19 Vaccination: Pervasive Skepticism and Employer Mandates in the United States

December 6, 2020
COVID-19, Employment, Food and Drug Law, Public Health

Drew Miller, MJLST Staffer

On December 31, 2019, the COVID-19 pandemic began when the World Health Organization’s (WHO) Chinese office picked up a media statement by the Wuhan Municipal Health Commission regarding cases of “viral pneumonia.” Nearly a year later, despite the protective measures instituted on a global scale to slow the spread, COVID-19 has claimed the lives of nearly 1,500,000 people worldwide) and shows no sign of slowing down. All hope is not lost; scientists and biopharmaceutical companies have worked diligently throughout the crisis, and a large-scale vaccination release seems imminent. However, given the prevalence of anti-vaccination sentiment in the United States, it may be difficult to distribute the vaccine to enough people; employer-mandated vaccines likely offer the best chance for widespread vaccination, but the standards governing such mandates remain unclear.

Anti-Vaccination Sentiment in the US

Whether the vaccine will provide outright immunity or simply partial protection, it will regardless be a critical step toward ending the pandemic. However, vaccines are obviously only effective if people agree to get the shot, and that may prove to be a significant barrier in the United States. Vaccine doubt and anti-vaccination movements continue to grow in popularity for a variety of reasons. Social media’s unique ability to bring together like-minded individuals across the globe inevitably results in the creation of insular groups; anti-vaccine support from celebrities such as Jenny McCarthy and Jim Carrey provide a degree of validation to “regular” people who feel the same way; and general government distrust, which has sharpened considerably under the tumultuous and polarizing Trump presidency, heightens suspicions surrounding FDA testing and approval processes. Finally, as noted by Dr. Paul A. Offit, an infectious disease expert and co-inventor of a vaccine for rotavirus, “Vaccines are a victim of their own success. We have largely eliminated the memory of many diseases.”

Moreover, skepticism regarding the safety and efficacy coronavirus vaccine is not entirely unfounded. The vaccine development process typically takes a decade, whereas this one began under a year ago. A group of researchers at the Johns Hopkins Center for Health Security and the Texas State University anthropology department writes, “If poorly designed and executed, a COVID-19 vaccination campaign in the U.S. could undermine the increasingly tenuous belief in vaccines and the public health authorities that recommend them – especially among people most at risk of COVID-19 impacts.” The results of a poll conducted by Pew Research Center in September indicates the consequences of all these factors: just over half (51%) of U.S. adults definitely or probably would get a COVID-19 vaccine if it were available today—a 21% drop from 72% in May.

Employer-Mandated Vaccines

With skepticism at an all-time high, the responsibility for raising vaccination rates in the U.S. may fall to employers. The U.S. Occupational Safety and Health Administration (OSHA) allows employers to legally impose an influenza vaccine requirement on their workers, but there are several requirements and exceptions that make such a mandate more difficult to impose.

First, employees are entitled under the Americans with Disabilities Act (ADA) to request medical and disability exemptions. This exemption requires proof of an underlying disability or medical condition that renders an employee essentially unable to safely get the vaccine. Second, employees may also claim religious exemptions to avoid an employer-mandated vaccine. However, Title VII of the Civil Rights Act of 1964 states that an employee must have a “sincerely held religious belief” against vaccination. In 2020, the Third Circuit Court of Appeals held that an employee’s “holistic health lifestyle” and personal belief that vaccines are harmful were insufficient to trigger protection under the Civil Rights Act. See Brown v. Children’s Hosp. of Philadelphia, 794 Fed. Appx. 226 (3^rd Cir. 2020). The court wrote, “[I]t is not sufficient merely to hold a ‘sincere opposition to vaccination’; rather, the individual must show that the ‘opposition to vaccination is a religious belief.’” Id. (citing Fallon v. Mercy Catholic Med. Ctr. of Southeast Pa., 877 F.3d 487, 490 (3^rd Cir. 2017)).

There are two primary standards governing the situations in which employers may legally require vaccinations regardless of religious or medical exemptions. Title VII does not require employers to make “reasonable accommodations” for medical or religious reasons if it would pose an undue hardship, which it defines as “more than de minimis cost” to the operation of the business. The ADA standard is stricter, requiring reasonable accommodation barring undue hardship, which it defines as an “action requiring significant difficulty or expense.”

Finally, because vaccinations are “medical examinations” under the ADA, the COVID-19 vaccine would need to be deemed “job-related, consistent with business necessity or justified by a direct threat, and no broader or more intrusive than necessary.” Although the Equal Employment Opportunity Commission (EEOC), which is responsible for enforcing federal anti-discrimination laws in employment, has labeled COVID-19 as a “direct threat” to the workplace and stated that employers are allowed under the ADA to “bar an employee from physical presence in the workplace if he refuses to have his temperature taken or refuses to answer questions about whether he has COVID-19, has symptoms associated with COVID-19, or has been tested for COVID-19,” it has not yet stated whether employers will have the right to make a vaccine mandatory.

Conclusion

As such, the rights of employers to legally impose COVID-19 vaccination requirements on employees are uncertain and, absent clear direction or regulation, will likely require case-by-case analysis to determine the validity of each exemption and the corresponding hardship to business. Consequently, even if employers do have the legal right, protracted legal battles are the only remedy, and given the pervasive fear of vaccinations in today’s social climate, there are likely to be a great many of them. Meanwhile, the COVID-19 pandemic will continue to ravage the nation.

Becoming “[COVID]aware” of the Debate Around Contact Tracing Apps

December 6, 2020
COVID-19, Data Privacy, Public Health, Regulatory

Ellie Soskin, MJLST Staffer

As COVID-19 cases continue to surge, states have ramped up containment efforts in the form of mask mandates, business closures, and other public health interventions. Contact tracing is a vital part of those efforts: health officials identify those who have been in close contact with individuals diagnosed with COVID-19 and alert them of their potential exposure to the virus, while withholding identifying information. But traditional contact tracing for a true global pandemic requires a lot of resources. Accordingly, a number of regions have looked to smartphone-based exposure notification technology as an innovative way to both supplement and automate containment efforts.

Minnesota is one of the latest states to adopt this approach: on November 23rd, the state released “COVIDaware” a phone application designed to notify individuals if they’ve been exposed to someone diagnosed with COVID-19. Minnesota’s application utilizes a notification technology developed jointly by Apple and Google, joining sixteen other states and the District of Columbia, with more expected to roll out in the coming weeks. The nature of the technology raises a number of complex concerns over data protection and privacy. Additionally, these apps are more effective the more people use them and lingering questions remain as to compliance and the feasibility of mandating use.

The joint Apple/Google notification software used in Minnesota is designed with an emphasis on privacy. The software uses anonymous identifying numbers (“keys”) that change rapidly, does not solicit identifying information, does not provide access to GPS data, and only stores data locally on each user’s phone, rather than in a server. The keys are exchanged via localized Bluetooth connection operating in the background. It can also be turned off and relies wholly on self-reports. For Minnesota, accurate reports come in the form of state-issued verification codes provided with positive test results. The COVIDaware app checks daily to see if any keys contacted within the last 14 days have recorded positive test results. Minnesota policymakers, likely aware of the intense privacy concerns triggered by contact tracing apps, have emphasized the minimal data collection required by COVIDaware.

The data privacy regulatory scheme in the United States is incredibly complex, as there is no single unified federal data protection policy. Instead, the sphere is dominated by individual states. Federal law enters into the picture primarily via the Health Insurance Portability and Accountability Act (“HIPAA”), which does not apply to patients voluntarily giving health information to third parties. In response to concerns over contact tracing app data, multiple data privacy bills were introduced to Congress, but even the bipartisan “Exposure Notification Privacy Act” remains unpassed.

Given the decentralized nature of the internet, applications tend to be designed to comply with all 50 states’ policies. However, in this case, state-created contact tracing applications are designed for local use, so from a practical perspective states may only have to worry about compliance with neighboring states’ data privacy acts. The Minnesota Government Data Practices Act passed in 1974 is the only substantive Minnesota state statute affecting data collection and neighboring states’ (Wisconsin, Iowa, North Dakota, and South Dakota) laws have similarly limited or dated schemes. In this specific case, the privacy-focused Apple/Google API that forms the backbone of COVIDaware and the design of the app itself, described briefly above, likely keep it complaint. In fact, some states have expressed frustration at the degree of individual privacy afforded by the Apple/Google API, saying it can stymie coordinated public health efforts.

Of course, one solution to even minimal data privacy concerns is simply not to use the application. But the efficacy of contact tracing apps depends entirely on whether people actually download and use them. Some countries have opted for degrees of mandatory use: China has mandated adoption of its contact tracing app for every citizen, utilizing unprecedented government surveillance to flag individuals potentially exposed, and India has made employers responsible for ensuring every employee download its government-developed contact tracing app. While a similar employer-based approach is not legally impossible in the United States, any such mandate would be legally complex, and anyone following the controversy over mask mandates should instinctively recognize that a mandated government tracking app is a hard sell (to put it lightly).

But mandates may not even be necessary. Experts have emphasized that universal compliance isn’t necessary for an app to be effective: every user helps. Germany and Ireland have not mandated use, but have download rates of 20% and 37% respectively. Some have proposed small, community-focused launches of tracking apps, similar to successful start-ups. With proper marketing and transparency, states need not even enter the sticky legal mess that is mandating compliance.

Virtually every policy response to COVID in the United States has been met with heated controversy and tracking apps are no different. As these apps are in their infancy, legal challenges have yet to emerge, but the area in general is something of a minefield. The limited and voluntary nature of Minnesota’s COVIDaware app likely places it out of the realm of significant legal challenges and significant data privacy concerns, at least for the moment. The general conversation around contact tracing apps is a much larger one, however, and has helped put data privacy and end user control into the global conversation.

Law School Simulator 2020

December 6, 2020
Legal Education, New Technology

Ian Colby, MJLST Staffer

You walk into the classroom. You read the cases and statutes last night. You wrote out a few notes. You think you’re ready. In this classroom, though, you don’t wait for the professor to get the PowerPoint ready. Instead, you slip on your virtual reality headset and start the simulation.

Now you’re sitting in the boardroom of a major corporation with the board of directors. Your headset lets you hear the simulated directors’ nervous talk. You get a few minutes to take in the glass paneling, the city skyline, and the furrowed brows of the worried directors. You can pick up and read reports on the table. You can select dialogue choices to chat with the directors. While the people and place aren’t photorealistic, it’s good enough to immerse you. When class starts, so does the meeting.

“Welcome, everyone,” the simulated President begins, “err…I’ve called this meeting to apprise you of a developing situation and to get some input from our counsel [you].” The president then lays out a series of facts that go from bad to worse: the EPA has identified a toxic leak in a river adjacent to one of the company’s facilities. While the corporation has urged inspections for months, your dialogue with the directors indicates employees skip them. Rumors float that the on-site manager knew about a leak and covered it up. Now the toxic discharge has polluted the nearby river, residents are getting sick, and the EPA may file suit. The president turns to you. She asks, “Okay, Counsel, what is our first move?”

Law School is a finite period of time in which the expectations start at “don’t even think about saying something possibly constituting legal advice” and ends at “you are qualified to evaluate, counsel, negotiate, and advocate for real clients without supervision.” Other than those students who go onto BigLaw jobs (where the firm grudgingly expects to train the new lawyers instead), these three years are it. For the majority of that time, though, becoming a lawyer involves passive learning: reading and sitting in lectures. At the University of Minnesota, students must attend in-person, passive learning courses for 2/3rds of the credits to graduate. The Law School caps other learning methods. Students hope to absorb enough legal knowledge from these passive methods to do well on the course’s lone exam.

Law schools generally wish to develop lawyers that not only know the law, but who have the necessary skills to serve future clients. For example, of the 23 bulleted learning outcomes sought in a University of Minnesota Law School graduate, only 2 directly state that “knowing the law” is the expectation (Under “Client Service”, there is “Demonstrate broad knowledge of the law and the legal system of the United States” and under Ethics & Professionalism, there is “Know and comply with rules of professional conduct.”) The other 21 constitute crucial skills that budding lawyers cannot absorb from reading cases, passively listening to lectures, or trying to keep their heart still as a 1L, hoping they dodge the cold call. For both learning the law and developing crucial lawyering skills, passive learning means inefficient learning. Jennifer M. Cooper & Regan A.R. Gurung, Smarter Law Study Habits: An Empirical Analysis of Law Learning Strategies and Relationship with Law GPA, 62 St. Louis U. L.J. 361 (2017). While you may be expected to master those crucial lawyering skills, most of your credits do not work to help you develop them.

Now you actively respond to the President. Your choices drive the next interaction with the board. The simulation tests your ability to work with the myriad director personalities, gather the necessary information, demonstrate the application of the law, and maintain a poised tone. The simulation does not limit you to the boardroom. You can instantly immerse yourself in the sights and sounds of the waterfront, watch the on-site manager’s facial expressions as you interview him, or review a 3D model of the toxic substance.

Active, simulated learning, on the other hand, is a dramatically more efficient way to learn knowledge and skills. Active learning means learning by doing. Simulations, a type of active learning, allow students to learn by working through a problem in complex, real-time interactions in which they will need to apply that learning. Simulations provide instant feedback on students’ application of knowledge within these real-time scenarios. Finally, simulations provide experiences that a student may have never witnessed before. Many other professions—particularly those that “require mastery of complex knowledge and skills where the stakes for getting it right are high”—utilize simulations to teach the necessary skills and knowledge. Medical professionals, military personnel, firefighters, astronauts, and pilots all perform simulations as a necessary part of their training.

Law schools, recognizing the benefit of active learning and simulation training, have taken steps toward incorporating simulations into the curriculum. At Minnesota, for example, first year students must take Law in Practice. Law in Practice is a simulation course which provides real-time scenarios in which students must elicit and evaluate information, advocate for a client, and negotiate deals. The simulation puts the student on the hot seat: Minnesota’s program is mandatory, provides real-life actors in real-time scenarios, and students demonstrate their skills with local attorneys, judges, and mediators.

However, these real-life simulations are costly, logistically complex, and usually limited to what’s available. Law schools tend to provide simulations separately from doctrinal classes. For those law schools that cannot or do not arrange for real actors and legal professionals, the simulation may lose immersion.

To offer similar benefits as these simulations with fewer costs, and to integrate those benefits into the greater curriculum, law schools should invest in digital simulations. A digital simulation means any interactive, immersive experience that uses technology to provide that experience. While digital simulations can include the latest tech has to offer, such as virtual reality headsets, it does not have to. Interactive CALI lessons can be digital simulations. Video games can be digital simulations. The level of technology does not matter as long as the simulation is immersive, interactive, and provides feedback.

A digital simulation, if done well, would be relatively cheap, repeatable, and provide active, simulated learning opportunities for students. The technology for digital simulations has progressed enough to be readily available—indeed, a student’s smartphone may be used for virtual reality simulations. Law schools could implement digital simulations with less friction than other active learning techniques. The other professions mentioned above have increasingly looked to utilizing digital simulations as a way to provide the benefits of active learning, without the added costs.

There are no defined limits to the variety of clients in a digital simulation. Real-life simulations and other experiential courses depend on availability. Whatever is available becomes the focus of the experience. By contrast, only the imagination of a creator limits the variety of digital simulations. Even if the local market cannot provide a niche area of law, a simulation could. Providing the ideal voice actor becomes easier.

You made a mistake and blurt out that the board should shred all company documents. But you’re not worried. If you make a drastic mistake, the simulation can give you a prompt to try again. Instant feedback. You asked the professor after class about it. You can attempt a different choice that night. Instead of shredding all documents, you advise the board to preserve emails, reports, and other documents.

Digital simulations have the added benefit of providing equity of experience. Unlike the real world, a digital simulation costs little to provide students with exposure to life, the world, or the legal industry. Further, students may repeat simulations with no additional cost until they become comfortable with the topic. By way of example, imagine that you are a law student who has never attended a boardroom meeting (shock!), never seen an easement on a plat, or never attended a courtroom hearing. A digital simulation would allow you to gain the experience of that context while also coming to understand the law. All other items being equal, would a student who has filed hundreds of complaints for a previous employer and a student who has no previous legal industry experience start out on the same footing in a Civil Procedure class? A digital simulation provides a chance for the latter student to catch up.

You remember the reading about environmental clean-up regulations, but this is your first time applying it. You “pause” the interactions with the board as you work your way through the problem. You don’t worry about wasting a professor’s time. You decide to keep the board paused, so you can check out the site itself. By the time you reach the final test in this class, you’ve lived the law as much as you’ve read about it.

Law school provides a crucial time period to develop students’ skills in communication, client services, collaboration, professionalism, legal analysis, and legal knowledge without real world consequences. So why not introduce the cheap, efficient method of digital simulation to adequately develop these skills in the time we have?

December 2020

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