Throughout the pandemic, many health care workers have sought religious exemptions to Covid-19 vaccine mandates. However, with a new protein-based vaccine option now available, some health care organizations are reconsidering their previously approved exemptions.

Will a protein-based Covid-19 vaccine change hospitals' vaccination requirements?

During the pandemic, many hospitals and health systems implemented Covid-19 vaccination requirements for their workers, citing a need to protect patients, employees, and the community. In addition, CMS earlier this year implemented a vaccine mandate for all health care facilities that participate in Medicare and Medicaid.

However, even with these mandates, some health care workers sought exemptions, either medical or religious, rather than be vaccinated. Of these employees, some received exemptions after arguing that fetal cell lines used in the development of the Covid-19 vaccines conflicted with their religious beliefs or medical situations.

According to the Milwaukee Journal Sentinel, Pfizer-BioNTech and Moderna used fetal cell lines when testing their mRNA vaccines, and Johnson & Johnson used a fetal cell line developed from retinal cells when producing and manufacturing its adenovirus vaccine. These cell lines were derived from fetal cells decades ago and have been replicated in laboratory settings for years.

But now, there is another Covid-19 vaccine option: Novavax's protein-based vaccine, which was initially authorized for use in adults in July. Unlike the other available vaccines, Novavax's vaccine did not use fetal cell lines during its development. It is also considered more traditional since several other vaccines, including for hepatitis B and whooping cough, are also protein based.

With this new vaccine option available, some health systems are reconsidering vaccine exemptions for their workers.

For example, Froedtert Health said that employees who originally sought religious exemptions because of fetal cell lines in the Covid-19 vaccines must now get vaccinated with Novavax's protein-based vaccine. Other staff members who were eligible for exemptions due to medical or other religious reasons may continue to be exempt.

"The Novavax vaccination for COVID-19 is now available. This protein-based vaccination option eliminates conflicts for those staff with religious or medical exemptions caused by mRNA-based vaccines and other concerns," Froedtert said in a statement. "Since those staff are now eligible for a vaccination that does not conflict with their religious beliefs or medical situation, their exemption will expire."

"This affects less than 1 percent of our staff. We continue to allow valid medical exemptions and sincerely held religious exemptions for the COVID-19 vaccine," Froedtert added. "Impacted staff were provided the opportunity to apply for an exemption after learning the previous exemption kept on file was no longer valid."

According to TMJ4, unvaccinated Froedtert employees whose exemptions expired were required to have their first dose of Novavax's vaccine by Sept. 14, and if they had not received a dose by Sept. 21, it would be their last day of employment and they would be considered "voluntarily resigned." A second dose of the vaccine is required by Oct. 5, and if employees do not receive it by Oct. 19, they will be considered voluntarily resigned.

Dorit Reiss, a professor at the University of California Hastings College of Law, said it was only a matter of time before some employers, including hospitals, adjusted their vaccination policies after Novavax was authorized for use.

"I've said publicly before that I think Novavax does change the situation in relation to arguments about cell lines," Reiss said. "This is the first I've heard of an employer actually moving on it."

However, some opponents of vaccine mandates may come up with other reasons to support their religious objections and avoid vaccinations. Although some objections to the Covid-19 vaccines may be sincere, Reiss noted that "for most of them, I think it's about safety concerns, many of them created by misinformation. For most of them, the religion is a cover for that concern." (Gooch, Becker's Hospital Review, 9/22; Goldbeck, TMJ4, 9/8; Shastri/Van Egeren, Milwaukee Journal Sentinel, 9/8; Putka, MedPage Today, 9/9)