Amicus Brief of APHA, AAMC, and 126 Public Health Scholars — Biden v. Missouri & Biden v. Louisiana

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A motion for leave to file and the accompanying amicus curiae brief of the American Public Health Association, the Association of American Medical Colleges, 22 deans and 126 public health and health policy scholars, filed in the Supreme Court of the United States on December 23, 2021 in Nos. 21A240 and 21A241. The filings support the applicants, who seek stays of injunctions issued by the U.S. District Courts for the Eastern District of Missouri and the Western District of Louisiana. The motion states notice of intent to file was given to all parties by email on December 22, 2021. The brief argues that COVID-19 poses a grave risk to Medicare and Medicaid recipients and healthcare workers, that vaccines are the most effective tool for reducing infection and transmission in healthcare settings, and that evidence supports the Secretary's determination under 86 Fed. Reg. 61,555.

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Nos. 21A240 & 21A241 
 
In the Supreme Court of the United States 
 
JOSEPH R. BIDEN, JR., PRESIDENT OF THE UNITED STATES, ET AL., Applicants, 
 
v. 
 
STATE OF MISSOURI, ET AL. 
 
XAVIER BECERRA, SECRETARY OF HUMAN AND HEALTH SERVICES, ET AL., Applicants, 
 
v. 
 
STATE OF LOUISIANA, ET AL. 
 
 
On Applications for Stays of Injunctions Issued by the United States District Courts  
for the Western District of Louisiana and Eastern District of Missouri  
Pending Appeals to the United States Courts of Appeals 
 for the Fifth and Eighth Circuits 
 
MOTION OF AMERICAN PUBLIC HEALTH ASSOCIATION,  
ASSOCIATION OF AMERICAN MEDICAL COLLEGES,  
22 DEANS OF LEADING ACADEMIC PROGRAMS, AND 
126 LEADING PUBLIC HEALTH AND HEALTH POLICY SCHOLARS FOR LEAVE TO FILE  
ATTACHED BRIEF AS AMICI CURIAE IN SUPPORT OF APPLICANTS 
 
 
NEIL K. SAWHNEY 
GUPTA WESSLER PLLC 
100 Pine Street, Suite 1250 
San Francisco, CA 94111 
 
 
DEEPAK GUPTA 
  Counsel of Record 
JOANNE GRACE L. DELA PEÑA 
GUPTA WESSLER PLLC 
2001 K Street, NW 
Suite 850 North 
Washington, DC 20006 
(202) 888-1741 
deepak@guptawessler.com 
 
Counsel for Amici Curiae 
December 23, 2021

 
 
1
MOTION FOR LEAVE TO FILE AN AMICUS BRIEF 
American Public Health Association, Association of American Medical Colleges, 22 
deans of leading academic programs, and 126 leading public health and health policy 
scholars respectfully move for leave to file the attached brief as amici curiae in support of 
the applicants’ applications for stays of injunctions issued by the United States District 
Courts for the Eastern District of Missouri and the Western District of Louisiana. 
The proposed amici seek to file this brief to demonstrate to the Court that the 
overwhelming public-health and scientific consensus supports the need to mandate 
vaccination of eligible staff at Medicaid and Medicare facilities to protect Medicare and 
Medicaid patients, as well as the healthcare workers who provide them care. Through this 
brief, the proposed amici also seek to explain that well-established evidence, buttressed by 
more recent, cutting-edge empirical studies during the pandemic, shows that vaccination 
can effectively reduce SARS-CoV-2 exposure and transmission in healthcare settings. The 
proposed amici are concerned that the injunctions entered in these cases will delay 
measures needed to control the spread of COVID-19 and will further endanger American 
healthcare workers and patients.  
Given the Court’s expedited consideration of this matter of significant national 
interest, the proposed amici provided notice to all parties of their intent to file by email on 
December 22, 2021. Counsel for the respondents in No. 21A240 stated that they consent to 
the filing, and counsel for the respondents in No. 21A241 stated that they do not object to 
it. The applicants take no position on this motion. 

 
 
2
To the extent that leave is required, the proposed amici respectfully move for leave 
to file the attached brief on 8½- by 11-inch paper rather than in booklet form, given the 
expedited briefing. Should the Clerk’s Office or the Court so require, the proposed amici 
commit to re-filing expeditiously in booklet format. See S. Ct. Rule 21.2(c). 
CONCLUSION 
For the foregoing reasons, the proposed amici respectfully request that the Court 
grant leave to file the attached  amicus brief in the format and at the time submitted.  
Respectfully submitted, 
 
NEIL K. SAWHNEY 
GUPTA WESSLER PLLC 
100 Pine Street, Suite 1250 
San Francisco, CA 94111 
 
 
 
DEEPAK GUPTA 
  Counsel of Record 
JOANNE GRACE L. DELA PEÑA 
GUPTA WESSLER PLLC 
2001 K Street, NW 
Suite 850 North 
Washington, DC 20006 
(202) 888-1741 
deepak@guptawessler.com 
 
Counsel for Amici Curiae 
 
 
 
 

Nos. 21A240 & 21A241 
 
In the Supreme Court of the United States 
 
JOSEPH R. BIDEN, JR., PRESIDENT OF THE UNITED STATES, ET AL., Applicants, 
 
v. 
 
STATE OF MISSOURI, ET AL. 
 
XAVIER BECERRA, SECRETARY OF HUMAN AND HEALTH SERVICES, ET AL., Applicants, 
 
v. 
 
STATE OF LOUISIANA, ET AL. 
 
 
On Applications for Stays of Injunctions Issued by the United States District Courts  
for the  Western District of Louisiana and Eastern District of Missouri  
Pending Appeals to the United States Courts of Appeals 
 for the Fifth and Eighth Circuits 
 
BRIEF OF AMERICAN PUBLIC HEALTH ASSOCIATION,  
ASSOCIATION OF AMERICAN MEDICAL COLLEGES,  
22 DEANS OF LEADING ACADEMIC PROGRAMS, AND 
126 LEADING PUBLIC HEALTH AND HEALTH POLICY SCHOLARS AS  
AMICI CURIAE IN SUPPORT OF APPLICANTS 
 
 
NEIL K. SAWHNEY 
GUPTA WESSLER PLLC 
100 Pine Street, Suite 1250 
San Francisco, CA 94111 
 
 
DEEPAK GUPTA 
  Counsel of Record 
JOANNE GRACE L. DELA PEÑA 
GUPTA WESSLER PLLC 
2001 K Street, NW 
Suite 850 North 
Washington, DC 20006 
(202) 888-1741 
deepak@guptawessler.com 
 
Counsel for Amici Curiae 
December 23, 2021

 
 
i
TABLE OF CONTENTS  
Table of authorities ......................................................................................................................... ii 
Interest of amici curiae and summary of argument ................................................................. 1 
Argument ......................................................................................................................................... 3 
I. 
COVID-19 poses a uniquely grave risk to Medicare and Medicaid 
recipients and healthcare workers. ...................................................................... 3 
II. 
Vaccines are by far the most effective tools for reducing COVID-19 
infection and transmission among patients and workers in the 
healthcare setting. ................................................................................................ 11 
III. 
Ample evidence supports the Secretary’s determination that staff 
vaccination will provide critical protection for patients and 
healthcare workers. .............................................................................................. 18 
Conclusion ...................................................................................................................................... 20 
Appendix ................................................................................................................................. App.1 
 
 
 
 
 

 
 
ii 
TABLE OF AUTHORITIES 
Cases 
Douglas v. Independent Living Center of Southern California, Inc.,  
565 U.S. 606 (2012) ................................................................................................................ 20 
South Bay United Pentecostal Church v. Newsom,  
140 S. Ct. 1613 (2020) ...................................................................................................... 19, 20 
State of Florida v. Department of Health & Human Services,  
19 F.4th 1271 (11th Cir 2021) ............................................................................................... 19 
Thorpe v. Housing Authority of Durham,  
393 U.S. 268 (1969) ................................................................................................................ 20 
Regulations and Statutes 
42 U.S.C. § 1395i-3(d)(4)(B) ......................................................................................................... 18 
42 U.S.C. § 1395x(e)(9) ................................................................................................................. 18 
42 U.S.C. § 1396r(d)(4)(B) ............................................................................................................ 18 
Omnibus COVID-19 Health Care Staff Vaccination, 86 Fed. Reg. 61,555 
(Nov. 5, 2021) ................................................................................................................ passim 
Other Authorities 
Linda H. Aiken et al., Effects of Nurse Staffing and Nurse Education on Patient 
Deaths in Hospitals With Different Nurse Work Environments, 42 Journal 
of Nursing Administration (Oct. Supplement) S10 (2012) ............................................... 15 
Theresa Andrasfay & Noreen Goldman, Reductions in 2020 US life expectancy 
due to COVID-19 and the disproportionate impact on the Black and Latino 
populations, 118 Proceedings of the National Academy of Sciences (2021) ................... 7 
Yoel Angel et al., Association Between Vaccination With BNT162b2 and 
Incidence of Symptomatic and Asymptomatic SARS-CoV-2 Infections 
Among Health Care Workers, 325 JAMA 2457 (June 2021) ........................................... 12 
Greg Arling & Priscilla Arling, The COVID-19 Long-Term Care Situation in the 
state of Minnesota (USA), International Long Term Care Policy Network 
(July 2020), https://perma.cc/S9VP-DG3H .......................................................................... 9 
Alex Bhattacharya et al., Healthcare-associated COVID-19 in England: A 
national data linkage study, 83 Journal of Infection 565 (2021) ...................................... 5 

 
 
iii 
Catherine H. Bozio et al., Centers for Disease Control and Prevention, 
Laboratory-Confirmed COVID-19 Among Adults Hospitalized with COVID-
19–Like Illness with Infection-Induced or mRNA Vaccine-Induced SARS-
CoV-2 Immunity—Nine States, January–September 2021, 70 Morbidity and 
Mortality Weekly Report 1539 (Oct. 29, 2021), https://perma.cc/RS9F-FPXJ ............ 12 
Alberto J. Caban-Martinez et al., High Burden of COVID-19 among 
Unvaccinated Law Enforcement Officers and Firefighters, medRxiv 
(preprint, posted Nov. 26, 2021) .......................................................................................... 15 
Andrew Capp, Amid court challenges, just 1% of impacted Ochsner staff rebuffs 
vax mandate, Lafayette Daily Advertiser (Dec. 2, 2021), 
https://perma.cc/ZR9R-ULT6 ............................................................................................. 16 
Centers for Disease Control and Prevention, Demographic Trends of COVID-19 
cases and deaths in the US reported to CDC (last visited December 22, 2021), 
https://perma.cc/9KLS-3K65 ................................................................................................. 5 
Centers for Disease Control and Prevention, Risk of Severe Illness or Death from 
COVID-19 (December 10, 2020), https://perma.cc/D5L6-E7X2 ....................................... 7 
M. Keith Chen et al., Nursing home staff networks and COVID-19, 118 
Proceedings of National Academy of Sciences of United States of America 1 
(Nov. 2020) ........................................................................................................................... 4, 8 
Po Ying Chia et al., Virological and serological kinetics of SARS-CoV-2 Delta 
variant vaccine-breakthrough infections: a multi-center cohort study, 
medRxiv (preprint, posted July 31, 2021) .......................................................................... 14 
Bernard Condon & Matt Sedensky, Nursing home to workers: Get vaccine or lose 
your job, ABC News (Aug. 4, 2021), https://perma.cc/9EZT-6HWQ ............................. 17 
Sally Hall Dykgraaf et al., Protecting Nursing Homes and Long-Term Care 
Facilities From COVID-19: A Rapid Review of International Evidence, 22 
Journal of the American Medical Directors Association 1969 (Oct. 2021) ................... 4, 8 
Ezekiel J. Emanuel & David J. Skorton, Mandating COVID-19 Vaccination for 
Health Care Workers, Annals of Internal Medicine (Sept. 2021) ................................... 16 
Ashley Fowlkes et al., Centers for Disease Control and Prevention, Effectiveness 
of COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among 
Frontline Workers Before and During B.1.617.2 (Delta) Variant 
Predominance, 70 Morbidity and Mortality Weekly Report 1167 (Aug. 27, 
2021), https://perma.cc/Q3EW-4GYM ................................................................................ 13 

 
 
iv 
Ethan Geringer-Sameth, Covid Toll at State Psychiatric Facilities Has 
Remained Disproportionately High, Gotham Gazette (Feb. 26, 2021), 
https://perma.cc/V5Z7-ABU6 ................................................................................................ 4 
Ross J. Harris et al., Effect of Vaccination on Household Transmission of SARS-
CoV-2 in England, New England Journal of Medicine (Aug. 19, 2021) ........................ 14 
Fiona P. Havers et al., COVID-19-associated hospitalizations among vaccinated 
and unvaccinated adults ≥18 years – COVID-NET, 13 states, January 1 – 
July 24, 2021, medRxiv (preprint, posted July 24, 2021) ................................................... 5 
Shawn Hubler, ‘Mandates Are Working’: Employer Ultimatums Lift Vaccination 
Rates, So Far, N.Y. Times (Sept. 30, 2021), https://perma.cc/JE86-3T69 ..................... 16 
Kaiser Family Foundation, “Breakthrough” COVID-19 Hospitalizations Among 
Fully Vaccinated Patients Occur Most Often among Older Adults and 
Involve People with Chronic Health Conditions (Dec. 15, 2021), 
https://perma.cc/2UM8-N3V7 ................................................................................................ 7 
Kaiser Family Foundation, State Health Facts, Distribution of the Nonelderly 
with Medicaid by Race/Ethnicity (2019), https://perma.cc/MLP9-J77E ........................ 6 
Jeannette Kates et al., The impact of COVID-19 on the hospice and palliative care 
workforce, 38 Public Health Nursing 459 (Oct. 2020) ......................................................... 4 
Scott D. Landes et al., COVID-19 outcomes among people with intellectual and 
developmental disability living in residential group homes in New York 
State, 13 Disability & Health Journal (2020) ....................................................................... 6 
Carlo Giacomo Leo et al., Burnout Among Healthcare Workers in the COVID 19 
Era: A Review of the Existing Literature, 9 Frontiers in Public Health (Oct. 
2021) ........................................................................................................................................ 11 
Lihong Liu et al., Striking Antibody Evasion Manifested by the Omicron Variant 
of SARS-CoV-2, bioRxiv (preprint, posted Dec. 17, 2021) ............................................... 12 
James MacPherson, Sanford: 97% of workforce complying with vaccine mandate, 
AP News (Oct. 29, 2021), bit.ly/30Z3nRu ........................................................................... 16 
Helena C. Maltezou et al., COVID-19 vaccination significantly reduces morbidity 
and absenteeism among healthcare personnel: A prospective multicenter 
study, 39 Vaccine 7021 (Nov. 26, 2021) ............................................................................... 15 
Brian E. McGarry et al., Nursing Home Staff Vaccination and Covid-19 
Outcomes, New England Journal of Medicine (Dec. 8, 2021) ......................................... 14 

 
 
v
Dierdre McPhillips, Risk of severe breakthrough Covid-19 higher for seniors and 
people with underlying conditions, CNN (Sept. 8, 2021), 
https://perma.cc/3TKZ-X8UD ............................................................................................... 5 
Med Center Health, Statement (September 3, 2021), https://perma.cc/Y8EV-
BSRH ...................................................................................................................................... 17 
Medicaid & CHIP Payment & Access Commission, Medicaid’s Role in Financing 
Maternity Care (Jan. 2020), https://perma.cc/BQ9D-H5GR ............................................. 6 
Yin Mo et al., Transmission of community- and hospital-acquired SARS-CoV-2 
in hospital settings in the UK: A cohort study, PLOS Medicine (Oct. 2021) ................. 8 
Seyed M. Moghadas et al., The impact of vaccination on COVID-19 outbreaks in 
the United States, National Institute of Health (preprint, revised Jan. 2, 2021) ......... 11 
Long H. Nguyen et al., Risk of COVID-19 among frontline healthcare workers 
and the general community: a prospective cohort study, 5 Lancet Public 
Health e475 (Sept. 2020) ....................................................................................................... 10 
Tamara Pilishvili et al., Effectiveness of mRNA Covid-19 Vaccine among U.S. 
Health Care Personnel, 385 New England Journal of Medicine e90(1) (Sept. 
22, 2021) ............................................................................................................................ 13, 14 
Kriti Prasad et al., Prevalence and correlates of stress and burnout among U.S. 
healthcare workers during the COVID-19 pandemic: A national cross-
sectional survey study, 35 EClinicalMedicine (May 2021) .............................................. 10 
Kit Ramgopal, Coronavirus in a psychiatric hospital: ‘It's the worst of all worlds,’ 
NBC News (Apr. 17, 2020), https://perma.cc/N93R-Z3VP ................................................ 9 
Aaron Richterman et al., Hospital-Acquired SARS-CoV-2 Infection Lessons for 
Public Health, 324 Journal of the American Medical Association 2155 (Nov. 
2020) .......................................................................................................................................... 8 
Susan R. Sama et al., Impacts of the COVID-19 Pandemic on Home Health and 
Home Care Agency Managers, Clients, and Aides: A Cross-Sectional Survey, 
March to June, 2020, 22 Home Health Care Management & Practice 125 
(2021) ......................................................................................................................................... 4 
Lok Wong Samson et al., Associations Between County-level Vaccination Rates 
and COVID-19 Outcomes Among Medicare Beneficiaries, Rep. No. HP-2021-
23, Office of the Assistant Secretary for Planning and Evaluation, United 
States Department of Health and Human Services (Oct. 2021), 
https://perma.cc/PN3Y-8J32 ................................................................................................ 11 

 
 
vi 
Eric C. Schneider et al., The U.S. COVID-19 Vaccination Program at One Year: 
How Many Deaths and Hospitalizations Were Averted?, Commonwealth 
Fund (Dec. 14, 2021), https://perma.cc/U5B7-8ZRX ........................................................ 11 
Heather M. Scobie et al., Centers for Disease Control and Prevention, Monitoring 
Incidence of COVID–19 Cases, Hospitalizations, and Deaths, by Vaccination 
Status—13 U.S. Jurisdictions, April 4–July 17, 2021, 70 Morbidity and 
Mortality Weekly Report 1284 (Sept. 10, 2021), https://perma.cc/QD6J-P24N ........... 12 
See Where 12 Million U.S. Employees Are Affected by Government Vaccine 
Mandates, N.Y. Times (Dec. 18, 2021), https://perma.cc/8HDP-DJR7 ......................... 15 
Tom Shakespeare et al., Triple jeopardy: disabled people and the COVID-19 
pandemic, 397 Lancet 1331 (Apr. 10, 2021) ......................................................................... 6 
Marc C. Shamier et al., Virological characteristics of SARS-CoV-2 vaccine 
breakthrough infections in health care workers, medRxiv (preprint, posted 
Aug. 21, 2021) ......................................................................................................................... 13 
Jonne J. Sikkens et al., Serologic Surveillance and Phylogenetic Analysis of 
SARS-CoV-2 Infection Among Hospital Health Care Workers, 4 Journal of 
the American Medical Association Network Open (July 28, 2021) ................................... 8 
Anika Singanayagam et al., Community transmission and viral load kinetics of 
SARS-CoV-2 Delta (B.1.617.2) variant in vaccinated and unvaccinated 
individuals, Lancet Infectious Diseases (2021) ................................................................ 14 
Paul Stinson, Houston Methodist Fires Employees Who Snubbed Vaccine 
Mandate, Bloomberg Law (June 23, 2021), https://perma.cc/L4EV-FQRF ................. 17 
Earl Strum et al., Healthcare workers benefit from second dose of COVID-19 
mRNA vaccine: Effects of partial and full vaccination on sick leave duration 
and symptoms, medRxiv (preprint, posted Nov. 21, 2021) ............................................. 14 
Mark W. Tenford, et al., Effectiveness of SARS-CoV-2 mRNA Vaccines for 
Preventing Covid-19 Hospitalizations in the United States, medRxiv 
(preprint, posted July 8, 2021) ............................................................................................. 12 
United States Government Accountability Office, GAO-21-367, COVID-19 in 
Nursing Homes (2021), https://perma.cc/LC7G-8H47 ...................................................... 4 
Jose Villar et al., Maternal and Neonatal Morbidity and Mortality Among 
Pregnant Women With and Without COVID-19 Infection: The 
INTERCOVID Multinational Cohort Study, 175 Journal of the American 
Medical Association Pediatrics 817 (Apr. 2021) .................................................................. 6 

 
 
vii 
Anne E. Watt et al., State-wide Genomic Epidemiology Investigations of COVID-
19 Infections in Healthcare Workers – Insights for Future Pandemic 
Preparedness, medRxiv (preprint, posted Sept. 13, 2021) ................................................ 8 
Sarah Wild, How the Omicron Variant Got So Many Scary Mutations So 
Quickly, Scientific American (Dec. 3, 2021), https://perma.cc/59MN-AXTU ............... 17 
World Health Organization, The impact of COVID-19 on health and care workers: 
a closer look at deaths, Health Workforce Department – Working Paper 1, 
Geneva: World Health Organization (Sept. 2021), https://perma.cc/ZV42-
KZYK ...................................................................................................................................... 10 
Annalee Yassi et al., Infection control, occupational and public health measures 
including mRNA-based vaccination against SARS-CoV-2 infections to 
protect healthcare workers from variants of concern: a 14-month 
observational study using surveillance data, 16 PLOS ONE (2021) ...................... 13, 14 
Ting-Yu Yeh & Gregory P. Contreras, Full vaccination against COVID-19 
suppresses SARS-CoV-2 delta variant and spike gene mutation frequencies 
and generates purifying selection pressure, medRxiv (preprint, posted Aug. 
10, 2021) .................................................................................................................................. 17 
 
  
 
 
 

 
 
1
INTEREST OF AMICI CURIAE AND SUMMARY OF ARGUMENT1 
Even before the Delta and Omicron variants, COVID-19 had profoundly 
transformed American life. As we are all too aware, the brunt of this pandemic has been 
disproportionately shouldered by America’s most vulnerable: Elderly people, the 
chronically ill, pregnant women, and people with disabilities all face far higher risks of 
infection, hospitalization, and death than the general population. Since the pandemic’s 
earliest days, nursing homes and long-term care facilities have repeatedly emerged as our 
nation’s worst hotspots, visiting serious illness and death on residents and staff alike.  
Throughout all of this, America’s healthcare workers have been toiling day-in and 
day-out at the front lines to keep their patients and their communities safe. Despite their 
heroic efforts, however, it is clear that this pandemic is not ending anytime soon. Cases and 
hospitalizations are once again increasing and, as long as much of the world remains 
unvaccinated, new variants will continually emerge. Even when vaccination cannot prevent 
COVID-19 entirely, the science is clear: vaccinations reduce transmissibility and severity. 
To protect the country’s most vulnerable people and its healthcare workers, the Secretary 
of Health and Human Services issued a rule requiring that facilities serving Medicare and 
Medicaid patients ensure that their staff are fully vaccinated. Omnibus COVID-19 Health 
Care Staff Vaccination, 86 Fed. Reg. 61,555, 61,601 (Nov. 5, 2021). 
 
1 Amici have moved for leave to file this brief. No party’s counsel authored this brief, 
in whole or in part, and no party or party’s counsel, nor anyone other than amici or their 
counsel, contributed money intended to fund its preparation or submission. 
 

 
 
2
As the Solicitor General persuasively explains, the Secretary of Health and Human 
Services acted well within his statutory authority in issuing a vaccination rule for healthcare 
facilities that receive federal dollars. See App. for Stay at 20–25, Becerra v. Louisiana, No. 
21A241; App. for Stay at 18–24, Biden v. Missouri, No. 21A240. This brief—on behalf of 
many of the nation’s leading public-health and healthcare scholars and professional 
organizations—explains how that rule also reflects the most recent scientific evidence and 
research. This evidence is clear: The nature of both the virus and healthcare facilities puts 
Medicare and Medicaid recipients, and the staff who care for them, especially at risk of 
COVID-19 transmission and infection. Because it is an airborne pathogen primarily 
transmitted through the inhalation of small respiratory particles, SARS-CoV-2 spreads 
particularly well between people who must spend hours together in close quarters 
indoors—which accurately describes those who receive and provide care in America’s 
hospitals, nursing homes, long-term care facilities, and other healthcare settings.2 
The scientific evidence is also clear about the best way to combat COVID-19’s 
spread: vaccines. All the evidence shows that vaccination significantly reduces the 
likelihood that healthcare workers will transmit COVID-19 and infect patients and other 
workers. And vaccination drastically reduces the chance of hospitalization and death for 
those who contract COVID-19. For these reasons, a number of private healthcare 
employers and states have already imposed vaccine requirements on healthcare staff, which 
have engendered widespread vaccination uptake and have consistently proven effective.   
 
2 “SARS-CoV-2” refers to the virus and “COVID-19” refers to the disease it causes. 
For the reader’s convenience, however, this brief (like much of the scientific literature) will 
often refer to “COVID-19” to mean both the virus and the disease. 

 
 
3
Amici curiae file this brief to explain that the vaccination rule reflects this 
overwhelming scientific and public-health consensus. Amici are a diverse group of scholars 
and professional organizations of public health and healthcare practitioners who share a 
deep commitment to the health of American healthcare workers and patients. They include 
more than one hundred of the country’s leading educators, scholars, and public health and 
healthcare professionals, as well as 22 deans and associate deans of leading academic 
programs across the United States. The individual amici are joined by the American Public 
Health Association and Association of American Medical Colleges, organizations dedicated 
to advancing public health and healthcare through education, research, and advocacy.3 
ARGUMENT 
I. 
COVID-19 poses a uniquely grave risk to Medicare and Medicaid recipients 
and healthcare workers. 
In issuing its vaccination rule, the Centers for Medicare and Medicaid Services 
emphasized that “[a]lmost all CMS-regulated providers and suppliers disproportionately 
serve people who are older, disabled, chronically ill, or who have complex health care 
needs.” 86 Fed. Reg. at 61,601. These groups are not only at heightened risk of contracting 
COVID-19—they are also more likely to experience devastating health outcomes once 
infected.  
To see why, consider first the locations where Medicare and Medicaid recipients 
access medical services. Overwhelming evidence shows that the facilities that provide care 
to these patient populations—hospitals, inpatient rehabilitation facilities, skilled nursing 
facilities (also known as nursing homes or long-term care facilities), psychiatric residential 
 
3 The identity of each amicus curiae is set forth in the appendix to this brief. 

 
 
4
treatment facilities, home-health agencies, and hospices—are especially susceptible to 
COVID-19 outbreaks.4 Patients and residents in these facilities often require close contact 
with staff, and these patients may have difficulty understanding information or practicing 
preventative measures themselves. 86 Fed. Reg. at 61,575. And, out of necessity, patients 
spend time in close contact with one other in shared living or treatment spaces. Id.  
The science shows that SARS CoV-2—an airborne, respiratory virus—can run 
rampant under precisely these conditions.5 It is well-known that nursing homes have been 
frequent sites of COVID-19 outbreaks, with about 94 percent experiencing two or more 
outbreaks of the disease among residents or staff.6 But there is a heightened risk of 
transmission in healthcare facilities more broadly. During the first six months of the 
 
4 See, e.g., Sally Hall Dykgraaf et al., Protecting Nursing Homes and Long-Term 
Care Facilities From COVID-19: A Rapid Review of International Evidence, 22 J. Am. 
Med. Dirs. Ass’n 1969, 1969–88 (Oct. 2021), http://doi.org/10.1016/j.jamda.2021.07.027; M. 
Keith Chen et al., Nursing home staff networks and COVID-19, 118 PNAS 1, 1–7 (Nov. 
2020), http://doi.org/10.1073/pnas.2015455118; Ethan Geringer-Sameth, Covid Toll at State 
Psychiatric Facilities Has Remained Disproportionately High, Gotham Gazette (Feb. 26, 
2021), https://perma.cc/V5Z7-ABU6 (reporting that “one-fifth of patients in state-run 
inpatient psychiatric centers have contracted COVID-19 since the outbreak began”); 
Jeannette Kates et al., The impact of COVID-19 on the hospice and palliative care 
workforce, 
38 
Pub. 
Health 
Nursing 
459, 
459–463 
(Oct. 
2020), 
http://doi.org/10.1111/phn.12827; Susan R. Sama et al., Impacts of the COVID-19 Pandemic 
on Home Health and Home Care Agency Managers, Clients, and Aides: A Cross-Sectional 
Survey, March to June, 2020, 22 Home Health Care Management & Practice 125, 125–29 
(2021), http://doi.org/10.1177/1084822320980415.  
 
5 See, e.g., Chen et al., supra n.4; 86 Fed. Reg. at 61,557–58 (citing studies).  
 
6 U.S. Gov’t Accountability Off., GAO-21-367, COVID-19 in Nursing Homes (2021), 
https://perma.cc/LC7G-8H47; see also 86 Fed. Reg. at 61,585 nn.207–09 (citing data). 
 

 
 
5
pandemic, for example, up to one in six COVID-19 infections among hospitalized patients 
in England was caused by transmissions in healthcare settings.7  
The risks of COVID-19 transmission and infection are compounded by the unique 
vulnerability of Medicare and Medicaid beneficiaries. Medicare recipients—primarily 
individuals who are over age 65—belong to the age group that has been at the greatest risk 
of hospitalization and death due to COVID-19. See 86 Fed. Reg. at 61,601. This cohort 
represents nearly 80 percent of all COVID-19 deaths.8 And while infections, 
hospitalizations, and deaths initially declined after the widespread vaccination efforts in the 
first half of 2021, in recent months they have increased exponentially. See 86 Fed. Reg. at 
61,559 (“Between late June 2021 and September 2021, daily cases of COVID-19 increased 
over 1200 percent; new hospital admissions, over 600 percent; and daily deaths, by nearly 
800 percent.”). The Centers for Disease Control and Prevention’s data also shows that the 
new “waves” of COVID-19 pose a particularly grave threat to older individuals: about 70 
percent of “breakthrough” infections that required hospitalization were among adults over 
age 65. More sobering still, this group accounted for 87 percent of all breakthrough deaths.9  
 
7 Alex Bhattacharya et al., Healthcare-associated COVID-19 in England: A national 
data 
linkage 
study, 
83 
J. 
of 
Infection 
565, 
565-72 
(2021), 
http://doi.org/10.1016/j.jinf.2021.08.039; see also 86 Fed. Reg. at 61,557. 
 
8 See CDC, Demographic Trends of COVID-19 cases and deaths in the US reported 
to CDC (last visited December 22, 2021), https://perma.cc/9KLS-3K65. 
 
9 Fiona P. Havers et al., COVID-19-associated hospitalizations among vaccinated 
and unvaccinated adults ≥18 years – COVID-NET, 13 states, January 1 – July 24, 2021, 
medRxiv (preprint, posted July 24, 2021), http://doi.org/10.1101/2021.08.27.21262356; see 
also Dierdre McPhillips, Risk of severe breakthrough Covid-19 higher for seniors and 
people with underlying conditions, CNN (Sept. 8, 2021), https://perma.cc/3TKZ-X8UD.  
 

 
 
6
Substantial evidence likewise confirms that the low-income individuals eligible for 
Medicaid—which includes pregnant women, people with disabilities, and children—are also 
particularly vulnerable to both COVID-19 infection and serious COVID-19 complications. 
See 86 Fed. Reg. at 61,557. Medicaid covers nearly half of all births nationally, and an even 
greater share of births in rural areas and among minority women.10 One multinational 
cohort study of pregnant women in 18 countries found that COVID-19 in pregnancy was 
associated with consistent and substantial increases in severe maternal morbidity and 
mortality, as well as neonatal complications.11 The risk of death from COVID-19 is also 
higher for people with disabilities, both for those who live in household settings as well as 
congregate residential settings.12  
The COVID-19 pandemic has also exacerbated existing health inequities suffered by 
people of color. Black Americans make up roughly 20 percent of Medicaid recipients, and 
Latino Americans make up roughly 30 percent.13 The evidence shows that Black and Latino 
 
10 Medicaid & CHIP Payment & Access Comm’n, Medicaid’s Role in Financing 
Maternity Care at 1 (Jan. 2020), https://perma.cc/BQ9D-H5GR.  
 
11 Jose Villar et al., Maternal and Neonatal Morbidity and Mortality Among 
Pregnant Women With and Without COVID-19 Infection: The INTERCOVID 
Multinational Cohort Study, 175 JAMA Pediatrics 817, 817–826 (Apr. 2021), 
http://doi.org/10.1001/jamapediatrics.2021.1050. 
 
12 See, e.g., Tom Shakespeare et al., Triple jeopardy: disabled people and the COVID-
19 pandemic, 397 Lancet 1331 (Apr. 10, 2021), http://doi.org/10.1016/S0140-6736(21)00625-
5; Scott D. Landes et al., COVID-19 outcomes among people with intellectual and 
developmental disability living in residential group homes in New York State, 13 
Disability & Health J. (2020), http://doi.org/10.1016/j.dhjo.2020.100969. 
 
13 See Kaiser Fam. Found., State Health Facts, Distribution of the Nonelderly with 
Medicaid by Race/Ethnicity (2019), https://perma.cc/MLP9-J77E. 
 

 
 
7
Americans are admitted to hospitals with more severe COVID-19 disease as compared with 
non-Hispanic White people, increasing the likelihood that these patients will require 
intubation, be admitted to the ICU, or die.14 And a February 2021 analysis found that both 
groups “have experienced a disproportionate burden of COVID-19 morbidity and mortality, 
reflecting persistent structural inequalities that increase risk of exposure to COVID-19 and 
mortality risk for those infected.”15  
Furthermore, emerging research confirms that viral spread from unvaccinated staff 
poses a significant danger to individuals with chronic conditions and complex health 
needs—which describes a significant portion of Medicare and Medicaid beneficiaries—even 
after they themselves are vaccinated. The data shows, for example, that the fully vaccinated 
adults who have been hospitalized with COVID-19 breakthrough cases tend to have chronic 
conditions like hypertension, diabetes, heart failure and lung disease. See Kaiser Fam. 
Found., “Breakthrough” COVID-19 Hospitalizations Among Fully Vaccinated Patients 
Occur Most Often among Older Adults and Involve People with Chronic Health Conditions 
(Dec. 15, 2021), https://perma.cc/2UM8-N3V7. 
The CMS rule acknowledges that prevention and control practices like physical 
distancing and the use of personal protective equipment can be effective when implemented 
 
14 CDC, Risk of Severe Illness or Death from COVID-19 (Dec. 10, 2020), 
https://perma.cc/D5L6-E7X2. 
 
15 Theresa Andrasfay & Noreen Goldman, Reductions in 2020 US life expectancy 
due to COVID-19 and the disproportionate impact on the Black and Latino populations, 
118 PNAS, at 1 (2021) http://doi.org/10.1073/pnas.2014746118; see also 86 Fed. Reg. at 
61,557. 
 

 
 
8
correctly and consistently. 86 Fed. Reg. at 61,557. But, as CMS concluded, the evidence 
shows that lapses inevitably happen, and patient deaths can result. The vaccination rule 
cited multiple studies that demonstrate that transmission occurs between healthcare 
workers and patients even when universal masking and other protocols are in place. 86 Fed. 
Reg. at 61,557.16 In many cases, healthcare staff are the linchpin—they are a “frequent 
source of risk through either introducing or transmitting infection” and are themselves 
“exposed to risk through attending [patients’] physical care needs,” just as “their absence 
when unwell or quarantined ha[s] substantial impact on operations and [patient] well-
being.”17 To take one example, a “cluster” of at least 55 infections at Baystate Medical 
Center in Massachusetts was traced to “staff who convened in a breakroom and removed 
their masks.”18  
This increased risk of viral transmission in healthcare settings has had a devastating 
effect on patients. One need look no further than the nation’s nursing homes to understand 
 
16 See, e.g., Chen, supra n.4; Jonne J. Sikkens et al., Serologic Surveillance and 
Phylogenetic Analysis of SARS-CoV-2 Infection Among Hospital Health Care Workers, 4 
JAMA Network Open (July 28, 2021), http://doi.org/10.1001/jamanetworkopen.2021.18554; 
Anne E. Watt et al., State-wide Genomic Epidemiology Investigations of COVID-19 
Infections in Healthcare Workers – Insights for Future Pandemic Preparedness, medRxiv 
(preprint, posted Sept. 13, 2021), http://doi.org/10.1101/2021.09.08.21263057. 
 
17 See Dykgraaf et al., Protecting Nursing Homes and Long-Term Care Facilities 
From COVID-19 at 1984, supra n.4. 
 
18 Aaron Richterman et al., Hospital-Acquired SARS-CoV-2 Infection Lessons for 
Public Health, 324 JAMA 2155, 2156 (Nov. 2020), http://doi.org/10.1001/jama.2020.21399; 
see also Yin Mo et al., Transmission of community- and hospital-acquired SARS-CoV-2 
in hospital settings in the UK: A cohort study, PLOS Medicine (Oct. 2021), 
http://doi.org/10.1371/journal.pmed.1003816. 
 

 
 
9
the stunning toll: While residents of these facilities make up less than 1 percent of the U.S. 
population, they “accounted for more than 35 percent of all COVID-19 deaths in the first 12 
months of the pandemic.” 86 Fed. Reg. at 61,566; see also id. at 61,601. Other long-term 
care and residential facilities have also been hit hard. In Minnesota, for instance, four-fifth 
of total COVID-19 deaths were among older people in long-term care facilities. Of these, 
over half were in nursing facilities, but 22 percent were in assisted living facilities and 19 
percent were in community settings.19 Likewise, data collected from state mental health 
facilities in 23 states and the District of Columbia indicate double the number of COVID-19 
cases in these facilities than in the entire federal prison system.20  
The impact of these outbreaks is not limited to patients. Healthcare workers, too, 
are at special risk of COVID-19 infection. The same features of Medicare- and Medicaid-
facility settings that create vulnerabilities for patients also put critical frontline workers at 
risk. CDC data indicates that healthcare staff have reported over half a million COVID-19 
cases since the start of the pandemic. See 86 Fed. Reg. at 61,559. One cohort study in the 
United States and the United Kingdom assessed between March and April 2020 determined 
that frontline healthcare workers “had a twelve-fold increase in risk of a positive [COVID-
 
19 Greg Arling & Priscilla Arling, The COVID-19 Long-Term Care Situation in the 
state of Minnesota (USA), Int’l Long Term Care Pol’y Network, at 2 (July 2020), 
https://perma.cc/S9VP-DG3H. 
 
20 Kit Ramgopal, Coronavirus in a psychiatric hospital: ‘It’s the worst of all worlds,’ 
NBC News (Apr. 17, 2020), https://perma.cc/N93R-Z3VP. 
 

 
 
10 
19] test.”21 And these results comport with historical data: During the Ebola crisis, for 
instance, healthcare workers were around twenty to thirty times more likely to contract the 
disease than the general public. Id. at e481.   
That the COVID-19 pandemic has been devasting for healthcare workers is also 
well-documented. The WHO estimates that between 80,000 and 180,000 health and care 
workers died from COVID-19 in the period between January 2020 to May 2021.22 Even for 
healthcare staff who do not become seriously ill, the effects of a prolonged, global pandemic 
are still serious. A survey of more than 20,000 U.S. healthcare workers found that almost 
half experienced feelings of burnout, which was associated with fear of exposure or 
transmission, anxiety and depression, and work overload.23 With every “wave” of new 
variants, healthcare facilities are forced to ration or cease routine services, repurpose 
clinical areas, redeploy staff to unfamiliar clinical environments, and ration personal 
protective equipment and medical resources due to unprecedented demand.24 Frontline 
 
21 Long H. Nguyen et al., Risk of COVID-19 among frontline healthcare workers 
and the general community: a prospective cohort study, 5 Lancet Pub. Health e475, e478–
79 (Sept. 2020), http://doi.org/10.1016/S2468-2667(20)30164-X. 
 
22 See WHO, The impact of COVID-19 on health and care workers: a closer look at 
deaths, Health Workforce Department – Working Paper 1, Geneva: World Health 
Organization, at 6–7 (Sept. 2021), https://perma.cc/ZV42-KZYK. 
 
23 Kriti Prasad et al., Prevalence and correlates of stress and burnout among U.S. 
healthcare workers during the COVID-19 pandemic: A national cross-sectional survey 
study, 35 EClinicalMedicine (May 2021), http://doi.org/10.1016/j.eclinm.2021.100879. 
 
24 Carlo Giacomo Leo et al., Burnout Among Healthcare Workers in the COVID 19 
Era: A Review of the Existing Literature, 9 Frontiers in Pub. Health (Oct. 2021), 
http://doi.org/10.3389/fpubh.2021.750529. 
 

 
 
11 
healthcare workers involved in the management of COVID-19 are particularly exposed to 
overwhelming pressure and, unsurprisingly, report physical and mental exhaustion. Id. 
And the pandemic’s effects on healthcare workers ripple far beyond individual health 
outcomes to the overall ability of our national healthcare system to deal with the crisis. As 
the CMS rule explains, staff absenteeism due to COVID–19-related exposures or illness 
exacerbates healthcare staffing shortages, disrupts patient care, and burdens staff that are 
already stretched impossibly thin. See 86 Fed. Reg. at 61,559.  
II. 
Vaccines are by far the most effective tools for reducing COVID-19 infection 
and transmission among patients and workers in the healthcare setting. 
There is no better way to prevent the transmission, morbidity, and mortality of 
COVID-19 than vaccination. So far, vaccines have prevented approximately 1.1 million 
additional COVID-19 deaths and 10.3 million COVID-19-related hospitalizations.25 As CMS 
explained, numerous large-scale studies have confirmed the power of vaccines to safely 
protect individuals from transmission and infection of COVID-19. 86 Fed. Reg. at 61,558.26 
Unvaccinated adults of prime working age (18 to 49 years) are 15.2 times more likely to be 
 
25 Eric C. Schneider et al., The U.S. COVID-19 Vaccination Program at One Year: 
How Many Deaths and Hospitalizations Were Averted?, Commonwealth Fund (Dec. 14, 
2021), https://perma.cc/U5B7-8ZRX.  
 
26 See also, e.g., Seyed M. Moghadas et al., The impact of vaccination on COVID-19 
outbreaks in the United States, Nat’l Inst. of Health at 2 (preprint, revised Jan. 2, 2021), 
http://doi.org/10.1101/2020.11.27.20240051 (finding that widespread COVID-19 vaccination 
has made a “substantial impact on mitigating COVID-19 outbreaks”); Lok Wong Samson 
et al., Associations Between County-level Vaccination Rates and COVID-19 Outcomes 
Among Medicare Beneficiaries, Rep. No. HP-2021-23, Office of the Assistant Secretary for 
Planning and Evaluation, U.S. Dep’t of Health and Hum. Servs., at 1 (Oct. 2021), 
https://perma.cc/PN3Y-8J32 (estimating reduction of approximately 265,000 COVID-19 
infections and 39,000 deaths among Medicare beneficiaries). 
 

 
 
12 
hospitalized and 17.2 times more likely to die of COVID-19 than fully vaccinated people in 
the same age range.27 And so-called “natural immunity” is no substitute: Vaccines are five 
times more effective in preventing serious illness and hospitalization than a previous 
COVID-19 infection.28 This appears even more true in light of early reports indicating that 
the antibodies generated by previous infection are less effective than vaccination at 
neutralizing Omicron.29  
Although vaccines are generally effective at preventing infection, hospitalization, 
and death, they are particularly so in healthcare facilities. Extensive evidence has shown 
vaccination “prevent[s] morbidity and mortality associated with COVID-19” and is 
“effective[] against asymptomatic SARS-CoV-2 infection.” 86 Fed. Reg. at 61,558.30 This is 
true for two straightforward reasons. First, vaccinated healthcare workers are in the 
 
27 Heather M. Scobie et al., CDC, Monitoring Incidence of COVID–19 Cases, 
Hospitalizations, and Deaths, by Vaccination Status—13 U.S. Jurisdictions, April 4–July 
17, 
2021, 
70 
Morbidity 
& 
Mortality 
Weekly 
Rpt. 
1284 
(Sept. 
10, 
2021), 
https://perma.cc/QD6J-P24N.  
 
28 Catherine H. Bozio et al., CDC, Laboratory-Confirmed COVID-19 Among Adults 
Hospitalized with COVID-19–Like Illness with Infection-Induced or mRNA Vaccine-
Induced SARS-CoV-2 Immunity—Nine States, January–September 2021, 70 Morbidity & 
Mortality Weekly Rpt. 1539 (Oct. 29, 2021), https://perma.cc/RS9F-FPXJ. 
 
29 See, e.g., Lihong Liu et al., Striking Antibody Evasion Manifested by the Omicron 
Variant 
of 
SARS-CoV-2, 
bioRxiv 
(preprint, 
posted 
Dec. 
17, 
2021), 
http://doi.org/10.1101/2021.12.14.472719. 
 
30 See, e.g., Yoel Angel et al., Association Between Vaccination With BNT162b2 and 
Incidence of Symptomatic and Asymptomatic SARS-CoV-2 Infections Among Health 
Care Workers, 325 JAMA 2457 (June 2021), http://doi.org/10.1001/jama.2021.7152; Mark W. 
Tenford, et al., Effectiveness of SARS-CoV-2 mRNA Vaccines for Preventing Covid-19 
Hospitalizations in the United States, medRxiv (preprint, posted July 8, 2021), 
http://doi.org/10.1101/2021.07.08.21259776. 
 

 
 
13 
aggregate significantly less likely to bring the virus into medical facilities. Id at 61,558–59.31 
Second, even those vaccinated workers who get infected are far less likely to spread the 
virus. See, e.g., Marc C. Shamier et al., Virological characteristics of SARS-CoV-2 vaccine 
breakthrough infections in health care workers, medRxiv (preprint, posted Aug. 21, 2021), 
http://doi.org/10.1101/2021.08.20.21262158 (concluding that infectious virus shedding is 
reduced in cases of breakthrough infections among vaccinated healthcare workers). Both 
of these rationales are critically important for protecting Medicare and Medicaid patients—
from elderly people and pregnant women to low-income children—who, as discussed, 
remain vulnerable to serious COVID-19 vaccinations even after they themselves are 
vaccinated. See supra, 5 n.9, 7.  
While it is true that COVID-19 vaccines, like other vaccines, do not completely 
prevent transmission of COVID-19 to others, growing evidence shows that they 
significantly decrease it.32 A recent study of vaccine uptake in nursing homes, for example, 
 
31 See, e.g., Tamara Pilishvili et al., Effectiveness of mRNA Covid-19 Vaccine among 
U.S. Health Care Personnel, 385 N. Eng. J. Med. e90(1) (Sept. 22, 2021), 
http://doi.org/10.1056/NEJMoa2106599; 
Annalee 
Yassi 
et 
al., 
Infection 
control, 
occupational and public health measures including mRNA-based vaccination against 
SARS-CoV-2 infections to protect healthcare workers from variants of concern: a 14-month 
observational 
study 
using 
surveillance 
data, 
16 
PLOS 
ONE 
(2021), 
http://doi.org/10.1371/journal.pone.0254920. 
 
32 See, e.g., Ashley Fowlkes et al., CDC, Effectiveness of COVID-19 Vaccines in 
Preventing SARS-CoV-2 Infection Among Frontline Workers Before and During B.1.617.2 
(Delta) Variant Predominance, 70 Morbidity & Mortality Weekly Rpt. 1167 (Aug. 27, 
2021), https://perma.cc/Q3EW-4GYM (finding that “full vaccination with COVID-19 
vaccines was 80% effective in preventing” COVID-19 infection in frontline workers, 
“further affirming the highly protective benefit of full vaccination up to and through the 
most recent summer U.S. COVID-19 pandemic waves”); Anika Singanayagam et al., 
Community transmission and viral load kinetics of SARS-CoV-2 Delta (B.1.617.2) variant 
 

 
 
14 
found that in counties with the highest community prevalence of COVID-19, nursing homes 
with the lowest staff vaccination coverage had 132% more COVID-19 cases among residents 
and 195% more COVID-related resident deaths than facilities in the same counties that had 
the highest vaccination coverage.33 And this finding held even when nursing home residents 
themselves were vaccinated. See id. Other research during the COVID-19 pandemic has 
confirmed the efficacy of vaccination against transmission between healthcare staff.34  
The evidence also shows that vaccinating healthcare workers has broader positive 
effects on the healthcare system. For example, it improves facility efficiency and 
effectiveness—vaccinated staff, on average, miss fewer days of work and experience milder 
symptoms if they are infected.35 A study of five tertiary-care hospitals in Greece found that 
COVID-19 vaccination prevented nearly seven out of ten episodes of absenteeism among 
 
in vaccinated and unvaccinated individuals, Lancet Infectious Diseases (2021), 
http://doi.org/10.1016/S1473-3099(21)00648-4 (vaccinated individuals spread Delta to the 
unvaccinated at twice the rate as to the vaccinated); Po Ying Chia et al., Virological and 
serological kinetics of SARS-CoV-2 Delta variant vaccine-breakthrough infections: a 
multi-center 
cohort 
study, 
medRxiv 
(preprint, 
posted 
July 
31, 
2021), 
http://doi.org/10.1101/2021.07.28.21261295 (shorter infectious period and decreased viral 
load for vaccinated individuals); Ross J. Harris et al., Effect of Vaccination on Household 
Transmission of SARS-CoV-2 in England, New Eng. J. of Med. (Aug. 19, 2021), 
http://doi.org/10.1056/NEJMc2107717. 
 
33 Brian E. McGarry et al., Nursing Home Staff Vaccination and Covid-19 
Outcomes, New Engl. J. Medicine (Dec. 8, 2021), http://doi.org/10.1056/NEJMc2115674. 
 
34 See, e.g., Pilishvili et al., supra n.31; Yassi et al., supra n.31. 
 
35 See Earl Strum et al., Healthcare workers benefit from second dose of COVID-19 
mRNA vaccine: Effects of partial and full vaccination on sick leave duration and 
symptoms, 
medRxiv 
(preprint, 
posted 
Nov. 
21, 
2021), 
http://doi.org/10.1101/2021.11.17.21266479. 
 

 
 
15 
healthcare personnel, and it significantly reduced the length of absences.36 And the knock-
on effects of more adequately staffed facilities are significant: better patient outcomes, 
lower patient mortality, and less staff burnout.37 
Given the compelling data, it is not surprising that numerous states, private health 
systems, and individual healthcare employers across the country have recognized the need 
to require vaccination. At least 25 states and 39 cities have required vaccines for some 
portion of healthcare workers.38 Numerous private facilities responded with vaccine 
requirements covering their entire workforce, which have proved highly effective at 
achieving adherence. For example, when Houston Methodist Hospital required its 25,000 
workers to get the vaccine, 99.5% of its staff complied. Sanford Health, a dominant provider 
 
36 Helena C. Maltezou et al., COVID-19 vaccination significantly reduces morbidity 
and absenteeism among healthcare personnel: A prospective multicenter study, 39 Vaccine 
7021, 7021–27 (Nov. 26, 2021), http://doi.org/10.1016/j.vaccine.2021.10.054. 
 
37 See Linda H. Aiken et al., Effects of Nurse Staffing and Nurse Education on 
Patient Deaths in Hospitals With Different Nurse Work Environments, 42 J Nursing 
Admin. 
(Oct. 
Supplement) 
S10, 
S10–S16 
(2012) 
http://doi.org/10.1097/01.NNA.0000420390.87789.67. This finding is also supported by 
evidence from other frontline workplace contexts. For example, a recent study found that 
the incidence of COVID-19 in unvaccinated firefighters was five times higher than in 
vaccinated firefighters—and twenty times higher for unvaccinated law enforcement 
officers. Alberto J. Caban-Martinez et al., High Burden of COVID-19 among Unvaccinated 
Law Enforcement Officers and Firefighters, medRxiv at 6 (preprint, posted Nov. 26, 2021), 
http://doi.org/10.1101/2021.11.24.21266396. Given that first responders on average were 
sick with COVID-19 for over two weeks and missed close to 40 hours of work due to their 
illness, the study’s authors found that “state and local governments with large numbers of 
unvaccinated first responders may face major disruptions in their workforce due to COVID-
19 illness” absent vaccination requirements. Id. at 4.  
 
38 See Where 12 Million U.S. Employees Are Affected by Government Vaccine 
Mandates, N.Y. Times (Dec. 18, 2021), https://perma.cc/8HDP-DJR7.  
 

 
 
16 
of healthcare in the Upper Midwest and one of the largest rural healthcare systems in the 
country, reported that 97% of its 48,000 workforce has complied with its vaccine 
requirement. And after Louisiana-based Ochsner Health instituted its vaccine 
requirement, 99% of its 30,000 employees complied. 39 In short, as CMS explained in its rule, 
evidence from numerous health systems and individual healthcare employees shows the 
“effectiveness of strong vaccination policies.” 86 Fed. Reg. at 61,566; see also, e.g., Shawn 
Hubler, ‘Mandates Are Working’: Employer Ultimatums Lift Vaccination Rates, So Far, 
N.Y. Times (Sept. 30, 2021), https://perma.cc/JE86-3T69 (observing that when employers 
require workers to get vaccinated, vaccination rates increase to over 90 percent). 
Substantial evidence likewise supports CMS’s finding that quit rates among 
healthcare workers in response to vaccine mandates remain low. In Houston Methodist, for 
instance, only 153 workers out of 25,000 were fired or resigned after the vaccine mandate 
was instituted. In rural Alabama, a state with one of the lowest vaccine uptake rates, 
Hanceville Nursing & Rehab Center lost only six of its 260 employees when it imposed a 
vaccine mandate. And even where facilities lose a small number of workers, these workers 
have been replaced as part of the normal churn of turnover in healthcare facilities. Med 
Center Health in Bowling Green, Kentucky, for example, lost only 180 staff members after 
it required its staff of 3,600 to be vaccinated, and it promptly hired 178 new vaccinated staff 
 
39 See Ezekiel J. Emanuel & David J. Skorton, Mandating COVID-19 Vaccination 
for Health Care Workers, Annals of Internal Med. (Sept. 2021), http://doi.org/10.7326/M21-
3150; James MacPherson, Sanford: 97% of workforce complying with vaccine mandate, AP 
News (Oct. 29, 2021), bit.ly/30Z3nRu; Andrew Capp, Amid court challenges, just 1% of 
impacted Ochsner staff rebuffs vax mandate, Lafayette Daily Advertiser (Dec. 2, 2021), 
https://perma.cc/ZR9R-ULT6. 
 

 
 
17 
to replace them.40 Both evidence and experience show, in other words, that a vaccine 
requirement is likely to cause little, if any, staffing shortages—and that any such shortages 
would be far outweighed by the benefits of the requirement. See App. for Stay at 31–34, No. 
21A240; App. for Stay at 33–34, No. 21A241. 
Finally, it should not be overlooked that vaccination reduces the opportunities for 
the virus to continue to mutate by reducing transmission and length of infection—meaning 
that vaccination could prevent future, more deadly, variants of COVID-19.41 This is 
particularly important in the case of medically fragile and immunosuppressed populations 
the CMS rule is designed to protect. Some scientists hypothesize that Omicron’s numerous 
mutations arose because the virus mutated significantly inside a single immune-suppressed 
person.42 The global concerns about the rapidly spreading Omicron variant serve as a timely 
reminder that vaccination is a critical tool that not only protects individual patient health 
and safety, but can prevent widescale social and economic disruption. 
 
40 Paul Stinson, Houston Methodist Fires Employees Who Snubbed Vaccine 
Mandate, Bloomberg Law (June 23, 2021), https://perma.cc/L4EV-FQRF; Bernard 
Condon & Matt Sedensky, Nursing home to workers: Get vaccine or lose your job, ABC 
News (Aug. 4, 2021), https://perma.cc/9EZT-6HWQ; Med Center Health, Statement (Sept. 
3, 2021), https://perma.cc/Y8EV-BSRH. 
 
41 See Ting-Yu Yeh & Gregory P. Contreras, Full vaccination against COVID-19 
suppresses SARS-CoV-2 delta variant and spike gene mutation frequencies and generates 
purifying selection pressure, medRxiv at 2 (preprint, posted Aug. 10, 2021), 
http://doi.org/10.1101/2021.08.08.21261768 (study of 16 countries finding that “the 
vaccination coverage rate is inversely correlated to the mutation frequency of the . . . 
SARS-CoV-2 delta variants”). 
 
42 See Sarah Wild, How the Omicron Variant Got So Many Scary Mutations So 
Quickly, Scientific American (Dec. 3, 2021), https://perma.cc/59MN-AXTU.   

 
 
18 
III. 
Ample evidence supports the Secretary’s determination that staff vaccination 
will provide critical protection for patients and healthcare workers. 
When Congress established the Medicare and Medicaid programs, it granted the 
Secretary of Health and Human Services express statutory authority to require that every 
Medicare- and Medicaid-participating facility meet such “requirements as the Secretary 
finds necessary in the interest of the health and safety of individuals who are furnished 
services in the institution.” 42 U.S.C. § 1395x(e)(9); see also, e.g., id. §§ 1395i-3(d)(4)(B), 
1396r(d)(4)(B). As explained above, the public-health evidence makes abundantly clear that 
the vaccination rule is necessary to protect patient health and safety. The virus that causes 
COVID-19 is highly transmissible and dangerous, and it is readily spread among healthcare 
workers and from healthcare workers to patients. 86 Fed. Reg. at 61,556-57. And 
unvaccinated healthcare workers in particular are highly susceptible to transmitting the 
virus to their colleagues and patients. Id. at 61,558 & n.42. Unvaccinated staff, therefore, 
pose a serious threat to Medicare and Medicaid patients—many of whom are more likely to 
face a high risk of developing severe disease and experiencing severe outcomes from 
COVID-19 infection. Id. at 61,566, 61,609. 
Given the evidence, the Secretary reasonably decided that the CMS vaccine rule was 
necessary to address the grave danger that COVID-19 poses to Medicare and Medicaid 
recipients, as well to as the efficient administration of the Medicare and Medicaid programs. 
And this decision falls well within the Secretary’s grant of authority. For decades, CMS has 
“established, maintained, and regularly updated extensive health and safety requirements 
. . . for Medicare- and Medicaid-certified providers and suppliers” that “focus a great deal 
on infection prevention and control standards.” 86 Fed. Reg. at 61,568. And healthcare 

 
 
19 
workers have long been required to receive vaccinations for infectious diseases like measles, 
rubella, mumps, among others. See id. at 61,567–68. As the Eleventh Circuit explained, 
“vaccination is a common-sense measure designed to prevent healthcare workers, whose 
job it is to improve patients’ health, from making them sicker.” State of Fla. v. Dep’t of 
Health & Hum. Servs., 19 F.4th 1271, 2021 WL 5768796, at *12 (11th Cir 2021). CMS 
determined that, in the case of COVID-19, merely offering vaccination to healthcare staff 
would be insufficient. See 86 Fed. Reg. 61,586. To protect against the spread of this rapidly 
transmitted virus, it was necessary to require vaccination. See id. at 61,559, 61,613–14. 
That determination warrants deference. As Chief Justice Roberts has recognized, 
the “precise question” of what restrictions should be imposed during “the pandemic is a 
dynamic and fact-intensive matter subject to reasonable disagreement.” S. Bay United 
Pentecostal Church v. Newsom, 140 S. Ct. 1613, 1613 (2020) (Roberts, C.J., concurring in 
denial of certiorari). Congress has entrusted CMS with the responsibility to protect the 
health and safety of Medicare and Medicaid patients, particularly when these high-risk 
populations face a novel and dangerous threat like COVID-19. Based on an extensive 
administrative record replete with public-health and scientific evidence showing that 
vaccination is the most effective tool to prevent COVID-19 transmission and infection in 
medical facilities, the agency issued its vaccination rule.  
Given this careful and deliberative process, CMS’s rule “should not be subject to 
second-guessing by an ‘unelected federal judiciary,’ which lacks the background, 
competence, and expertise to assess public health.” Id. at 1614. This Court has held that 
CMS “is comparatively expert in the statute’s subject matter,” and it has emphasized that 

 
 
20 
where the delegation provision of a statute is broad and general, “the agency’s expertise is 
relevant in determining its application,” Douglas v. Indep. Living Ctr. of S. Cal., Inc., 565 
U.S. 606, 614 (2012); see also Thorpe v. Hous. Auth. of Durham, 393 U.S. 268, 277 n.28 
(1969). Even more so when, as here, the agency adopted its rule to deal with “changing facts 
on the ground.” S. Bay United, 140 S. Ct. at 1614 (Roberts, C.J., concurring).  
And the facts on the ground continue to change. In just the last few weeks, countries 
around the world have again closed their borders and instituted lockdowns in response to 
the threat of a new, more transmissible COVID-19 variant. Cases are once again rising, and 
increased hospitalizations and deaths are likely to follow. The public-health evidence has 
uniformly concluded that vaccines are the primary way to protect against the rise and 
spread of such variants, and the threat they pose to our country’s most vulnerable 
populations. Because CMS’s vaccination rule appropriately reflects this overwhelming 
scientific consensus, this Court should uphold it.  
CONCLUSION 
The amici curiae respectfully request that this Court grant the stay applications. 
Respectfully submitted, 
 
DEEPAK GUPTA  
   Counsel of Record 
JOANNE GRACE L. DELA PEÑA 
GUPTA WESSLER PLLC 
2001 K Street, NW, Suite 850 North 
Washington, DC 20006 
(202) 888-1741 
deepak@guptawessler.com 
 
NEIL K. SAWHNEY 
GUPTA WESSLER PLLC 
100 Pine Street, Suite 1250 

 
 
21 
San Francisco, CA 94111 
 
Counsel for Amici Curiae 

 
 
App.1 
APPENDIX 
INSTITUTIONAL AMICI CURIAE 
 
American Public Health Association. APHA champions the health of all people 
and all communities; strengthens the profession of public health; shares the latest research 
and information; promotes best practices; and advocates for public health issues and 
policies grounded in scientific research. APHA represents more than 22,000 individual 
members and is the only organization that combines a nearly 150-year perspective, a broad-
based member community, and the ability to influence federal policy to improve the public’s 
health. 
 
Association of American Medical Colleges. AAMC is a nonprofit association 
dedicated to transforming health through medical education, health care, medical research, 
and community collaborations. Its members are all 155 accredited U.S. and 17 accredited 
Canadian medical schools; more than 400 teaching hospitals and health systems; and more 
than 70 academic societies. 
 
INDIVIDUAL AMICI CURIAE* 
 
Deans and Associate Deans 
1. 
Adnan A. Hyder, MD, MPH, PhD, Senior Associate Dean for Research, Professor, 
Department of Global Health, Director, Center on Commercial Determinants of 
Health, Milken Institute School of Public Health, The George Washington 
University 
2. 
Amy Lauren Fairchild, PhD, MPH, Dean and Professor of Health Services 
Management and Policy, College of Public Health, The Ohio State University 
3. 
Ana V. Diez Roux, MD, PhD, MPH, Dana and David Dornsife Dean, Dornsife 
School of Public Health, Drexel University 
4. 
Ayman El-Mohandes, MBBCh, MD, MPH, Dean, CUNY Graduate School of 
Public Health & Health Policy 
5. 
Barbara K. Rimer, DrPH, Dean, Alumni Distinguished Professor, UNC Gillings 
School of Global Public Health 
6. 
Boris D. Lushniak, MD, MPH, Dean, University of Maryland School of Public 
Health 
7. 
Cheryl Healton, DrPH, MPH, Dean and Professor of Public Health Policy and 
Management, NYU School of Global Public Health 
8. 
Edith A Parker, DrPH, MPH, Dean, University of Iowa College of Public Health 
9. 
Eric A. Feldman, JD, PhD, Deputy Dean for International Programs, Heimbold 
Professor of International Law, Professor of Medical Ethics & Health Policy, 
University of Pennsylvania Carey Law School 
 
* Amici listed here have joined this brief in their individual capacity only, and do not 
represent the interests of any institution with which they may be affiliated. 

 
 
App.2 
10. 
Eyal Oren, PhD, MS, Interim Director, Professor, Division of Epidemiology & 
Biostatistics, Core Investigator, Institute for Behavioral and Community Health, 
School of Public Health, San Diego State University   
11. 
James W. Curran, MD, MPH, Dean and Professor, Emory University Rollins 
School of Public Health 
12. 
Jane Hyatt Thorpe, JD, Sr. Associate Dean for Academic, Student and Faculty 
Affairs, Professor of Health Policy and Management, Milken Institute School of 
Public Health, The George Washington University 
13. 
John R. Finnegan, PhD, Professor and Dean, School of Public Health, University 
of Minnesota-Twin Cities 
14. 
Linda Forst, MD, MPH, Senior Associate Dean, School of Public Health, 
Professor, Environmental and Occupational Health Sciences, Attending Physician, 
Occupational Medicine, UlHealth, University of Illinois at Chicago 
15. 
Lynn R. Goldman, MD, MPH, MS, Michael and Lori Milken Dean of Public 
Health, Professor, Environmental and Occupational Health, Milken Institute 
School of Public Health, The George Washington University 
16. 
Megan L. Ranney, MD, MPH, FACEP, Professor of Emergency Medicine, Alpert 
Medical School, Associate Dean of Strategy and Innovation, School of Public 
Health, Brown University 
17. 
Michael G. Perri, PhD, Dean, College of Public Health and Health Professions, 
University of Florida 
18. 
Saad B. Omer, MBBS, MPH, PhD, FIDSA, Associate Dean, Global Health 
Research, Director, Yale Institute for Global Health, Professor of Medicine 
(Infectious Diseases), Yale School of Medicine, Susan Dwight Bliss Professor of 
Epidemiology of Microbial Diseases, Yale School of Public Health 
19. 
Sheldon D. Fields, PhD, RN, CRNP, FNP-BC, AACRN, FAANP, FNAP, FAAN, 
Associate Dean for Equity and Inclusion, Research Professor, Ross and Carol 
Nese College of Nursing, The Pennsylvania State University, First Vice President 
and Health Policy Chair, National Black Nurses Association 
20. 
Sherry Glied, PhD, Dean and Professor of Public Service, Robert F. Wagner 
Graduate School of Public Service, New York University 
21. 
Susan Klitzman, DrPH, MPH, CPH, Senior Associate Dean for Administration 
and Professor, CUNY Graduate School of Public Health and Health Policy 
22. 
Wayne H Giles, MD, MS, Dean and Professor, School of Public Health, University 
of Illinois at Chicago 
Academic Chairs 
1. 
Alexander M. Capron, LLB, MA (Hon.), University Professor, Scott H. Bice Chair 
in Healthcare Law, Policy, and Ethics, Gould School of Law, and Professor of 
Medicine and Law, Keck School of Medicine, University of Southern California 
2. 
Alexander J. Travis, VMD, PhD, Chair, Department of Public and Ecosystem 
Health, Director, Cornell University Master of Public Health Program, Professor 

 
 
App.3 
of Reproductive and Wildlife Conversation, Cornell Atkinson Center for 
Sustainability, Senior Faculty Fellow, Cornell University College of Veterinary 
Medicine 
3. 
Anne Markus, PhD, MHS, JD, Professor and Chair, Department of Health Policy 
and Management, Milken Institute School of Public Health, The George 
Washington University 
4. 
Anthony L. Schlaff, MD, MPH, Director, Public Health Program, Professor, 
Department of Public Health and Community Medicine, Tufts University School of 
Medicine 
5. 
Brian S. Schwartz, MD, MS, Professor of Environmental Health and Engineering, 
Epidemiology, and Medicine, Johns Hopkins Bloomberg School of Public Health   
6. 
Carrie A. Redlich, MD, MPH, Professor of Medicine, Occupational and 
Environmental Medicine and Pulmonary, Director, Yale Occupational and 
Environmental Medicine Program, Yale School of Medicine 
7. 
George Friedman-Jimenez, MD, DrPH, Director, Occupational Physician and 
Epidemiologist, Bellevue/NYU Occupational Environmental Medicine Clinic, 
Bellevue Hospital and NYU Grossman School of Medicine 
8. 
Heather Young, PhD, MPH, Professor and Vice Chair, Department of 
Epidemiology, Milken Institute School of Public Health, The George Washington 
University 
9. 
Jack Dennerlein, PhD, MS, Interim Chair, Department of Physical Therapy, 
Movement and Rehabilitation Sciences, Northeastern University, Professor, Bouvé 
College of Health Sciences, Northeastern University, Adjunct Professor of 
Ergonomics and Safety, Harvard T.H. Chan School of Public Health 
10. 
Jonathan Levy, ScD, Professor and Chair, Department of Environmental Health, 
Boston University School of Public Health 
11. 
Julia Zoe Beckerman, JD, MPH, Teaching Associate Professor and Vice Chair, 
Department of Health Policy and Management, Milken Institute School of Public 
Health, The George Washington University 
12. 
Lawrence O. Gostin, JD, LLD, LLD, University Professor, Founding O'Neill Chair 
in Global Health Law, Faculty Director, O'Neill Institute for National and Global 
Health Law, Director, World Health Organization Collaborating Center on 
National & Global Health Law, Georgetown Law School 
13. 
Mary-Katherine McNatt, DrPH, MPH, MCHES, CPH, COI, Chair and Associate 
Professor, Department of Public Health, A.T. Still University College of Graduate 
Health Studies 
14. 
Manya Magnus, PhD, MPH, Professor and Interim Chair, Department of 
Epidemiology, Milken Institute School of Public Health, The George Washington 
University 
15. 
Melissa Perry, ScD, MHS, Professor and Chair of Environmental and 
Occupational Health, The George Washington University 

 
 
App.4 
16. 
Michael E. Martell, PhD, Associate Professor and Chair, Economics, Bard College 
17. 
Robert M. Wachter, MD, Professor and Chair, Dept of Medicine, University of 
California, San Francisco 
18. 
Robert M. Weiler PhD, MPH, Senior Associate Dean for Academic Affairs and 
Professor, George Mason University Graduate Programs in Public Health 
Scholars 
1. 
Adam M. Finkel, ScD, CIH, Clinical Professor of Environmental Health Sciences, 
University of Michigan School of Public Health, Former Director of Health 
Standards, OSHA, Former Regional Administrator (VIII) 
2. 
Barbara H. Braffett, PhD, Associate Research Professor, Department of 
Epidemiology, Co-PI, DCCT/EDIC Data Coordinating Center, Co-I, TODAY 
Coordinating Center, The George Washington University 
3. 
Barry S. Levy, MD, MPH, Adjunct Professor of Public Health, Tufts University 
School of Medicine, Past President, APHA 
4. 
Beate Ritz, MD, PhD, Professor of Epidemiology, Environmental Health, and 
Neurology, Fielding School of Public Health and Geffen School of Medicine, UCLA 
5. 
Bernard D. Goldstein, MD, Professor Emeritus and Dean Emeritus, University of 
Pittsburgh Graduate School of Public Health 
6. 
Beth Rosenberg, ScD, MPH, Associate Professor, Department of Public Health 
and Community Medicine, Tufts University School of Medicine 
7. 
C. William Keck, Past President, APHA, Professor Emeritus, Department of 
Family and Community Medicine, Northeast Ohio Medical University 
8. 
Celeste Monforton, DrPH, MPH, Public Health Lecturer, Texas State University    
9. 
Christina S. Ho, JD, MPP, Professor of Law, Rutgers Law School 
10. 
Christopher T. Robertson, JD, PhD, MA, Professor of Law, Boston University 
School of Law 
11. 
Craig Slatin, ScD, MPH, Professor Emeritus, Zuckerberg College of Health 
Sciences, University of Massachusetts Lowell, Editor, New Solutions: A Journal of 
Environmental and Occupational Health Policy 
12. 
D. Douglas Blanke, JD, Robins, Kaplan Executive Director, Public Health Law 
Center, Mitchell Hamline School of Law 
13. 
David M. Cutler, PhD, Otto Eckstein Professor of Applied Economics, Faculty of 
Arts and Sciences, Harvard University 
14. 
David Diemert, MD, FRCP(C), Professor, Depts. of Medicine and Microbiology, 
Immunology & Tropical Medicine, The George Washington University School of 
Medicine & Health Sciences 
15. 
David Kriebel, ScD, Professor Emeritus, University of Massachusetts Lowell 
16. 
David Michaels, PhD, MPH, Professor, Department of Environmental and 
Occupational Health, Milken Institute School of Public Health, The George 
Washington University  

 
 
App.5 
17. 
David Ozonoff, MD, MPH, Professor Emeritus of Environmental Health, Boston 
University School of Public Health 
18. 
David Rosner, PhD, MPH, Lauterstein Professor and Co-Director, Center for the 
History and Ethics of Public Health, Mailman School of Public Health and 
Department of History, Columbia University 
19. 
David H. Wegman, MD, MSc, Professor Emeritus, Department of Work 
Environment, UMass Lowell, Adjunct Professor, Harvard School of Public Health 
20. 
Donald K. Milton, MD, DrPH, MPower Professor, Professor, Environmental and 
Occupational Health, School of Public Health, University of Maryland 
21. 
Donna E. Levin, JD, National Director, Network for Public Health Law 
22. 
Dorit Rubinstein Reiss, PhD, LLB, Professor of Law, UC Hastings College of Law 
23. 
Edward L. Baker MD, MPH, MSc, Former Assistant Surgeon General, RADM 
(ret), USPHS, Adjunct Professor, Harvard Chan School of Public Health, Adjunct 
Professor, UNC Gillings School of Global Public Health 
24. 
Emily A. Spieler, JD, Edwin W. Hadley Professor of Law, Northeastern 
University 
25. 
Eric Topol, MD, EVP and Professor, Molecular Medicine, Scripps Research, 
Founder and Director, Scripps Research Translational Institute 
26. 
Erica N. White, JD, Research Scholar, Center for Public Health Law and Policy, 
Sandra Day O’Connor College of Law, Arizona State University 
27. 
Gerald Markowitz, PhD, MA, Distinguished Professor of History, John Jay 
College of Criminal Justice and The Graduate Center, CUNY 
28. 
Gregory R. Wagner, MD, Adjunct Professor of Environmental Health, 
Department of Environmental Health, Harvard School of Public Health 
29. 
Heather Walter-McCabe, JD, MSW, Associate Professor, Wayne State University 
School of Law and School of Social Work 
30. 
Helene D. Gayle, MD, MPH, President and Chief Executive Officer, The Chicago 
Community Trust  
31. 
Henry Aaron, PhD, Bruce and Virginia MacLaury Chair, Senior Fellow, Economic 
Studies Program, Brookings Institution   
32. 
Hillary Nelson, PhD, MPH, Director, MPH Program, University of Pennsylvania 
33. 
James G. Hodge, Jr., JD, LLM, Peter Kiewit Foundation Professor of Law, 
Sandra Day O’Connor College of Law, Arizona State University 
34. 
James A. Merchant, MD, DrPH, Emeritus Professor of Medicine and Public 
Health, Emeritus Founding Dean, College of Public Health, University of Iowa 
35. 
Janet Dolgin, JD, PhD, Jack and Freda Dicker Distinguished Professor of Health 
Care Law, Maurice A. Deane School of Law at Hofstra University 
36. 
Janet Heinrich, DrPH, RN, FAAN, Research Professor, Department of Health 
Policy and Management, Milken Institute School of Public Health, The George 
Washington University 

 
 
App.6 
37. 
Jay Himmelstein, MD, MPH, Professor Emeritus, Population and Quantitative 
Health Sciences, UMass Chan Medical School 
38. 
Jeffrey Levi, PhD, Professor, Department of Health Policy and Management, 
Milken Institute School of Public Health, The George Washington University  
39. 
Jennifer L. Piatt, JD, Research Scholar, Center for Public Health Law and Policy, 
Sandra Day O’Connor College of Law, Arizona State University 
40. 
John Balmes, MD, Professor of Medicine Emeritus, University of California, San 
Francisco, Professor of Environmental Health Sciences Emeritus, University of 
California, Berkeley 
41. 
John P. Moore, PhD, Professor of Microbiology and Immunology, Weill Cornell 
Medical College, New York 
42. 
Jose L. Jimenez, PhD, Distinguished Professor of Chemistry, Fellow of CIRES, 
University of Colorado-Boulder 
43. 
Julia Raifman, ScD, Assistant Professor, Health Law, Policy, and Management, 
Boston University School of Public Health 
44. 
Karen B. Mulloy, DO, MSCH, Associate Professor, Case Western Reserve 
University School of Medicine 
45. 
Kari Hartwig, DrPH, MPH Program Director, Associate Professor, St. Catherine 
University 
46. 
Katherine Swartz, PhD, Professor of Health Economics and Policy, Harvard 
School of Public Health 
47. 
Kyle Steenland, PhD, PhD, MS, Professor, Department of Environmental Health, 
Rollins School of Public Health, Emory University 
48. 
Lance Gable, JD, MPH, Professor of Law, Wayne State University Law School 
49. 
Laura Hermer, JD, LLM, Professor of Law, Mitchell Hamline School of Law 
50. 
Laura Punnett, ScD, Professor, Department of Biomedical Engineering, Co-
Director, Center for the Promotion of Health in the New England Workplace, 
Senior Associate, Center for Women and Work, University of Massachusetts 
Lowell 
51. 
Lee S. Newman, MD, MA, FACOEM, FCCP, F. Colleg. Ramazzini, Distinguished 
University Professor and Center Director, Center for Health, Work and 
Environment, Department of Environmental and Occupational Health, 
Department of Epidemiology, Colorado School of Public Health, Department of 
Medicine, University of Colorado School of Medicine 
52. 
Leighton Ku, PhD, MPH, Professor and Director of the Center for Health Policy 
Research, Department of Health Policy and Management, Milken Institute School 
of Public Health, The George Washington University  
53. 
Leslie I. Boden, PhD, Professor, Boston University School of Public Health 
54. 
Linda S. Birnbaum, PhD, DABT, ATS, Scientist Emeritus and Former Director, 
National Institute of Environmental Health Sciences and National Toxicology 

 
 
App.7 
Program, Scholar in Residence, Nicholas School of the Environment, Duke 
University 
55. 
Linda C. Degutis, DrPH, MSN, Lecturer, Yale School of Public Health, Past 
President, APHA, Former Director, National Center for Injury Prevention and 
Control, CDC 
56. 
Linda C. Fentiman, JD, LLM, Professor of Law Emerita, Elisabeth Haub School 
of Law, Pace University 
57. 
Linda Rosenstock MD, MPH, Professor of Medicine and Public Health, UCLA, 
Former Director, NIOSH 
58. 
Lisa M. Carlson, MPH, MCHES, Past President, APHA, Executive Administrator, 
Research Administration, Emory School of Medicine 
59. 
Lisa C. Ikemoto, JD, LLM, Professor, University of California, Davis School of 
Law 
60. 
Magda Schaler-Haynes, JD, MPH, Adjunct Professor of Health Policy and 
Management, Mailman School of Public Health, Columbia University 
61. 
Marc Siegel, MD, Associate Professor of Medicine, Division Director, Infectious 
Diseases, The George Washington University School of Medicine and Health 
Sciences 
62. 
Marice Ashe, JD, MPH, Lecturer, University of California Berkeley Law 
63. 
Mark R. Cullen MD, Professor of Medicine and Biomedical Data Science, Stanford 
University (retired) 
64. 
Marsha Regenstein, PhD, Professor, Department of Health Policy and 
Management, Milken Institute School of Public Health, The George Washington 
University 
65. 
Martha Jean Schecter, JD, LLM, Attorney at Law 
66. 
Maureen Byrnes, MPA, Teaching Instructor, Department of Health Policy and 
Management, Milken Institute School of Public Health, The George Washington 
University 
67. 
Melissa A. McDiarmid, MD, MPH, DABT, Professor of Medicine and 
Epidemiology and Public Health, Director, Division of Occupational and 
Environmental Health, University of Maryland School of Medicine 
68. 
Michael Felsen, Former Regional Solicitor, US Department of Labor, Boston   
69. 
Michael T. Osterholm, PhD, MPH, Director, Center for Infectious Disease, 
Research and Policy, University of Minnesota 
70. 
Michael Silverstein, MD, MPH, Former Director of Policy, OSHA, US Department 
of Labor, Former Director, Washington State OSHA 
71. 
Michael S. Sinha, MD, JD, MPH, Adjunct Faculty, Northeastern University 
School of Law, Visiting Scholar, NUSL Center for Health Policy and Law 
72. 
Michael R. Ulrich, JD, MPH, Assistant Professor, Center for Health Law, Ethics, 
and Human Rights, Boston University School of Public Health, Boston University 
School of Law, Distinguished Visiting Scholar, Solomon Center for Health Law 
and Policy, Yale Law School 
73. 
Morgan Jones-Axtell, JD, Staff Attorney, Network for Public Health Law 

 
 
App.8 
74. 
Myron Allukian Jr., DDS, MPH, Past President, APHA 
75. 
Nadia N. Sawicki, JD, M. Bioeth., Georgia Reithal Professor of Law, Co-Director, 
Beazley Institute for Health Law and Policy, Loyola University Chicago School of 
Law 
76. 
Nancy Krieger, PhD, Professor of Social Epidemiology, American Cancer Society 
Clinical Research Professor, Harvard T.H. Chan School of Public Health 
77. 
Nicholas A. Ashford, PhD, JD, Professor of Technology and Policy, Massachusetts 
Institute of Technology 
78. 
Noah S. Seixas, PhD, MS, Professor Emeritus, Department of Environmental and 
Occupational Health Sciences, University of Washington, School of Public Health 
79. 
Oliver Fein, MD, Professor of Clinical Medicine Emeritus, Weill Cornell Medical 
College 
80. 
Oni Blackstock, MD, MHS, Founder and Executive Director, Health Justice 
81. 
Peter D. Jacobson, JD, MPH, Professor Emeritus of Health Law and Policy, 
University of Michigan School of Public Health 
82. 
Peter LaPuma, PhD, CIH, PE, Professor, Department of Environmental and 
Occupational Health, Milken Institute School of Public Health, The George 
Washington University 
83. 
Peter Shin, PhD, MPH, Associate Professor and Geiger Gibson-RCHN Research 
Director, Department of Health Policy and Management, Milken Institute School 
of Public Health, The George Washington University  
84. 
R. Alta Charo, JD, Knowles Professor Emerita of Law and Bioethics, University of 
Wisconsin, Madison 
85. 
Raphael J. Landovitz, MD, MSc, Professor of Medicine, UCLA Clinical AIDS 
Research and Education 
86. 
Renée M. Landers, JD, Professor of Law and Faculty Director, Health and 
Biomedical Law Concentration, Suffolk University Law School 
87. 
Richard Fairfax, Former Deputy Assistant Secretary, OSHA, US Department of 
Labor 
88. 
Richard Riegelman, MD, MPH, PhD, Professor of Epidemiology and Founding 
Dean, Milken Institute School of Public Health, The George Washington 
University 
89. 
Richard S. Saver, JD, Arch T. Allen Distinguished Professor, UNC School of Law, 
Professor (Secondary Appointment), UNC School of Medicine 
90. 
Robert I. Field, JD, MPH, PhD, Professor of Law and Professor of Health 
Management and Policy, Drexel University Thomas R. Kline School of Law and 
Dornsife School of Public Health 
91. 
Robert Harrison, MD, MPH, Clinical Professor of Medicine, Division of 
Occupational and Environmental Medicine, University of California San Francisco 

 
 
App.9 
92. 
Robyn R.M. Gershon, MHS, DrPH, Clinical Professor, Department of 
Epidemiology, Program Director, Early Career Research Development, New York 
University School of Global Public Health 
93. 
Rosemary K. Sokas, MD, MOH, Professor of Human Science and of Family 
Medicine, Georgetown University School of Nursing and Health Studies 
94. 
Sallie Thieme Sanford, JD, Associate Professor of Law, Adjunct Associate 
Professor of Health Systems and Population Health, University of Washington 
95. 
Sara Rosenbaum, JD, Harold and Jane Hirsh Professor, Health Law and Policy, 
Department of Health Policy and Management, Milken Institute School of Public 
Health, The George Washington University 
96. 
Sarah Henn, MD, MPH, Chief Health Officer, Whitman-Walker Health 
97. 
Scott Burris, JD, Professor and Director, Center for Public Health Law Research, 
Temple University Beasley School of Law 
98. 
Seth Trueger, MD, MPH, FACEP, Associate Professor of Emergency Medicine, 
Northwestern University, Feinberg School of Medicine, Emergency Physician, 
Northwestern Memorial Hospital, Digital Media Editor, JAMA Network Open 
99. 
Sheldon Krimsky, PhD, MS, Lenore Stern Professor of Humanities and Social 
Sciences, Adjunct Professor, Public Health and Community Medicine, Tufts 
University 
100. 
Sherry Baron, MD, MPH, Professor, Barry Commoner Center for Health and the 
Environment, Queens College, Affiliate Professor, Graduate School of Public 
Health and Health Policy, City University of New York 
101. 
Sonia M. Suter, JD, MS, The Kahan Family Research Professor of Law, Founding 
Director, Health Law Initiative, The George Washington University Law School 
102. 
Stacie Kershner, JD, Associate Director, Center for Law, Health and Society, 
Georgia State Law 
103. 
Steven Markowitz, MD, DrPH, Director and Professor, Barry Commoner Center 
for Health and the Environment, Queens College, City University of New York 
104. 
Susan S. Addiss, MPH, MUrS, Past President, APHA, Vice-Chair, Board of the 
East Shore Health District, Branford, CT 
105. 
Thomas Wm Mayo, JD, Professor of Law, Dedman School of Law, Southern 
Methodist University 
106. 
Vernellia R. Randall, JD, MSN, Professor Emerita of Law, The University of 
Dayton School of Law 
107. 
Wendy E. Parmet, JD, Matthews University Distinguished Professor of Law and 
Professor of Public Policy and Urban Affairs, Northeastern University  
108. 
William M. Sage, MD, JD, James R. Dougherty Chair for Faculty Excellence, School 
of Law, Professor of Surgery and Perioperative Care, Dell Medical School, The 
University of Texas at Austin

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