Army leadership has been eyeing the possibility of a mandated COVID-19 vaccine this summer, including in a June information paper originating from the Army’s health care operations directorate that discusses how to deal with vaccine refusals.

Now that the Food and Drug Administration has fully approved the Pfizer vaccine, the Pentagon is moving for full vaccination of service members. The Army has fully vaccinated about 40 percent of its roughly 1 million soldiers — 57 percent when partial vaccinations are considered.

That leaves a sizable chunk of the service’s personnel unvaccinated, some of whom have expressed a reluctance to get the vaccine even after it becomes mandatory. But the Army already has regulations on the books that deal with involuntary immunization, as well as religious and medical exemptions.

Those regulations were reiterated in an information paper dated June 13, and obtained by Army Times, which lays out how immunizations required by AR 40-562, or other legal directives, may be given involuntarily.

Though the paper does not mention COVID-19 by name, Army planners were beginning preparations for a mandatory vaccine rollout around that same timeframe.

On Wednesday, Army Headquarters also issued an execute order to the force that said “the processing of service member exceptions, exemptions and refusals of the mandatory COVID-19 vaccination are forthcoming and will be address[ed] in a later [order].” Army Times located screenshots of the order on social media.

Involuntary vaccines amid an ‘imminent threat’

The information paper, “Vaccine Refusal and Exemption Procedures,” was authored by the service’s director of healthcare operations, Col. Dubray Kinney Sr., and approved by Brig. Gen. Wendy Harter, Army Medical Command’s deputy chief of staff overseeing planning and operations.

The document says commanders can order refusing soldiers under their court-martial authority to receive “involuntary vaccinations” when “conditions of imminent threat exist (where the threat of naturally occurring disease or use of biological weapons is reasonably possible).”

The information paper, which is not binding, says it is intended “to inform leaders on immunization responsibilities, procedures for exemptions, exemption categories, and procedures for dealing with Soldier vaccine refusals.”

The regulations it summarizes and clarifies were in force before the COVID-19 vaccines were even developed. Still, the paper is a rare, direct glimpse into how senior medical planners understand the service’s existing regulations for administering the nine vaccines it already mandates to all troops.

One line in the information paper that will likely raise eyebrows says, “unit personnel will only use the amount of force necessary to assist medical personnel in administering the immunization.” But, again, that is not new. It reflects language already found in AR 600-20, Army Command Policy.

Kinney deferred comment on the document to Army public affairs at the Pentagon.

Army spokesman Lt. Col. Gabriel Ramirez confirmed the document’s authenticity. He did not answer a question seeking clarification on what types of force are authorized in administering involuntary vaccines, nor did he answer a question concerning whether COVID-19 meets the “imminent threat” standard for involuntary immunization.

Involuntary vaccinations can only occur after extensive verbal and written counseling from a refusing soldier’s commander, the paper explains. The counselings include discussion about possible legal action for continued vaccine refusal.

Army Times could not locate any examples of physically forced administration of the anthrax vaccine, which anti-mandate activists have considered to be a parallel for the COVID-19 vaccine debate.

But the analogy isn’t perfect.

The legal reasoning for making the anthrax vaccine mandatory was flawed, judges ultimately ruled — the Food and Drug Administration never even gave it a true emergency use authorization before the military first mandated it, much less the full seal of approval that the agency gave the COVID-19 vaccine. However, that didn’t stop the military from pursuing courts-martial and other administrative action against troops who refused the anthrax shots.

Religious, medical and administrative exemptions

As the regulations currently stand, religious exemptions may be a high bar to meet.

According to AR 600-20, the service’s surgeon general, Lt. Gen. R. Scott Dingle, is the approval authority for all religious accommodation requests, Kinney explains in the paper.

And before such requests reach Dingle’s level, unit chaplains must interview requesters and “provide a memorandum that summarizes this interview and addresses the religious basis and sincerity of the Soldier’s request,” according to the paper. In addition to the religious sincerity interview, “a licensed healthcare provider” must counsel religious objectors as well.

Finally the soldier’s “immediate commander” must sit down with them and explain “that noncompliance with immunization requirements may adversely impact deployability, assignment, or international travel, and that the exemption may be revoked under imminent risk conditions,” according to Kinney.

The commander also recommends approval or denial of the religious accommodation request, which is routed up the chain of command to Dingle.

Even if the surgeon general approves the request, “religious exemptions may be revoked in the case of an imminent risk of exposure to a disease for which an immunization is available,” according to Kinney’s synopsis of the regulation. It was not immediately clear where in the chain of command revocation authority lies, and Army spokesperson Ramirez did not answer a question seeking clarification on the matter.

Personnel separating or retiring from the Army within 180 days are exempt from mandatory vaccines if they contact their commanders, produce an approved separation or retirement order, and request exemption, Kinney explains in the paper, with a handful of exceptions.

Troops transitioning from the active component to the Army National Guard or Army Reserve must still receive all of their mandated shots, for example.

Army civilians and contractors are governed by different procedures for requesting exemption.

In narrow circumstances, troops can receive medical exemptions from the vaccine, too, Kinney summarized from AR 40-562.

“General examples” of medical exemptions include “underlying health condition[s]” such as previous adverse responses to immunization, immune system issues or pregnancy; or evidence of natural immunity.

But it’s not clear yet whether the natural immunity exemption will apply to the COVID-19 vaccine. A frequently asked questions document from the Centers for Disease Control urges even people who previously had COVID-19 to still get the shot.

The overarching theme of the regulations is the Army’s desire to obtain informed, if reluctant, consent before resorting to adverse action or — if authorized — involuntary vaccinations.

But in a misinformation-heavy environment, some troops will undoubtedly dig in their heels and refuse the vaccine in spite of the mandate for what they sincerely believe to be legitimate reasons.

Pentagon officials insist that the vaccines are safe, citing FDA and CDC guidance.

“These efforts ensure the safety of our service members and promote the readiness of our force, not to mention the health and safety of the communities around the country in which we live,” said Pentagon spokesperson John Kirby in his Monday briefing.

Davis Winkie covers the Army for Military Times. He studied history at Vanderbilt and UNC-Chapel Hill, and served five years in the Army Guard. His investigations earned the Society of Professional Journalists' 2023 Sunshine Award and consecutive Military Reporters and Editors honors, among others. Davis was also a 2022 Livingston Awards finalist.

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