In this report, the authors examine how the Department of Defense (DoD) coronavirus disease 2019 (COVID-19) vaccination program was developed and implemented, determine how previous DoD vaccination programs influenced those decisions, and identify opportunities to strengthen the department's vaccination program, particularly against emerging infectious diseases, such as COVID-19.

Examining New Approaches for Implementing Vaccine Mandates Within the Department of Defense

How Lessons Learned from COVID-19 Vaccine Mandates Could Improve Future Vaccination Campaigns

Daniel M. Gerstein, Trupti Brahmbhatt, Samantha Cherney, Kristie L. Gore

ResearchPublished May 30, 2023

The U.S. military has a long history of vaccinating service members against infectious disease as a military necessity to protect soldiers and contribute to the overall mission readiness of the force. The coronavirus disease 2019 (COVID-19) pandemic has once again demonstrated the importance of the health and readiness of the force.

In this report, the authors examine how the Department of Defense (DoD) COVID-19 vaccination program was developed and implemented, determine how previous DoD vaccination programs influenced those decisions, and identify opportunities to strengthen the department's vaccination program, particularly against emerging infectious diseases, such as COVID-19. They examine the laws and policies that guide the overall DoD vaccination program, study lessons learned from other DoD vaccination programs, and determine the policies for handling medical and administrative (including religious) exemptions.

The authors also created an exploratory framework for considering vaccine acceptability — including the key attributes of a vaccination campaign — which could provide an important basis for thinking about how to manage future DoD vaccination campaigns.

Key Takeaways

  • DoD has a well-founded and well-documented vaccination program that dates to the earliest times of U.S. military history.
  • Decisions about DoD vaccine policies regarding COVID-19 were inextricably linked with and dependent on the broader U.S. guidance that came from civilian authorities, such as the Department of Health and Human Services, Centers for Disease Control and Prevention, and Food and Drug Administration.
  • The two primary drivers for all DoD decisions were force health protection and mission readiness.
  • Comparing three DoD mandatory vaccine programs — for smallpox, anthrax, and COVID-19 — demonstrates that perceptions can contribute positively or negatively to the acceptability of mandatory vaccines.
  • A RAND-developed exploratory framework provides six key attributes for consideration in establishing a mandatory vaccine policy: (1) approval status of vaccine, (2) targeting groups for vaccines, (3) consistent messaging, (4) confidence in the technology, (5) disinformation surrounding the vaccine, and (6) perceived care in making decisions about mandates.

Recommendations

  • DoD should develop a department-wide tracking mechanism for vaccinations. Although a decentralized approach to implementing the vaccine programs across the military services provides flexibility in how the services manage their workforce, operational readiness, and force health protection, having a consolidated, department-wide view of the status of vaccinations would be useful.
  • DoD should employ a structured framework for development and implementation of future vaccination campaign plans. The exploratory framework provided in this report could provide the basis for such a structured approach.
  • For future vaccination campaigns, DoD should seek to prioritize timely, accurate strategic communications based on factual information. Although this messaging did occur for the COVID-19 vaccine, additional emphasis could lead to improved understanding of the vaccine and, ultimately, its acceptance across the force. Such communications could also be targeted to particular populations, such as the U.S. Army National Guard and Reserves, that have demonstrated less willingness to get the vaccines.

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Gerstein, Daniel M., Trupti Brahmbhatt, Samantha Cherney, and Kristie L. Gore, Examining New Approaches for Implementing Vaccine Mandates Within the Department of Defense: How Lessons Learned from COVID-19 Vaccine Mandates Could Improve Future Vaccination Campaigns. Santa Monica, CA: RAND Corporation, 2023. https://www.rand.org/pubs/research_reports/RRA1829-1.html.
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The research described in this report was prepared for the Department of Defense (DoD) and conducted within the Forces and Resources Policy Program of the RAND National Security Research Division.

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