On December 13, the U.S. Supreme Court declined to hear an appeal of a decision upholding New York state’s recent COVID-19 vaccine mandate for health care workers. The plaintiffs challenged the mandate based on its lack of any exception accounting for religious beliefs. They sought an emergency injunction from the court while they pursue their challenge to the rule. The Supreme Court rejected that request in a 6-3 vote. While the majority of justices did not issue an opinion setting forth their reasoning, Justice Neil Gorsuch wrote a dissent stating that New York’s governor had made statements about the mandate that evidenced her hostility toward certain religious beliefs, and that this was sufficient to enjoin the new rules until the case could be heard in full. This decision continues a string of judicial rulings upholding state-based vaccine mandates. The Supreme Court recently refused to hear a similar appeal of a Massachusetts health system’s vaccine requirements. These decisions may reflect long-standing precedent upholding the ability of state and local governments to impose mandatory vaccination requirements.