The Equal Employment Opportunity Commission’s (EEOC) revised COVID-19 Technical Assistance Q&A clarifies how employers should evaluate employee requests for exemptions from mandatory vaccination requirements based on medical needs. True medical exemption requests are relatively unusual and typically involve allergic reactions to ingredients found in the vaccines. According to the new Q&A, an employer can only decline such exemption requests under the Americans with Disabilities Act (ADA) when they can demonstrate a direct threat. This means that the employer must make a medical judgment that the unvaccinated employee’s presence in the workplace constitutes an imminent threat of death or serious illness to themselves or others. In order to make this assessment, the EEOC says that employers should conduct a careful assessment of the individual’s medical condition, along with current community spread conditions and the risks of exposure posed by the employee’s job tasks. The employer should also consider potential accommodations such as enhanced PPE or ventilation or allowing the employee to telecommute. This guidance does not apply to requests for religious exemptions from vaccination mandates. Unlike the ADA, Title VII allows employers to decline religious accommodation requests when they present more than a minor burden to the operation. This standard would not require the demonstration of an ADA direct threat.