Key Points

  • The Seventh Circuit held that Cook County's affidavits from HR, EEO, and infection control officials—citing CDC guidance and outbreak history—were sufficient to show undue hardship under the Groff standard.
  • The pharmacist provided no evidence that her proposed accommodation of masking and distancing was a reasonable alternative to vaccination.
  • The court rejected the plaintiff's comparator argument because the county did not know the Sanitarian I employee was unvaccinated (she was in a blind trial) and enforced compliance once it learned she might not be vaccinated.
  • The dissent argued the county's evidence was too conclusory and that Sanitarian I's year-long non-compliance without discipline undermined the county's claim that unvaccinated employees posed an unacceptable safety risk.
  • The majority noted the county could have provided expert testimony and a roster of alternative positions, signaling what stronger undue-hardship evidence would look like.

The Seventh Circuit affirmed summary judgment for Cook County on Monday, holding that the county's COVID-19 vaccination mandate did not violate Title VII when it fired a hospital pharmacist who refused the shot on religious grounds and offered no evidence that masking and social distancing would have been a reasonable substitute.

The 2-1 decision in Mason v. Cook County is the first time the Seventh Circuit has addressed when summary judgment is appropriate on the undue-hardship question in a pandemic-era vaccine case. Judge Lee, writing for the majority, concluded that declarations from the county's human resources, equal employment opportunity, and infection control officials—grounded in CDC guidance and the hospital system's own outbreak experience—were enough to meet the employer's burden under the Supreme Court's 2023 Groff v. DeJoy standard.

Brooke Mason had worked as a pharmacist at John H. Stroger Jr. Hospital in Chicago from 2010 until Cook County Health fired her in May 2022. She worked in a room with twenty other pharmacists and forty pharmacy technicians, counseled patients at a pharmacy window one day per month, and occasionally delivered medications to the floor where COVID-19 patients were treated.

When Cook County implemented its vaccine mandate in August 2021, Mason sought a religious exemption, citing 1 Corinthians 6:19 and explaining that her beliefs included the requirement to keep her body and soul pure. The county denied her request, informing her it could not accommodate her because doing so would compromise workplace safety and pose an undue hardship. The county gave her 90 days to find a remote position within the system; none was available, and the county terminated her for gross insubordination.

Judge Lee wrote that the county made an adequate showing that accommodating Mason could not be accomplished without undue hardship. At summary judgment, the county provided declarations from its Associate Chief Human Resources Officer, Equal Employment Opportunity Director, and Department Chair of Infection Control and Epidemiology. According to those officials, the county's experiences in 2020 and 2021 showed that healthcare workers faced elevated risk of both contracting COVID-19 and infecting medically vulnerable patients.

The majority distinguished the case from Groff, where a postal worker's Sabbath observance conflicted with Sunday mail delivery, and from EEOC v. Abercrombie & Fitch, where a job applicant's religious headscarf conflicted with a no-headwear policy. Mason, by contrast, worked in a hospital. She "not only worked in the same room with numerous other pharmacists and technicians, but, as a pharmacist, she regularly interacted with patients and visited patient floors, where the risks and consequences of spreading the COVID-19 virus were high," Judge Lee wrote.

The court acknowledged that the county could have done more. It could have offered expert testimony comparing individual masking to universal vaccination, Judge Lee wrote. And "it could have recounted in detail the analytical steps it took to arrive at this conclusion as well as, perhaps, a roster of the different positions at the hospital where an employee with Mason's qualifications could work."

But Mason's side of the ledger was barren. She "provided no evidence that her proposed accommodation (continuing to mask and social distance) would have been a reasonable alternative to vaccination," the court found. She did not contest that vaccination was more effective than masking, that she worked in a room with sixty other employees, that she counseled patients directly, or that she delivered medication to the COVID-19 treatment floor.

Mason had pointed to another Cook County employee, identified only as Sanitarian I, who she said violated the vaccine policy but was not fired. The majority rejected the comparison. Sanitarian I had been participating in a blind vaccine trial and did not know whether she had received the vaccine or a placebo. The county did not know Sanitarian I was unvaccinated, Judge Lee explained—at least one person at the county was aware only that the employee had received either the vaccine or a placebo as part of her study participation. Once human resources realized the employee might not be in compliance, the county required her to unblind her study and obtain the vaccine.

The court also affirmed summary judgment on Mason's disparate treatment claim, finding that Sanitarian I was not a valid comparator because the two employees had "completely different jobs, in different locations, with different supervisors." Mason worked as a pharmacist at Stroger Hospital in Chicago, while Sanitarian I worked for the Department of Public Health in Rolling Meadows, Illinois.

Judge Taibleson dissented, arguing that the case should have gone to a jury. She wrote that the county had explained why it adopted a vaccination mandate but had not proven that granting an exception for Mason specifically would have been unduly burdensome.

The dissent found the county's affidavits too conclusory. The three declarations totaled fifteen pages and were "at times repetitive; several paragraphs are copied and pasted almost verbatim into more than one affidavit," Judge Taibleson wrote. Quoting a recent Ninth Circuit decision, she wrote that "[a]ssertions of undue hardship are not enough" and that there must instead be "a showing—with facts and evidence—of what the costs on the employer are."

Judge Taibleson noted that of Cook County Health's nearly 6,000 employees, only 102 submitted religious exemption requests, and just nine—all fully remote workers—received them. The county made "no effort to quantify the burden of accommodating the remaining 93 religious employees," she wrote.

The dissent found the Sanitarian I evidence particularly troubling. "For a year, CCH knew that Sanitarian I had violated its vaccination policy by failing to provide proof of an approved vaccine," Judge Taibleson wrote. "CCH fired Mason in May of 2022—at which point, CCH had yet to even follow up with Sanitarian I about her vaccination status." Sanitarian I remained employed and unvaccinated for five more months after Mason's termination and faced no apparent discipline.

Judge Taibleson also contrasted the record with other circuit decisions upholding vaccine-mandate summary judgments. In Peterson v. Snohomish Regional Fire and Rescue, the Ninth Circuit had before it an expert's "extensive declaration" about firefighters' work conditions, evidence that nearly one quarter of the force had requested accommodations, and proof that the employer's insurer would deny coverage for any COVID-19 transmission suit involving an unvaccinated employee. "If cases like Petersen set the bar for an undue-hardship showing, then the County has fallen far short here," Judge Taibleson wrote.

Title VII, the dissent concluded, "has no exceptions for hospitals or pandemics, and the County's hand-waving about COVID-19's challenges cannot substitute for actual evidence that accommodating Mason would have been an undue hardship."

The panel consisted of Judges Jackson-Akiwumi, Lee, and Taibleson. The case was argued June 2, 2026. Mason's counsel and the county's attorneys were not identified in the opinion.

The decision leaves intact the district court's grant of summary judgment by Judge Matthew F. Kennelly of the Northern District of Illinois.