The Supreme Court on Monday refused to stop the COVID-19 vaccine request for New York medical staff, which does not provide an exemption for religious reasons.

The court took action on urgent appeals from doctors, nurses and other medical workers who said they were forced to choose between work and religion.

As is typical in such appeals, the court did not explain its order, although it also refused to obstruct vaccine authorization elsewhere.

Justices Neil Gorsuch, Clarence Thomas, and Samuel Alito disagree. “Thousands of New York health care workers now face losing their jobs and eligibility for unemployment benefits,” Gorsuch wrote in a 14-page opinion joined by Alito.

With the exception of Maine and Rhode Island, New York is one of only three states that do not accept medical staff who oppose vaccination for religious reasons.

The court had previously rejected medical workers in Maine, who raised similar challenges, and the same three judges held different opinions.

The state told the High Court that as of October 19, approximately 90% of health care workers had been vaccinated, and most of the remaining people had received one of two doses. The state stated that less than 2% of nursing homes, adult care facilities and hospital staff seek religious exemptions.

In his dissent, Gorsuch linked the medical staff with schoolchildren of Jehovah’s Witnesses during World War II who refused to stand up for the pledge of allegiance and salute the American flag for religious reasons.

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When a public school in Pennsylvania expelled the child, the court initially refused to intervene. But three years later, the judge rejected the earlier case in a landmark decision that declared that the school cannot force students to salute the national flag or recite oaths.

“Today, our country is not facing a world war, but an epidemic. However, just like war, epidemics often produce new harsh social rules designed to protect collective interests—and these rules may bring conflicts. Personal fear and anger that cannot be observed due to religious reasons,” Gorsuch wrote.