Soldiers who refuse to be immunized against the deadly disease will be either dismissed or temporarily suspended, the U.S. Army warned on Sept. 14.

A mandate has been in place since late August to meet a mid-December deadline to fully vaccinate all active duty personnel. Anyone who fails comply, and cannot produce a valid exemption, could face questioning from superiors, harsh penalties, and even loss of income.

Commanders, command sergeants major, first sergeants, and officers in command select list positions could be relieved of duty for violating the rule.

“This is quite literally a matter of life and death for our soldiers, their families and the communities in which we live,” U.S. Army Surgeon General Raymond Scott Dingle said in a statement obtained by Reuters.

The remarks came after Defense Secretary Lloyd Austin ordered all active duty service members to receive the jab on Aug. 24.

“Mandatory vaccinations are familiar to all of our service members, and mission-critical inoculation is almost as old as the U.S. military itself,” he said in a memo.

The U.S. Food and Drug Administration fully authorized the Pfizer vaccine.

“Our administration of safe, effective COVID-19 vaccines has produced admirable results to date, and I know the Department of Defense will come together to finish the job, with urgency, professionalism, and compassion,” Austin said.

The department recently recorded more than 353,000 COVID-19 cases and over 450 fatalities among employees.

The Biden administration and federal health agencies have pushed for more vaccination to minimize the virus’s impact, especially during the Delta wave.

Common reasons for refusing the vaccine include its experimental nature, side effects, and clinical testing on fetal cell lines sourced from aborted babies. However, religious, medical complications, and administrative grounds were the only accepted grounds for exemption at the time of publication.