►Vaccine Safety ►Vaccine Boosters ►Vaccine Benefits ►Vaccine Availability/Getting the Shot ►Guidance for Employers: Vaccine Mandate ►Strategies for Employers ►Messaging for Health Care Workers ►Messaging for Different Demographics ►Resources ►Downloadable Print Resources (CDC)
Updated December 17, 2021
ACOEM continues to follow the latest information related to COVID-19 and will update as necessary.
COVID-19 Vaccine Safety
- COVID-19 vaccines are safe and continue to be effective at preventing severe illness, hospitalizations, and deaths. The process to develop the vaccines was systematic with each U.S. vaccine undergoing rigorous clinical trials – no steps were skipped or overlooked.
- On August 23, 2021, the FDA granted full approval to the Pfizer-BioNTech COVID-19 vaccine for individuals aged 16 years and older (marketed now as Comirnaty).1 For full approval of a new drug, the FDA requires extensive data on safety and effectiveness, inspection of manufacturing facilities, and a comprehensive review of all clinical and “real-world” use. The vaccine also continues to be available under emergency use authorization (EUA), for individuals 5 thru 15 years of age and for the administration of a third (booster) dose.
- On December 16, 2021, the CDC endorsed the updated recommendations made by the Advisory Committee on Immunization Practices (ACIP) to preferentially recommend the use of mRNA vaccines over the Johnson & Johnson/Janssen vaccine. While the Johnson & Johnson/Janssen vaccine remains quite safe and effective, very rare but potentially fatal adverse events related to blood clotting in the brain make mRNA vaccines an even safer option. Given the available supply of mRNA vaccines, these should be used primarily, with the Johnson & Johnson/Janssen vaccine reserved for individuals who are unable to take a mRNA vaccine due to medical contraindications or local supply constraints.
1. U.S. Food and Drug Administration. FDA Approves First COVID-19 Vaccine. Available at: https://www.fda.gov/news-events/press-announcements/fda-approves-first-covid-19-vaccine.
Back to top
COVID-19 Vaccine Boosters
Back to top
- CDC now recommends that individuals who are 18 years and older who received the Pfizer-BioNTech or Moderna two-dose COVID-19 vaccine also receive a booster dose at least 6 months past their second dose. CDC also recommends that 16- and 17-year-olds receive a booster dose of Pfizer/BioNTech Covid-19 vaccine six months after their second dose. For individuals who received the Johnson & Johnson/Janssen COVID-19 vaccine, a second dose is recommended for those who are 18 years and older who were vaccinated two or more months ago.
- Eligible individuals may choose which vaccine they receive as a booster dose. The CDC now allows for a booster shot that is not the same type as the initial vaccination(s).
COVID-19 Vaccine Benefits
- Receiving a COVID-19 vaccine is a safe way to build protection against the disease. COVID-19 can have serious, life-threatening complications, and there is no way to know how COVID-19 will affect you. COVID-19 vaccinations can help protect you by teaching your body to fight the virus without having to experience sickness or putting yourself at increased risk of severe illness.
- Currently, all COVID-19 vaccines authorized in the U.S. have proven to be highly effective against COVID-19, preventing severe disease, hospitalization, and death.2 Data show that the mRNA vaccines (Pfizer-BioNTech or Moderna) also provide significant protection against variants of the virus, including the Delta strain.3 Scientists are still learning more about the latest variant, Omicron, but current vaccines are expected to protect against severe illness, hospitalizations, and deaths due to infection with this variant.4,5 While current data suggest lower vaccine effectiveness against infection and symptomatic disease caused by the variants, the breakthrough infections in those fully vaccinated are associated with far fewer hospitalizations and deaths.
- If you remain unvaccinated, you and your family may be at risk of serious lifelong complications from COVID-19 infection. Vaccination can prevent regret and fear that someone you love will die from COVID-19, such as from transmitting it between family members.
- Getting back the moments we miss – being able to visit family and friends, gathering indoors at a favorite restaurant, celebrating birthdays and holidays, traveling, returning children to school-- are all the things we have missed. We can resume these moments when we take simple actions, such as getting vaccinated, to keep ourselves, families, and communities safe.
- Fully vaccinated individuals may participate in many activities that they participated in prior to the pandemic but for some of these activities, they may have to resume masking based on state and local ordinances.
Back to top
2. Scobie HM, Johnson AG, Suthar AB, et al. Monitoring Incidence of COVID-19 Cases, Hospitalizations, and Deaths, by Vaccination Status — 13 U.S. Jurisdictions, April 4–July 17, 2021. MMWR Morb Mortal Wkly Rep. 2021;70:1284–1290. DOI: http://dx.doi.org/10.15585/mmwr.mm7037e1external icon.
3. Bernal JL, Andrews N, Gower C, et al. Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant. New Engl J Med. 2021;385(7):585-594. Available at: https://www.nejm.org/doi/full/10.1056/nejmoa2108891.
4. Centers for Disease Control and Prevention. Omicron Variant: What You Need to Know. December 15, 2021. Available at: https://www.cdc.gov/coronavirus/2019-ncov/variants/omicron-variant.html.
5. Pfizer. Pfizer and BioNTech Provide Update on Omicron Variant. December 8, 2021. Available at: https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-provide-update-omicron-variant.
COVID-19 Vaccine Availability and Getting the Shot
Back to top
- Individuals aged 5 years and older are eligible to receive the vaccine.
- Vaccine supply is plentiful and is available in doctors’ offices, retail pharmacies, hospitals, and clinics.
- Prior to receiving the vaccine, you will be screened for any contraindications.
- There may be minor side effects from the vaccine (fatigue, sore arm, mild fever, headache, body/muscle aches). You should expect to be monitored for 15-30 minutes after the vaccination to watch for rare severe reactions. Though rare, allergic reactions, including anaphylaxis, have been reported. If this occurs, vaccination providers can effectively and immediately treat anaphylaxis. If you have concerns about your medical condition(s) and receiving the vaccine, consult with your doctor.
- If there is more than one type of vaccine available, your specific circumstances (e.g., availability for a second vaccination due to work schedules) may be taken into consideration.
Guidance for Employers Overseeing Mandatory Vaccination
On November 5, 2021, OSHA published its COVID-19 Vaccination and Testing Emergency Temporary Standard (ETS).6
The ETS would:
- Mandate all employers with more than 100 workers to require vaccination or weekly testing for COVID-19, and
- Require these employers to offer employees paid time off for vaccination and recovery from possible side effects.
On November 12, 2021, the U.S. Court of Appeals for the Fifth Circuit granted a motion to stay the ETS and ordered that OSHA take no steps to implement or enforce the ETS until further court order. The U.S. Court of Appeals for the Sixth Circuit now has jurisdiction over ETS challenges, and the Department of Labor has filed a motion to lift the stay. On December 17, 2021, the U.S. Court of Appeals for the Sixth Circuit dissolved the Fifth Circuit’s stay of the ETS allowing OSHA to implement this workplace health standard once again.
On November 5, 2021, the Centers for Medicare & Medicaid Services also published the Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule (CMS Rule).7
Under this rule, facilities regulated under the Medicare Conditions of Participation (CoPs) must have a process or plan for:
- Vaccinating all eligible staff (regardless of clinical responsibility or patient contact),
- Providing exemptions and accommodations for those who are exempt, and
- Tracking and documenting staff vaccinations.
On November 29, 2021, a federal judge blocked the rule for COVID-19 vaccines for health care workers in 10 states; however, a second judge in another case expanded this prohibition nationwide.
ACOEM provides the following guidance to assist employers in implementing the requirements under the ETS and CMS Rule if/when they go into effect. Employers must meet the requirements in both the ETS and CMS Rule, but they can also choose to exceed the requirements. It is important to also check with your current local and state recommendations.
Under the OSHA ETS, exemptions are not addressed. It is the employee’s choice to either vaccinate or test weekly. Employers could exceed the OSHA ETS if they could appropriately vet medical and religious exemptions.
Not under the purview of occupational and environmental medicine. These are usually addressed by human resources and legal departments.
There are very few medical conditions that qualify someone for an exemption from receiving the COVID-19 vaccine. Medical exemptions require a medical provider to attest that the employee has one of the contraindications identified by the CDC to the vaccine. Permanent or temporary exemptions may be allowed for employees under the following situations.
- Serious allergic reaction to COVID-19 vaccine
- Serious allergic reaction to component of COVID-19 vaccine (may be able to take other vaccine)
- Serious adverse effect to the first COVID-19 vaccine of a 2-dose vaccination series (e.g., myocarditis)8
- Wait 90 days post monoclonal antibody infusion
- Wait until out of isolation from a current COVID-19 infection9
- Under the Equal Employment Opportunity Commission (EEOC), an employer is allowed to ask an employee’s vaccination status.
- Request for a medical exemption should be documented in a form with attestation from a medical provider.
- Request for medical exemption should be treated as protected health information (PHI), managed, and recorded at the human resource level.
- Employee’s personal health information should be blinded when a medical exemption is requested.
How will the employer need to interface with the occupational medicine physician to ensure that record keeping is done correctly and within compliance (e.g., HIPAA, OSHA, etc.)?
Back to top
The employer should ensure they are following proper HIPAA procedures. It is important to confirm the status of the organization to know whether or not they are a HIPAA covered entity. For employers who are not considered a HIPAA compliant entity, then the HIPAA laws do not apply. Defer to state laws as it pertains to workers’ compensation, e.g., if the vaccine is mandated by the employer.
The employer should be educated in advance regarding the acceptable medical conditions that might qualify for an exemption. As stated above, possible medical exemptions include: (1) serious allergic reaction to COVID-19 vaccine, (2) serious allergic reaction to component of COVID-19 vaccine (may take other vaccine) (e.g., if you are allergic to PEG, you should not get an mRNA COVID-19 vaccine, if you are allergic to polysorbate, you should not get the Johnson & Johnson/Janssen COVID-19 vaccine), (3) serious adverse effect to the first COVID-19 vaccine of a 2-dose vaccination series (e.g., myocarditis),8
(4) 90 days post monoclonal antibody infusion, and (5) waiting until out of isolation from a current COVID-19 infection.
What are the testing requirements in lieu of vaccination?
: Asymptomatic employees granted a medical or religious exemption are required to test once a week. Weekly testing does not apply to employees working remotely or only outside.
: Asymptomatic employees granted a medical or religious exemption are not required to test. Testing post-exposure should follow current guidelines.
In addition, federal workers and federal contractors are also required to test once a week.
What test is appropriate for weekly testing of an employee in lieu of vaccination?
For those that need to be tested, PCR testing is more sensitive and thus should be preferred for post exposure or symptomatic tests. Antigen testing is adequate for asymptomatic individuals who have not been exposed, but PCR testing is also reasonable for those lower risk tests.
Who can administer COVID-19 tests?
Employers should consult with local public health professionals to determine which type of testing should be used. Medical professionals or employee under direct observation of a medical professional can administer COVID-19 tests. Self-tests have also been approved by CDC, results are reported to healthcare provider or local/state health department (https://www.cdc.gov/coronavirus/2019-ncov/testing/self-testing.html
). If home testing is used, it is recommended to conduct a video observation to track compliance. PCR confirmation is preferred due to the risk of false negatives or testing too early in the infection.
Will the mandatory testing be the responsibility of the employer or employee?
Under the OSHA ETS, companies are not required to pay for the mandatory weekly testing. Some companies will require the employees to take responsibility to get the testing while other companies will set up sites for the employees to get tested. There are a variety of ways employers can meet the mandate. Large employers such as hospitals may utilize existing resources and acute care centers. Other employers may utilize resources in the community.
When should you require unvaccinated remote employees to test?
: Remote employees do not need to test unless they are expected to be onsite.
: There is no mandatory testing for any employees who receive a medical or religious exemption. In addition, individuals who provide services 100% remotely and who do not have any direct contact with patients and other staff (i.e., fully remote telehealth or payroll services) are not subject to the vaccination requirements in this rule.
9. Bozio CH, Grannis SJ, Naleway AL, et al. Laboratory-Confirmed COVID-19 Among Adults Hospitalized with COVID-19–Like Illness with Infection-Induced or mRNA Vaccine-Induced SARS-CoV-2 Immunity — Nine States, January–September 2021. MMWR Morb Mortal Wkly Rep. 2021;70:1539–1544. DOI: http://dx.doi.org/10.15585/mmwr.mm7044e1external icon.
Strategies for Employers to Promote the Vaccine Message in the Workplace
Back to top
- Ensure that the information is personal and targeted to the individual, so it addresses their questions and concerns in a nonjudgmental way.
- Communicate using simple and clear language when explaining side effects or any potential risks associated with the vaccine.
- Convene town hall meetings with workers and identify champions within your workplace who are trusted and can deliver the message. Many workers may feel comfortable with the health care provider at their workplace providing them information and sharing their experience.
- It is important to acknowledge and be truthful about uncertainty to help gain trust.
- Storytelling about those affected positively by vaccinations is more likely to be effective than statistics.
- Consider incentivizing employees (e.g., paid time off to get vaccinated) who receive the vaccine to encourage them to contribute to a safe and healthy workplace.
- Acknowledge COVID-19 fatigue and emotional well-being issues that employees have been experiencing this past year.
- Encourage vaccination among employees’ family members including eligible children. If you are providing a vaccination program for your employees, consider inviting family members to participate.
Targeted Messages for Health Care Workers
Back to top
- Protect yourself – you are on the front lines and risk being exposed to people with COVID-19 each day on the job.
- You can potentially transmit the virus to patients, co-workers, your family, and to others in your community.
- Protecting yourself also helps protect your patients, coworkers, family, and community including those who may be at higher risk for severe illness from COVID-19.
- Vaccination allows you to protect vulnerable patients that you care for every day.
- You matter, and you play an essential role in keeping your community healthy.
- You are a leader in science and can set an example to others in the community.
- You can serve as a vaccine champion and positively influence vaccination decisions of peers, patients, friends, and family.
Targeted Messages for Different Demographics
- COVID-19 vaccines have been studied in clinical trials with large and diverse groups of people of various ages, races and ethnicities.
- The vaccine development process is heavily regulated and transparent. For COVID-19, a diverse group of doctors and public health practitioners were assembled to ensure that the vaccine was safe and effective across racial groups.
- Focus on making decisions that are best for you and your family, following fact-based, trusted information about vaccine safety and efficacy, including links to trusted sources of information (e.g., CDC, WHO, academic institutions).
- Messaging from personal doctors and other health care providers are typically among the most trusted sources for Black/African Americans. Black/African Americans may also be more responsive to messaging from faith-based leaders.
- Messaging from medical experts and community health providers are the most trusted sources for Hispanic/Latinos. Hispanic/Latinos may also be more receptive to messages from their inner circle such as neighbors, their mayor, and people they follow on social media.
WATCH: RWJBH: Fears, Hesitation & Access: What the Black Community Needs to Know About the COVID-19 Vaccine
Back to top
- Ad Council and COVID Collaborative. Black Audience Creative Brief. Available at: https://adcouncilvaccinetoolkit.org/download/storage/Black-Creative-Brief-4.5.21_2021-04-08-171359.pdf.
- Ad Council and COVID Collaborative. Hispanic Audience Creative Brief. Available at: https://adcouncilvaccinetoolkit.org/download/storage/Hispanic-Creative-Brief-4.5.21.pdf.
- The American College of Obstetrics and Gynecology. Practice Advisory: COVID-19 Vaccination Considerations for Obstetric-Gynecologic Care. July 30, 2021. Available at: https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/12/covid-19-vaccination-considerations-for-obstetric-gynecologic-care.
- American Medical Association. AMA COVID-19 Guide: Background/Messaging on Vaccines, Vaccine Clinical Trials & Combatting Vaccine Misinformation. Chicago, IL: American Medical Association; Winter 2021. Available at: https://www.ama-assn.org/system/files/2021-02/covid-19-vaccine-guide-english.pdf.
- Centers for Disease Control and Prevention (CDC). COVID-19 Vaccination Communication Toolkit. Available at: https://www.cdc.gov/vaccines/covid-19/health-systems-communication-toolkit.html.
- Centers for Disease Control and Prevention (CDC). Essential Workers COVID-19 Vaccine Toolkit Information for Employers and Employees. Available at: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/toolkits/essential-workers.html.
- Centers for Disease Control and Prevention (CDC). Workplace Vaccination Program. Available at: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/essentialworker/workplace-vaccination-program.html.
- Centers for Disease Control and Prevention (CDC). Importance of COVID-19 Vaccination for Essential Workers. Available at: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/essentialworker.html.
- Centers for Disease Control and Prevention (CDC). Interim List of Categories of Essential Workers Mapped to Standardized Industry Codes and Titles. Available at: https://www.cdc.gov/vaccines/covid-19/categories-essential-workers.html.
- Centers for Disease Control and Prevention. Interim Public Health Recommendations for Fully Vaccinated People. Available at: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html#anchor_1615143336158.
- Centers for Disease Control and Prevention. Domestic Travel During COVID-19. Available at: https://www.cdc.gov/coronavirus/2019-ncov/travelers/travel-during-covid19.html.
- Centers for Disease Control and Prevention. When You’ve Been Fully Vaccinated – How to Protect Yourself and Others. Available at: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html.
- Centers for Disease Control and Prevention. Science Brief: COVID-19 Vaccines and Vaccination. Available at: https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/fully-vaccinated-people.html.
- Centers for Disease Control and Prevention. COVID Data Tracker. Available at: https://covid.cdc.gov/covid-data-tracker/#datatracker-home.
- Centers for Disease Control and Prevention. How to Address COVID-19 Vaccine Misinformation. Available at: https://www.cdc.gov/vaccines/covid-19/health-departments/addressing-vaccine-misinformation.html.
- Centers for Disease Control and Prevention. Self-testing. Available at: https://www.cdc.gov/coronavirus/2019-ncov/testing/self-testing.html.
- Centers for Disease Control and Prevention. New CDC Data: COVID-19 Vaccination Safe for Pregnant People.. August 11. 2021. Available at: https://www.cdc.gov/media/releases/2021/s0811-vaccine-safe-pregnant.html.
- Centers for Disease Control and Prevention. COVID-19 Vaccine Booster Shots. November 29, 2021. Available at: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/booster-shot.html.
- Centers for Disease Control and Prevention. Answering Patients’ Questions About COVID-19 Vaccine and Vaccination. November 9, 2021. Available at: https://www.cdc.gov/vaccines/covid-19/hcp/answering-questions.html.
- Chou W-Y S, Burgdorf CE, Gaysynsky A, Hunter CM. COVID-19 Vaccination Communication: Applying Behavioral and Social Science to Address Vaccine Hesitancy and Foster Vaccine Confidence. National Institutes of Health. December 2020. Available at: http://obssr.od.nih.gov/sites/obssr/files/inline-files/OBSSR_VaccineWhitePaper_FINAL_508.pdf.
- de Beaumont Foundation. Language That Works to Improve Vaccine Acceptance: Communications Cheat Sheet. Available at: https://debeaumont.org/covid-vaccine-poll/.
- de Beaumont Foundation. Communicating About FDA Approval to Build Confidence in COVID-19 Vaccines. Available at: https://debeaumont.org/wp-content/uploads/2021/08/FDA-APPROVAL_8.24.3.pdf.
- Food and Drug Administration and Centers for Disease Control and Prevention. Joint CDC and FDA Statement on Johnson & Johnson COVID-19 Vaccine. April 13, 2021. Available at: https://www.prnewswire.com/news-releases/joint-cdc-and-fda-statement-on-johnson--johnson-covid-19-vaccine-301267526.html.
- Health Action Alliance. Quick Start Guide: Preparing Your Company for COVID-19 Vaccines. February 23, 2021. Available at: https://docs.google.com/document/d/1MBH5tGPcOo7WywuZTKUqp5RU2YeHxdl_LxZDujoedEo/edit#.
- Health Action Alliance. Communicating about COVID-19 Vaccines Key Messages for Employees and Workers. March 31, 2021. Available at: https://health-action-alliance.webflow.io/resources/communications/communicating-about-covid-19-vaccines-key-messages-for-employees-and-workers
- Health Action Alliance. Communicating about COVID-19 Vaccines Updated Guidance for Businesses. March 31, 2021. Available at: https://docs.google.com/document/d/1jrM4fJFkqOT6aEGzrZU0avyYUt10IDdMdRvjDD3HBWk/edit.
- Health Action Alliance. COVID-19 Vaccines Audience Insights & Messaging Guidance for Black, Hispanic, American Indian and Alaska Native Communities. April 6, 2021. Available at: https://www.health-action-alliance.webflow.io/resources/communications/covid-19-vaccines-audience-insights-messaging-guidance-for-black-hispanic-american-indian-and-alaska-native-communities..
- Health Action Alliance. Responding to Sensitive Questions - COVID-19 Vaccines and Misinformation. February 26, 2021. Available at: https://docs.google.com/document/d/13sezI2fnxHgDnlkzlpUmw6WFvLIEmSID9_W-NMyPDzw/edit.
- Hughes B, Miller-Idriss C, Piltch-Loeb R, et al. Development of a codebook of online anti-vaccination rhetoric to manage COVID-19 vaccine misinformation. Pre-print on March 26, 2021. doi: https://doi.org/10.1101/2021.03.23.21253727.
- Institute for Public Relations. A Communicator’s Guide to COVID-19 Vaccination. Research, Theories, Models, and Recommendations Communicators Should Know. December 2020. Available at: https://instituteforpr.org/a-communicators-guide-to-vaccines/.
- Opel DJ, Lo B, Peek ME. Addressing Mistrust about COVID-19 vaccines among patients of color. Annals Int Med. 2021. Available at: https://doi.org/10.7326/M21-0055.
- Pfizer. Pfizer and BioNTech Announce Positive Topline Results from Pivotal Trial of COVID-19 Vaccine in Children 5 to 11 Years. September 20, 2021. Available at: https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-announce-positive-topline-results.
- Public Health Communications Collaborative. About the COVID-19 Vaccines. Available at:https://publichealthcollaborative.org/resources/graphic-about-the-3-covid-19-vaccines/.
- Tenforde MW, Olson Sm, Self WH, et al. Effectiveness of Pfizer-BioNTech and Moderna Vaccines Against COVID-19 Among Hospitalized Adults Aged ≥65 Years - United States, January-March 2021. MMWR Morb Mortal Wkly Rep. ePub: 28 April 2021. DOI: http://dx.doi.org/10.15585/mmwr.mm7018e1external icon.
- Thompson MG, Burgess JL, Naleway AL, et al. Interim Estimates of Vaccine Effectiveness of BNT162b2 and mRNA-1273 COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among Health Care Personnel, First Responders, and Other Essential and Frontline Workers - Eight U.S. Locations, December 2020-March 2021. MMWR Morb Mortal Wkly Rep. 2021;70:495-500. Available at: https://www.cdc.gov/mmwr/volumes/70/wr/mm7013e3.htm.
- U.S. Food & Drug Administration. FDA Approves First COVID-19 Vaccine. Available at: https://www.fda.gov/news-events/press-announcements/fda-approves-first-covid-19-vaccine.
- The White House. Remarks by President Biden on Fighting the COVID-19 Pandemic. September 9, 2021. Available at: https://www.whitehouse.gov/briefing-room/speeches-remarks/2021/09/09/remarks-by-president-biden-on-fighting-the-covid-19-pandemic-3/.
- Wood S, Schulman K. Beyond politics – promoting Covid-19 vaccination in the United States. New Engl J Med. 2021;384(7):e23(1)-e23(8). Available at: https://www.nejm.org/doi/full/10.1056/NEJMms2033790.