What are the best tactics to incentivize employees to get the COVID-19 vaccine? Can an employer require employees who work in certain high-risk areas to get the COVID-19 vaccine?

Since COVID-19 vaccines became available, there have been numerous questions regarding the uptake of the vaccine and how to incentivize employees to get the vaccine as soon as it is available.  Current COVID-19 vaccines are approved under the FDA’s Emergency Use Authorization (EUA).  The EUA means that approved vaccines do not have all the usual evidence that they are safe and effective.  Despite vaccine trials demonstrating the effectiveness and safety of the vaccines1,2,3, employers are unlikely to mandate vaccination for their employees. However, their decisions may change based on other circumstances.3

Vulnerable working populations: Vulnerable workers - and workers with significant potential for exposures to SARS-CoV-2 - should be given priority for vaccination.6,7 

Reluctance to get vaccinated: There has been some reluctance in getting the COVID-19 vaccine. Only 49% of Americans planned to get vaccinated against SARS-CoV-2.3 Some of the groups like police officers and firefighters have shown some reluctance in getting the vaccine when it is available to them.6,7
Adverse effects related to vaccination will be a challenge: Employees may develop side effects from the first dose of a two dose COVID-19 vaccine as we have seen with other vaccines.  These side effects may make employees reluctant to take the second dose of the vaccine, which is required to confer maximum immunity of ~ 90%.1,2 Any significant vaccine side effect would likely be considered an on-the-job injury potentially covered through worker's compensation programs.

Previous precedents for mass vaccination: The Equal Employment Opportunity Commission (EEOC) already allows companies to require employees to be vaccinated for influenza. The Americans with Disabilities Act (ADA) provides reasonable accommodations to employees with disabilities that prevent them from receiving a vaccine.  In addition, workers for whom taking a vaccine would violate their religious beliefs will find protection under Title VII of the Civil Rights Act of 1964. Asking employees about history of prior infection with, and/or history of immunization for, COVID-19 is permissible under the ADA8.  Information on employee immunization and prior infection status should be recorded.  It may prove valuable in future updates of workplace safety practices.

Incentivizing employees to get vaccinated against COVID-19: Offering incentives for employees to get vaccinated, like gift cards or other perks, could be more effective than mandates, but messaging needs to be realistic and grounded. If we ultimately learn that vaccination prevents infection and viral spread, as opposed to only preventing symptomatic disease, the potential to discontinue mask wearing and other mitigation practices will be an additional incentive for vaccination, once there is sufficient immunity in the community. Should the concept of an immunity passport gain acceptance, employees will have further reason to get vaccinated.  Discussion and coordination with the employee’s treating provider will ultimately make a significant difference.5,7  Finally, the body of knowledge gained from the field of behavioral economics may provide insight as to how to effectively motivate the workforce to get immunized. COVID-19 vaccination programs will succeed only if there is widespread belief that available vaccines are safe and effective and that policies for prioritizing their distribution are equitable and evidence-based.4


  1. Oliver, S. E. (2020). The Advisory Committee on Immunization Practices’ Interim Recommendation for Use of Pfizer-BioNTech COVID-19 Vaccine—United States, December 2020. MMWR. Morbidity and Mortality Weekly Report, 69.
  2. Polack, F. P., Thomas, S. J., Kitchin, N., Absalon, J., Gurtman, A., Lockhart, S., ... & Bailey, R. (2020). Safety and efficacy of the BNT162b2 mRNA covid-19 vaccine. New England Journal of Medicine.
  3. Mello, M. M., Silverman, R. D., & Omer, S. B. (2020). Ensuring uptake of vaccines against SARS-CoV-2. New England Journal of Medicine, 383(14), 1296-1299.
  4. Schwartz, J. L. (2020). Evaluating and Deploying Covid-19 Vaccines—The Importance of Transparency, Scientific Integrity, and Public Trust. New England Journal of Medicine, 383(18), 1703-1705.
  5. Cunningham, A., Stoeckle, J., Diaz, V., Valko, G., & Arenson, C. (2017). Back to basics: five steps to better influenza vaccination rates. Family Practice Management, 24(6), 30-33.
  6. Mbaeyi, S. A. (2020). COVID-19 vaccine prioritization: Work Group considerations.
  7. Messonnier, N., & Cohn, A. (2020). COVID-19 Vaccine Implementation.
  8. What You Should Know About COVID-19 and the ADA, the Rehabilitation Act, and Other EEO Laws | U.S. Equal Employment Opportunity Commission (eeoc.gov)

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The Forum does not necessarily represent an official ACOEM position. The Forum is intended for health professionals and is not intended to provide medical or legal advice, including illness prevention, diagnosis or treatment, or regulatory compliance. Such advice should be obtained directly from a physician and/or attorney. Questions are answered with the best available data or recommendations at the time.