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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 vaccines
1,2,3, employers are unlikely to
mandate vaccination for their employees. However, their decisions may change based on other circumstances.
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Vulnerable working populations: Vulnerable workers - and workers with significant potential for exposures to SARS-CoV-2 - should be given priority for vaccination.
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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.
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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.
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