Lauren Rauh, Senior Program Manager, CONVINCE USA Initiative, CUNY Graduate School of Public Health and Health Policy; Hannah Stuart Lathan, Program Manager, CONVINCE USA Initiative, CUNY Graduate School of Public Health and Health Policy; Katharine Fields, Program Assistant, International Program in Health Policy and Practice Innovations, The Commonwealth Fund; and Reginald D. Williams II, Vice President, International Health Policy and Practice Innovations, The Commonwealth Fund co-authored an article in The Commonwealth Fund blog entitled “Key Considerations for Employers Contemplating COVID-19 Vaccine Requirements,” which was published on August 25.
With many parts of the United States experiencing surges in COVID-19 cases and some hospitals overwhelmed with seriously ill patients — and with the first full approval of a COVID-19 vaccine this week — President Biden urged employers to require their employees to get vaccinated. A study from Yale University and the Commonwealth Fund has demonstrated that the U.S. vaccination campaign against COVID-19 prevented nearly 1.25 million hospitalizations and 280,000 deaths nationwide by the end of June.
Some state lawmakers have tried to ban employer vaccine mandates, and some Americans remain adamantly opposed. Yet for some of those who remain unvaccinated, a science-based, transparent, and equitable mandate from their employer may be the final push they need to act. In a recent national survey conducted by the African American Research Collaborative and the Commonwealth Fund, one-third (31%) of unvaccinated respondents said they’d get a COVID-19 vaccine if their employer required it in order to continue employment. And a recent USA Today and Ipsos poll reported 68 percent of participants supported businesses refusing service to the unvaccinated and 62 percent supported employers requiring workers to vaccinate.
Federal guidance has clarified employers can legally require their employees to be vaccinated against COVID-19. Supreme Court rulings have upheld this, and the federal government, New York City, and New York State have pushed forward their own requirements. Companies such as Google, Facebook, and Netflix have since announced they will require their staff members to be vaccinated if they want to return to their offices.
In a series of in-depth interviews conducted by a team at CUNY Graduate School of Public Health and Health Policy, unvaccinated individuals voiced their lingering concerns. This qualitative research focused on trust as a determinant in vaccine decision-making. Through a national, online survey, interview participants were recruited and screened for vaccine hesitancy and distrust. Individuals that demonstrated unwillingness to vaccinate and high levels of distrust in the vaccines were prioritized for participation. Thirty transcripts were coded and analyzed.
Participants discussed how the information overload during the pandemic and frequently changing guidance undermined their trust in the safety and efficacy of the vaccines. These were not COVID-19 deniers; all participants had followed social distancing guidelines and altered their lives to prevent infection. Still, for many, getting a vaccine remained a concern, though some others worried that their unvaccinated status would bar them from returning to activities like school, travel, or live concerts.
Findings from the interviews suggest — and behavioral science research has shown — that people would be more willing to get vaccinated if their peers in a given setting, whether it’s a school, workplace, or hospital, were required to receive a COVID-19 vaccine (with appropriate exceptions and reasonable accommodations).
Based on the insights from the qualitative research, employers contemplating COVID-19 vaccination requirements for their employees may want to consider the following strategies:
Provide honest, transparent, and consistent messages. Trusted, diverse messengers in the workplace should communicate how the vaccine requirement will work and, most important, why it is likely to be more impactful than masking or routine testing alone. These messengers should share why they personally have chosen to get vaccinated and how it helps them feel more protected at the workplace.
Connect science to the workplace policy. Many of the unvaccinated want scientific evidence and clear guidance, but evolving information and misinformation feed their ambivalence. Employers can inform their employees of the risks of the workplace environment for unvaccinated individuals (e.g., from close working conditions or travel). They also can discuss the risks that the unvaccinated pose to clients, the public, or vulnerable populations. Explaining the science behind a mandate is key to conveying the policy as protective and not infringing on personal freedoms.
Demonstrate understanding that employers may feel unwell after receiving vaccinations and ensure employee policies support paid sick leave. In our research, people voiced concerns about class inequities in vaccine policy and distribution — articulating views that professional athletes, celebrities, and politicians who have access to excellent health care do not have to worry about feeling sick from the vaccine, but that others may not have that luxury. Employers can clarify that there have been few serious reactions to the vaccine. They also can implement and clearly communicate policies that allow for paid time off to get the shot and recuperate from any side effects.
This includes examining workplace culture regarding sick leave. Many workers in certain industries feel pressure to continue to work through illness, either as a badge of honor or out of fear of losing their job. This culture shift needs to come from the top down in the form of clear and equitable workplace policies.
Make vaccination easy. Employers also can try to make vaccination convenient for employees. If a vaccination pop-up clinic at the worksite is not possible, employers could provide employees with a list of local pharmacies offering vaccinations, and help employees sign up for notifications of appointments, for example.
Consider and prepare for exemptions. Employer vaccine mandates remain legal when in compliance with the Americans with Disabilities and Civil Rights acts. Similarly, mandates must acknowledge the possibility of religious or medical exemptions. Research shows that mandating the vaccine but allowing people to opt out is effective in achieving high uptake; only those with serious concerns will go through the process of opting out.
The pandemic has laid bare the need to build trust by engaging community members at the local level. Some interview participants felt they didn’t have forums in which to voice their concerns and receive reliable information about the vaccine. Policymakers should support local efforts for engagement and discussion about the vaccines that are free of blame for people who remain unvaccinated.
The federal government promotes labor regulations that support employer-based policies; they could do the same for vaccine mandates. While a federal COVID-19 vaccine mandate is unlikely, policymakers at state and local levels can reinforce workplace mandates by crafting transparent, honest, and fact-based messages. And employers can help keep their employees and communities healthy — and their businesses operating — by encouraging vaccination.