Abstract
The recent full approval of the Pfizer-Bio NTech COVID-19 vaccine by the Food & Drug Administration (FDA) changes the implementation strategy for vaccination among employers and their workplace policies (Parums, 2021). When the FDA originally issued an emergency use authorization (EUA) of the vaccine, many employers found it legally difficult to require workers to be vaccinated. In an earlier statement, we proposed a balanced approach to employers, suggesting they follow the guidelines from the Equal Employment Opportunity Commission (EEOC) and the Americans With Disabilities Act (ADA) related to employee vaccination (Culp et al., 2021). In the context of this FDA full approval and the surging Delta variant, we are witnessing increased social, political, and economic momentum in favor of vaccine mandates in the workplace.
On June 10, 2021, the U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) issued an emergency temporary standard (ETS) to protect health care workers (HCWs) from COVID in 29 CFR Section 1910.502(f) from COVID-19 (Carey, 2021). This ETS broadly supported employee COVID-19 vaccination and respiratory protection for HCWs and directed employers to provide their employees with reasonable time during work hours to receive COVID-19 vaccinations and to provide paid leave for employees to receive vaccinations for any side effects experienced following COVID vaccination. Despite this support, understaffed hospitals with exhausted staff continue to have employees who are opposed to vaccination. Some health care employers fear the vaccine mandates would negatively impact employee morale, result in more resignations, or make them more vulnerable to liability in the event of adverse reactions, and fear the policy would not be effective given requests for medical or religious exemptions. On the other hand, it is notable that there is excellent penetrance of the COVID-19 vaccine within certain health care organizations across the country. The authors’ home institution has over 90% vaccination among all health care providers and staff (UI Healthcare, 2021).
In August, President Biden announced mandatory vaccination for all members of the Department of Defense and those enterprises with government contracts. Soon after, on September 9, 2021, two additional executive orders called for vaccination of all federal workers and for companies with 100 or more employees (Rogers & Sheryl Gay, 2021). In addition, he issued orders to require those workers who refuse vaccination to submit to weekly COVID-19 testing. These executive orders arrive as many companies continue to experience severe labor shortages and ongoing supply chain disruptions (Krick & Reese, 2021).
There is a paucity of data regarding employer attitudes toward vaccine mandates. However, two major private consulting firms conducted surveys related to acceptance of COVID-19 vaccine mandates among corporate employers. One survey of corporate in-house lawyers and human resource managers (n = 1,630) revealed an openness to the concept of vaccine mandates (Littler, 2021). In this report, 9% of employers were proceeding with required vaccination, 4% were considering a mandate, and the remainder decided employees may voluntarily participate in vaccination programs. In a second survey by Willis Towers Watson (2021), 52% of 1,000 companies planned to issue a mandate by the end of the year and 21% said they already had a mandate (Emerman, 2021).
There may be legal challenges to the presidential executive order on required employee vaccination in the months ahead, but we generally support vaccine mandates. Two pressing issues point to the need for a mandate in this public health emergency. In some states, COVID incidence has nearly eliminated hospital beds and causes staffing issues (Adams, 2021). Many of these hospitalizations could have been prevented with COVID vaccination. Second, in public schools, unvaccinated children are at risk if the school staff are unvaccinated. This is also the case in higher education where students, university faculty, and staff must share classroom and office space (Mullin & Wu, 2021). Employers should assist those who are hesitant to get vaccinated with accurate information and accommodate those with medical or religious reasons for refusal. We recommend a written workplace policy, an infrastructure for the timing of doses, and a provision for reporting and documenting vaccination status and COVID testing should an employee decline the vaccine. We also encourage employers to add other protections for workers, to consult employees on policies to ensure their safety, and to give workers a voice in their safety from the COVID-19 pandemic (Moriarty, 2021).
