Abstract
We wish to comment on the potential for increased vaccine hesitancy if employers make the COVID-19 vaccine a condition of employment or mandatory. We strongly support vaccine implementation and advocate its equitable distribution for all work communities, especially vulnerable and minority workers. However, the approval of COVID-19 vaccines for emergency use authorization (EUA) by the Food and Drug Administration (FDA) could create conflict in the coming weeks between employers and employees who are hesitant to get vaccinated.
The EUA facilitates vaccine availability during public health emergencies “when other medical interventions to treat or prevent serious life-threatening diseases” are unavailable (FDA, 2020). The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) recommends health care workers (HCWs) and long-term care residents as the highest priority group for receiving the first available vaccinations (Phase 1A). Phase 1B consists of police, firefighters, teachers, grocery store workers, correction officers, utilities, and transportation workers (Dooling, 2020).
After just a few weeks, vaccine hesitancy has proven to be a challenge to mass vaccination across the country. There may be obstacles with vaccine hesitancy for individuals including reluctance on the part of minorities and HCWs (Harrison & Wu, 2020). In response to the equitable distribution document from the National Academy, a group of social scientists found in a national survey that two thirds of those who say they would not get a vaccine primarily cite safety concerns (Societal Experts Action Network, 2020). An American Nurses Association (ANA) survey conducted during October 2020 found only 27% of nurses who provide direct care to COVID patients (n = 5,879) said yes when asked “If your employer does not require it, would you voluntarily vaccinate for COVID-19?” (ANA, 2020). Only 9% of Black or African American nurses (n = 342) answered yes.
Some low-income Phase 1B workers face limitations on their ability to mitigate their own disease risk because staying at home is not an option. These often “invisible”—but now “essential”—workers, especially those who are Black, Latinx, or Indigenous, may face disproportionately high risk for COVID-19 transmission and disease (Webb-Hooper et al., 2020). Vaccination hesitancy now threatens to deepen this disproportionate risk to our most vulnerable populations. They now distrust their employers’ requiring mandatory vaccination because their employers did not supply personal protective equipment for them at the beginning of the pandemic (Blow, 2021).
The Equal Employment Opportunity Commission (EEOC) has recently issued guidance that employers can require employees to obtain vaccination (EEOC, 2020), but there is no clear legal consensus on whether an employer can require vaccination which is in use under an EUA (Costello, 2020). Given workers’ concerns about the vaccine mandate in some workplaces, we feel employer policies on COVID-19 vaccination should address what happens when an employee declines. Our opinion is that a vaccination waiver should follow the Americans with Disabilities Act (ADA) legal authorities and that a concerted effort be made to educate employees on vaccine benefits and risks as well as employer vaccine expectations in a hazardous or infection-prone work environment (Yang & Rubinstein-Reiss, 2020).
