Considerations for Employers in the Era of the COVID-19 Vaccine

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On December 14, 2020, an intensive care unit nurse in New York was the first American to receive an injection of the COVID-19 vaccine.
Please note: This is an archived post. Some of the information and data discussed in this article may be out of date. It is preserved here for historical reference but should not be used as the basis for business decisions. Please see our main Insights section for more recent posts.

In less than 12 months, biomedical researchers developed 2 vaccines (1 from Pfizer-BioNtech and 1 from Moderna), received approval from the US Food and Drug Administration, and established a plan for worldwide distribution. The blistering pace of scientific advancement leaves room for some important questions regarding vaccination and the workplace, as businesses consider the implications of bringing employees physically back into offices.

  • Will employers require their workers to get a COVID-19 vaccine and bar them from the workplace if they refuse?
  • What does an organizational mandate look like for clients and their customers?
  • Do companies have the legal right to mandate that employees get a COVID-19 shot?
  • What does the continued environment look like for testing, mask-wearing, use of personal protective equipment and social distancing?

Since December, states have been receiving their first doses based on population size, and governors are responsible for determining how to distribute the vaccine. Healthcare personnel and long-term care facility residents were advised to receive the vaccine first, according to an independent advisory group to the Centers for Disease Control and Prevention (CDC), the independent panel of medical and public health experts that is responsible for coordinating vaccine distribution. President Biden announced on January 15 that he wants to expand the priority groups originally established by the CDC so that frontline essential workers like teachers, first responders, grocery store employees, and anyone who is 65 and older can get vaccinated. Guidance issued from the Equal Employment Opportunity Commission in mid-December indicates that when the vaccine is available to the general public, employers will have the green light to require immunization for most workers in the United States. This alone makes establishing a policy from an employer’s perspective difficult and reinforces the importance of employers’ role in advancing the country toward herd immunity through vaccination.

The 2 exceptions to this guidance are if an individual has a sincerely held religious belief or a disability, which employment lawyers are preparing to address as businesses will need to determine accommodations for employees who fall within these 2 categories. There will also be medical exemptions, for example, an individual who is pregnant or breastfeeding, which could make this decision an individual choice.

Undoubtedly, the guidance regarding employer-mandated immunization causes skepticism from the public, in addition to hesitancies about being vaccinated in the first place. A recent survey by Kaiser Family Foundation found that about a quarter (27%) of the public remains vaccine hesitant, saying they “probably or definitely would not get a COVID-19 vaccine even if it were available for free and deemed safe by scientists.” Vaccine hesitancy is highest among Republicans (42%), those ages 30–49 (36%), and rural residents (35%). Importantly, 35% of Black adults (a group that has been disproportionally affected by the pandemic) say they “definitely or probably would not get vaccinated,” as do one third of those who say they “have been deemed essential workers” (33%) and 3 in 10 (29%) of those who work in a healthcare delivery setting. Beyond demographics, key factors that are associated with vaccine hesitancy and the uptake of immunization services in general—such as physical availability, affordability and willingness to pay, geographical accessibility, and the ability to understand (language and health literacy)—may also become increasingly important for employers to address in the conversations regarding vaccines in the workplace.1

As such, businesses and employers are uniquely positioned; employment from large numbers of Americans who would otherwise not receive a vaccination will soon become dependent on receiving the vaccine. Thus, employers will be faced with varying amounts of coordination as they consider bringing individuals back into the physical workplace. Avalere outlined 8 high-level considerations of employer return-to-work strategies last year. Of particular importance are 3 high-level vaccine-related workplace considerations to prioritize as employers seek to elevate their role in supporting their employees (outlined in Figure 1 below).

Figure 1. Three High-Level, Vaccine-Related Workplace Considerations
Figure 1. Three High-Level, Vaccine-Related Workplace Considerations

Building on this existing framework, Avalere has laid out specific key tactics for employers to consider related to vaccines:

  • Administering the vaccine, whether this is done by the employer or a third-party vendor. In either case, there are legal considerations such as the pre-vaccination medical screening questions.
  • Conducting vaccinations in a confidential manner in a way that does not increase exposure risk and that improves initial access to vaccines (e.g., avoiding long lines in places such as stadiums).
  • Adapting policies that may make it easier for employees to get vaccinated, such as providing paid time off to obtain the vaccination or on-site vaccinations.
  • Responding to accommodation requests from an individual with a sincerely held religious belief or an individual with a disability (and being adequately trained to appropriately handle these requests in accordance with federal, state, and local jurisdictions).
  • Crafting a policy summarizing the vaccination plan and process of employee exemption requests.
  • Developing a schedule for vaccinating employees and communicating this accordingly, such that employees can be made aware of when to receive both the first and second dose, recognizing additional vaccines are expected to be approved for use in 2021.
  • Continuing to follow guidance both from the CDC and state and local jurisdictions, but adapting guidance to company needs.
  • Continuing to use COVID-19 testing and measures for safety and protection, as part of President Biden’s new national testing strategy to expand testing supplies and increase laboratory capacity.

Hundreds of thousands of Americans could die of COVID-19 in the next few weeks, as the country faces shattering records of deaths and infection rates. There is still missing information about how much vaccines prevent infections; 95% does not equate to 100%. Infections are rising, with over 4,000 deaths per day during the second week of January, which shows an alarming need for continued vigilance. President Biden has a $1.9 trillion plan to combat the pandemic, with the expansion of COVID-19  testing, accelerated vaccine distribution, and a new action plan to prepare for future public health threats.

Businesses will soon be able to look at examples from pioneers in the coming months, which may help employers understand best practices for vaccinating in the workplace. A vaccine passport is likely something individuals will need to upload with details of their COVID-19 tests and vaccinations and also show before entering concert venues, stadiums, and movie theatres or crossing country borders.  Microsoft has launched a vaccine-management platform both for government and healthcare customers to deploy vaccine-management solutions that enable registration capabilities for patients and providers, phased scheduling for vaccinations, streamlined reporting, and management dashboarding with analytics and forecasting. Employers may seek to implement a similar vaccine-management system for their employees but will need to be cautious of privacy and security challenges.

While these varying complexities are not meant to be exhaustive, each of the considerations and tactics associated with vaccination in the workplace requires a level of strategic thinking and partnership. The vaccine rollout has been slow, and Dr. Anthony Fauci, the nation’s top infectious-disease doctor, estimates that 80–85% of Americans need to be vaccinated to reach herd immunity. At the current rate of vaccination, experts predict that the US could need 10 more years to reach herd immunity.  Through its customer base, access to and experience analyzing real-world data, and lens on national health policy expertise, Avalere is prepared to help employers in developing vaccination-coordination plans, evaluating strategies, and establishing effective communications that are needed to ensure widespread transparency.


Leana Wen, MD, an Avalere Senior Advisor/Contractor, is an emergency physician and visiting professor of health policy and management at the George Washington University’s Milken School of Public Health, where she is also a distinguished fellow at the Fitzhugh Mullan Institute for Health Workforce Equity. Dr. Wen is an expert in public health preparedness and previously served as Baltimore’s health commissioner.

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  1. Biasio LR. Vaccine hesitancy and health literacy. Hum Vaccin Immunother. 2017;13(3):701–702. doi:10.1080/21645515.2016.1243633

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