Dr. Ezekiel J. Emanuel, Matthew Guido and Amaya Diana
The United States has made COVID-19 vaccines accessible and free. Go to almost any local pharmacy or pop-up site, and you can easily get the shot – and pay nothing. And yet, only about 50% of Americans are fully vaccinated against this deadly virus. The unfortunate consequence is that the highly transmissible delta variant is causing surges in cases, hospitalizations and even deaths throughout the country, particularly in spots with low vaccination rates.
The government and experts have tried education and persuasion. The surgeon general is leading an all-out effort to combat misinformation. President Joe Biden has resorted to pleading. What more can we do to get the U.S. fully vaccinated and put COVID-19 behind us for good?
The private sector needs to step up and mandate COVID-19 vaccines for their workers. Vaccine mandates are legal, ethical and, most importantly, effective.
A void the business sector must fill
The Biden administration cannot and will not introduce a nationwide COVID-19 vaccine mandate. The federal government’s legal authority to issue a vaccine mandate is unclear. More practically, a federal mandate would be nearly impossible to enforce. If someone refuses the vaccine, how would the federal government respond?
The politicization of everything related to COVID-19, even masks, also negates this possibility. Going into the 2022 midterms, Democrats are right not to risk political backlash and conservative claims of government overreach.
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While states’ legal authority to mandate vaccines is well established, similar political concerns and enforcement challenges are present. By late April, more than 40 states had already introduced legislation restricting vaccine mandates, reflecting the harsh polarization such measures generate.
The private sector needs to fill the void. Private employers are in a better position to institute mandates, and have precedent to do so. Most health care facilities, many universities and some employers already require flu, MMR, HPV and-or meningococcal vaccines. As workers transition back to in-person activity this summer and fall, employers have a responsibility to keep them all safe.
The mandates are legal. The Equal Employment Opportunity Commission has made clear federal laws do not prevent an employer from requiring all employees physically entering the workplace to be vaccinated for COVID-19. Courts have backed up employers on this.
The mandates are ethical, providing huge benefits that outweigh risks and higher immunization rates maximize the vaccine’s benefits in the workplace and community.
And the mandates are effective. Houston Methodist Hospital’s vaccine mandate resulted in a hospital vaccination rate of over 99%. IntegraCare, which operates 13 senior living homes across several states, announced last month that it has reached a 100% vaccination rate among staff.
Many employers have already had the courage to lead on mandates. Nearly 600 universities have required students to get COVID-19 vaccines for the fall. And like our own, the University of Pennsylvania, many have also mandated that faculty and staff be vaccinated. New employees at United and Delta airlines must be vaccinated. Even the show “Hamilton” is requiring vaccines for actors and stage staff.
On Monday morning, 57 organizations representing every part of the health care industry – from physicians and nurses to pharmacists and physician assistants, from public health officials to long-term care workers – called for mandatory vaccinations for health care workers. CEOs, corporate leaders and employers in other parts of the economy need to follow suit.
Vaccine approval status is no excuse
Vaccine mandates should begin with health care workers and settings where employees have close contact with others, such as grocery stores, food production facilities and restaurants. Any employer calling workers back to the office, even for three days a week and especially if those offices are open design, should also mandate vaccines to protect workers from COVID-19 exposure and spread.
After the private sector begins to generate momentum for a mandate approach, the public sector can follow by requiring the military, police and other first responders to get a vaccine.
Many companies have used the vaccines’ emergency approval status as justification for not mandating them. This is a poor excuse. These vaccines are among the most effective and safe vaccines ever produced. It is widely expected that in the next month or two, the Food and Drug Administration will grant full approval to the mRNA vaccines from Pfizer and Moderna. After this change in status, there is no realistic excuse left.
Companies can take several steps to make mandates work for their employees. They can eliminate the hassle of having to plan around work to get vaccinated by making vaccines available at work sites for employees and their families. Employers should also give paid time off the day after vaccination for potential fever, fatigue and other transitory side effects so employees do not worry about lost wages. Polling shows that 75% of workers whose employers offer PTO for shots are vaccinated compared to 51% at companies that don’t.
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For vaccine-hesitant employees, education campaigns that clarify common misconceptions can reduce safety concerns fueled by misinformation or disinformation. Mandates are the best way to reach people who are apathetic about vaccines, possibly because they don’t view COVID-19 as a real threat, and get them vaccinated. Employer enforcements could be the push these people need to view vaccines as “worth it.”
The federal government can do its part by issuing guidance and expressing support for private sector mandates. The Biden administration has already offered tax credits for small- and medium-sized businesses that give employees paid time off to get the vaccine. It could potentially expand these credits to employers that introduce mandates. The message should be clear: Mandates spearheaded and executed by the private sector are our most crucial tool for thwarting delta surges.
Dr. Ezekiel J. Emanuel (@ZekeEmanuel) is co-director of the Healthcare Transformation Institute at the University of Pennsylvania and author of “Which Country has the World’s Best Health Care?” Matthew Guido and Amaya Diana (@amayahdiana) are research coordinators in Penn’s Department of Medical Ethics and Health Policy.