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3 strategies for right now to encourage employees to get COVID vaccines

And 3 others that could backfire if they're rolled out too soon.
By: | December 21, 2020 • 5 min read
Dave Lacknauth, executive director of Pharmacy Services, Broward Health Medical Center, shows off a bottle containing the Pfizer-BioNtech COVID-19 vaccine on Dec. 17, 2020. (Photo by Joe Raedle/Getty Images)

Many employers are eager to encourage their employees to receive the COVID-19 vaccination, which will allow safe return to the workplace and drive economic recovery. But with many Americans unsure about getting the vaccine, it won’t be easy to establish “herd immunity,” where the virus dies out as enough of the population is immune and patients with new COVID infections can’t infect others.

Many employers are evaluating actions to get their employees vaccinated as soon as possible. It is a pursuit filled with caution. Thoughtful benefit design and effective communication can help, but some well-meaning proposals could paradoxically decrease the number of people who eventually get the vaccine.

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3 ways to promote vaccination

The federal government will provide all COVID-19 vaccines at this point, and the Coronavirus Aid, Relief and Economic Security (CARES) Act requires employer-sponsored health insurance plans to provide vaccinations with no out-of-pocket costs. Therefore, employer-sponsored health insurance plans are responsible for paying administrative fees for the vaccine, which will likely be under $50 for two shots. Employers can increase early vaccination by covering all available COVID-19 vaccines in both the medical and pharmacy benefit so that employees will not be turned away wherever they seek a vaccine.

Jeff Levin-Scherz

Employers may want to offer employees time off to be vaccinated, especially for the all-important second dose. Studies show that 35%-60% of adults fail to get the second dose of a two-shot vaccine course, and herd immunity will be substantially delayed if many get just one of the two required injections of the Pfizer or Moderna vaccines. The Johnson & Johnson vaccine requires a single injection, so this concern could diminish later in 2021 if that vaccine proves effective.

Employers have a long history of promoting healthy behaviors including exercise, tobacco cessation, healthy eating and influenza vaccines. Effective communication can also help encourage employees to get COVID vaccines when they are available. Using stories, social influencers and showing that the vaccine can avert future losses can help overcome the natural optimism bias, where many feel that they are unlikely to get COVID, or unlikely to get seriously ill if they do.

3 areas to avoid—for now

The Advisory Committee on Immunization Practices (ACIP) has recommended that healthcare workers and residents and employees of nursing homes get the first available vaccines, and this phase of vaccination delivery started on Dec. 14. Future groups that will be prioritized by ACIP could include the elderly, those with diseases that make COVID more dangerous, frontline workers and critical infrastructure workers. The federal government will distribute vaccines to each state, and each state will use its own guidelines for distribution to residents. Some states have already indicated they will prioritize different groups, including teachers and prisoners and correction workers.

Vaccines are currently in short supply, so most employers will not be able to vaccinate employees at the workplace at this time. One exception is nursing homes, where CVS and Walgreens will administer vaccines to both residents and employees. Some manufacturing companies with high employee density where physical distancing is difficult, like meat processing plants, might also benefit from on-site vaccine efforts. Most employers considering setting up on-site vaccination will not likely be able to obtain a supply of vaccine until late in 2021, and on-site plans must account for refrigeration requirements and the challenging administration of a two-dose vaccine.

See also: 4 takeaways for HR from the EEOC guidelines on COVID-19 vaccines

Some employers are already lobbying for their employees to get earlier access to the COVID-19 vaccination. Employers seeking to influence local distribution of COVID vaccine are targeting their efforts at state health officials, who will make distribution decisions. Such efforts are not likely to be fruitful, given that the vaccine is in such short supply now, getting ahead in line won’t lead to earlier vaccine access. We expect vaccine supplies to be robust by late spring, so there will be little advantage to being closer to the “front of the line.”

Many employers have wellbeing incentive programs, and some are considering offering a financial incentive to employees who receive a COVID vaccination. But how would such an incentive play out? There is no vaccine currently available for those not in early-priority groups, so few would be able to earn the incentive. Incentives that cannot be achieved are profoundly demotivating. Worse, employees who are rebuffed when they seek a vaccine this winter might not make the effort to get the vaccine in the spring when it becomes available to them based on supply and their priority.

An incentive would be better timed for later in 2021 when there is no vaccine shortage. If an employer offers an incentive for the COVID vaccine, it should be continued for any future required booster shots, as discontinuing an incentive can lead to a decline in the desired behavior.

There is no reason for employers to make COVID vaccination mandatory for employees at this point. Most employees outside of healthcare won’t qualify for vaccines now, so mandating a vaccine will not increase vaccine penetration among workers. On the contrary, mandating vaccines will force many employees to make a decision about the vaccine now, i.e., a time when vaccine hesitancy remains high. Once employees have made such a decision, they will pay more attention to misleading reports of complications due to “confirmation bias.” Vaccine hesitancy will wane as the pandemic recedes and life returns to normal, and employee objection to vaccination is likely to be much lower in the future.

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Further, COVID vaccines, so far, have obtained emergency use authorization only from the Food and Drug Administration and are not likely to gain full approval until late spring, after they report six months of safety data. Employers will be on firmer ground to require a vaccine at some future point when vaccines are fully approved and when employees have seen many of their friends and co-workers benefit from being vaccinated.

Related: Number of the Day: Mandated COVID-19 vaccines

Proof of vaccine or immunity will eventually be required for travel or for entry into some buildings or events, much as physicians must show proof of immunity to measles and receipt of an annual flu shot before seeing patients. The promise of the vaccine is overpowering. Employers can play an important role in promoting COVID vaccination, but it would be sadly ironic if well-meaning employers took actions that inadvertently decreased the number of people who receive it.

Jeff Levin-Scherz, MD, MBA, is a population health leader of the North American Health and Benefits practice at Willis Towers Watson. Levin-Scherz trained as a primary care physician and has played leadership roles in provider organizations and a health plan. He is an assistant professor at the Harvard T.H. Chan School of Public Health.

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