What doctors wish employers knew about COVID-19 vaccine mandates

Each COVID-19 vaccine authorized or approved for use in the U.S. has been proven highly effective in controlling the spread of SARS-CoV-2 and its variants. Yet the virus continues to spread, primarily among those who are unvaccinated.

While officials across the country have launched incentive programs, stressed personal responsibility, deployed mobile vaccination units and provided ongoing education to encourage COVID-19 vaccine uptake, those efforts have fallen short. As the push to get more people vaccinated against COVID-19 intensifies, businesses, schools, cities, states and the federal government are turning to vaccine mandates.

With full approval of the Pfizer-BioNTech COVID-19 vaccine, the AMA supports greater and stronger use of vaccine mandates by public and private sector employers and other organizations for the populations recommended to receive the vaccine by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices.

In fact, major companies such as Walt Disney, Walmart, McDonald’s, Walgreens, Twitter, Facebook and Google have already expressed to their employees that they must get fully vaccinated against COVID-19 this fall. The Pentagon also noted they would make vaccinations mandatory for service members following the Food and Drug Administration’s full approval of Pfizer’s COVID-19 vaccine. And President Joe Biden has even ordered sweeping federal vaccine requirements for as many as 100 million Americans in private-sector companies as well as health professionals and federal contractors.

But this all-out effort of mandating COVID-19 vaccines to curb the quick spreading Delta Variant can be confusing.

The AMA’s “What Doctors Wish Patients Knew™” series provides physicians with a platform to share what they want patients to understand about today’s health care headlines, especially throughout the COVID-19 pandemic. In this installment, two AMA members took the time to discuss what employers need to know about COVID-19 vaccine mandates. They are:

• Douglas W. Martin, MD, an occupational medicine physician and medical director for UnityPoint Health St. Luke’s Occupational Medicine in Sioux City, Iowa.
• Purvi Parikh, MD, an allergist and immunologist as well as a vaccine researcher in New York City.

“This is not anything new. All schools mandate vaccines,” said Dr. Parikh, noting that “many workplaces like hospitals, doctor’s offices and nursing homes do as well—long before this pandemic.”

“We’ve had influenza vaccine mandates within our health system for years,” Dr. Martin concurred, noting that “the policy is either you get the influenza vaccine every year or you have to completely don personal protective equipment.

“No. 1, nobody wants to do that stuff full-time because it’s just not easy to do your job and, No. 2, there’s a little bit of a scarlet letter that’s on people in that type of a work environment,” he added, noting that another issue is “when you’re talking about school attendance requirements—we’ve had those mandates forever.”

“It varies a little bit from state to state as far as what is required, but typically it’s tetanus and diphtheria vaccines, MMR and others,” said Dr. Martin. “Those school requirements for vaccinations clearly have been in existence for decades. That’s nothing new and people should be somewhat aware of that—this isn’t some kind of brand-new concept for people to deal with.”

Mandates also help send the message that these vaccines are safe and effective “because it shows that companies are putting their faith in the vaccine,” Dr. Parikh said. “Also, when people see their coworkers stepping up to get the vaccine, it will inspire others to do so.”

“I don't think anybody from a government perspective and employer perspective—or any perspective—is in the business of risk-taking—no one is going to start a mandate unless you’ve got good science behind it,” said Dr. Martin, adding that “nobody’s going to mandate something that’s risky or dangerous.”

“The safety process has been looked at and has been evaluated—everything has been thumbs up as far as that's concerned,” he said. “You’ve got to look at it from the population health perspective,” which “clearly shows that vaccination is the right way to go.”

When it comes to COVID-19 vaccine mandates, some people “are worried it is an infringement on their rights or that the vaccine is experimental or dangerous,” said Dr. Parikh. That is why it is important for employers to address those concerns head on.

For example, “assure people that the vaccine is very safe and efficacious, and now one is fully FDA-approved, so there is no experimental nature to it,” she said. “Moreover, these vaccine platforms are not new—both have been around and tested for decades.

“I also tell people they should be far more afraid of the virus because 99.5% of deaths and over 90% of hospitalizations are among those who are unvaccinated,” said Dr. Parikh.

“For some people, this vaccine mandate really is a polarizing thing,” said Dr. Martin. “And it's interesting when you talk to some of these folks about it because they're adamant—they don't want to hear the science.

“It's not about a scientific argument. It's about a freedom and liberty argument,” he added, noting that “we're not going to force you to have the vaccine at gunpoint. That's not our society, but you also need to understand that a decision is going to have consequences.”

Discover what doctors wish patients knew about going back to work.

“This is something that affects everyone’s health and safety, not just your own,” said Dr. Parikh. “It is no different than laws that already exist for seat belts, guns, cell phone use while driving and traffic laws—they protect everyone.”

“When we're talking about the occupational medicine situation with both the employee and employer concerns on this, what we have done that has worked well is tailoring the message to the specific employee in that environment,” said Dr. Martin. “We try to turn the messaging about how important it is that they're at work and that they're healthy in order for their corporation to do the things that they need to do.

“Now, that's frankly not a difficult sell in this part of the world because it's agriculture—people have got to eat,” he added. For example, “when we're talking about the meatpacking industries, the messaging is the country relies on you to provide protein sources for food. We want to make sure that you're safe and able to continue to do that for the country to benefit.”

“So, it's trying to turn that into a positive message,” Dr. Martin emphasized.

Read this Q&A about Dr. Martin’s work minimizing the threat of COVID-19 among meatpacking facilities.

“The other thing that has been successful is the American College of Occupational and Environmental Medicine webpage that has some strategies for how to help employers and employees,” said Dr. Martin. “One of the things that’s in there that I have found has been very helpful is to set up town hall informational meetings at the workplace.

“Administrative and supervisory people have been very supportive of this because they see the bigger picture,” he added. “The meetings provide a forum for people to ask questions in an environment that’s not threatening because they’re there with their coworkers—it’s part of their work family so it’s nonconfrontational information sharing.”

“Another thing that these town hall meetings do is they show the employee that they employer actually has their health in their best interest,” said Dr. Martin. “I can't underscore how important that whole process is. There's been way too many previous examples of where employees and employers get this interface where they're antagonistic against each other for various reasons.

“You cannot have that in this environment because the ultimate goal here is to get over this pandemic,” he added. “We’ve got to make sure that people are safe, people are still at work and that the economy is still going, and people are still making an income.”

Discover what physicians should know about COVID-19 vaccine mandates.

“The only medical exemptions would be a severe allergy to a component in the vaccine,” said Dr. Parikh, adding that “any other reason would have to be cleared by a physician on a case-by-case basis.”

“We've had some discussions with employer groups about medical exemptions and we want to make sure that there's some validation of that, so we’re requesting some sort of documentation from the primary care givers of the employee,” said Dr. Martin. “It's not just a self-report kind of a deal because what we've found is that there's too much non-validated stuff that just appears.”

Some leaders may be hesitant to enter the fray on vaccination, viewing it as a political issue. But “it really shouldn’t be a political issue,” said Dr. Parikh. “The virus does not discriminate based on your politics.”

“With over 650,000 Americans who have died from COVID-19 and many who continue to suffer long-term consequences of the virus over a year later, we should all be more afraid of the virus than the vaccine,” she said, emphasizing that “it is not political. It is science.”

Read about the AMA’s robust policy on COVID-19 vaccine mandates, adopted at the June 2021 AMA Special Meeting.

The AMA has developed frequently-asked-questions documents on COVID-19 vaccination covering safety, allocation and distribution, administration and more. There are two FAQs, one designed to answer patients' questions (PDF), and another to address physicians’ COVID-19 vaccine questions (PDF).