Although two-thirds of U.S. adults have received at least one dose of a COVID-19 vaccine, vaccination rates are leveling off and risks of new outbreaks are rising, driven by the hypercontagious delta variant. For employers that is an intolerable situation. If they want to operate reliable in-person workplaces and attract customers, they will have to embrace a solution that government has so far shied away from: vaccine mandates.
The trend is already unmistakable, led by higher education and healthcare providers. More than 580 campuses nationwide will require vaccinations this fall for most students and employees, including the huge University of California system, which has ordered its 280,000 students and 227,000 faculty and staff to be fully vaccinated before returning to campus.
Healthcare systems, which have an overwhelming interest in instilling confidence and protecting patients, are following suit. Penn Medicine, the largest employer in Philadelphia, RWJ Barnabas healthcare system in New Jersey, and New York-Presbyterian hospital system with 48,000 employees, have all recently instituted mandates.
Houston Methodist hospital threatened employees who failed to get vaccinated with suspension and termination. While some employees protested and even filed an unsuccessful lawsuit, the mandate has proven highly effective. Out of more than 25,000 employees, 97% have been fully vaccinated, and 2% received a medical or religious exemption. Less than 1% (153 employees) resigned or were terminated in June.
Of course setting up different rules for those who are vaccinated and those who are not can be a minefield. There is no better example than the battered cruise industry, which is trying to resume embarkations from Florida ports.
The big operators, including Norwegian Cruise Lines
and Carnival Corp.
clearly would like a vaccine requirement to avoid the onboard outbreaks that killed their businesses 18 months ago. They are stymied by a new Florida law that deems proof of vaccination to be discriminatory against un–vaxxed passengers. Norwegian is suing Florida in federal court and threatening to move operations out of the state.
Meanwhile the cruise lines are deploying some reverse incentives to persuade customers to get jabbed, including segregating the unvaccinated aboard ship (think smoking vs. nonsmoking sections), assessing fees up to $180 for pre- and post-trip COVID tests, and insisting on travel insurance policies in case they have to be medically evacuated.
The cruise lines are also mandating vaccines for all crew members. The Florida law does not ban such a requirement, nor do similar laws or executive orders in other states. The U.S. Equal Employment Opportunity Commission has ruled that employers can require employees to be vaccinated subject to reasonable accommodations for medical complications or sincerely held religious beliefs.
Political objections have kept the federal government from going further and imposing a nationwide vaccine mandate. One recent survey found that only a bare majority of American supported proof of vaccination as a requirement for returning to work. The objections range from allegations that the FDA authorization for the vaccines was rushed to that a mandate is an affront to individual freedoms to that vaccination status is not readily verifiable.
But employers can rely on strong counter arguments. One federal court has already thrown out the argument that the vaccines are still experimental. Mandatory vaccinations against other infectious diseases in the past have taken precedence over individual rights. And fulfillment of immunization requirements for school and work are already being certified by healthcare providers in the private sector.
The fact that the Food and Drug Administration has issued only an emergency use authorization (EUA) for Covid-19 vaccines should be no cause for delay. These vaccines have been so successful in preventing serious disease and so devoid of serious side effects that they will undoubtedly receive full FDA approval in a matter of months. As another federal judge recently noted in his decision to deny a petition to block Indiana University’s vaccine mandate, “Not all EUAs are equal, and the one required for COVID-19 vaccines was more robust than usual.”
We are tantalizingly close to crushing COVID, which makes vaccine resistance hugely frustrating for individuals and businesses trying to return to normal.
Maybe the federal government will step in with a national mandate if vaccination resistance results in another damaging wave of hospitalizations and death. But employers can’t wait. If they depend on in-person workplaces and face-to-face connections with customers, they will have to be the ones to turn up the pressure. And that may be enough to get us to herd immunity.
Karen Mulligan, Ph.D., is a fellow at the USC Schaeffer Center for Health Policy & Economics. Jeffrey E. Harris, MD, Ph.D., is a physician and an economist at the Massachusetts Institute of Technology.