Building an Employee Vaccination Program? Start Here

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March 17, 2021


The global campaign to tackle COVID-19 vaccination is picking up pace. By mid-March, more than 391 million COVID-19 vaccine shots had been administered worldwide. Meanwhile, in the U.S., the White House has promised that it will have enough vaccines for every adult by the beginning of May.

Employers, along with everyone else, are hoping that vaccinations will help us return us to a life in which it’s once again safe to work, travel and meet one another. Those same employers can play a significant role in encouraging their workers to get vaccinated when they’re eligible.

As more doses of COVID-19 vaccine become available, employers start to think about their role in the vaccination process — one that’s important for addressing vaccine hesitancy, speeding up the vaccination rollout and getting us to the other side of the pandemic.

And the ultimate question, says Lori Goltermann, chief executive officer Aon U.S. Commercial Risk and Health Solutions, is: “As a country, as a global community, how do we get better? How do we create a safe environment for us to go back to our offices, that allows us to see our families?

“Businesses will continue to operate; people will continue to gather. It will look different. But as we come through this crisis, we can and will adjust.”

In Depth

While the COVID-19 vaccination program may well be the answer to a lot of problems surrounding the pandemic, it also raises a number of questions. One is around whether there are any adverse reactions to the COVID-19 vaccines. Incidents of severe side effects have been extremely rare: only about 11 for every 1 million patients, according to Dr. Neal Mills, chief medical officer at Aon.

“The good news is the vaccine is safe and effective,” Mills says.

The longer COVID-19 circulates, the more variants of the virus will evolve. These new variants are still being studied but they may affect the virus’s infectiousness, mortality and whether it can be combated by the existing range of vaccines. “This will drive whether we need booster vaccines as well,” Mills says. The best bet for now? Vaccinating broadly and quickly, with the vaccines now available.

The U.S. government is taking steps to accelerate vaccine rollout, such as partnering with select retail pharmacies to get shots to high-risk areas. In parallel, many employers are seeking direct partnerships with ready-and-willing providers and pharmacies to vaccinate their employees, says Mills.

As leaders move beyond information campaigns to build employee vaccination programs, here are a few considerations to bear in mind.

Laws, Lawsuits and Cost Coverage Considerations

The Equal Employment Opportunity Commission issued guidance on December 16, 2020, indicating that requiring employees to be vaccinated is generally allowed. But employers must consider accommodation of disabilities and sincerely held religious beliefs that are inconsistent with vaccination, according to J.D. Piro, senior vice president and national practice leader for the U.S. healthcare legal consulting group at Aon.

“You can ask employees whether they’ve been vaccinated, but you can’t ask them why they haven’t been vaccinated,” says Piro.

The regulatory landscape is changing quickly though, so employers will have to keep up, he says.

There are other issues as well.

“You might have to address reluctant employees who refuse the vaccination for any number of reasons that aren’t exempted under federal or state law,” says Piro. Employers will have to determine the consequences for those refusals — from reassignment of duties or permanent work-from-home status to termination.

There also will be employee lawsuit risks. “You do remain at risk for possible lawsuits over COVID-19,” Piro says. “Those lawsuits should be litigated under workers’ compensation laws.” But, because there are 50 state workers’ compensation laws and other jurisdictional laws, multistate employers might face different laws in different states and jurisdictions. Employees might also seek to circumvent the workers’ compensation laws, says Piro.

As far as costs, the U.S. government is covering the cost of the vaccine itself. Most group healthcare plans will pay for costs to administer COVID-19 vaccinations without cost sharing, but only for enrollees. Businesses considering providing vaccinations to nonenrollees such as spouses or dependents might face fiduciary issues under the federal Employee Retirement Income Security Act (ERISA), according to Piro.

Workers’ Compensation Considerations

In the unlikely event that an employee has an adverse medical reaction to a COVID-19 vaccination, there are two potential workers’ compensation scenarios that could play out: one if an employer is mandating vaccinations and another if it is simply encouraging them, according to Carol Ungaretti, managing consultant, Global Risk Consulting at Aon.

“In case of an adverse medical reaction in a situation where the vaccine has been mandated, in nearly every jurisdiction the injury would be deemed compensable and payable under the workers’ comp statute,” she says.

The situation is more varied when the vaccination is encouraged as a voluntary protocol. “Even in a nonmandatory vaccination program, if someone does have an adverse reaction, they will likely be able to pursue workers’ comp and quite likely be able to get benefits,” says Ungaretti.

She recommends that employers track and report cases of employees experiencing adverse reactions to COVID-19 vaccinations.

The Issue of Incentives

There are several ways an employer can encourage its workforce to get vaccinated, including the following:

  • Host an on-site clinic where vaccination is free to the employee and provided during work hours.
  • Establish HR policies that allow employees to take paid leave to obtain the COVID-19 vaccination.
  • Post articles in company communications promoting the importance of COVID-19 vaccination and where to get vaccinated.

Some employers are offering incentives — cash, gift cards, small appliances — to encourage employees to receive COVID-19 vaccinations, but businesses considering them should discuss the issue with benefits counsel, Piro says. The fair-market value of those incentives will likely be taxable.

In Piro’s opinion, clear communication and education take priority over incentives. According to the best available published material, the vaccine appears to reduce likelihood of developing COVID-19 disease and reduce transmission of the virus. “The best incentive to get vaccinated is to decrease dramatically the chance of getting COVID,” says Piro. “You need to have a really good communications program in place to let people know exactly what COVID-19 is. Have webinars in place to educate employees, to talk to them about what the different types of vaccines are.”

Tracking Vaccinations

Though there’s currently no directive to do so, employers are recommended to track their workforce’s vaccinations. This will mean following certain requirements.

Records and documents related to an employee’s medical history or vaccination must be maintained as confidential medical records in separate files from the usual personnel files and in conformance with confidentiality requirements under the federal Americans with Disabilities Act (ADA), Genetic Information Nondiscrimination Act of 2008 (GINA), and Health Insurance Portability and Accountability (HIPAA) privacy requirements, Ungaretti says.

“As you structure any sort of vaccine program, whether it’s mandatory or simply recommended, I think you have to bring in legal counsel to look at the consequences,” Piro says.

Some companies might have other business purposes for tracking employees’ vaccinations. The hospitality and entertainment industries, for example, are beginning to consider how they would deploy a vaccinated workforce versus a nonvaccinated workforce, says Ungaretti. That issue is becoming significant as some customers request to interact only with vaccinated workers.

“From a legal perspective, it’s unclear as to where this will all go as far as how you deploy vaccinated versus a nonvaccinated workforce. Most employers usually use their own judgment as to how they are going to staff or manage their own business,” she says.

Getting to the Other Side of the Pandemic

After a year of confronting the challenges of COVID-19, the rollout of vaccines brings hope for individuals and businesses. Employers with well-considered vaccination programs can help us recover more quickly.

“We will look back at 2020 as one of the most difficult years in our personal and professional lives. From the strain of distressed companies locking down and many of us working from our homes, to the uncertainty of what’s to come,” says Goltermann. “We have to move speedily to get to the other side of this pandemic. Making sure we get to that safe path as quickly as possible is absolutely critical.”

For more information about planning for the COVID-19 vaccine, including past and upcoming webinars, browse Aon’s COVID-19 Insights & Resources site.