Pressure mounts for employers to mandate COVID vaccine

Feature Vaccine Mandates Panel

Employers have tried pleading, cajoling, and a myriad of incentives, but so far even the devasting effects of the Delta variant haven’t compelled the most stubborn COVID-19 vaccine procrastinators from taking the pandemic poke. But now, a cascading confluence of developments, including the increased hospitalizations cause by the variant, are forcing the hand of employers who have been reluctant to mandate the vaccine for their workers.

The dam might have finally broken early this week with news that the Food and Drug Administration has given the Pfizer-BioNTech vaccine its full approval, which could not only boost public confidence in the jabs, but also convince more employers to make COVID vaccinations mandatory.

In the U.S., more than 200 million Pfizer doses have been administered since December under emergency-use provisions, but in granting full approval, the FDA cited months of evidence that serious side effects are extremely rare. According to Pfizer, the approval process required a 360,000-page application and rigorous inspections, and the FDA has never had so much evidence to judge a vaccine’s safety.

Pfizer CEO Albert Bourla, who has acknowledged that people will likely need a booster dose within 12 months of getting fully vaccinated, and that it’s possible that people will need to get annual vaccinations against the coronavirus, called the FDA’s action an important milestone that will “unlock some of the more skeptical minds.”

Based on the longer-term follow-up data that Pfizer submitted, Bourla says the FDA’s decision affirms the efficacy and safety profile of the vaccine at a time when it is urgently needed. “About 60% of eligible Americans are fully vaccinated, and infection, hospitalization, and death rates continue to rise rapidly among unvaccinated populations across the country,” Bourla says. “I am hopeful this approval will help increase confidence in our vaccine, as vaccination remains the best tool we have to help protect lives and achieve herd immunity.”

Presidential seal

While more than half of the U.S. population is fully vaccinated, the pace began to slow in July as the more contagious Delta variant began to fill hospital beds. Vaccinations are on the rise again, and President Joe Biden, noting that full FDA approval is the “gold standard,” once again encouraged employers to mandate the vaccine. It was the second time he’s enlisted the help of the business community after announcing new requirements for federal workers to either get vaccinated against the virus or get tested regularly.

It appears that mandating becomes much easier with full FDA approval. As it became clear that full FDA approval was anticipated, Group Health Cooperative of South Central Wisconsin announced that all employees must receive at least one dose of the COVID-19 vaccine by Nov. 1, 2021, unless they receive an exemption for religious or medical reasons. According to the organization, 92% of its 800 employees already have been vaccinated.

GHC-SCW joins a list of local vaccine-mandating employers that includes UnityPoint Health, which owns Meriter Hospital in Madison, UW Health, Advocate Aurora Health, SSM Health, and Epic Systems. SSM Health, the parent of Dean Health Plan, got the ball rolling in June, announcing it would require all employees and contractors be vaccinated before the fall, prior to the onset of cold and flu season. At the time, about 77% of SSM’s employees were fully vaccinated, but it cited the prevalence and impact of the Delta variant in announcing its decision to mandate a COVID-19 vaccine.

Government employers also are getting ahead of the vaccination curve. City of Madison and Dane County employees will also need to provide proof of vaccination or submit to regular testing. Effective Aug. 30, the University of Wisconsin–Madison will require all unvaccinated students and employees to undergo weekly tests for COVID-19. The university had planned to test only unvaccinated students living in campus housing, but rising cases attributed to the Delta variant resulted in the new, expanded policy that includes students living off campus and unvaccinated employees. The policy also applies to those who are vaccinated but have not shared their proof of vaccination.

Nationally, major employers are going a step further, or in some cases even two steps further. Delta Air Lines, which is self-insured and sets premiums for its health plans, announced that it will charge employees on the company health plan $200 a month if they fail to get vaccinated against COVID-19. Citing financial risk to the company, Delta CEO Ed Bastian says the policy is necessary because the average hospital stay for the virus costs the airline $40,000. In addition, Delta said as of Sept. 30, it will stop extending pay protection to unvaccinated workers who contract COVID-19, and it will require unvaccinated workers to be tested weekly beginning Sept. 12, though Delta will cover the cost. Delta stopped short of matching United Airlines, which will require employees to be vaccinated starting Sept. 27 or face termination.

Event venues are getting into the act as well. Madison’s Forward Theater Co. decided to require masks, a photo ID, and either a physical vaccination card or a photo of a valid card, to see an in-person performance. Overture Center for the Arts, which will resume live events next month, announced  that all people entering the building must wear a face mask that covers their nose and mouth, they must be fully vaccinated with the last dose administered at least 14 days before the performance, and they must show proof of a COVID-19 vaccination or a negative COVID-19 test result taken within 72 hours before the performance. Meanwhile, officials at Milwaukee’s Summerfest, a large outdoor music festival to be held in September, said they would require either a negative COVID-19 test or proof of vaccination for attendees.

Green light

For several months, employers have had enough federal guidance to require vaccines. In May, the U.S. Equal Employment Opportunity Commission, the federal agency that enforces federal laws pertaining to job discrimination, gave employers the green light to mandate vaccines within certain parameters. Noting that federal law permits vaccine mandates for all employees who physically enter the workplace, the EEOC stated that such mandates are subject to the reasonable accommodation provisions of the Americans with Disabilities Act and Title VII of the Civil Rights Act of 1964.

The emergence of the Delta variant, and the halting impact it’s beginning to have on office reopening plans, have given employers added incentive, and state governments continue to offer incentives. This week, Gov. Tony Evers announced the state’s COVID-19 Vaccine Reward Program, which offers a $100 Visa gift card to anyone who receives their first dose of COVID-19 vaccine between Aug. 20 and Sept. 6. Thus far, more than 50% of the state’s residents have completed their vaccine series.

Meanwhile, additional progress toward full FDA approval continues. Pfizer’s vaccine, which will be marketed as Comirnaty, will continue to be dispensed to 12- to 15-year-olds under an emergency-use authorization, but the company is expected to file an application for full approval for that age group.

Moderna also has applied to the FDA for full approval of its vaccine in adults, and Johnson & Johnson, maker of a third vaccine alternative for the American market, hopes to follow suit later this year. Both Pfizer and Moderna have vaccine studies underway in children under 12.

Approvals for additional doses also are being sought. Pfizer announced it has started the FDA application process for a third dose of its vaccine for everyone age 16 and older. Earlier this month, the agency said transplant recipients or others with weakened immune systems can get an extra dose of the Pfizer or Moderna vaccines, and to add a layer of protection against the Delta variant, U.S. health officials also have announced plans to give COVID-19 booster shots to all Americans.

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