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Can Employers Mandate COVID Shots?

August 4, 2021 By

Just when many of us were beginning to feel that COVID vaccinations were improving the landscape of our lives in 2021, we now have the delta variant surge to worry about. This variant is much more infectious – perhaps as contagious as chickenpox, according to an internal CDC document. 

On July 27, the U.S. Centers for Disease Control and Prevention (CDC) issued a recommendation that everyone in areas of high COVID-19 infection rates wear masks in public indoor spaces REGARDLESS OF VACCINATION STATUS.

As of that same date, 49 percent of Americans have been fully-vaccinated, while 7.8 percent of people have only been partly vaccinated against COVID-19. Whether herd immunity, widely considered to be between 70 percent and 90 percent, is possible in this country is now debatable. As mentioned earlier, the variants that continue to evolve, along with the persistent hesitancy of vaccinations will make herd immunity difficult, if not impossible.

Dr. Kevin Kavanagh, a member of Infection Control Today’s® Editorial Advisory Board, recently wrote: “The virus that we’re currently dealing with has a lot of room to continue to mutate, and to become more infectious and more lethal.” His last few statements, however, were most alarming to me: “I am convinced this virus is about one or two iterations away from completely avoiding the vaccine. And remember, we have the lambda variant and the kappa variant which are sitting out there in the wings, waiting for immunity to drop and possibly cause another wave.”

With this latest delta variant surge, more employers are justifiably looking at options to either strongly insist or incentivize their employees to get vaccinated. Should employers use the stick or the carrot to move the needle on vaccinations?

Do Employers Have a Legal Right to Mandate COVID shots?

Overall, can employers require that employees get vaccinated for COVID? The quick answer is “yes.” 

Recently, the U.S. Department of Veterans Affairs, the State of California, New York City, hospitals and nursing homes, colleges and universities have introduced COVID-19 vaccine mandates into the workplace, including masking protocols. This past week, President Biden announced that federal employees and contractors must be vaccinated or be tested once or twice a week. 

Government agencies and private employers can require their employees to get vaccinated as a condition of working there. Employees can certainly refuse to be vaccinated, but they have no right to legal protection. However, there are a few exceptions. Employees with medical or religious reasons may seek reasonable accommodation under civil rights laws, but such accommodation must not constitute an undue hardship for the employer. These employees could get tested weekly, wear masks while in the office, or work remotely. 

For those employees who are unable to meet these exceptions, they will likely need to seek different employment opportunities.

On July 6, the Department of Justice Office of Legal Counsel issued an opinion that federal law does not stop private businesses or public agencies from mandating COVID vaccines. This opinion comes two months after the Equal Employment Opportunity Commission (EEOC) released guidance (May 28) that said U.S. employers could require all employees who physically enter an office space to get vaccinated.

Google and Facebook have recently implemented requirements that any employees returning to the office must first be vaccinated. Google is also extending its work-from-home policy until October 18. Should this policy change, employees will be given at least a 30-day notice.

Can States Ban Vaccine Mandates?

The EEOC guidance has pushed lawmakers in some states to introduce legislation prohibiting businesses from mandating COVID-19 vaccinations as a condition of employment. According to the National Academy for State Health Policy (NASHP), Iowa had two bills introduced that would ban employer mandates, but neither was enacted. 

Non-Mandate Strategies that include Incentives

This discussion is really centered around using the carrot or stick approach. Mandating vaccinations at the workplace serves as the stick, while using carrots to incentivize employees to get vaccinated may serve as the middle ground for many employers. Short of mandating that workers are fully-vaccinated and having mask protocols, what options do employers have to keep employees safe while at the workplace? 

One option is to mandate vaccinations for certain classes of employees, and then offer carrots to all other employees. As an example, Walmart announced that all of its corporate staff employees and regional managers must be fully vaccinated by October 4. However, for store and warehouse employees, Walmart is offering a $150 vaccine bonus (carrot).

The May 28 EEOC guidance provides updated and expanded technical assistance on how the Genetic Information Nondiscrimination Act (GINA) and the Americans with Disabilities Act (ADA) affect establishing policies when offering incentives to employees to get the COVID-19 vaccine. In short, the employer may offer an incentive to employees for voluntarily obtaining a vaccine that is administered by the employer or its agent if the incentive is not so substantial as to be considered ‘coercive’. 

Unfortunately, the EEOC guidance does not state a standard for what would be considered ‘coercive’, which may deter employers from arranging onsite vaccinations to provide an incentive. However, the EEOC guidance states no specific limit on incentives for vaccinations that are NOT administered by employers or their agents, which can actually provide a reasonable level of comfort for employers who wish to offer cash or gift card incentives.

The EEOC clarified that, under GINA, the employer may offer employees incentives for getting vaccinated, but the employer cannot acquire genetic information while administering the vaccines. Additionally, employers should have protocols in place to ensure that vaccination information is kept confidential – such as proof of vaccination – and be stored separately from regular personnel files. 

RECOMMENDED READING: The Society of Human Resource Managers (SHRM) provided an article on four key takeaways from the EEOC guidance.

Summary

Should employers use a stick or carrot to increase a vaccinated workplace? It really depends on the organization’s culture, its geographical location, and the level of trust that an organization has with its employees. Similar to the elongated pandemic, the answers to this Rubik’s Cube are evolving and somewhat complicated – but need immediate attention.

In an abundance of caution, it is recommended that businesses seek legal guidance about any potential associated hurdles of mandating vaccinations, in addition to considering other strategies in lieu of fully implementing a vaccine mandate.

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Filed Under: David P. Lind, Lindex Tagged With: , , , , , , , , ,

New Study on Exercise Guidelines

May 4, 2021 By

New Study about Exercise GuidelinesDespite religiously biking and working on both the elliptical and rowing machines, I recently learned that my blood pressure is somewhat elevated. I can only assume that this may be caused by my high-salt dietary habits. Having garnered my attention, it’s time to make necessary changes.

The motivation for change was also heightened by a new report on how high blood pressure can possibly be reduced without relying on medications.

A new study published in the American Journal of Preventative Medicine suggests that exercise guidelines from the U.S. Department of Health and Human Services (HHS) might require an update. Here are the new findings:

  1. Weekly Exercise of at Least Five Hours (300 minutes) – The current HHS guidelines suggest that adults should aspire to perform at least 150 to 300 minutes weekly of moderate-intensity exercise. Brisk walking, swimming, and mowing the lawn are three good examples. However, the new study concludes that moderate exercise should be around five hours per week. In other words, if you exercise at 150 minutes per week, you are only half-way to the new recommended level. As mentioned in the study, “Moderate physical activity levels may need to exceed current minimum guidelines to prevent hypertension onset using the 2017 American College of Cardiology/American Heart Association definitions.”
  2. How Five Hours Per Week was Determined – Researchers analyzed a mid-1980’s project that extended for 30 years. Of the 5,000 teens followed, only those who completed more than 300 minutes of exercise every week avoided hypertension. Hypertension occurs in nearly half of all American adults and is defined as blood pressure at or above 130/80mm Hg. High blood pressure levels can cause risk for cardiovascular disease and events, which can be fatal. In 2018, nearly half a million deaths in the U.S. included hypertension as a primary or contributing cause.
  3. Racial Disparities – The new study indicates that Black respondents exercise far less than White respondents. The result? Black individuals suffered more acutely from the effects of hypertension than White respondents. This finding, it should be noted, is not earth shattering. According to the Centers for Disease Control and Prevention (CDC) in 2020, racial disparities in hypertension prevalence is greater in non-Hispanic Black adults (54 percent) than in non-Hispanic White adults (46 percent), non-Hispanic Asian adults (39 percent), or Hispanic adults (36 percent). Hypertension rates also vary greatly by state.

Summary

It is widely known that high blood pressure can be treated by a combination of medication and lifestyle changes. For employers, worksite programs related to physical activities, nutrition, alcohol use, stress, type 2 diabetes and obesity can aid employees in prevention and reducing high blood pressure.

Of course, modifying behaviors is the ultimate challenge to employers, their employees and family members. It begins and ends with finding the ‘right’ motivations to alter lifestyle choices.

As for me, exercising is no problem, and I feel confident that my blood pressure can be reduced by making a few dietary changes that I should have been making earlier. With that said, I really will miss those salted pistachios!

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Filed Under: Lindex Tagged With: , , , ,

Trusting Science – Who will be the next ‘Elvis’ in 2020-21?

September 2, 2020 By

Unfortunately, the race for a Covid-19 vaccine is sounding so political that it is proving to divide Americans by party voting preference. As we are now keenly aware, science and politics do not mix well.

Following the Democratic National Convention, V.P. Mike Pence told CNN: “We think there is a miracle around the corner. We believe it’s very likely that we’ll have one or more vaccines for the coronavirus before the end of this year.  All of that’s attributed to President Trump’s leadership.”

As of August 31, the number of confirmed Covid-19 infections in the U.S. has topped 6 million, while national fatalities approach 183,000. Based on state sources in Iowa, there have been 64,102 confirmed cases and 1,110 deaths.

Vaccine speed is desperately needed, but will it come at the expense of accuracy and safety? Should Americans be concerned? Yet, just as important as having an effective vaccine, is the trust that Americans have in believing that government officials will do what’s right, not just what is most expedient for political purposes.

Trusting science during this era of social media and partisan politics may be very difficult to overcome. But 64 years ago this coming October, Elvis Presley stepped up. The eventual King of Rock-and-Roll became an influencer for a segment of Americans. More on that later…

Herd Immunity

Having trust in our national infrastructure to develop and distribute effective and safe vaccines is paramount to reaching herd immunity, which is having enough people become immune to a disease to make its spread unlikely. Many experts estimate between 60% and 70% of the population need to be immune in order to achieve herd immunity.

Here’s the growing concern: We could have the most effective and safe vaccine available, but if few Americans take it, then it won’t matter.

During the past six months, Americans have seen highly-touted solutions fall short of the hype. The U.S. and the world are starving for good news concerning a Covid-19 vaccine. The haste for finding the silver bullet is causing both confusion and hesitation for Americans to feel comfortable enough to eventually obtain a vaccine when it does become available.

As intent as one political party is for news of a year-end vaccine that could help ‘save’ the presidential election, the opposing party is nervously hoping any promising news does not occur until AFTER the election. Both parties are in precarious and compromised positions. This tug of war competition uses science as the rope.

Polling on ‘Vaccine Hesitancy’

Vaccine hesitancy is showing up in national polling during August. The results indicate that about half of Americans are ‘highly likely’ to get vaccinated for Covid-19. An Associated Press/NORC Center for Public Affairs online poll in May indicated that half of Americans would hesitate to take or refuse a vaccine, while a King’s College London study found similar numbers in the United Kingdom. To make matters worse, a vaccine may likely need two doses, not just one. Convincing people to seek a vaccine twice will be quite challenging.

According to scientists and America’s own Dr. Anthony Fauci, a widespread uptake of a coronavirus vaccine is the most effective tool in combating infectious diseases. But so far, the type of information being shared with Americans is both inconsistent and, in many cases, inaccurate. This is not a good combination needed to build the necessary trust in achieving herd immunity.

Below is a short list of examples that will erode American public trust if and when a proven vaccine becomes available.

1. Operation Warp Speed (OWS)

Introduced in early April 2020, Operation Warp Speed was initiated by the Trump Administration to facilitate and accelerate the development, manufacturing, and distribution of Covid-19 vaccines, therapeutics, and diagnostics. As a public-private partnership consisting of federal agencies and private pharmaceutical firms, OWS promotes mass production of multiple vaccines based on preliminary evidence allowing for faster distribution if clinical trials confirm one of the vaccines is safe and effective. Congress has directed nearly $10 billion to fund OWS so that any vaccine or therapeutic doses purchased with U.S. taxpayer money will be given to Americans at little or no cost.

Four coronavirus candidate vaccines are expected to be in large-scale clinical trials by the middle of September – a remarkable timeline since the SARS-CoV-2 virus was discovered in December. However, the marketing of “Warp Speed” causes concerns for critics and some science experts that the government and its research partners may cut corners that would increase the likelihood that chosen vaccines are not really safe and effective.

2. Convalescent Blood Plasma Treatments

On the eve of the Republican National Convention, the FDA Commissioner, Dr. Stephen Hahn, reiterated President Trump’s proclamation that 35 people out of 100 (35 percent) would survive the coronavirus if they were treated with convalescent plasma. This “historic breakthrough” was based on preliminary findings of Mayo Clinic observations.

However, medical experts and scientists – including former FDA officials – pushed back saying the treatment’s value has not been established, and the claims vastly overstated preliminary findings of the Mayo Clinic.  One day later, Hahn backtracked from his comments, stating, “…The criticism is entirely justified. What I should have said better is that the data show a relative risk reduction not an absolute risk reduction.”

The FDA is under intense pressure from the White House to move the approval process along when deciding whether upcoming vaccines are safe and effective for Covid-19.

3. CDC Using Yesterday’s Technology to Fight Covid-19

The Centers for Disease Control and Prevention (CDC) is the federal agency that has primary responsibility for handling infectious diseases, which is a huge lift during this pandemic. Yet, according to authors Joel White and Doug Badger in a recent Op-Ed in the Chattanooga Times Free Press, “the CDC uses an antiquated system to collect information essential to fighting the coronavirus.” The CDC, since 2006, has ignored four separate laws requiring it to build a modern, efficient system for collecting information to combat disease. Currently, they argue that “medical workers literally phone or fax in their data. And when they do, it’s not the data we need.” Fax???

During the week of August 24, the CDC quietly released controversial new guidelines that caused an outcry from various medical groups and allegations of political intervention. The agency dropped its previous recommendation to test everyone who’s come into close contact with a person infected with Covid-19 – even those who don’t have symptoms. Confusion reigns on what one should do if they become recently exposed but have no symptoms.  In fact, several large states and providers rebuke this latest testing plan.

4. Hydroxychloroquine

On May 18, President Trump claimed that he has been taking doses of hydroxychloroquine, a drug he has highly touted as a potential coronavirus cure despite concerns from medical experts and the FDA, specifically regarding its efficacy and potential harmful side effects.

Initial data from observational studies have shown this drug has limited or unproven benefits for Covid-19 patients, and could be harmful when used in certain combinations.

5. Reporting Glitches from the Iowa Department of Public Health

Not to be outdone by the CDC, according to an August 28 Des Moines Register article authored by Lee Rood, the state health department has drawn widespread criticism from other Iowa county authorities because of data collection and reporting problems, resulting in thousands of coronavirus infections being misreported. The accuracy of underreported new infections has plagued the state for months.

6. U.S. Postal Service Delivery Problems

This summer, U.S. Postmaster General Louis DeJoy, a Republican, has been slashing budgets and services due to poor finances, causing concern on whether the USPS can handle mailed-in ballots of three-quarters of the voting population this coming November. In fact, the Postal Service informed 46 states and the District of Columbia that it did not have service capacity to meet the deadlines for voters to request and send in ballots, prompting almost two dozen states to sue DeJoy and the Postal Service. The fundamental infrastructure for voting now becomes highly questionable because the mail service has become politicized.

Who will be the next ‘Elvis Presley’?

The first half of the 20th century saw a series of polio epidemics affect hundreds of thousands of children across the world. As a result, many were left seriously incapacitated, with one victim being Franklin D. Roosevelt, the future U.S. president.  Major research was launched to combat polio, and in 1955, Dr. Jonas Salk announced that he developed a vaccine, that provided more than 90 percent protection after three shots.

At that time in America, the American public was somewhat indifferent towards the importance of vaccinations, in fact, there were organizations that lobbied against vaccinations in general, including polio.

Initiatives were launched for children to take the vaccine, but few U.S. teenagers and adults sought to be immunized, most believing they were not at risk. To boost teenager take-up of the polio vaccine, Elvis Presley was recruited, receiving massive media coverage while receiving the shot prior to his appearing on the Ed Sullivan Show 64 years ago this coming October 28. Newspapers all over the country published photos of the Presley vaccination. This publicity ‘stunt’ suggested that the vaccine was safe and helped promote public confidence. Presley, it should be mentioned, continued to work on behalf of the National Foundation for Infantile Paralysis and the vaccination became one of his advocacies.

Moving Forward

Even in ‘better’ times, there is a segment of the American population that believe vaccinations are not safe and can cause dangerous health problems, such as autism. In 2015, a Pew Research Center study found that about one in 10 Americans believe vaccines for diseases such as measles, mumps and rubella are not safe for healthy children.

By this November, the U.S. Department of Health and Human Services plans to launch a public-awareness campaign across television, radio and social media, with the intent of focusing on vaccine safety and efficacy. Medical experts will be paired with celebrities to help these messages resonate with the public. Based on the confusion, doubts and concerns mentioned earlier, this will be a formidable challenge to overcome.

Several health policy experts envision vaccine ‘mandates’ coming from the government, much like the current vaccine requirements for school-age children, military personnel, and hospital workers. Imagine restaurants and bars having signs at the entrance saying, “No Shirt, Not Shoes, No Inoculation, No Service.” Providing proof of inoculation (and booster shots) could be mandatory before entering the establishment. In essence, being inoculated becomes your reward for doing the right thing.

It’s time to put science ahead of politics. Trust, as we all know, must be diligently earned.

Will the next ‘Elvis’ be able to restore our sagging confidence?

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Filed Under: David P. Lind, HHRI Tagged With: , , , , , , , , , , , , ,