University of Western Australia
This article by Dr Katie Attwell, from UWA's School of Social Sciences, and Mark Navin from Oakland University, was originally published in The New York Times.
Since banishing the coronavirus from workplaces will be a key to opening the economy — and keeping it open — some companies are considering whether to require their workers to be vaccinated. The chief executive of United Airlines has said he favors making the shots mandatory, and several cruise lines will ask their crews to be vaccinated before returning to work. The U.S. Equal Employment Opportunity Commission has said it is legal for companies to require their employees to get coronavirus vaccines. But these types of mandates are best imposed by governments, not by private companies.
Most vaccine mandates in the United States apply to children entering school. These rules, which vary from state to state, have long been the subject of fierce debate. Veterans of those battles know that immunization policy operates at the intersection of important values: Vaccines are medical treatments, symbols of science and progress, opportunities for community solidarity and objects of government power.
Given the U.S. government’s failure to control the Covid-19 pandemic and the political polarization of public health policies, it may seem wise to allow private corporations to require coronavirus vaccines. After all, it is common for American bosses to manage or attempt to influence the health of their employees through workplace drug testing, company-funded tobacco cessation programs and discounts on gym memberships. Some hospitals and other employers already require their workers to be inoculated for the flu, for example.
But when a company demands that its employees should be vaccinated, this dictate expresses the private power of capital over individuals in ways we should be reluctant to accept. The mere fact that workers and employers are bound together by voluntary contracts doesn’t give bosses license to make medical decisions for their employees. It’s different when the government requires vaccinations, since mandates are typically introduced, removed or modified by democratically elected legislatures, lending legitimacy to public efforts to govern people’s immunization choices.
Private employer mandates aren’t subject to democratic debate, but they’re not apolitical, nor are they free of government oversight. Workplace vaccine mandates have already generated substantial political polarization. Legislators in at least 23 states have proposed laws that would ban employers from making vaccination a condition of employment, and many of those bills have been introduced by Republicans. This partisanship is a calamity for public health, regardless of the merits or shortcomings of employer vaccine mandates. Immunization policies need overwhelming buy-in to succeed.
Governments oversee many actions of private corporations. For example, markets are underpinned by regulatory instruments that uphold contracts, limit monopolies and prevent anti-competitive behavior and insider trading. Thanks to labor laws and worker protections, employer vaccine mandates would also be under at least indirect government influence.
When state governments require vaccinations for school entry, they also specify criteria for exemptions, generally for religious or medical reasons. But establishing criteria for exemptions is beyond the capacities of most private companies, so governments will likely need to do the same for coronavirus vaccine mandates, whether they’re imposed by corporations or legislators. In other words, even private mandates will need government involvement to be operational, let alone effective.
Prominent scholars of childhood vaccination policies recognise that mandates should be used only after governments have meaningfully attempted other strategies. The same applies to employer vaccine requirements for adults in all but the most acute contexts. For example, hospitals, prisons, long-term-care facilities and other settings that are home to vulnerable people and prone to viral spread should be staffed by workers who are immunized for coronavirus.
In other workplace contexts, however, we should approach employer vaccine mandates with caution. In The New England Journal of Medicine, Michelle Mello and colleagues recently argued that state governments should consider coronavirus vaccine mandates only when an outbreak is inadequately controlled and when the mandated vaccines are easily accessible, among other criteria. Similar benchmarks should apply to workplace vaccine mandates.
For now, employers should take steps to nudge employees to get inoculated. For example, Target is paying workers for the time they spend traveling to vaccination appointments, and it is providing transportation vouchers for workers who need them. Other measures can include bringing mobile vaccination clinics to the workplace, displaying posters about the benefits of vaccination, providing incentives such as gift cards and mandating alternative disease-control measures, such as masks, for employees who refuse vaccination. Governments can help these efforts by funding paid vaccination leave and mobile clinics, and by requiring health insurers to offer discounted premiums for those who are vaccinated or medically exempt.
We hope that alternative measures will be successful, but vaccine mandates might still be necessary for workers and even customers in some industries. However, it would generally be better for government to enact such mandates.
The legacy of Trumpism and the continuing pandemic risk making America a failed state. The capacity of the nation’s federal and state governments to protect the public’s health remains limited, but we cannot leave Covid-19 vaccine mandates to the private sector. People need their governments to provide legitimate and effective vaccination policies.