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Employers Step Up Efforts to Raise Workers' Vaccination Rates

New guidance greenlights incentives, which few employers have offered to date

June 15, 2021 | Stephen Miller, CEBS

A bottle of coronavirus vaccine sits on top of a pile of money.

[Editor's note: This article has been updated from a previous version published June 7, 2021.]

Before the U.S. Equal Employment Opportunity Commission (EEOC) gave employers the go-ahead to incentivize workers to get COVID-19 vaccines, few businesses were offering cash or other rewards to vaccinated employees.

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Using financial incentives to promote coronavirus shots may now increase following the EEOC's May 28 release of updated and expanded technical assistance on how the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA) apply when an employer offers incentives to employees to get a COVID-19 vaccine.

The guidance clarified that under the ADA, an employer may offer an incentive to employees for voluntarily getting a vaccine administered by the employer or its agent if the incentive is not so substantial as to be coercive.

Even this modest and vaguely defined restriction, however, does not apply when employers offer incentives to employees who voluntarily provide documentation that they received a COVID-19 vaccination on their own from a third-party provider that is not their employer or an agent of their employer, such as a pharmacy, public health department or other health care provider in the community.

'Expect more employers to offer incentives in an effort to boost vaccination rates.'
—Wade Symons, Mercer

Under GINA, the EEOC said, as long as an employer does not acquire genetic information while administering the vaccines, the employer may offer employees incentives for getting vaccinated.

Incentive Concerns

A survey conducted from April 15 to May 16 by HR consultancy Mercer found that among 431 employer respondents, few provided financial incentives for getting vaccinated:

7 percent provided cash or gift cards.
1 percent provided contributions to health spending accounts (e.g., health savings accounts or flexible spending accounts).

David Zieg, clinical services leader at Mercer, said he hasn't seen data on average incentive payments but that "based on my anecdotal experience, it likely sits somewhere around $200 to $300."

The EEOC's guidance states no specific limit on incentives for vaccinations that are not administered by employers or their agents, which "should provide a reasonable level of comfort for employers who were somewhat reluctant to offer cash or gift card incentives because of the legal uncertainty," said Wade Symons, Mercer's regulatory resources group leader. "We would expect more employers to offer incentives in an effort to boost vaccination rates, and our recent conversations with employers reflect this."

Offering PTO

While employers have been skittish about financial incentives, many are providing extra paid time off (PTO) so employees don't have to use existing vacation or sick days to get vaccinated, Mercer found:

53 percent are offering PTO to get vaccinated.
34 percent are offering PTO to recover from side effects.

Zieg noted that "given the prevalence of side effects, especially after the second dose of the [two-dose Pfizer and Moderna] vaccines, providing a little additional PTO to recover is a prudent gesture to support employee vaccination."

Providing Vaccination Access

Aside from incentives and PTO, employers are making it easier for employees to get vaccinated by providing onsite or near-site vaccinations, the survey found:

6 percent are already doing this.
11 percent plan to begin soon.
20 percent are considering it.

According to Zieg, "some pharmacy chains and local providers are now offering onsite vaccination clinics to employers," including small businesses with fewer than 100 planned vaccinations for employees and dependents. "Availability is variable but appears to be increasing around the U.S.," he noted.

But given the new EEOC guidance, Symons said, "there are a couple of areas of risk for employers to consider if the employer is providing the vaccine onsite or contracts with a third party to provide the vaccine to employees." An employer in these circumstances would not be able to offer incentives for employees to get vaccinated "unless the incentive is so small that it could not be considered coercive—think a T-shirt or water bottle," he pointed out.

The lack of a standard for what would be considered coercive, Symons said, "may be a deterrent for employers that have arranged for onsite vaccination to provide an incentive, given that whether an incentive feels coercive to an employee is certainly going to vary individual by individual."

Another potential risk is in making sure vaccination information is kept confidential, he noted. "If an employer is collecting proof of vaccination, that is medical information, and the ADA requires that the information be stored separately from regular personnel files," Symons said. "Employers should have protocols in place to keep vaccine-status information private."

A Commitment to Workers

"Employers understand that by taking an active part in supporting the vaccination of employees, they can play a crucial role in ending the pandemic," said Jeff Levin-Scherz, M.D., population health leader at consultancy Willis Towers Watson. "A common strategy for employers is to make vaccines an easy choice for employees by first helping convince them to get the vaccine and then making it easy for them to do so."

By encouraging vaccinations, "employers are demonstrating their commitment to employee safety and well-being," he added. "Taking various approaches and using clear, targeted communications about the importance of vaccination will enable employers to protect employees, their families and the community. It will also help speed the transition to a post-pandemic future."

The consultancy's Spring 2021 COVID-19 Vaccination and Reopening survey, conducted May 19 through May 28 with responses from 660 large employers, identified steps employers are taking as workplaces reopen, such as:

Providing pay for time spent getting vaccinated, such as extra leave or vacation time (62 percent of respondents).

Performing or considering onsite or near-site vaccine administration for employees (59 percent).

Offering or considering offering additional leave for any employee who has negative reactions from the vaccine (58 percent).

Offering or considering providing financial incentives for getting vaccinated (20 percent).

"While the lessons of COVID-19 are still unfolding, employers have already learned the ability to adapt and be flexible is essential," Levin-Scherz said. "For instance, we expect many employers will relax their current mask-wearing policies if data confirms a low level of risk to people who are fully vaccinated.

He added, "By keeping abreast of the latest developments, employers can continue to play a vital role in boosting vaccination while also creating the safest workplaces possible."

Getting Vaccinated—and Back to Work

In Willis Towers Watson's 2021 Emerging Trends in Health Care Survey, conducted Feb. 23 through March 12 with responses from 446 large U.S. employers:

84 percent of respondents said immunization would reactivate the nation's economy.
80 percent said it will allow more employees to return to the workplace.

Relatively few employers (10 percent), however, believed vaccines should be mandatory.

While reaffirming its position that employers may mandate COVID-19 vaccinations, the EEOC cautioned that employers must still provide reasonable accommodation for employees who are exempt from a vaccination mandate under the ADA and Title VII of the Civil Rights Act, unless this accommodation poses an undue hardship to the employer's business.

Do Vaccination Incentives Work?

While financial incentives have been shown to encourage participation in some health improvement programs—such as for losing weight or quitting smoking—they may be less effective with the COVID-19 vaccine, according to David Asch, executive director of the Penn Medicine Center for Health Care Innovation and a professor of management at The Wharton School of the University of Pennsylvania.

"Someone who has a lot of distrust of the vaccine might think, 'They'd never offer money if this was a good thing,' " he said in an interview with the Association of American Medical Colleges.

"A better approach is to try to reduce obstacles that people face in getting vaccines," Asch advised. "Think of all those logistical, scheduling and access challenges that are limiting the use of vaccines."

Another Kind of Incentive

While financial incentives are being debated, interest in getting vaccinated against COVID-19 increased after May 13 when Rochelle Walensky, director of the U.S. Centers for Disease Control and Prevention, announced that "Anyone who is fully vaccinated can participate in indoor and outdoor activities, large or small, without wearing a mask or physical distancing."

"This shows incentives matter," Jonathan Reiner, professor of medicine and surgery at George Washington University School of Medicine, told CNN. "People needed a carrot, and the carrot was the ability to drop the mask in most settings."

The CDC's new guidance still requires fully vaccinated workers to comply with their employer's safety protocols.