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Covid-19 presents unprecedented challenges for considering vaccine mandates and predicting their impacts. Vaccine mandates have historically focused on school children or hospital workers. Hospitals that mandate vaccination see >94% compliance with few lost employees (less than 0.2% in one study). Mandates are now being adopted in other industries such as technology, manufacturing, food processing and transportation. There is some evidence to suggest that vaccine mandates are not increasing turnover except in industries that already have high turnover rates. 


Public health experts acknowledge that vaccine mandates may be key to U.S. herd immunity. Yet, vaccine mandates may also generate employee pushback, resentment, and turnover. This is especially likely when there is low trust, transparency, and clarity – none of which develop overnight.

Be prepared to move quickly.

Be prepared to move quickly on a vaccine mandate. Many organizations are or may soon be required  to implement a vaccine mandate under government directives at the federal, state or city level. Public pressure for or against mandates is also a factor. Even if not required, it may make sense to require mask wearing and some, if not all, employees to be vaccinated or submit to regular testing. It's wise to think through the many issues and implications in advance. Who is covered? What is the deadline? How will vaccination or testing be tracked and verified? If testing is an option, where will it happen and who will pay? What are the implications for people who choose not to participate? How will policies and processes be communicated inclusively and over time? If you are mandating vaccination, clearly explain your reasons.

Consider a vaccine mandate in terms of organizational values, needs and context.

If you are weighing whether to implement a vaccine mandate, consider your organization's operational and strategic needs, employee and community attitudes, and legal factors. You may serve vulnerable people who are at high risk of illness. You may learn from your employees that they want colleagues – and perhaps customers or clients – to be vaccinated to feel safe at work. Still other employees may object to inquiries about vaccination status or to requests that they become vaccinated. Listen to and acknowledge everyone’s concerns, and give people options and time to transition when possible. If you do decide to mandate vaccination, be sure to clearly explain your reasons and recognize that some employee turnover may be inevitable. Describe how vaccination  -- and how you plan to implement the mandate -- relate to your organizational mission and values. 

Considering Vaccine Mandate Plans

Mandating vaccinations – and for whom – is a timely and often controversial decision. Although vaccines have become widely available, variants are driving new Covid-19 infections. As a result, The White House has announced several major vaccine mandate policies (See "Track legal regulations" below). In addition, many state and local governments and private organizations have decided to mandate vaccination for all or some employees. Businesses, hospitals, and schools report that mandates are effective at slowing the spread of Covid.

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Be proactive about barriers and concerns.

Think about what challenges employees may face and how they might feel about a mandate. If rolling out a mandate, outline any options. Allow some time for them to think about and discuss their decision and make transition plans, as needed.  Provide training to managers on how to handle these issues. Choose your words and timing carefully. Consider making onsite vaccination available if that becomes an option.


Consider a phased rollout.

If you do issue a mandate, you might consider starting with people at the highest risk of exposure at first or those whose roles require them to be in the office. If you can, allow employees who do not wish to be vaccinated to temporarily work from home or avoid client or public contact. Consider offering to connect them with third party medical experts as well to address their concerns. Organizations that mandate flu vaccines generally provide plenty of time and reminders. They also provide support to help employees get vaccinated. They then put employees who do not get vaccinated on a period of unpaid administrative leave. If the employees get vaccinated during leave, they may resume their jobs. Otherwise, they face termination.

Compare vaccination to other terms of employment.

Compare vaccine mandates to other common requirements in your field (e.g., drug or TB testing, background checks). This will help people connect vaccination to other conditions of employment they already follow. Normalizing the requirement may make a mandate easier to accept.

Try not to go it alone.

It may be helpful to communicate and/or work with local or peer organizations. Consider unions, licensing organizations, trade associations, and other policy-influencers. If you decide to mandate vaccination, it will be easier to do it together than alone.

Consider many points of view.

Do not assume that unvaccinated people are opposed to vaccination, or reckless. When considering a mandate, consider the perspectives of your diverse employees and clients. They may belong to communities that are disproportionately affected by Covid-19. They may be barred from healthcare and adequate medical coverage. They could be wary of government or medical authorities based on lived experience. Some people cannot be vaccinated for medical reasons and will depend on herd immunity for protection. Some also may not have extensive scientific or medical knowledge. Consider each point of view before proceeding with mandates. 


Build up trust and transparency.

Announcing a mandate without building trust may result in backlash and unintended consequences. You may see baseless exemption claims or submissions of fake vaccination cards. Leaders should get vaccinated as soon as possible and share their experiences. Leaders and managers must also communicate the reasons for a vaccine mandate clearly and continuously. They should create opportunities to learn and discuss together with employees. These could include town halls, webinars, or small group meetings.


Reach out to unions in advance, if relevant.

When exploring a vaccine mandate, engage any collective bargaining groups that represent your employees. Reach out early to avoid blindsiding organizers. They can be valuable partners.

Track legal regulations and interpretations on vaccine mandates.

Issues involving vaccine mandates continue to evolve. A significant mandate plan was put forth by the White House in September. Federal employees and contractors and many healthcare workers are required to be vaccinated. The Center for Medicare and Medicaid Services (CMS) has issued implementation guidelines for health care settings. In addition, new rules proposed by OSHA would require businesses with over 100 employees to mandate vaccination or regular testing for employees (with certain religious and health exemptions). These businesses must also provide paid time off for getting or recovering from vaccinations. Vaccine or testing mandates have been enacted by some state and local governments, while others have passed legislation to prohibit  mandates. Mandates are also being tested in the courts. It’s a dynamic and confusing patchwork.

For organizations not covered by specific regulations, mandating vaccination is generally legal and employers may ask to see proof of vaccination as a condition of continued employment – at least in some businesses. Exemptions may be offered in some states for certain religious affiliations and disability statuses, or because employees have already had Covid-19. Some states have legislatively banned vaccine mandates under FDA emergency use authorization. That may be subject to challenge now that the Pfizer-BioNTech vaccine has been granted full approval (with other vaccines likely to follow). Regardless of mandates, it appears that employers may require more frequent Covid-19 testing and other safety protocols. You will need to track both local and national updates on vaccine mandates. Federal sources to track include the CDC, FDA, EEOC, ADA, NLRB, OSHA, CMS, and DOL.


Not all organizations - or employees within an organization - are at equal risk of getting or spreading Covid-19. Some employees may also be more hesitant about vaccination. These are factors when considering a vaccine mandate. Yet, as vaccine access has improved, people may prefer working in fully-vaccinated organizations, and customers or partners may prefer only engaging with vaccinated employees. This may particularly apply to organizations expected to have high health and safety standards. Example organizations include health and personal services, retail, and food manufacturing/service. In some circumstances, pressure to mandate client or customer vaccination may also increase. Invest in ongoing communication, trust-building, and overcoming vaccine access barriers now. These will help you respond as these pressure points become clearer.

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