How Vaccine Requirements Can Advance Equity
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By Malcom Glenn, Senior Advisor at Meteorite
When President Biden announced this month that he would be requiring COVID-19 vaccinations for two-thirds of all American workers, it was widely heralded by members of the business community and public health leaders as the safest way to protect employees and customers. But there's another potentially game-changing benefit to vaccine requirements: Handled right, they may also help the country advance health equity.
In most states where the race of vaccine recipients is recorded, both Black and Hispanic people have received smaller shares of vaccinations.
Nine months since the Food and Drug Administration granted emergency use authorization to the first COVID-19 vaccine in the US, disparities in vaccine uptake across racial lines are especially stark. In most states where the race of vaccine recipients is recorded, both Black and Hispanic people have received smaller shares of vaccinations compared to their shares of COVID-19 cases and the total population.
For example, in Washington, DC, Black people have received 44% of vaccinations, while making up 56% of cases, 71% of deaths, and 46% of the total population. In California, 31% of vaccinations have gone to Latinx people, while they account for 61% of cases, 47% of deaths, and 40% of the state's total population.
These numbers are consistent across other states that report the race of vaccine recipients, and are particularly painful considering that since the pandemic began, people of color are almost three times as likely to be hospitalized and twice as likely to die compared to Whites when they contract COVID-19. Among people ages 40 to 64, the racial gap in COVID-19 deaths is even worse.
This was predictable. Last March, days before lockdowns began across the nation, Dr. Richard Besser, president and CEO of the Robert Wood Johnson Foundation and one of the nation's leading advocates for health equity, wrote, "Even when structural failures could imperil every American, the greatest strains will fall on certain demographics because of their economic, social or health status."
Reasons for these disparities are well-known, well-reported, widespread, and just the latest and most egregious example centuries-long discrimination against people of color in the American healthcare system. Now, COVID-19 vaccine requirements may be a shot to gain some measure of equity in this pandemic.
Many companies were quick to require vaccines for their office employees, but didn't extend those same requirements to retail workers or customer-facing employees. The President's action puts all employees at large companies, regardless of whether they do their job in an office or on an assembly line, on equal footing.
As representatives from the American Civil Liberties Union pointed out, vaccine requirements are particularly important for frontline workers and other people who are regularly exposed to the public in the course of their jobs, like teachers, delivery and rideshare drivers, janitorial staff, and nurses. Despite composing less than 30% of the American workforce, Black and Latinx workers make up more than half of all workers in building cleaning services, and almost 40% of child care, trucking, warehouse, and postal service workers. This puts them in vulnerable positions, often without access to healthcare or paid time off to see a doctor or visit a vaccination site.
The Biden administration's action was just a first step, though. The responsibility now falls on companies to implement vaccine requirements — and it is by prioritizing the needs of the hardest-hit populations that they can make the most meaningful progress.
A vaccine requirement is only as good as people's access to the vaccine. Currently, for low-income workers in particular, one of the most significant barriers to vaccination is missing work to recover from side effects. That is why paid time off to get vaccinated and recover is a welcome part of the federal plan for businesses of 100 or more workers, and why it's encouraged for companies of all sizes.
Making vaccination a condition of employment is a strong motivator. The National Safety Council found a 35 percent increase in vaccine uptake when employers required it, and rising numbers of unvaccinated people say they would be likely to get vaccinated if it meant keeping their jobs.
Without also facilitating access to the vaccine, though, employers could unintentionally do further harm to communities of color. People who are fired for not getting vaccinated may be ineligible for unemployment benefits, and there's already a long history in this county of unemployed people of color being less likely to receive aid than unemployed White Americans.
Companies should offer positive incentives before taking punitive actions. This is true, too, for "nudges" like higher health insurance premiums. While well-intended, it's key for employers not to put in place barriers that might make health insurance unaffordable for workers of color who are already much more likely to be uninsured than their white counterparts.Instead, businesses can offer support to make vaccination as easy as possible. This could include free transportation or childcare or hosting on-site or mobile vaccination clinics, even on evening shifts.
Or it may be something else entirely: employers should ask workers from hard-hit communities what incentives would encourage them to get vaccinated and offer that That's part of the conversation — building trust, listening for what's holding people back, then helping them find their own reason to get vaccinated — that employers are well positioned to have.
Companies now have an opportunity to lead where public health has historically failed. Vaccine requirements are here; employers can make sure they work for everyone. Otherwise, to return to Dr. Besser's foresight from 18 months ago: "We don't know how the COVID-19 story will end, but even before the ending is written, we know its lessons. Every long-term solution must be viewed through the health equity lens, for if they are not, we'll be setting the stage for our next public health failure."