Employer Requirements and COVID-19 Vaccination and Attitudes among Healthcare Personnel in the U.S.: Findings from National Immunization Survey Adult COVID Module, August – September 2021

Abstract

Introduction Employer vaccination requirements have been used to increase vaccination uptake among healthcare personnel (HCP). In summer 2021, HCP were the group most likely to have employer requirements for COVID-19 vaccinations as healthcare facilities led the implementation of such requirements. This study examined the association between employer requirements and HCP COVID-19 vaccination status and attitudes about the vaccine. Methods Participants were a national representative sample of United States (US) adults who completed the National Immunization Survey Adult COVID Module (NIS-ACM) during August—September 2021. Respondents were asked about COVID-19 vaccination and intent, requirements for vaccination, place of work, attitudes surrounding vaccinations, and sociodemographic variables. This analysis focused on HCP respondents. We first calculated the weighted proportion reporting COVID-19 vaccination for HCP by sociodemographic variables. Then we computed unadjusted and adjusted prevalence ratios for vaccination coverage and key indicators on vaccine attitudes, comparing HCP based on individual self-report of vaccination requirements. Results Of 12,875 HCP respondents, 41.5% reported COVID-19 vaccination employer requirements. Among HCP with vaccination requirements, 90.5% had been vaccinated against COVID-19, as compared to 73.3% of HCP without vaccination requirements—a pattern consistent across sociodemographic groups. Notably, the greatest differences in uptake between HCP with and without employee requirements were seen in sociodemographic subgroups with the lowest vaccination uptake, e.g., HCP aged 18—29 years, HCP with high school or less education, HCP living below poverty, and uninsured HCP. In every sociodemographic subgroup examined, vaccine uptake was more equitable among HCP with vaccination requirements than in HCP without. Finally, HCP with vaccination requirements were also more likely to express confidence in the vaccine safety (68.3% vs. 60.1%) and importance (89.6% vs 79.6%). Conclusion In a large national US sample, employer requirements were associated with higher and more equitable HCP vaccination uptake across all sociodemographic groups examined. Our findings suggest that employer requirements can contribute to improving COVID-19 vaccination coverage, similar to patterns seen for other vaccines.

Behavioral and social drivers of COVID-19 vaccination initiation in the US: a longitudinal study March─ October 2021

“…Thus, we restrict the interpretation of these by frontline workers identified in this study and elsewhere (Henneberger et al, 2022;Prince et al, 2022) could be attributed to limited access to COVID-19 vaccines among non-healthcare frontline workers, and could be addressed, in part, by increasing workplace flexibilities to receive a vaccination, as reported in an assessment of non-healthcare frontline workplaces in Chicago (Lendacki et al, 2023). Among the items assessed at follow-up, vaccination requirements had a strong association with vaccine initiation, consistent with another nationally-representative survey (Lee et al, 2022). Given this finding, equitable, clearly communicated vaccine requirement policies could provide an opportunity to increase vaccine initiation (Mello et al, 2020) particularly among health care workers (Emanuel & Skorton, 2021).…”

Did COVID vaccine mandates work? What the data say

“…In the United States, James Lee, an epidemiologist at the Centers for Disease Control and Prevention in Atlanta, Georgia, led a national phone survey of 12,875 health-care professionals who self-reported their vaccination status and the presence or absence of a workplace mandate 5 . Where mandates existed, 90.5% of respondents were vaccinated; where they did not, only 73.3% were.…”

Covid-19 Vaccines As a Condition of Employment: Impact on Uptake, Staffing, and Mortality in Elderly Care Homes

“…Despite the controversies, there is only limited empirical evidence on the actual impacts of requiring Covid-19 vaccination as a condition of employment. 3 Cohn et al (2022) report that employer-based vaccine mandates in New York City were associated with a significant increase in uptake and this finding is supported by survey evidence of hypothetical responses to mandates (Lee et al, 2021;Bennet, Bloom and Ferranna, 2022;Fishman et al, 2022). Evidence on real-world impacts for care homes is limited to a case study of a single US nursing home (Ritter et al, 2021) and descriptive data from Mississippi (Syme, Gouskova and Berry, 2021).…”