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The Health 202: States propose bills to ban employers from mandating coronavirus vaccines

with Paige Winfield Cunningham

It's not yet clear whether U.S. states and employers aim to use their broad power to mandate vaccinations to force people to get inoculated against the coronavirus. 

But that hasn't stopped some state lawmakers from trying to preempt any potential mandates. 

Lawmakers in nearly two dozen states have introduced anti-mandate legislation.

The bills, mostly backed by Republicans, would limit employers’ ability to require coronavirus vaccines for their staff, according to data from the National Council on State Legislatures. Some would go even further and limit the ability of workplaces to require any vaccines at all, potentially affecting existing rules for flu and hepatitis B vaccines in hospitals and nursing homes. 

But there’s a long history of private businesses, especially in the health sector, requiring immunizations for their employees. 

Some of the proposals limiting employer vaccine mandates have already failed. One such measure in Indiana stalled in the face of opposition from the state's chamber of commerce, health care groups and public health experts. And in North Dakota, the Republican-led state House roundly voted down a bill that would have banned employers from requiring workers to get vaccines. Similar anti-mandate bills have also failed in Mississippi, Wisconsin and Virginia. In many other states, they have not received serious consideration.

The vast majority of recent legislation related to vaccine mandates is aimed at preventing any new requirements. There’s one exception: A bill being considered in the New York legislature would require all long-term-care facilities to vaccinate workers and residents.

Companies mostly aren’t mandating coronavirus vaccines — yet.

Two long-term care chains, Juniper Communities and Atria Senior Living, are requiring that their workers get vaccinated if they want to stay employed. 

But those companies are rare exceptions. The vast majority of workplaces and institutions are steering clear of mandates, even as nursing homes and hospitals battle high rates of vaccine refusal among staff. 

Karen DeSalvo, chief health officer at Google Health, has said the company won’t require coronavirus vaccinations for workers.

“Google is not going to mandate their employees get vaccinated, but we’re certainly encouraging it,” DeSalvo said during a Washington Post Live interview. 

Google Chief Health Officer Karen DeSalvo says Google will not mandate that its employees be vaccinated, but they are “encouraging it.” (Video: Washington Post Live)
There’s an ethical reason companies may be hesitant to go down the road of mandates.

The shots currently offered in the United States — those from Moderna, Pfizer-BioNTech and Johnson & Johnson — are only authorized for emergency use by the Food and Drug Administration.

Lawrence Gostin, a professor at Georgetown University who specializes in public health law, argues that it would be “unethical and arguably illegal” to mandate the coronavirus vaccines now, given that the emergency use approval requires a lower standard of safety and efficacy data than full approval.

Gostin also points to another obstacle: Right now, there simply aren’t enough shots to go around. “It’s hard to mandate something that you can’t get,” he said. 

The status could change.

Pfizer has suggested it could apply for full approval of its drug as soon as April, and President Biden has said the U.S. will have enough vaccines for every eligible adult by the end of May. As of Sunday afternoon, 116 million vaccine doses had been shipped around the country, with about half of them administered so far.

Once vaccines get full FDA authorization and supply ramps up, the question of whether to require shots could become more prominent.

Employers seem open to the idea of mandates. A recent survey of 150 executives conducted by Yale School of Management found that nearly three-quarters support making vaccines mandatory. 

The military — which requires troops to get a series of immunizations — is not currently requiring the vaccine, but Pentagon officials have indicated that could change once the shot is fully FDA licensed. 

Some British companies are planning vaccine mandates.

Two private elderly care home companies, employing more than 20,000 people between them, have said they’ll require vaccinations for staff, our colleague Adam Taylor reports. The chairman of Pimlico Plumbers, a London-based maintenance company that employs around 400 people, has also said he expects his staff to get the vaccine to continue working.

“Labor rights groups have come out against the policy, dubbed ‘jabs for jobs,’ arguing that mandatory vaccines would not stop the spread of the virus but could lead to discrimination on socio-economic and ethnic grounds,” Adam writes.

“A ‘no jab, no job’ approach will be counterproductive,” said Christy Hoffman, general secretary of UNI Global Union, which represents more than 2 million service workers worldwide. “To make workplaces safer, employers cannot take shortcuts, and that is what these proposals are.”

There may be alternatives to mandates. 

Some U.S. companies are offering incentives to employees who get the shots and making it easier to take time off for an appointment. Target, Trader Joe’s and Dollar General have all offered payment to cover the time it takes to get a shot. 

Research shows that creating default clinic appointments for vaccinations or requiring employees to proactively opt-out if they don’t want the shots can increase uptake. 

Opting for a nudge instead of a mandate may also help prevent backlash, according to Mark Navin, a professor of bioethics at Oakland University in Rochester, Mich. who has spent years researching the battles between anti- and pro-vaccine camps when it comes to childhood immunizations in school. 

“Our bosses have a lot of power over us, and this is not a power we should give to them lightly,” Navin said. “We should exhaust other opportunities for getting employees vaccinated.”

Ahh, oof and ouch

AHH: The Senate passed the $1.9 trillion coronavirus relief bill on Saturday.

The Senate approved the bill in a party line 50-49 vote. It now goes back to the House, which is expected to approve it tomorrow.

The sweeping legislation authorizes $1,400 checks for millions of low- and middle-income Americans, provides new yearly child tax benefits, and boosts unemployment support for workers who are out of a job. Schools and hospitals will receive money to aid their response to the virus. Other health care related provisions include money to support community health centers, nursing home infection control, and services that support care for disabled and elderly individuals in their homes.

President Biden spoke at the White House on March 6 after senators passed a $1.9 trillion relief plan. The House of Representatives will vote on the bill next. (Video: The Washington Post, Photo: Oliver Contreras/The Washington Post)

Republicans were unified in their opposition to the legislation, which will push the total national debt beyond $23 trillion. Sen. Charles E. Grassley, the top Republican on the Senate Finance Committee, said in a statement that the bill represented a “partisan agenda untethered to real relief.”

But polling shows that Americans overall are supportive. A Monmouth University poll taken in late February found more than 60 percent of Americans support the measure, The Post's Jeff Stein reports. The widespread public support and backing from centrist Democrats reveals shifting attitudes about the role of government in helping the economy, he writes.

The measure contains pots of money for coronavirus vaccines, testing and supplies; health care services; and insurance subsidies. It includes:

  • $7.6 billion for federally-qualified community health centers
  • $12.7 billion for health care services for people with disabilities and those requiring assistance at home
  • $4 billion for mental health services
  • $6.1 billion for the Indian Health Service
  • $14 billion for improving vaccine administration and distribution
  • $50 billion for the FEMA Disaster Relief Fund to ramp up the vaccination program
  • $49 billion for testing, variant sequencing, contact tracing, manufacturing and personal protective equipment
  • $10 billion to procure protective and medical equipment through the Defense Production Act
  • $8 billion for public health workforce development
OOF: Biden is struggling to meet his school reopening promise.

Biden declared in early December, “the majority of our schools can be open by the end of my first 100 days.” But “the reality has been far more complicated,” The Post’s Ashley Parker, Laura Meckler, Fenit Nirappil and Annie Linskey report.

On Biden’s first full day as president, he clarified that the school reopening plan only included K-8 schools, not high schools. Later, the administration made conflicting statements about whether hybrid schools that were open less than five days a week would count toward the goal.

“The shifting messages on school reopenings illustrate the administration’s ongoing struggle to meet one of Biden’s central promises — and to get as many of the nation’s children as possible back in classrooms, as soon as possible,” our colleagues write.

The federal government has little authority over reopening schools. Those decisions are controlled by local, district and state leaders. Biden has instead focused on trying to create conditions that may make it easier to open schools, including expanded coronavirus testing sites and offering vaccinations directly to educators. 

But recent guidance on reopening from the Centers for Disease Control and Prevention may have slowed down school reopenings more than sped them up.

“The document recommended that communities with high levels of virus transmission operate school remotely or on a part-time schedule — known as hybrid — with reduced numbers of students in the building at any given time,” our colleagues write. “Under the CDC’s rubric, that included the vast majority of the country.”

OUCH: Scientists underestimated the coronavirus’s ability to evolve.

“For much of 2020, most people — including most experts — weren’t particularly worried about the virus’s ability to evolve. SARS-CoV-2 was changing, but so far that hadn’t amounted to anything especially concerning. Then, in late fall, it jumped. Distinctive new versions of the virus sparked alarming surges in Brazil, South Africa and the United Kingdom,” The Post’s Carolyn Y. Johnson reports.

It’s not that researchers didn’t know the coronavirus could evolve into a more formidable foe. But most scientists did not expect the changes would happen quite so quickly. The sudden emergence of a slew of new variants — some of which appear more transmissible or better adapted to evade the body’s immune responses — caught many experts off-guard.

Still, there had been some warning signs: In some patients with weakened immune systems, the virus stuck around for months, morphing into a chronic infection and rapidly accumulating new mutations. Meanwhile, researchers at Rockefeller University in New York and the Fred Hutchinson Cancer Research Center in Seattle had separately raised concerns about potential mutations at a site on the virus's spike protein known as E484, only to see changes on that site emerge in new coronavirus variants in South Africa and Brazil.

Going forward, it’s possible that the virus could end up like the flu, constantly changing and forcing the world to adapt with updated vaccines each year, or it could be that after a period of rapid evolution the virus slows down, Carolyn writes.

More in coronavirus news

The CDC reaffirms that mask mandates are linked to a decrease in coronavirus cases and deaths.

New research from the Centers for Disease Control and Prevention found that mandating masks was associated with a decrease in daily covid-19 cases and death rates within 20 days of implementation. The findings come just days after governors in Texas and Mississippi announced plans to lift mask mandates in their states and ease other coronavirus restrictions.

“I know the idea of relaxing mask-wearing and getting back to everyday activities is appealing, but we’re not there yet,” CDC Director Rochelle Walensky said at a White House news briefing Friday. “And we have seen this movie before: When prevention measures like mask mandates are rolled back, cases go up.”

Top U.S. infectious disease expert Anthony S. Fauci warned on March 5 that Texas and Mississippi could see coronavirus cases rise after ending mask mandates. (Video: Whitney Shefte/The Washington Post, Photo: Eric Gay / AP/The Washington Post)

The study also found that counties in states that allowed for indoor dining also saw an increase in daily cases and deaths from the virus.

As states ease public health requirements, individual businesses are left with decisions about whether to enforce mask-wearing for their staff and customers. The Post’s Meryl Kornfield reports on the case of Picos, a Mexican restaurant in Houston, that faced a barrage of hate mail after it announced it would continue requiring masks. The backlash included threats to send immigration authorities to the restaurant.

Cuomo’s nursing home scandal is spilling onto Capitol Hill.

House Ways and Means Committee Republican staff have called officials at two federal health agencies as part of a probe into data tracking nursing home deaths. The move comes as New York’s Gov. Andrew M. Cuomo, a Democrat, is enmeshed in a high-profile political scandal over accusations that his administration underreported deaths in nursing homes, Politico’s Erin Banco and Rachel Roubein report.

Sources told Politico that the GOP committee staffers are planning to meet with officials at the Centers for Disease Control and the Centers for Medicare and Medicaid Services in an effort to determine whether Cuomo had intentionally used death data obtained by federal sources that did not include where the deceased lived. 

“The upcoming meeting combines the intensifying high-profile political scandal with long-running congressional inquiries into the reliability and accuracy of Covid-19 data — a conversation that, until now, has taken place out of view among officials within the various federal health agencies,” Erin and Rachel write.

  • A Tennessee advisory panel deemed vaccinating prisoners to be a “public relations nightmare,” according to records of the panel’s closed door meetings obtained by the Associated Press. Despite acknowledging that prison inmates were high-risk from the virus, prisoners are in the last group to be vaccinated in the state, the Associated Press’s Kimberlee Kruesi and Jonathan Mattise report.
  • The Biden administration is preparing to launch the first of the first of several coronavirus testing hubs that will form part of the federal government’s national testing strategy, Politico’s David Lim reports.
  • World Health Organization director Tedros Adhanom Ghebreyesus renewed calls for a waiver on some intellectual property rights for coronavirus vaccines in an op-ed in the Guardian  The global health leader also railed against a “me first” approach toward vaccinations, calling for greater vaccine sharing among countries.

Elsewhere in healthcare

The leading association of health insurers is launching its biggest education campaign ever.

Today, America's Health Insurance Plans will kick off its new, 8-figure “Care Changes Everything” campaign. The campaign “spotlights the meaningful ways in which health insurance providers are standing shoulder-to-shoulder with the American people through these uncertain times and beyond,” according to a release provided to The Health 202.

The ads will highlight how health insurers have covered testing and treatment related to the coronavirus, including a pilot initiative announced last week in which AHIP members will specifically target the most vulnerable seniors for advising them on vaccines and helping them to get immunized.

“This is about the perceptions of Americans of health insurance providers and the trust they place in us as their advocates and partners along the path to better health,” said David Merritt, AHIP's executive vice president of public affairs and strategic initiatives. “We are in a time of great uncertainty for people. Covid-19 is adding to concerns people have about their health care. We want people to know that we think the health care system should work for the people it serves.”

Sugar rush