With vaccination now (or soon) available to healthcare workers under EUA, medical practices should be thinking about their policies regarding vaccination of office staff.  Here are some key questions you should consider – having policies in place will protect you from potential problems.

• Can you require all of your employees to get vaccinated?
• Should employees continue to wear masks even after they’ve been vaccinated?
• What to do if an employee refuses (either vaccination, or mask wearing)?

Requiring Vaccination?

Since these new vaccines were approved subject to an EUA, there is some question about your ability to require the vaccination of all employees. Once the vaccine has general FDA approval, as a medical practice, you can require it. But it must be your official policy and the policy must be reasonable, in the interests of the health of patients and other staff, and uniformly enforced. (Example: If an employee conducts all of their work from home, NEVER comes into the office and never has direct contact with patients, it might be unreasonable to insist they get the vaccine.)

If an employee objects to being vaccinated, there should be an informal investigation of their stated reasons. If you grant an exception to any employee due to their circumstances, you must be willing to grant that exception to any other employee with similar circumstances. If an employee objects on the basis of medical or disabling condition, you may ask for proof of that condition. If they object on religious grounds and you believe they are using that as an excuse, tread carefully – this might mean it is time to get the opinion of your attorney or HR consultant.

Mask Requirements Post-Vaccination?

If a vaccinated employee says that they are now immune to Coronavirus and no longer need wear a mask, you should direct them to the CDC website or the website of your state’s Department of Health. What they will learn is that masks should continue to be worn even after vaccination, for two good reasons.

1) From the testing done thus far, we know that several of the vaccines are highly effective at preventing disease – we do not know how effective they are at preventing infection. This means a vaccinated person could be infected with Coronavirus but be asymptomatic. Such people might still be able to spread the virus, despite being themselves protected from contracting the illness. 2) The Moderna and Pfizer vaccines are ‘only’ ~95{081c6818d320d90058ff6a2926b50d7e60efee5effcf91aa012a77f8c657986a} effective. While this efficacy is very high for a vaccine, it is not 100{081c6818d320d90058ff6a2926b50d7e60efee5effcf91aa012a77f8c657986a}. There will be vaccinated individuals who nonetheless become ill and can spread the virus. Continuing to wear masks is imperative until the pandemic is over.

From the CDC website (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/faq.html): “Given the currently limited information on how much the mRNA COVID-19 vaccines may reduce transmission in the general population and how long protection lasts, vaccinated persons should continue to follow all current guidance to protect themselves and others. This includes wearing a mask, staying at least 6 feet away from others, avoiding crowds, washing hands often, following CDC travel guidance, following quarantine guidance after an exposure to someone with COVID-19, and following any applicable workplace or school guidance, including guidance related to personal protective equipment use or SARS-CoV-2 testing.”

What if an employee refuses?

If an office employee refuses to get vaccinated, or once vaccinated, refuses to wear a mask against your practice policy, that should not be a reason to put patients and staff at greater risk. If possible, such an employee could be offered an accommodation such as a change in position where they would have no direct interaction with patients or other staff.

If you are either truly unable to offer such accommodations due to practical limitations, or your offer of accommodation is refused, you may have no choice but to let the employee go. Preferably, this is a last resort. But, just as your policies should be reasonable, the employees objections should also be reasonable. An employee who refuses reasonable accommodation or insists on their position without good cause may be deliberately causing friction which affects the working environment – this would be a legitimate reason to consider termination.

Your best protection against any legal blowback is to have a written policy describing who is required to be vaccinated and wear masks (roles, not individuals) along with a list of acceptable exceptions. You may make an exception outside those listed in the policy as long as the exception is based on circumstances, not personalities. All employees should read the policy or have it explained to them – it is best to have this in place and have the employees understand the policy before the request to vaccinate comes up.