Essential workers, often low-wage and compensated by the hour, are getting vaccinated at lower rates than other groups. Many attribute this reduced vaccine uptake to “vaccine hesitancy” due to false beliefs or even justified skepticism. But there is a systematic “Catch-22” that has been created: At least 40% of people who get vaccinated experience flu-like symptoms one to two days after their injection, and anyone with these symptoms is not allowed to come to work.
Compounding this risk is if the person has already been infected with COVID-19, their likelihood of experiencing flu-like symptoms is even higher.
Many of these workers cannot afford to take additional time off. Many have already had to take time off to recover from COVID-19 or care for family members.
Many have chronic health conditions that already predictably consume their 10-day allotment of sick days. And many have seen a reduction in paid hours due to the pandemic. Is it realistic to ask them to do something where they have a high likelihood of needing to take additional unpaid time off work when already in a precarious financial position?
We support a coherent national policy that ensures that low wage employees receive an additional two days of paid vaccine adverse event leave: this would be supported by federal dollars so employers are only responsible for costs related to higher wage workers, and would only be offered for those who achieve full vaccination.
Among our health care workers at Yale University and Yale New Haven Hospital, 75% have been vaccinated. However, among low-wage, hourly employees, one in two have not yet been vaccinated. We surveyed our employees, and found that one of the factors that would make people more comfortable getting vaccinated was a provision of additional paid sick days. This finding has been replicated in subsequent surveys of essential workers as well.
Taking the gamble of potentially getting — or not getting — COVID-19 and continuing masking and distancing precautions is a rational decision. If a person does not get COVID-19, then they do not need to take any time off work and can maintain financial security. Conversely, a known high likelihood of needing to take one to two days off work after being vaccinated, may seem unwise.
With vaccines soon to become available to all U.S. adults, we have an opportunity to resolve this difficult choice. If hourly-wage employees making less than 300% the federal poverty level were all given two days of additional, paid adverse event leave (premised on full vaccination), an impossible tug-of-war between financial security and health would be eliminated. This policy should be funded by the federal government for all employees below 300% of the federal poverty level so that businesses with a high percentage of low-wage workers are not unfairly burdened.
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To be sure, it is possible that employees may abuse this privilege. It is possible that people will stay home for simply a sore arm or if they are not ill at all after vaccination. However, the cost of two days of paid leave is minor compared with the cost of 10-14 days needed for quarantine if an employee contracts or is exposed to COVID-19. Not to mention the costs if an employee is hospitalized, sustains longer-term disability from COVID-19, or dies.
By the nature of their jobs, these essential workers come into contact with many other people in our community in places like grocery stores, hospitals, food service and laundromats. Vaccinating this population is critical to mitigating the spread of disease. As such, investment in supporting essential workers to get vaccinated is likely to result in great returns in population health.
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A healthy, supported workforce is a productive workforce. Providing our most vulnerable people with the support needed to keep themselves, their families, and our communities healthy is paramount. The CARES Act does offer expanded sick leave, but this effort requires additional executive branch interpretation and a clear communication strategy so that employers and employees are fully aware of what is available to them, as they make their decisions.
This is a once-in-a-hundred-year pandemic. Funding two additional days of “vaccine leave” for the year for those who cannot afford it seems like a low price to pay to support the health and well-being of our nation. If these workers are truly essential to keep our communities and our economies going, let’s provide the essential support needed to keep them and our communities healthy.
Brita Roy, MD, MPH, MHS (@Broy3445) is director of Population Health and an assistant professor of Medicine and Epidemiology at Yale University; Howard P. Forman, MD, MBA (@thehowie) is a professor of Public Health, Management and Economics at Yale University.