A guide to implementing COVID-19 vaccine as a condition of employment in healthcare facilities

To the Editor—Vaccination as a condition of employment (CoE) is an effective method for healthcare facilities to reduce the risk of disease transmission among patients, personnel, and their communities. Once a facility decides to enact such a policy, coordinated planning and logistics are needed to develop and implement it.

The Multisociety Statement on COVID-19 Vaccination as a Condition of Employment for Healthcare Personnel recommends COVID-19 vaccination as a CoE for healthcare personnel. ^1,2 This statement was led by the Society for Healthcare Epidemiology of America (SHEA), published in July 2021, and endorsed and referenced by many professional societies and leaders. ^3,4 As a subgroup of these authors, we have developed this companion statement and an online tool kit to assist facilities with planning and implementing a policy of COVID-19 vaccination for healthcare personnel (HCP).

Inclusivity and fairness

The decision regarding COVID-19 vaccine as a condition of employment (CoE) requires consideration of a healthcare facility’s goals, mission, and culture. Implementing a condition of employment requirement for COVID-19 vaccination requires employers to direct time and resources to engage HCP early and often to develop a fair, ethical, and transparent process based on the principles of diversity, equity, and inclusion. These factors are essential to progress toward the goal of a safer workforce through broad immunity while minimizing feelings of resentment or exclusion. Key elements necessary for organizational leadership during the strategic decision-making process include leadership transparency to garner trust and credibility among staff, an approach that includes and reflects the diversity of opinion and backgrounds of HCP, assessment of perceptions among HCP, and visible engagement and facilitation to seek input from stakeholders. While they are not likely to influence the requirement itself, facilities should acknowledge concerns at the organizational and individual levels for the smooth implementation of the policy, including COVID-19 vaccine safety and effectiveness, an institutional culture of respect and inclusivity, consistent and transparent exemption review, and collaboration with unions and other stakeholders. ¹

Access and support

Operationalizing a CoE policy requires facilities to identify how to facilitate vaccination of HCP, tracking HCP vaccination status at facility and offsite locations, evaluating and approving medical and religious exemptions, and compensating HCP for vaccination and post-vaccination sick days without causing staffing shortages.

Implementation tool kit

SHEA has developed a tool kit for facilities implementing a policy of COVID-19 vaccination as a CoE. The kit is designed for facilities that have made the decision to require COVID-19 vaccination of employees and/or others functioning at their facilities, but it also can be utilized by those currently considering a requirement. As detailed in the Multisociety Statement, ¹ facilities can take actions to promote vaccination in the absence of a CoE, to which the same implementation principles apply. Building on the SHEA/CDC Outbreak Response Training Program (ORTP) ⁵ , which provides guidance on how to mobilize an effective and successful outbreak response, ⁵ this report is intended to provide a framework for healthcare facilities to plan and implement COVID-19 vaccination as a CoE for their HCP and as a source of readily available information, templates, and resources to help manage both strategic decision-making and establishing processes needed to operationalize a policy. Facilities with an existing performance improvement infrastructure will recognize many of the methodologies, and we have provided explanations and instructions for those less familiar. The tool kit is available publicly without registration (https://ortp.guidelinecentral.com/covid-19/).

Importantly, the inclusion of content and tools in this online resource does not indicate endorsement by SHEA, the authors, the authors’ institutions, or other affiliated organizations. We welcome feedback, sharing, and suggestions; the tool kit is meant to be a “living” resource that may be updated as indicated, as long as the need for it remains.

COVID-19 vaccination as a CoE is an important tool for pandemic mitigation. We hope that SHEA members, partnering organizations’ members, and the healthcare community will find the tool kit useful in their efforts to successfully implement a CoE policy.