Large employers should consider onsite vaccination programs, the U.S. Centers for Disease Control and Prevention (CDC) said
in recent guidance. The CDC didn't recommend onsite vaccination programs for small or midsize employers, saying they should encourage offsite vaccination.
The guidance recommended that an employer consider a workplace vaccination program if it has:
- A large number of workers onsite with predictable schedules.
- The ability to enroll with the local jurisdiction's immunization program as a vaccination provider, including appropriately training staff or using an enrolled vaccination provider.
- A location with enough space to have a vaccination clinic while maintaining social distancing through the entire process, from screening to post-vaccination observation.
The CDC said an employer should consider offsite vaccination if it:
- Is a small or midsize organization that does not have the resources to host a vaccination clinic.
- Has mobile workers who frequently move from one jobsite to the next.
- Has workers with highly variable schedules.
- Has a majority of workers who prefer vaccination in a community clinic rather than an employer-run clinic.
"Most employers that choose to mandate or even strongly encourage vaccines should rely on pharmacies and other health care providers to administer vaccinations to employees and then simply request proof of vaccination instead of administering or hosting the administration of the vaccine themselves," said Lindsay Ryan, an attorney with Polsinelli in Los Angeles.
Nonetheless, she added, for health care or other large employers that have the space and resources to host or contract with a third party to operate an onsite clinic, doing so can help encourage vaccination. Onsite clinics make vaccination "convenient and accessible and help reduce the time and cost associated with employees traveling offsite for vaccination," Ryan said. "However, hosting an onsite vaccination center also presents increased liability risks that must be carefully considered."
CDC Guidance
If an employer decides to host onsite COVID-19 vaccinations, the planning process should include input from management, HR, employees and, if present, labor representatives, the CDC noted.
Employers considering an onsite clinic should contact the health department in their jurisdiction for guidance.
Employers may want to use a community vaccination provider or vendor. Such providers typically deliver worksite flu vaccinations and are expanding to provide COVID-19 vaccination, the CDC said. The providers have trained nursing staff available and can report vaccine administration data to immunization registries.
Vaccination providers must prepare to monitor for and manage potential allergic reactions after vaccination.
Workplace vaccination clinics must offer vaccinations at no charge and during work hours, the CDC said.
The CDC recommended that employers provide easy access to vaccination for all people working at the workplace, even if they are contractors or temporary employees.
In addition, the CDC recommended staggering employee vaccination to avoid worker shortages due to vaccine side effects.
For those receiving a two-dose vaccine, staggering may be more important for the second dose, after which side effects are more frequent. Facilities may consider staggering vaccination for employees in the same job category or who work in the same area of a facility. "Staggering vaccination for employees may cause delays in vaccinating your staff, and the decision to stagger vaccination will need to be weighed against potential inconveniences that might reduce vaccine acceptance," the CDC said.
Prioritization Plan
Employers with onsite clinics should prioritize who gets vaccinated first if there is not enough vaccine supply for all workers eligible within a phase, the CDC recommended. Prioritization should be done according to risk, age or underlying health condition and not by worker status (i.e., employee versus contractor), the CDC said.
"Don't allow employees, contractors, owners or anyone else associated with the business to skip ahead in the vaccine line," said Robin Samuel, an attorney with Baker McKenzie in Los Angeles. Vaccines should be administered to those who are eligible to receive them under state and local orders.
"Employer clinics should plan so that doses are not wasted at the end of the day," he added. He said employers should create waiting lists prioritizing who's eligible so that missed appointments don't lead to wasted doses that cannot be refrozen or put back into vials once drawn into syringes.
If there aren't enough qualified employees to receive allocated doses each day, employers should have a backup plan for transferring the leftover doses to nearby hospitals, clinics and other places that can administer them that same day, he said. "In a worst-case scenario, doses should be given to others who may not yet qualify if there is no way to administer the doses to eligible persons, but this shouldn't happen with adequate planning."
Legal Considerations
"Large employers probably tend to have advantages for managing the legal and logistical complexities associated with hosting an onsite vaccination clinic," said Jill Cohen, an attorney with Eckert Seamans in Princeton, N.J.
She said potential laws that may be triggered by onsite clinics include the Americans with Disabilities Act with respect to pre-vaccine screening medical or disability-related inquiries, and workers' compensation laws when an employee has an adverse reaction to a vaccine.
"Medical information must remain confidential," said Katherine Dudley Helms, an attorney with Ogletree Deakins in Columbia, S.C. "If you use a third-party provider, be sure it has a system for handling confidential medical information. Have things set up so others do not see or overhear medical information."
She added, "Communicate clearly why this is being done. If it remains voluntary, communicate that."
Employers should work with their attorneys to ensure their companies are considered "program planners" as defined in the Public Readiness and Emergency Preparedness (PREP) Act, Samuel said. All those who administer vaccines onsite should be "qualified persons" under the PREP Act. "This federal statute provides broad immunity to employers and qualified persons who administer COVID-19 vaccines in the workplace, but only if they fall within the statute's definitions," he noted.