Weigh the Pros and Cons of Requiring Booster Shots

​As the number of COVID-19 cases attributed to the omicron variant of the coronavirus wanes in the U.S., some employers are considering whether to make booster shots mandatory. While there would be benefits for doing so, many employers are reluctant to implement such a requirement at this time.

"If the company already has a mandatory vaccination policy, requiring boosters seems like a necessary and logical extension," said Randi May, an attorney with Hoguet Newman Regal & Kenney in New York City. However, she added that "people seem to have serious COVID fatigue" and requiring vaccines and boosters is becoming less common.

Many "are just worn out with all things COVID," said David Miller, an attorney with Bryant Miller Olive in Miami. "Right or wrong, they—including employers—may just not want to deal with it anymore."

Benefits of Booster Requirement

Booster shots substantially decrease the risk of infection and severe illness, so workplaces that have more boosted employees will have fewer workplace exposures, less illness and less time lost from work, said Jeff Levin-Scherz, M.D., population health leader for health and benefits in North America at WTW, formerly Willis Towers Watson, in Boston.

Lower health care costs are another benefit of requiring boosters, noted LaKeisha Caton, an attorney with Pryor Cashman in New York City.

"The omicron surge forced some businesses to close due to a lack of healthy workers or to require that their employees work remotely in order to avoid exposure," she said. "Mandating booster shots for employees may decrease the likelihood of further disruptions in the workplace."

Requiring booster shots would be consistent with guidance from the U.S. Centers for Disease Control and Prevention (CDC), said Amy Traub, an attorney with BakerHostetler in New York City.

Individuals are eligible for boosters five months after their second dose of an mRNA vaccine, such as Pfizer or Moderna, and two months after the single-dose Johnson & Johnson vaccine, Levin-Scherz explained.

"Those who are boosted are 97 times less likely to die of COVID than those who are unvaccinated, and seven times less likely to die of COVID than those who have just the initial vaccination series," Levin-Scherz said. "Employees, their families, the community and employers all benefit by getting to the highest possible vaccination and booster adoption rate."

Fully boosted employees can avoid quarantine after a COVID-19 exposure, according to the CDC's quarantine guidelines, while those who are not boosted should quarantine for five days after such exposure, Traub said.

Just as many individuals felt safer being in person with other people who were vaccinated, many want their co-workers to be boosted, she added.

That said, "because it has been controversial enough mandating the first doses of the vaccine, many employers are a little reluctant" to require booster shots, said Jim Paul, an attorney with Ogletree Deakins in St. Louis. "But those employers who felt strongly about the initial vaccination continue to believe that boosters make sense."

Drawbacks of Making Boosters Mandatory

There are a number of reasons, however, why employers might be reluctant to require boosters, according to Brett Coburn, an attorney with Alston & Bird in Atlanta, including the following:

• Vaccine rules for many workers put forward by the federal government did not require boosters. Even though the Occupational Safety and Health Administration rule has been withdrawn and the federal contractor rule remains in judicial limbo with a district court blocking its vaccine directive nationwide, employers may not have thought to require boosters because those rules did not address boosters.
• Vaccines continue to be politicized, and some employers may be exhausted from managing this highly charged issue.
• Given all of the breakthrough cases that have happened with the omicron variant, there may be some sense that boosters are not really adding material protection to the workforce. "This is not actually true," Coburn said. "It just may be a sense that some employers have."
• Some employers may be reluctant to wade into the administrative burden of tracking periodic and ongoing boosters, as compared to the initial task of tracking when employees received their first vaccines.
• Some states have laws that prohibit or limit the ability of employers to require vaccinations.

Employees may object to a potentially never-ending cycle of booster shots, although employers can assure them that changes to policies will be consistent with evolving public health guidance, Caton said.

"Employers are hearing from many vaccinated employees—and those who have recently recovered from COVID—that they do not want to receive a booster," said Jenifer Bologna, an attorney with Jackson Lewis in White Plains, N.Y. Employers that are struggling with staffing are concerned that adding any additional vaccination requirements might result in further staff reductions if employees who do not want to comply with the booster requirement leave for other jobs, she noted.

"In addition, unlike the primary series where employers could set a date by which all employees have to have the vaccination, tracking booster compliance is more complicated," Bologna said. "Employee eligibility for boosters varies. It is generally based on the date the employee finished their primary series. Since every employee finished their primary vaccination on different days, tracking employees' booster doses is logistically difficult."

There also is the question of when employers should require employees to get boosted, she said. Employers that have booster requirements must decide if they will provide grace periods to be boosted—such as two weeks or 30 days after eligibility for the shots—adding to the complexity.

"We are seeing some employees raise religious objections to the booster even though they received their primary series and did not raise a religious objection at that time," Bologna noted. She cautioned employers that they should not dismiss such requests simply because the employee already is vaccinated. "Just because the religious basis was not raised initially does not necessarily mean it is not sincere," Bologna said. Instead, discuss the exemption requests with employees.

"The bottom line is that there are a lot of different issues that might be leading employers to decide not to require employees to get boosters," Coburn said.