The debate about which workers should get the Covid-19 vaccine next, explained.
Uber has spent years and millions of dollars making sure its workers aren’t classified as such and insisting it’s not responsible for those people’s health care. Now the company is pushing for its “earners” — the word it uses to refer to its drivers and delivery people so as not to call them workers — to get priority access to the Covid-19 vaccine.
It’s hardly alone in lobbying public health officials and states to put its people near the top of the list.
Companies and industry groups from across the economy are undertaking efforts at the federal and state level to make the case that when it comes to the limited-supply Covid-19 vaccine, their employees should get priority. The meat industry, airlines, banks, retail, exterminators, restaurants, and zoos are among the myriad groups lobbying decision-makers. So are specific companies such as Amazon, Lyft, DoorDash, and Perdue. Unions are trying to get their members vaccines. Even professional sports leagues, like the NHL, are making a play.
In early December, the Advisory Committee on Immunization Practices (ACIP), an arm of the Centers for Disease Control and Prevention, recommended that health care personnel and long-term care residents should be first to receive the Covid-19 vaccine. That “phase 1a” cohort represents about 17.6 million people, or 7 percent of the US adult population, and seems straightforward enough.
What comes next is more complicated. There’s been a mad dash among a variety of stakeholders to try to secure the next spots and a lively debate about who should be prioritized. On Sunday, ACIP issued its recommendation for 1b — the next phase — to be front-line essential workers and people over the age of 75. For 1c, it suggested people 65 or older, people with high-risk conditions, and essential workers not included in 1b.
Ultimately, it is up to states to decide what to do with federal recommendations and decipher which people, including workers, go where. States could deviate from those guidelines — theoretically, a place like California could say entertainers should be higher up on the list, or in New York, bankers. Companies may have an easier time influencing decisions at the state and local level. But in general, states take the guidelines seriously and could face enormous backlash if they ignore them.
“I don’t blame businesses for trying to make their case,” Georges Benjamin, executive director of the American Public Health Association, told Recode. “But the people that are listening to their rationale ought to use criteria that are going to save the most lives and return our economy.”
Prioritization is just the first chapter in what will likely be months of discussions around how employers approach the Covid-19 vaccine. Which workers within an organization will get the vaccine is going to be an important factor. If a meatpacking company gets access to a vaccine supply, who’s going to ensure it’s the workers on the floor getting a dose and not the CEO? It’s a scenario already playing out in hospitals. And what does it look like for companies to be taking such an activist role in their workers’ health in trying to compel them to get the vaccine? It’s one thing for your boss to recommend you take a vaccine; it’s another for them to require it.
“Pretty much everybody is on the same page with vulnerable people and front-line workers” going first on the vaccine, said Matt McCambridge, founder and CEO of Eden Health, a personal health platform. “There’s a lot of gray area in terms of what happens next.”
The politics of Covid-19 is now the politics of the vaccine
The United States got a preview of vaccine lobbying efforts in the spring, when various interest groups and industry associations fought to get their business activities and workforces deemed “essential” so that they could stay up and running. (It was a designation not all workers desired or appreciated.) You might remember that in April, Florida Gov. Ron DeSantis inexplicably declared the WWE essential in the Sunshine State.
So now that there are two emergency-approved vaccines in America, it makes sense that the rich and powerful are going to be jockeying for it. Also pushing for priority are companies that know getting their workers vaccinated would be a big deal for getting their operations back to full capacity. Jonathan Slotkin, chief medical officer for Contigo Health, described the situation as a “wrestling match” where “many interests want to make it clear that the people they represent have a lot of essential workers” in an interview with the Washington Post.
The federal government estimates that there are about 87 million essential workers in the US, half of whom are over the age of 40. Racial and ethnic minorities are disproportionately represented in many industries deemed essential, and about a quarter of essential workers live in low-income families.
On Sunday, ACIP recommended that along with those over the age of 75, some 30 million front-line essential workers should be part of phase 1b of vaccinations. The group includes teachers, first responders, corrections workers, postal workers, public transit workers, grocery store workers, and people who work in food, agriculture, and manufacturing. A second group of some 57 million other essential workers — including those in finance, telecommunications, and construction — will be part of group 1c.
Again, these are just federal guidelines. States will be the ones to decide who gets priority. So in a pandemic that’s been politicized from the get-go, the politics of vaccine distribution gets dicey quickly.
“Where we’ve gone wrong with our Covid response is that we’ve had politics impact policy, practice, and then science,” said Daniel Salmon, director of the Institute for Vaccine Safety at Johns Hopkins. “We need science to drive policy and public health to drive politics.”
Salmon cited an article written by former CDC Director Jeffrey Koplan and epidemiologist Melissa McPheeters in 2004 warning of the dangers of politics having too much influence over public health and science. “If that’s what this looks like, it’s going to be a disaster, it’s going to be really inequitable, and it’s going to be who has more influence over politics,” he said. “This needs to come from science — we need to say who’s most at risk, what jobs are really essential, and that’s how the priority should be done.”
Not every group can lobby for themselves, or have someone do it on their behalf. Homeless people, incarcerated people, and those living in group settings are among those at high risk of contracting Covid-19. If there’s too much politicization and corporate power in the process, those are the types of people who are going to be left out.
Who should get priority is a hard question
A litany of industries, companies, and unions are claiming the workers they represent should get an early spot in the line for vaccines. And many of them have a solid case.
The meatpacking industry, which has seen waves of Covid-19 cases and deaths throughout the pandemic, lobbied the CDC for front-line meat and poultry workers to get early access and has gained support from Kansas Gov. Laura Kelly in its endeavors. The American Bankers Association has advocated for its tellers and other employees, who are in direct contact with the public, to be prioritized. Groups representing air conditioning contractors, transit workers, and pest control workers submitted comments to the CDC arguing for their workers to get priority.
Figuring out what’s right to do here is not particularly easy.
Take, for example, Amazon. It submitted a letter to the CDC asking that workers at its warehouses, data centers, and grocery stores get vaccinated “at the earliest possible time,” noting that it employs 800,000 people, making it the second-largest employer in the US, behind Walmart. Amazon workers have struggled during the pandemic, with tens of thousands sickened by the disease. Who’s to say these workers haven’t more than earned a place in line? The same goes for companies like Walmart, Delta Airlines, Uber, Lyft, Cargill, and the list goes on and on.
Many companies and industries can make a solid case that they’re vital to keeping the economy running and the country going — the same case they made to be deemed essential — and that constitutes a place in line.
In an interview with Recode, Bryan Zumwalt, executive vice president of public affairs for the Consumer Brands Association, which represents companies such as Clorox, Coca-Cola, and General Mills, emphasized the importance of his members’ role in supplying products people rely on every day during the pandemic. “We just want to make sure that our people are in that early 1b group … and that the states are being as clear as possible what the process is going to be,” he said.
After ACIP’s recommendations were released, the group released a statement urging states to follow that guidance and get its 1.7 million essential workers the vaccine soon, arguing that they “must be vaccinated to ensure shelves are stocked and Americans can continue to stay home and stay safe” for the duration of the pandemic.
Some employers and groups are offering to help health officials and governments with the distribution of the vaccine. Perdue, which has sent letters to the governors of 15 states and the CDC asking to be part of 1b, has offered to assist with community outreach, including a multilingual campaign. Uber is offering 10 million free rides to vaccination locations.
To be sure, it’s important to be clear about the motives here. While a lot of these industries and companies do want to protect their workers, they are also well aware that doing so will come with a financial benefit. That’s a big driver.
As the Intercept pointed out, the North American Meat Institute, which is now lobbying for a vaccine for its workers, also drafted an executive order signed by President Donald Trump ordering meatpacking plants to stay open in the spring, even as their workers were getting sick and dying. Uber and Lyft just spent tens of millions of dollars in California to make sure they don’t have to give their drivers typical employee benefits. Amazon cut hazard pay for workers over the summer, though it did recently announce a one-time holiday bonus.
DoorDash is petitioning the CDC and all 50 state governors to prioritize delivery workers for the vaccine, noting that those people have worked throughout the pandemic and “connect goods and services throughout our local communities and serve an essential role with restaurants and other small businesses.” While its business has been booming this year, conditions for its delivery workers — the workers it’s now using to try to exert political pressure — have worsened.
“You can’t blame Uber from a financial self-interest perspective,” Salmon said. “But they should consider that for every dose their driver gets, there’s somebody who’s not going to get one. And who is going to give up that dose?”
Companies that are now taking an interest in their workers’ health and well being could be doing so all the time, not just when it’s financially expedient. And a vaccine does not eliminate the need for other workplace protections. Businesses shouldn’t let their guard down on the ways to prevent the virus from spreading, especially until broad swaths of the population are vaccinated.
There is also a looming issue of who will get the vaccine in organizations once they get a certain amount of doses. There was uproar at Stanford Medicine when hospital administrators and physicians who weren’t in contact with patients were given vaccine doses over those in direct contact with patients because of an algorithm the hospital was using to determine distribution. It’s very easy to imagine a case where a company gets a vaccine and hands it to the C-suite instead of people on the factory floor.
The NHL came under fire recently over a report that it was planning the private purchase of a vaccine for its upcoming season.
To a certain extent, it makes sense — professional sports is a high-dollar industry, and players are being asked to put their lives at risk amid a pandemic to keep people entertained. When Recode contacted the league for comment, an NHL spokesperson pointed to a clarification that it would only look at that possibility “in the context of the availability of excess capacity” and not compete with health care workers, vulnerable populations, and symptomatic individuals for doses. When Recode in a follow-up asked who the vaccines would be for — players? coaches? concession workers? — the NHL did not respond.
Private vaccine sales are possible, though inventory may be hard to come by because most doses are already spoken for by governments. For a private organization such as the NHL to get a Covid-19 vaccine, it would need to buy excess supply from states on a secondary market or buy from another country. In India, for example, the vaccine will be for sale on private markets. The US government turned down a chance to secure more of the Pfizer/BioNTech vaccine over the summer, and the drugmaker could theoretically sell that excess production to a private entity, though it’s unclear how likely a scenario that is in the short term.
In the case of the NHL, for example, the league would presumably go through Canada’s system to obtain vaccine doses. Its health minister told reporters that the country doesn’t “have any mechanisms to block corporations from purchasing on a private, contractual basis with corporations around the world.” Pfizer told Canada’s CTV News in response that its contract is with the federal government.
The future of work has vaccines in it
Getting access to the vaccine is part of the equation of how businesses will approach the issue, but it’s not all of it. There’s also the matter of getting the workforce to take it, and companies are still in the early stages of figuring out how that will go.
Apart from the broader (and misguided) anti-vaccination movement in the US, many Americans are particularly concerned about getting the Covid-19 vaccines so early. They’ve been given the go-ahead under the FDA’s emergency use authorization. And while there’s been plenty of testing of them, the vaccines are still new, and people are nervous.
Dana, a 55-year-old registered nurse in California (whose last name is being withheld for privacy reasons), told Recode that while she is happy to be among the first in line to be vaccinated, even some of her colleagues have expressed some concerns. “We have a group of people who are like, ‘I don’t know, I’m worried about this vaccine,’ even though obviously there are not vaccine deniers among those people,” she said. “I think that part of it is just the unknown quality of it.”
Health care workers are largely accustomed to being required to have certain vaccinations for their jobs, but regular workers aren’t. Sure, a lot of people are used to there being a flu vaccine campaign at work in the fall, but if you ignore it, it’s usually no big deal. That’s not the case with Covid-19.
Now one debate happening among industry leaders and businesses is how to talk to their workers about the Covid-19 vaccine and how far to go to get them to take it.
“People are looking at this issue now. It’s one of the more difficult ones to grapple with,” said Zumwalt, from the Consumer Brands Association.
On the less aggressive end, employers are working on programs to educate their workers about the vaccine, its benefits, and its safety, and to make workers aware of their efforts to get them vaccinated. Uber sent a letter to its drivers and delivery people telling them the company believes they “should be near the front of the line for the vaccine” and that it is focused on ensuring “that if you choose to take the vaccine, you’re able to access it quickly and easily.” Some employers may start to consider incentives, such as vacation time or gift cards, for workers to get vaccinated.
On the more aggressive end, there is the possibility of employers requiring workers to get a Covid-19 vaccine. It’s likely within their legal capabilities, said Lindsay Ryan, an employment lawyer based in California. “The short answer is that, in general, employers can mandate vaccines,” she told Recode.
Requiring vaccines isn’t a new phenomenon in some professions — it’s something that health care workers and teachers deal with. And plenty of jobs come with certain parameters that rule people out. Some employers have strict policies about hiring people with drunk driving convictions or who don’t pass drug tests, for example. CNN recently reported that nearly three-quarters of CEOs polled at a virtual summit held by Yale signaled they would be open to vaccine mandates.
“I could see a lot of employers doing that, but it does presume that there’s a vaccine available. You can’t tell your workforce you have to get vaccinated or you’re fired but you can’t get a vaccine,” said Salmon, who opposes government-mandated vaccinations.
The situation isn’t straightforward. On the one hand, Covid-19 is a more direct threat to workforces than the flu, and so the analysis around requiring it will take that into account. On the other hand, the vaccine being under emergency use authorization could make mandating it more unpalatable for employers. Even if they can do it, they might not want to. Employers have an obligation to maintain a safe and healthy workforce, including infection mitigation procedures, but mandating a vaccine comes with special obligations in terms of liability. And some people are going to need waivers.
Benjamin, from the American Public Health Association, said that understanding not everyone will get the vaccine, whatever their situation, is baked into public health planning. “At the end of the day, that’s why we push for herd immunity. We realize there is a population of people who won’t be able to vaccinate early, and there’s a population of people who won’t be able to vaccinate at all,” said Benjamin, who estimates about 75 percent of the population needs to be vaccinated to reach herd immunity.
Ryan said she doubts employers will go so far as to fire employees who won’t get vaccinated, but they could use other measures, such as placing them on unpaid leave or having them work remotely. In the case of companies like DoorDash and Uber that work with contractors, they can pretty much do whatever they want when it comes to asking people to get vaccines. Just because employers, at the federal level, can mandate vaccines for workers “doesn’t necessarily mean that they should,” she said.
Wherever they fall on the list of priorities, phase 1b, 1c, whatever’s next, businesses lobbying for the vaccine now have a lot of decisions ahead of them. The ethics of the situation are far from clear.
Umair Irfan contributed reporting to this story.