As the COVID-19 Delta variant continues to dominate the country, the science community is looking ahead at what this means for the future. Local and national debates over mask and vaccine mandates, along with a flurry of misinformation, pose the question: What responsibilities do employers have in keeping employees healthy? Two recent webinars explored the current state of the pandemic as well as the role we all play in ending it. The webinars took place prior to the recent executive order requiring COVID-19 vaccinations for federal employees.

“Getting the Facts: COVID-19 Vaccines and Ending the Pandemic,” hosted by Missouri Behavioral Health Council’s (MBHC) Stevan Whitt, M.D., provided medical insight around the COVID-19 pandemic and vaccines. Dr. Whitt is the senior associate dean of clinical affairs and chief medical officer at the University of Missouri Health Care. The second half of the presentation addressed audience questions about vaccine hesitancy and provided education on topics surrounding common misconceptions and fears.

“COVID-19: Lessons Learned & How Business Leaders Can Prepare for the Next Health Crisis,” hosted by Virgin Pulse, featured presenters Dr. David Batman and Dr. Gary Smithson. Dr. Batman has been a registered medical practitioner in the United Kingdom for more than 40 years, and has been a part of a number of U.K. government employee health committees. Dr. Smithson is a board-certified pediatrician and accomplished healthcare executive. He volunteers each week in the outpatient clinic at Children’s Hospital Los Angeles as a clinical instructor of resident physicians. 

The presentation began with an overview of the state of the pandemic and vaccine rollout, then addressed employers’ roles in promoting employee wellness. A series of audience polls sparked discussion on what methods employers are using, if any, to promote vaccination efforts, and if they should be doing so.

The Current State of COVID-19

The recent rise of the Delta variant, the latest and most transmissible variant of the virus thus far, has created confusion. The fact that the virus has mutated and can now be transmitted by or cause outbreak illnesses within vaccinated people has re-sparked fear in those already hesitant to get the vaccine. However, Dr. Batman says the progression of variants is expected, especially with the disproportionate vaccination statuses globally. “It’s changed but that’s not unexpected,” he said. “This is what viruses do. It’s not surviving, and it needs to change to do that.”

While we may have successfully combated the original strain of the coronavirus, the uneven vaccination populations have allowed it the opportunity to mutate. The Delta variant is now the predominant strain in the United States and is two times as transmissible as previous variants. Delta also has a shorter incubation period, faster replication rate, and high viral loads – 1,000 times higher than the original strain.

According to Dr. Smithson, someone infected with the original strain of the virus could, on average, infect 2.4-2.6 others. The version of coronavirus that caused Europe’s first wave infected about three people on average. The Alpha variant infected four to five. The Delta variant’s average is now up to nine people, creeping comparatively closer to that of mumps (12) and measles (18). “The Delta variant is really challenging to our goal to achieve global herd immunity,” Dr. Smithson said.

Originally, scientists estimated that if 60-70% of the population was vaccinated or had the disease, the result would be herd immunity and the spread would slow. “But with this more contagious and infectious Delta variant,” he continued, “the estimate is now up to 80-90%. It’s a real challenge.”

As of the webinar on Aug. 25, only 10% of the world’s population has been fully vaccinated. Many developing countries are only 1% vaccinated. Some of the challenges to global herd immunity include:

  •       Unevenness of vaccine rollout globally.
  •       Uncertainty about how long immunity lasts from infection and vaccination.
  •       Delta and other potential future variants.
  •       Inability to vaccinate children.
  •       Vaccine hesitancy.

 “I don’t believe we will ever reach full herd immunity,” Dr. Batman said, citing vaccine hesitancy as the biggest obstacle. “It’s an education problem. We need to listen to people, hear people, and understand where they are. You can make your own choices for yourself, but who do you go home to? More and more, we have to start worrying about other people as well.”

Vaccine Hesitancy Fueled by Misinformation

Dr. Whitt echoed this concern in his own presentation, also pointing to vaccine hesitancy as the main opponent of herd immunity. However, current vaccines are still 66% effective against the Delta variant (91% effective overall against original strain). While it is possible to transmit infection even if you are fully vaccinated, it occurs far less frequently.

As of Sept. 1, 5.3 billion vaccine doses have been administered worldwide. Though breakthrough infections can occur, the number of cases compared to the number of successful doses administered is effectively zero, especially in Missouri. According to Dr. Whitt, the unvaccinated remain the majority group affected by the Delta variant. “Even if it was even – and it’s certainly not – the unvaccinated population makes up the vast majority of cases. The vaccine remains extraordinarily protective.”

Despite the data, the recent FDA approval of the Pfizer vaccine, now called Comirnaty (koe-mir’-na-tee) has also raised eyebrows. One audience question asked Dr. Whitt to describe the difference between the Emergency Use Authorizations of the vaccines versus FDA approval, and why full approval hasn’t occurred until now.

“FDA approval is not the same thing as ‘work versus doesn’t work.’ What it means is, did it go through a scientific process necessary to prove that it is safe and effective? Did it go through the standard steps of every drug to receive that verification?” Though the side effects during studies were apparent, symptoms such as a day or two of mild illness paled in comparison to the danger of a global pandemic. “It was clear that these needed to be released as a tool for the public.”

Because of the misinformation and fear surrounding the vaccine, the approval process was still a priority. However, Dr. Whitt said he noticed just as quickly as people had questioned the vaccine not having approval, people then questioned why the approval was taking so long and what was “being hidden.” “I can tell you that there were no shortcuts to the science,” he said. “The science was the same as it always is. I think this is too public for anything to be hidden.”

Employers’ Role In Ending the Pandemic

Because of the misinformation surrounding the vaccine, Dr. Batman and Dr. Smithson pose the possibility of employers being responsible for promoting employee health and wellness through education. “Right at the beginning of the pandemic, and consistently since then, people are confused about the mixed messages coming out of social media,” Dr. Batman said. “Your employees are most likely to listen to you. If you can get the right education to them that they may not get anywhere else, and you aren’t, that could be a missed opportunity.”

Dr. Smithson encouraged employers to consider options such as paid time off to get the vaccine and recover from symptoms, education regarding where vaccines are available, and having onsite or nearby vaccine options for organizations with medical providers available. “There are certain options that employers have to make vaccine accessibility easier,” he said. Promoting education resources, as well as offering routine testing and time off to do so, are tools Dr. Batman suggested employers add to their armory.

 “Everyone has got to wake up about lifestyle and the social determinants of health,” Dr. Batman continued. “We need to get those back on the agenda and there is no better place to do that than within a business setting. COVID-19 is proving the impact that health can have on economics and all societies throughout the world. Wellness should be an integral part of your culture. Mental health and lifestyle play such an important part going forward.”

Because the conversation around the pandemic can be emotional and challenging, it can be hard to navigate mandates on masks and vaccinations and know the correct course of action. “It’s about this balance between protection of individuals, trying to get to a level to drive the virus down, but it’s also about freedom of personal choice,” he said. “There is no hard and fast answer to this.”

But to be able to make the correct choice, people need to have the correct information. Employers, especially in the health care industry, have a responsibility to ensure that employees are at least supplied with (or directed to) resources from which they can make the best science-informed decision for themselves.

“A lot of people have good hearts,” Dr. Whitt said. “We love one another and we have things we need clarity around. But I continue to be honestly frustrated about how we’ve lost our ability to do what’s best to care for one another. I hope we all can think about our responsibility and how we care about each other as friends, neighbors, and family.”

White House Strengthens Position Against Pandemic

President Joe Biden agrees. On Sept. 9, he announced an executive order requiring COVID-19 vaccinations for federal employees. The press release underscores the recent FDA approval of the  Pfizer-BioNTech COVID-19 vaccine (also known as Comirnaty), and the authorization of Moderna and Johnson & Johnson vaccines for emergency use. 

“I have determined that ensuring the health and safety of the Federal workforce and the efficiency of the civil service requires immediate action to protect the Federal workforce and individuals interacting with the Federal workforce,” Biden stated in the press release. 

“It is essential that Federal employees take all available steps to protect themselves and avoid spreading COVID-19 to their co-workers and members of the public. The CDC has found that the best way to do so is to be vaccinated.”

The order is one step among many of President Biden’s Path out of the Pandemic. The plan features a six-pronged, science-backed approach to saving lives while protecting schools, businesses, and the economy. The plan’s six areas of focus are:

  • Vaccinating the unvaccinated.
  • Further protecting the vaccinated.
  • Keeping schools safely open.
  • Increasing testing and requiring masking.
  • Protecting our economic recovery.
  • Improving care for those with COVID-19.

The vaccine requirement for federal employees is the first priority under vaccinating the unvaccinated, soon to be followed by a rule currently under development by the Department of Labor’s Occupational Safety and Health Administration (OSHA). The rule will require all employers with 100 or more employees to ensure their workforce is fully vaccinated. Any workers who remain unvaccinated will be required to produce a negative test result on a weekly basis before coming to work. 

OSHA will issue an Emergency Temporary Standard (ETS) to implement this requirement. This requirement will impact more than 80 million workers in private sector businesses with 100+ employees.

While debates about vaccines are muddled with misinformation, the White House has made their position clear: We have the science to save lives and it’s our responsibility — as a united nation — to do so as the Delta variant continues to surge.

Stay up to date on COVID-19, the Delta variant, vaccine safety, and more via the CDC.