Vaccination and the Workplace
Workplace settings can determine the spread of infectious disease. Workers subjected to extensive social contact and mobility should be first in line for COVID-19 vaccinations. Some of the most affected workplaces during the COVID-19 pandemic have been hospitals and nursing homes, and meatpacking plants where employees are in close quarters for long shifts.
As of June 2020, according to estimates, nearly 1,000 COVID-19 deaths had been reported among healthcare workers in the US alone, and nursing and long-term care facilities have registered COVID-19 fatalities among residents and staff that account for a third of that country’s total death toll.
In July 2020, as Africa was anticipating an uptick in reported cases, more than 11,000 healthcare workers had already been reported as infected across multiple countries there. Protecting frontline workers is essential, and as COVID-19 vaccines become available healthcare workers are likely to be the first in line in many places. Those working in the meatpacking industry and in similar sectors should also be given priority.
While the US has seen thousands of confirmed cases of COVID-19 among workers at meat and poultry processing facilities, the disease has also had a heavy impact on plants in countries including Spain, Brazil, and Australia.
Any workplace that involves large gatherings of people or high levels of mobility, such as in the military or travel industry, are at higher risk of disease spread. Bus drivers, railway workers, airline staff, truck drivers and everyone they come into contact with during work hours are key populations for vaccinating against not just COVID-19 but also influenza and measles.
Vaccination in these settings is a crucial and invaluable investment. Theme parks provide a perfect opportunity for infectious disease outbreaks; a measles outbreak at Disneyland in California in 2015, for example, ultimately spread to three other US states, Mexico, and Canada.
Schools are also a workplace where students and staff can be vulnerable. In Israel, after they started to reopen schools following a long closure in July 2020 with social distancing and mask measures in place, officials nonetheless reported that despite the protections more than 150 students and dozens of staff members were found to be infected. Teachers suffered the most, and some were hospitalized, in an instance where COVID-19 vaccination in the workplace could not only have protected people but also enabled education to continue.
Vaccinating Against Pandemics
We will always have to live with disease outbreaks, of both old and new varieties, ranging from local flare-ups to global pandemics. Building trust in COVID-19 vaccines is essential for rebuilding the global economy. Pandemics are often triggered by a new virus - or a new virus strain - against which humans have no natural protection because they have never been exposed to it before.
COVID-19 has shaken the world not only with its impacts on health and lives lost, but also by disrupting “normal” social life and breaking economies. This tumult is all due to a virus for which we had no vaccine or treatment to stop its unchecked spread - facilitated by weak leadership in many places, unprepared systems, and strong anti-globalization sentiment at a time when global cooperation has never been more necessary.
When a virus is new, at the beginning there are no available vaccines. Not all pandemics lead to the development of a vaccine. While vaccine was developed relatively quickly after the 2009 H1N1 outbreak, as it was adapted from an existing influenza vaccine, the HIV/AIDS pandemic - first identified in 1981 - still has no approved vaccine despite extensive investment and research. Nearly 33 million people have died from AIDS-related illness, and every year more people are infected.
Surveys and reports in multiple countries show many people are hesitant to accept a new vaccine, and some are already determined not to take anything to stem COVID-19. One of the challenges for any vaccine that can effectively stop the spread of COVID-19 is the question of whether people will actually take it. The reasons for this include broad vaccine skepticism, and the heightened uncertainty as the media reports on the accelerated pace of vaccine research and development in ways that are not necessarily comforting for a public anxious about related risks.
Public trust and cooperation are fundamental to any pandemic response, however - and pandemics offer a global opportunity for new modes of trust-building and cooperation. Some people will be persuaded of the value of the vaccine once they have clear evidence of its effectiveness and safety, but others have lost too much trust in authorities amid a generally inadequate global COVID-19 response.
The promise of COVID-19 vaccines, and the opportunity to improve public perception of the value of vaccination for getting people back to work and school, is an essential part of rebuilding the global economy in a more sustainable way.
Vaccinating for Security
In 2019, the World Health Organization included “vaccine hesitancy” among its top 10 threats to global health security. Anti-vaccination campaigns can be stirred by genuine concern or a cynical desire to manipulate. This is particularly true in relation to COVID-19.
Multiple vaccines are now available to protect people and enable them to regain some sense of normalcy. However, a vaccine will only succeed if it is widely accepted. Hesitancy and concerns about vaccines have historically been connected to political movements like the rise of populism and nationalism, anti-abortion sentiment, and gun rights advocacy - which sometimes share financial, political, and social resources, and have stirred disruption in a number of places.
In this context, it can be difficult to mobilize an entire population to accept health interventions like vaccines or other COVID-19 control measures, as the motives of the government are often not trusted.
Securing access to communities in order to offer medical services is often a negotiation point amid broader political struggles; in Latin America during the turbulent 1980s, and in the Democratic Republic of Congo in the 1990s, for example, representatives from the WHO, UNICEF, and other organizations successfully negotiated cease-fires to allow for polio vaccinations.
However, these types of negotiations have been breaking down in recent years, as some groups refuse health officials any kind of access to people living in areas they control - whether it is the Taliban in Afghanistan or Boko Haram in Nigeria. Meanwhile, security threats caused by “digital wildfires,” as described by the WEF in its Global Risks Report, can lead to sudden spikes in panic and fear among populations that already lack confidence in the public sector.
In Pakistan, for example, rumors spread online in 2019 that a polio vaccine contained poison, and children in Peshawar had negative reactions to it - bringing vaccinations to a near standstill. Community mobilization against immunization campaigns in Madagascar, Nigeria, and the Philippines has been difficult to assess, particularly when participants use the encrypted service WhatsApp.
While the impacts of vaccine hesitancy are felt primarily in terms of public health, the solutions needed to address it require expertise from other fields including political science, anthropology, psychology, artificial intelligence, cyber security, and digital media. Some digital wildfires may be sparked by genuine questions about vaccine safety, though research suggests others are initiated to exacerbate social divisions and spread mistrust.
Economic and Business Implications of Vaccination
Employers have a duty to encourage responsible behavior during pandemics. Vaccination is playing a key role in responding to the COVID-19 crisis. It is reducing transmission of the disease, preventing avoidable illness and death, and protecting high-risk individuals. In addition, vaccination is critical for businesses.
Companies in the US have reported losing more than $500 billion per year due to illness-related productivity losses - and that was before the spread of COVID-19. The direct personal benefits of immunization include lowering healthcare costs and productivity loss, both for the infected and for anyone tasked with caring for the infected. Broader benefits that can positively affect the global economy include preventing the spread of illness, and immunization that improves children’s cognitive skills, and fosters their physical strength and performance at school in ways that, long term, lead to increased collective productivity.
By improving financial security and reducing risk, vaccination may also help lead to increased investment levels, and bolster political and economic stability. And, by moving populations closer to something known as “herd immunity,” it also helps protect unvaccinated individuals in the community.
Employers can also play a key role in providing health information to employees, and encourage responsible behavior to advance public health. Ultimately, achieving herd immunity will be necessary to to stop COVID-19, enable people to get back to work and school, and help businesses to return to normal.
Based on early estimates of the infectiousness of the coronavirus, we will likely need between 50% and 70% of the global population to be vaccinated in order to achieve herd protection. There is a critical need for business leadership to help usher in a safer and healthier post-COVID-19 workplace; meeting COVID-19 vaccination needs cannot happen if employers do not help ensure a responsible roll out of the vaccine, and facilitate its acceptance in different communities.
Studies have shown that employees trust their employers more than government agencies or the media to provide them with credible, trustworthy information - including information specific to COVID-19. Many companies have already heeded the World Health Organization’s recommendation to advance health promotion in the workplace.
The past decade has seen increased hesitancy around the world to embrace vaccines. Anti-vaccine groups have gained influence around the world, potentially undermining the COVID-19 response. In 2019, the World Health Organization named vaccine hesitancy as one of the top 10 threats to global health, alongside issues like air pollution, climate change, non-communicable disease, influenza pandemics, antimicrobial resistance, and weak primary healthcare.
There is a significant amount of evidence showing that decreases in vaccination uptake can lead to increases in vaccine-preventable diseases. For example, in 2018 - despite the existence of a safe and effective vaccine - there were more than 140,000 deaths worldwide resulting from measles, most of which occurred among children. This was a direct result of a decrease in vaccination rates. While some of this decrease was due to access issues related to weak health systems, conflict and insecurity, or natural disasters, there was also an element of vaccine hesitancy and refusal at play.
Declines in vaccine coverage like this threaten to reverse gains made in combatting vaccine-preventable diseases. Vaccine hesitancy may also be a challenge to overcome in relation to COVID-19; if enough people refuse to receive a vaccine shown to protect against the disease, it could undermine efforts to achieve herd immunity.
Anti-vaccine groups are highly organized and have broad reach and influence in many countries. Roughly half of Americans have expressed a reluctance to get a COVID-19 vaccination, according to surveys. The preliminary results of a survey run by the Vaccine Confidence Project (which monitors public trust in vaccination programs worldwide) and ORB International showed that between mid-March and mid-April of 2020, one-fifth of Swiss respondents said they would refuse a COVID-19 vaccine, as did 16% of Austrians, and 9% in Germany (these three countries had some of the lowest vaccination rates in Western Europe by late 2021).
The Welcome Trust Global Monitor in 2018 showed that confidence levels in the safety of vaccines varied globally. In Japan, only 32% of the public believed vaccines are safe, while in China the figure was 72% - which still demonstrates an underlying level of concern. Another study in France showed 26% of those surveyed said they would not take a vaccine if one became available, though mandates and other measures boosted the vaccination rate in that country during 2021.
Building confidence in vaccination more broadly will be a critical component of containing the impacts of COVID-19.
Trust, Misinformation and Health
Misinformation about health is a common phenomenon, and vaccines were a target long before the COVID-19 pandemic sparked a related “infodemic.” False rumors and conspiracy theories have undermined many public health efforts.
There have been numerous documented instances of conspiracies undermining vaccines, such as rumors that polio vaccinations caused sterilization in Nigeria in 2003 and 2004, or claims that children born with microcephaly in Brazil in 2015 were not the result of Zika but instead were the result of bad vaccines.
Among the more routinely recommended vaccines, the cervical-cancer-preventing HPV vaccine was criticized by some people for allegedly promoting promiscuity among teenage girls. Many people still believe that vaccines can cause autism, despite the fact that scientific research has disproven this supposed connection.
New, as yet mysterious phenomena can fuel a flurry of speculation and rumors, as people try to make sense of complex information - driving a psychological phenomenon known as aversion to ambiguity. Strong believers in conspiracy theories tend to emerge in these ambiguous settings and cultivate audiences eager for some kind of explanation. This can take advantage of the genuine concerns and questions that people often have about vaccines, including parents being newly exposed to reams of online misinformation.
In the context of the COVID-19 pandemic, the World Health Organization has publicly acknowledged the harm caused by the spread of misinformation, rumors, and fake news about the virus by referring to the phenomenon as an infodemic (a term used by the WEF more than a decade ago, and suddenly regaining relevance).
In terms of vaccines in particular, the combination of distrust of authorities and an abundance of alternative misinformation can impact the ways in which people process information and make decisions, sometimes risking unnecessary disease outbreaks and fatalities.
WHO officials have recognized that rumors ranging from the purported laboratory origins of COVID-19, to the idea that it can be cured by eating garlic, can be easily transmitted from person to person, carried by both the unwitting and the devious and spread almost invisibly through a vast virtual world - much like a virus. This infodemic points to a larger crisis rooted in the decline of public confidence in health systems, scientific expertise, and government authority - sometimes undermining the willingness to comply with recommended or required public health measures meant to keep infectious diseases such as COVID-19 in check.
Immunization is key to advancing toward UHC by relieving the burden that diseases place on the healthcare services, freeing essential resources to use elsewhere within the healthcare system. Immunization is an essential, readily available strategy that countries can deploy to achieve Universal Health Coverage.
In the past few decades, morbidity and mortality attributable to vaccine-preventable diseases such as measles, mumps, and polio have dramatically declined as immunization coverage increased - especially in countries with routine vaccination programs. However, global vaccine uptake has stagnated as misinformation and anti-vaccination propaganda have spread.
Now, amid efforts to vaccinate populations against COVID-19 as swiftly as possible, technology giants are under pressure to remove harmful associated distortions and inaccuracies from their platforms.