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A guide to implementing COVID-19 vaccine as a condition of employment in healthcare facilities

Published online by Cambridge University Press:  20 September 2021

Joshua K. Schaffzin*
Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
A. Rekha K. Murthy
Cedars-Sinai, Los Angeles, California
Valerie M. Deloney
Society for Healthcare Epidemiology of America, Arlington, Virginia
Trini Mathew
HealthTAMCycle3, PLLC, Troy, Michigan Beaumont Hospital, Royal Oak, Michigan
Erica Pettigrew
Orange County Health Department, Santa Ana, California University of North Carolina, Chapel Hill, North Carolina
Ann Marie Pettis
University of Rochester Medicine, Rochester, New York
Kavita K. Trivedi
Trivedi Consults LLC, Berkeley, California
David J. Weber
University of North Carolina, Chapel Hill, North Carolina
Author for correspondence: Joshua K. Schaffzin, MD, PhD, E-mail:
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Letter to the Editor
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

To the Editor—Vaccination as a condition of employment (CoE) is an effective method for healthcare facilities to reduce the risk of disease transmission among patients, personnel, and their communities. Once a facility decides to enact such a policy, coordinated planning and logistics are needed to develop and implement it.

The Multisociety Statement on COVID-19 Vaccination as a Condition of Employment for Healthcare Personnel recommends COVID-19 vaccination as a CoE for healthcare personnel. Reference Weber, Al-Tawfiq and Babcock1,Reference Schaffzin and Shenoy2 This statement was led by the Society for Healthcare Epidemiology of America (SHEA), published in July 2021, and endorsed and referenced by many professional societies and leaders. 3,4 As a subgroup of these authors, we have developed this companion statement and an online tool kit to assist facilities with planning and implementing a policy of COVID-19 vaccination for healthcare personnel (HCP).

Inclusivity and fairness

The decision regarding COVID-19 vaccine as a condition of employment (CoE) requires consideration of a healthcare facility’s goals, mission, and culture. Implementing a condition of employment requirement for COVID-19 vaccination requires employers to direct time and resources to engage HCP early and often to develop a fair, ethical, and transparent process based on the principles of diversity, equity, and inclusion. These factors are essential to progress toward the goal of a safer workforce through broad immunity while minimizing feelings of resentment or exclusion. Key elements necessary for organizational leadership during the strategic decision-making process include leadership transparency to garner trust and credibility among staff, an approach that includes and reflects the diversity of opinion and backgrounds of HCP, assessment of perceptions among HCP, and visible engagement and facilitation to seek input from stakeholders. While they are not likely to influence the requirement itself, facilities should acknowledge concerns at the organizational and individual levels for the smooth implementation of the policy, including COVID-19 vaccine safety and effectiveness, an institutional culture of respect and inclusivity, consistent and transparent exemption review, and collaboration with unions and other stakeholders. Reference Weber, Al-Tawfiq and Babcock1

Access and support

Operationalizing a CoE policy requires facilities to identify how to facilitate vaccination of HCP, tracking HCP vaccination status at facility and offsite locations, evaluating and approving medical and religious exemptions, and compensating HCP for vaccination and post-vaccination sick days without causing staffing shortages.

Implementation tool kit

SHEA has developed a tool kit for facilities implementing a policy of COVID-19 vaccination as a CoE. The kit is designed for facilities that have made the decision to require COVID-19 vaccination of employees and/or others functioning at their facilities, but it also can be utilized by those currently considering a requirement. As detailed in the Multisociety Statement, Reference Weber, Al-Tawfiq and Babcock1 facilities can take actions to promote vaccination in the absence of a CoE, to which the same implementation principles apply. Building on the SHEA/CDC Outbreak Response Training Program (ORTP) Reference Hanrahan, Kammeyer, Sievert, Naylor, Khuder and Kaminski5 , which provides guidance on how to mobilize an effective and successful outbreak response, Reference Hanrahan, Kammeyer, Sievert, Naylor, Khuder and Kaminski5 this report is intended to provide a framework for healthcare facilities to plan and implement COVID-19 vaccination as a CoE for their HCP and as a source of readily available information, templates, and resources to help manage both strategic decision-making and establishing processes needed to operationalize a policy. Facilities with an existing performance improvement infrastructure will recognize many of the methodologies, and we have provided explanations and instructions for those less familiar. The tool kit is available publicly without registration (

Importantly, the inclusion of content and tools in this online resource does not indicate endorsement by SHEA, the authors, the authors’ institutions, or other affiliated organizations. We welcome feedback, sharing, and suggestions; the tool kit is meant to be a “living” resource that may be updated as indicated, as long as the need for it remains.

COVID-19 vaccination as a CoE is an important tool for pandemic mitigation. We hope that SHEA members, partnering organizations’ members, and the healthcare community will find the tool kit useful in their efforts to successfully implement a CoE policy.


Financial support

No financial support was provided relevant to this article.

Conflicts of interest

All authors report no conflicts of interest relevant to this article.


Weber, DJ, Al-Tawfiq, JA, Babcock, HM, et al. Multisociety statement on COVID-19 vaccination as a condition of employment for healthcare personnel. Infect Control Hosp Epidemiol 2021. doi: 10.1017/ice.2021.322.Google ScholarPubMed
Schaffzin, J, Shenoy, E. Viewpoint: COVID-19 vaccines should be a condition of employment for healthcare personnel. Becker’s Hospital Review website. Published July 14, 2021. Accessed August 6, 2021.Google Scholar
Joint statement in support of COVID-19 vaccine mandates for all workers in health and long-term care. American College of Physicians (ACP) website. Published July 26, 2021. Accessed August 8, 2021.Google Scholar
VHA directive 1193(1): coronavirus disease 2019 vaccination program for Title 38 healthcare personnel. Department of Veterans’ Affairs website. Amended August 5, 2021. Accessed August 8, 2021.Google Scholar
Hanrahan, JA, Kammeyer, JA, Sievert, D, Naylor, B, Khuder, S, Kaminski, B. Implementation of Society for Hospital Epidemiology of America (SHEA) and Centers for Disease Control and Prevention (CDC) Outbreak Response Training Program tools to develop a dedicated coronavirus disease 2019 (COVID-19) hospital in Lucas County, Ohio. Infect Control Hosp Epidemiol 2021. doi: 10.1017/ice.2021.158.Google ScholarPubMed