Covid-19 vaccines are cause for celebration. Family members are reuniting, people are traveling and returning to restaurants. Yet many of the essential workers who have kept transportation running throughout the pandemic, who grow and cook food, and who fill the boxes that arrive on America’s doorsteps still have not been vaccinated.
In mid-to-late May 2021, less than half of low-income workers living with children reported being vaccinated. Structural barriers are preventing vaccine access among workers. People facing food and housing insecurity are more likely to be unvaccinated but want a vaccine, as are people with children. It is not a matter of lack of individual responsibility for health among those who haven’t yet been vaccinated because they are providing food, housing, and care for themselves and their families. Policymakers can support essential workers by improving vaccine delivery.
The U.S. must not accept a prolonged Covid-19 pandemic among essential workers.
The Biden administration has announced it will not reach the goal of vaccinating 70% of the population by the Fourth of July. Many of those who aren’t vaccinated are essential workers. Workers in meatpacking plants, agriculture, mail services, public transportation, and many other industries that kept the country running during the pandemic continue to face elevated exposure to Covid-19 and deaths due to Covid-19, but have lower vaccination rates than people working from home. The administration should make essential workers central to our country’s Fourth of July celebrations and to the next phase of vaccination efforts.
Targeting these workers is efficient, given that low-income people are at least five times more likely to report probably or definitely planning to get vaccinated but not yet being vaccinated. It is also essential to preventing further infections and deaths.
To succeed, federal and state leaders should focus on meeting people who face structural barriers to Covid-19 vaccines where they are: at work, on the commute from work, and at home.
Meatpacking plants, agriculture settings, and grocery stores are ideal workplaces to deliver vaccines based on Household Pulse Survey data showing that more than one-third of workers in these industries have not been vaccinated. These are many of the same workplaces in which many workers have died of Covid-19 and in which workers remain vulnerable, especially with the end of indoor mask orders and the spread of new variants. Providing workers paid sick leave would allow them to recover from vaccine side effects without losing pay due to missing work. Accompanying vaccination delivery with meals for families as workers recover from vaccine side effects could help address food insufficiency and bring the celebratory spirit to essential workplaces.
Businesses can receive tax credits for providing paid sick leave to their employees and will benefit if workers miss only one day of work to be vaccinated or to recover from vaccine side effects and avoid missing several days of work — or worse —due to Covid-19. But most people in households earning less than $90,000 a year do not have paid sick leave for getting Covid-19 vaccines or recovering from any side effects.
Only 1 in 3 workers in low-income jobs, who are disproportionately Black and Latinx people, have access to paid sick leave. Nearly half of those who have not yet received a Covid-19 vaccine have valid concerns about missing work, either to attend a vaccine appointment or to recover from side effects. Missing work could jeopardize their jobs and leave them without the paychecks they need to feed their families. An April survey indicated that more than half of unvaccinated Hispanic workers would get vaccinated if they were given paid sick days to do so.
Public transportation hubs also present an opportunity to meet people with vaccines on their commute to or from work. This approach has had success in the subway stations of New York City. As schools distribute Covid-19 vaccines to children on site, they should also make doses available to their students’ guardians and caretakers.
A new Vaccine Equity Planner shows that many people in states with low vaccination rates live more than a 15-minute drive from a vaccination site. Bringing vaccines to peoples’ homes may help those with limited mobility or availability. People who live in more crowded households have been less likely to get the vaccine. High vaccine uptake with door-to-door registration in the hard-hit community of Central Falls, R.I., demonstrates this can be an effective approach. In-home Covid-19 vaccination, as is available in New York City, may help reach those who are homebound or disabled.
The federal government should invest in the proven leadership of community organizations like the Black Doctors Covid-19 Consortium and community health centers that have high rates of success bringing vaccines to populations most affected by Covid-19.
Covid-19 cases may surge again among people who are not vaccinated, now driven by a more infectious variant of the virus. Workers continue to lose their lives and children continue to lose their parents. In early 2021, many states excluded essential workers from the priority phases of their vaccine eligibility plans in favor of age-based thresholds, and online appointment systems were difficult to navigate. Racial and ethnic disparities in vaccines widened, and the rate of deaths among Black individuals relative to white individuals increased. The end of indoor mask policies before most low-income workers were vaccinated, combined with the decision by the federal government to allow Occupational Safety and Health Administration to issue only recommendations rather than an Emergency Temporary Standard for workers outside the health care industry, will likely accelerate Covid-19 transmission rates.
Now is the time to support low-income families in accessing vaccines. Let this Fourth of July be an opportunity to celebrate workers who carried our country through the pandemic. Bringing vaccines to the people who need them most will bring us all one step closer to surpassing the goal of vaccinating 70% of the country.
Julia Raifman is an epidemiologist and assistant professor at the Boston University School of Public Health, where she leads the Covid-19 U.S. State Policy Database. Alexandra Skinner is a research fellow at the Boston University School of Public Health and manages the Covid-19 U.S. State Policy Database. David Michaels is an epidemiologist and professor of environmental and occupational health at the Milken Institute School of Public Health at George Washington University and a former assistant secretary of labor for occupational safety and health under President Obama.
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