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The COVID-19 vaccine and employers: Frequently asked questions

By Jeff Levin-Scherz, MD and Chantell Sell Reagan, PharmD | February 1, 2021

Employers can help support employee efforts to obtain the highly effective COVID-19 vaccine.
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This series covers opportunities for employers to transform key elements of their health and benefits program to generate greater value to the company as well as improve the employee experience.

The COVID-19 pandemic surge continues, and we face the increasing threat of more contagious variants. Public health measures, including masks, physical distancing, better ventilation and barriers will continue to help reduce the number of infections, but the vaccines, which are safe and highly effective, are key to ending the pandemic and enabling us to return to work and other activities.

Here’s what employers need to know about the COVID-19 vaccines.

Current status of vaccines in the U.S.

COVID-19 vaccines from Pfizer/BioNTech and Moderna are all 95% effective. The Food and Drug administration granted Emergency Use Authorization of the two in December. Additionally, two other vaccines are in late-stage testing. Astra-Zeneca’s vaccine was 62% – 90% effective and has been approved for use in the U.K., Argentina and India. We expect Phase 3 data from Johnson & Johnson’s single-dose vaccine later in January. J&J’s vaccine could be approved in the U.S. in early to mid-February, while AstraZeneca’s may be weeks to months later. A fifth vaccine from Novavax began Phase 3 testing in December.

How much will the COVID-19 vaccine cost and who will pay for it?

The Coronavirus Aid, Relief and Economic Security (CARES) Act mandates that all employer-sponsored health insurance plans provide coverage with no cost sharing for all COVID-19 vaccines recommended by the Centers for Disease Control and Prevention (CDC).

Transform 2021: COVID-19 vaccines and employer opportunities

The federal government will purchase and distribute all COVID-19 vaccinations through state and local health departments, and employer-sponsored plans will be responsible only for payment of administration fees. Employers should cover this administration fee through both the medical and pharmacy benefit of their group health plans to make it easiest for members to get vaccinated. We expect that administrative costs will generally be similar to Medicare’s fee-for-service administration fees, which are about $45 for the two-shot course.

Who can get the vaccine?

The Pfizer/BioNTech vaccine is approved for those at least 16 years of age, and the Moderna vaccine has been approved for those over 18. Neither has been tested in pregnant women, although experts believe it is likely safe in pregnancy. The Pfizer vaccine is now being tested in children between the ages of 12 and 16, while the Moderna’s version is being tested in those 12 to 17 years old.

The CDC has also provided guidance on prioritization for COVID-19 vaccines, although each state may distribute vaccines at its own discretion. More recent guidance suggests less strict adherence to prioritization in order to increase the speed at which the population gets vaccinated. As a result, many states have made the vaccine available to all those over 65.

Monthly doses available from Jan-Aug 2021. Please find more details below.
Figure 1. CDC recommended allocation of COVID-19 vaccines and monthly doses available
Phase 1a (Health care workers, nursing home workers and residents, ~24m, monthly doses of Jan: 40m Feb:40m), 1b (Frontline essential workers and those over 75, ~49m, monthly doses of Feb: 40m, Mar: 40m, Apr 80m), 1c (Ages 65-74, ages 16-64 with high-risk conditions, and all other essential workers, ~129m, monthly doses of Apr: 80m, May: 80m Jun: 80m) and phase 2 (Everyone else, ~118m, monthly doses of May: 80m, June: 80m, Jul:TBD, Aug: TBD).

Frontline essential workers (1b)

  • First responders (firefighters, police)
  • Education (teachers, support staff, daycare)
  • Food and agriculture
  • Manufacturing
  • Corrections workers
  • U.S. postal service workers
  • Public transit workers
  • Grocery store workers

Other essential workers (1c)

  • Transportation and logistics
  • Food service
  • Shelter and housing (construction)
  • Finance
  • Energy
  • Media
  • Legal
  • Public safety (engineers)
  • Water and wastewater

Source: Phased Allocation of COVID-19 Vaccines, U.S. Centers for Disease Control and Prevention

Vaccine and new virus variants

New variants of the coronavirus are more contagious, but preliminary research shows that the vaccines remain effective against new viral mutations. As more contagious strains of the virus emerge and become dominant, the need to accelerate vaccinations will be even more critical to saving lives.

As more contagious strains of the virus emerge and become dominant, the need to accelerate vaccinations will be even more critical to saving lives.

Safety considerations and logistics

There have been a few serious allergic reactions associated with the Pfizer/BioNTech vaccine: approximately 11 per million during the first month of use. This means that vaccines must be given in settings where patients can be observed for at least 15 minutes and where emergency doses of epinephrine can be administered. That will make worksite administration more challenging.

Organizations considering offering vaccine at the worksite need to consider refrigeration requirements, staffing, emergency capabilities and logistics. Those with onsite clinics may be well-positioned to offer onsite vaccination. At the moment, there is a shortage of per diem nurses or pharmacists to run onsite vaccination clinics.

Vaccine distribution and ‘cold chain’ considerations

Vaccines have temperature requirements for their storage while being distributed. It is imperative to maintain product quality from the time of manufacture until the point of administration by ensuring that vaccines are stored and transported within World Health Organization-recommended temperature ranges. The Pfizer vaccine requires ultracold storage and is distributed in special containers with 970 doses. The Moderna vaccine requires normal freezing and refrigeration, distributed as 100 doses. The Johnson & Johnson vaccine is expected to require only refrigeration.

Incentivizing or mandating vaccines for employers

The U.S. Equal Employment Opportunity Commission released guidance in mid-December that allows employers to mandate that employees get vaccinated if necessary for safety in the workplace, although medical and religious objections must be considered.

Willis Towers Watson recommends not mandating vaccines or adding them to an incentive program at this time:

  • Incentives: Not everyone will have access now, and some who try to get vaccinated and are rebuffed might be less likely to get vaccinated in the spring when there will (hopefully) be plenty of vaccine. An incentive might signal to some that there is a risk, too.
  • Mandates: These will require a process to opt out – and if we mandate vaccines now, before employees see that the vaccine is safe (and liberating), many people will decide against it. Once people decide against the vaccine, they will be subject to confirmation bias and will be less likely to pay attention to evidence of the vaccine’s safety and effectiveness.

If we mandate vaccines now, before employees see that the vaccine is safe (and liberating), many people will decide against it.

Actions employers can take right now

Employers should continue their current efforts to keep employees safe until they get vaccinated. This includes maintaining remote work when possible and continuing public health efforts to distance, mask, encourage handwashing, increase ventilation and use barriers to decrease risk of transmission.

COVID-19 modeling projections show that continuing public health measures will remain important ways of preventing illness and death until summer or later. Employers should cover all available vaccines in both the pharmacy and medical benefit and offer employees flexibility to leave work to get vaccinated, especially the second dose where timing is critical. Many employers will set up a reimbursement program for those who are not covered by an employer-sponsored health plan.

By using narrative, influencers and learnings from behavioral science, employers can effectively communicate and emphasize the importance of vaccination. Describing the losses that employees can prevent by getting vaccinated is also especially effective. Some states will set up opportunities for employers to be “points of distribution” or PODs for the COVID-19 vaccine.

Employers with large numbers of concentrated onsite workers, especially those who are public facing or high risk, will be in the best position to offer onsite or near-site vaccination. And to keep on top of developments, employers can proactively create communications channels with state and local health departments so they are ready to promote or administer vaccines when they become available.

By providing effective communication, benefits and access, employers can assist employees in getting vaccinated – an important step toward ending the pandemic and returning to work and other activities.


Population Health Leader, Health and Benefits, North America

Jeff is a practicing physician and has led WTW’s clinical response to COVID-19. He has served in leadership roles in provider organizations and a health plan, and is an Assistant Professor at Harvard Chan School of Public Health.


Director, National Pharmacy Community Clinical Leader, North America

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