Flu Shot Protocols for Employers

The cost of getting sick taxes employers and employees alike. Chronic illness and injuries—though not always anticipated—can be managed, but it’s hard to limit exposure to viruses and bacteria. However, there are steps we can take to mitigate the chances that we and our fellow workers will come down with and share certain contagious illnesses, especially in the workplace.

High on the list of contagions that can be controlled is influenza, or the flu. Every year, millions of Americans contract the flu, losing three to five days of work or more, requiring visits to physicians or walk-in clinics, and for many, a stay in the hospital. It’s also life threatening for seniors, small children and adults with compromised immune or respiratory systems. The annual medical costs run in the billions, as do the costs of lost productivity.

With easy, convenient, and affordable access to safe immunizations for preventing the flu, employers across the country, especially in the healthcare industry, are taking a more proactive stance toward ensuring employee compliance. Some companies are shooting for 100%compliance, launching educational campaigns, team competitions, rallies, and incentive options such as discounts and premiums. Others are taking a carrot and stick approach, linking employer contribution incentives to medical savings accounts. Others are just wielding the stick, insisting that employees receive a flu vaccination as a condition of employment, with exceptions for those who have legitimate religious concerns or allergies to the vaccination.

Recognizing the central role businesses and employers play in protecting the health and safety of their employees, the Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA) have produced materials intended to guide employers in their planning and preparedness for seasonal and pandemic influenza. The guidance is intended to help employers take actions to decrease influenza spread, maintain business continuity, and secure critical infrastructure. OSHA recommends that employers prioritize vaccination because it is a long-term and effective intervention that reduces reliance on employee behavioral changes such as hand hygiene and respiratory etiquette.

As far back as February of 2010, the Advisory Committee for Immunization Practices (ACIP) released their provisional recommendation that all people six months of age or older receive an annual influenza vaccination, unless contraindicated. The CDC also recommends that employers encourage employees to seek vaccination against both seasonal and pandemic influenza, offer influenza vaccination opportunities at their worksite or consider allowing employees time off from work to seek vaccination.

Despite the potential benefits of vaccination, self-reports within the National Health Interview Survey suggest that vaccine coverage among healthy adults 18 to 49 years is only approximately 20%. Offering vaccination in the workplace could increase coverage by making vaccination more convenient, and reducing or eliminating the associated cost may further improve influenza vaccine participation.

Studies have shown that individuals who received influenza vaccine at work cited convenience as an important factor in the decision to be vaccinated. Following physicians’ offices, workplaces are the most common location to receive an influenza vaccination, with one-third of 18- to 49-year-old vaccine recipients and one-fifth of 50 to 64-year-old vaccine recipients receiving the vaccine at work. The addition of workplace education programs can provide information and alleviate employees’ concerns and misinformation about influenza vaccination.

Compliance and the law

More and more healthcare employers are requiring that all employees get the influenza vaccine in order to help protect patients and coworkers during flu season. This trend has resulted in questions pertaining to the legality of such policies, as well as how to properly implement a mandatory influenza vaccination policy for employees. Employers may adopt mandatory flu shot policies which are drafted and implemented in a legally compliant manner.

As a condition of employment, an employer may require that all employees receive a flu shot. However, an employer’s compulsory flu shot policy must provide for exemptions in order to comply with various laws regulating the employer/employee relationship. For example, if an employee with a physical or mental disability refuses a flu shot, the employer may have to make a reasonable accommodation in order to comply with the federal Americans with Disabilities Act (ADA). A reasonable accommodation could take the form of exempting the employee from the requirement and instead requiring a different protective measure, such as wearing a surgical mask. Similarly, if an employee objects due to a sincerely held religious belief, the employer may also have to provide a reasonable accommodation, unless doing so would impose an undue hardship on the employer.

If an employee refuses to comply with the employer’s policy and/or any reasonable alternative protective measures required by the employer if an exemption is granted, an at-will employer may pursue disciplinary action which could include termination. Employers should consult knowledgeable legal counsel before making employment-based decisions.

Employers wishing to require flu shots should adopt a written flu shot policy so that all employees have reasonable advance notice that receiving an annual influenza vaccination is a condition of employment. The policy should set an annual compliance deadline based on the anticipated start of the flu season and outline consequences for noncompliance. For instance, the policy may list the steps triggered by noncompliance, such as a written warning, suspension, and termination if the noncompliance is not addressed within a certain time frame. The policy should also specify what written documentation the employee must furnish the employer to prove that the employee was vaccinated.

An Employer’s Policy Should Include Exemptions

An employer’s influenza vaccination policy should provide a process for employees to request an exemption from the employer. Additionally, the policy should notify employees that if the employer grants an exemption, employees are required to comply, as a condition of employment, with reasonable alternative protective measures specified by the employer.
Exemptions should be allowed for reasons such as

  • A sincerely held religious belief or creed;
  • A qualifying physical or mental disability;
  • A prior severe allergic reaction to the flu shot;
  • A history of Guillain-Barré Syndrome; or
  • Some other relevant medical reason.

Ultimately, educating employees about the benefits and importance of the flu shot may help maximize employee participation. Just like frequent hand washing, the flu shot is an important protective measure for employees and their families. The Centers for Disease Control and Prevention (CDC), the Advisory Committee on Immunization Practices (ACIP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) recommend that all U.S. health care workers get vaccinated annually against influenza. The CDC has a variety of resources related to influenza vaccination  that may be helpful to employers and employees, especially those in the healthcare field.


Be sure to check out the CBIA Healthy Connections wellness program at your company’s next renewal. It’s free as part of your participation in CBIA Health Connections!